The Effect of Number of Pregnancies on Aortic Stiffness Index, Aortic Velocity Propagation, and Epicardial Fat Thickness.

OBJECTIVE: Pregnancy causes physiological, hormonal, and hemodynamic changes that affect the aortic wall dimensions and elastic properties. Multiple pregnancies increase the risk of aortic enlargement and reduce aortic elasticity. The aortic stiffness index (ASI) and aortic velocity propagation (AVP) are markers of elasticity. Additionally, epicardial fat thickness (EFT) is associated with cardiovascular risk factors. The impact of multiparity on ASI, AVP, and EFT has not been previously reported in the literature. Therefore, we aimed to investigate the association of these parameters with the number of live pregnancies in this study. METHODS: A total of 410 patients were enrolled in this prospective study. Patients were divided into three groups based on the number of live births: Group 1 (n = 0, 128 patients), Group 2 (4 ≥ n > 0, 157 patients), and Group 3 (n ≥ 5, 125 patients). A linear regression analysis was conducted to investigate trend associations of ASI, AVP, and EFT between the study groups. Multiple linear regression analysis was used to evaluate the independent predictors of continuous parameters. RESULTS: There were increasing trends in multiparity with variables such as aortic systolic (ASD) and diastolic diameters, pulmonary artery diameters, ASI, and EFT, and a decreasing trend in AVP. The number of pregnancies was strongly and positively correlated with ASI, moderately and positively correlated with EFT and ASD, and moderately and negatively correlated with AVP. CONCLUSION: Multiparity was independently associated with ASI, EFT, ASD, and AVP, reflecting decreased elasticity and elevated cardiovascular risk in multiparous women.

Incremental Value of Radiomics Features of Epicardial Adipose Tissue for Detecting the Severity of COVID-19 Infection.

INTRODUCTION: Epicardial adipose tissue (EAT) is known for its pro-inflammatory properties and association with Coronavirus Disease 2019 (COVID-19) severity. However, existing detection methods for COVID-19 severity assessment often lack consideration of organs and tissues other than the lungs, which limits the accuracy and reliability of these predictive models. MATERIAL AND METHODS: The retrospective study included data from 515 COVID-19 patients (Cohort 1, n=415; Cohort 2, n=100) from two centers (Shanghai Public Health Center and Brazil Niteroi Hospital) between January 2020 and July 2020. Firstly, a three-stage EAT segmentation method was proposed by combining object detection and segmentation networks. Lung and EAT radiomics features were then extracted, and feature selection was performed. Finally, a hybrid model, based on seven machine learning models, was built for detecting COVID-19 severity. The hybrid model's performance and uncertainty were evaluated in both internal and external validation cohorts. RESULTS: For EAT extraction, the Dice similarity coefficients (DSC) of the two centers were 0.972 (±0.011) and 0.968 (±0.005), respectively. For severity detection, the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) of the hybrid model increased by 0.09 (p<0.001), 19.3 % (p<0.05), and 18.0 % (p<0.05) in the internal validation cohort, and by 0.06 (p<0.001), 18.0 % (p<0.05) and 18.0 % (p<0.05) in the external validation cohort, respectively. Uncertainty and radiomics features analysis confirmed the interpretability of increased certainty in case prediction after inclusion of EAT features. CONCLUSION: This study proposed a novel three-stage EAT extraction method. We demonstrated that adding EAT radiomics features to a COVID-19 severity detection model results in increased accuracy and reduced uncertainty. The value of these features was also confirmed through feature importance ranking and visualization.

Influence of Cardiovascular Risk Factors and Metabolic Syndrome on Epicardial Adipose Tissue Thickness in Rural Spanish Children and Adolescents.

The presence of visceral adipose tissue implies a higher risk of cardiovascular diseases than subcutaneous adiposity, the most dangerous heart fat. Epicardial adipose tissue (EAT) could have great potential as a detection indicator of cardiovascular diseases, although it has seldom been studied in Spanish children. OBJECTIVE: The objective of the current research was to describe the values of EAT in a Spanish pediatric population and to investigate the associations between EAT and anthropometric measures, blood pressure, lipid and glucose profiles, and metabolic syndrome. METHOD: An analytical cross-sectional study of elementary and high school students (aged 6 to 17) measured anthropometrics, blood pressure, lipid and glycemic profiles, and echocardiographic fat thickness. The analysis was based on regression and discriminant analysis. RESULTS: The results of this study (N = 227) showed that the body mass index (BMI) was 20.29 ± 4.54, with an overweight set of 49.77%, and the percentage for metabolic syndrome was 5.3%. EAT was linked to being male, BMI percentile, waist circumference, waist-to-height ratio (p < 0.001), hypertension, higher low-density lipoprotein (LDL) levels, and metabolic syndrome (p < 0.05). CONCLUSIONS: This paper argues that in children with higher elevated EAT thickness values, this correlates with cardiovascular risk factors including high blood pressure, elevated LDL levels, and metabolic syndrome.

Epicardial transplantation of antioxidant polyurethane scaffold based human amniotic epithelial stem cell patch for myocardial infarction treatment.

Myocardial infarction (MI) is a leading cause of death globally. Stem cell therapy is considered a potential strategy for MI treatment. Transplantation of classic stem cells including embryonic, induced pluripotent and cardiac stem cells exhibited certain repairing effect on MI via supplementing cardiomyocytes, however, their clinical applications were blocked by problems of cell survival, differentiation, functional activity and also biosafety and ethical concerns. Here, we introduced human amniotic epithelial stem cells (hAESCs) featured with immunomodulatory activities, immune-privilege and biosafety, for constructing a stem cell cardiac patch based on porous antioxidant polyurethane (PUR), which demonstrated decent hAESCs compatibility. In rats, the administration of PUR-hAESC patch significantly reduced fibrosis and facilitated vascularization in myocardium after MI and consequently improved cardiac remodeling and function. Mechanistically, the patch provides a beneficial microenvironment for cardiac repair by facilitating a desirable immune response, paracrine modulation and limited oxidative milieu. Our findings may provide a potential therapeutic strategy for MI.

The spatial overlap between left atrial epicardial adipose tissue and fibrosis is not associated to clinical stage of atrial fibrillation.

Left atrial (LA) epicardial adipose tissue (EAT) and wall fibrosis are both proven to contribute to the pathogenesis and progression of atrial fibrillation (AF). The theory of LA wall fibrosis induction by local EAT infiltration, paracrine secretions, and activation of the inflammatory process is strongly advocated, but the imaging evidence for anatomical proximity of the two tissue types and its association to AF stage is lacking. Accordingly, the aim of the study was to analyse the spatial overlap between LA EAT and adjacent wall fibrosis using 3D Dixon water-fat separated late gadolinium enhancement (LGE-Dixon) MRI and correlate the findings with the clinical AF stage. Forty-two AF patients (18 paroxysmal, 10 persistent, and 14 permanent) and nine non-AF patients were scanned. The permanent AF patients had greater LA volume and EAT than the paroxysmal group. The LA fibrosis area showed the same trend. The LA EAT-fibrosis overlap area was small and there was no significant difference between the three AF stages. There was no significant relationship between LA EAT- fibrosis overlap area and AF type. The findings shed light on the complex interplay between LA fibrosis and EAT during the progression from paroxysmal to permanent AF.

An enhanced deep learning method for the quantification of epicardial adipose tissue.

Epicardial adipose tissue (EAT) significantly contributes to the progression of cardiovascular diseases (CVDs). However, manually quantifying EAT volume is labor-intensive and susceptible to human error. Although there have been some deep learning-based methods for automatic quantification of EAT, they are mostly uninterpretable and fail to harness the complete anatomical characteristics. In this study, we proposed an enhanced deep learning method designed for EAT quantification on coronary computed tomography angiography (CCTA) scan, which integrated both data-driven method and specific morphological information. A total of 108 patients who underwent routine CCTA examinations were included in this study. They were randomly assigned to training set (n = 60), validation set (n = 8), and test set (n = 40). We quantified and calculated the EAT volume based on the CT attenuation values within the predicted pericardium. The automatic method demonstrated strong agreement with expert manual quantification, yielding a median Dice score coefficients (DSC) of 0.916 (Interquartile Range (IQR): 0.846-0.948) for 2D slices. Meanwhile, the median DSC for the 3D volume was 0.896 (IQR: 0.874-0.908) between these two measures, with an excellent correlation of 0.980 (p < 0.001) for EAT volumes. Additionally, our model's Bland-Altman analysis revealed a low bias of -2.39 cm³. The incorporation of pericardial anatomical structures into deep learning methods can effectively enhance the automatic quantification of EAT. The promising results demonstrate its potential for clinical application.

Radiomics parameters of epicardial adipose tissue predict mortality in acute pulmonary embolism.

BACKGROUND: Accurate prediction of short-term mortality in acute pulmonary embolism (APE) is very important. The aim of the present study was to analyze the prognostic role of radiomics values of epicardial adipose tissue (EAT) in APE. METHODS: Overall, 508 patients were included into the study, 209 female (42.1%), mean age, 64.7 ± 14.8 years. 4.6%and 12.4% died (7- and 30-day mortality, respectively). For external validation, a cohort of 186 patients was further analysed. 20.2% and 27.7% died (7- and 30-day mortality, respectively). CTPA was performed at admission for every patient before any previous treatment on multi-slice CT scanners. A trained radiologist, blinded to patient outcomes, semiautomatically segmented the EAT on a dedicated workstation using ImageJ software. Extraction of radiomic features was applied using the pyradiomics library. After correction for correlation among features and feature cleansing by random forest and feature ranking, we implemented feature signatures using 247 features of each patient. In total, 26 feature combinations with different feature class combinations were identified. Patients were randomly assigned to a training and a validation cohort with a ratio of 7:3. We characterized two models (30-day and 7-day mortality). The models incorporate a combination of 13 features of seven different image feature classes. FINDINGS: We fitted the characterized models to a validation cohort (n = 169) in order to test accuracy of our models. We observed an AUC of 0.776 (CI 0.671-0.881) and an AUC of 0.724 (CI 0.628-0.820) for the prediction of 30-day mortality and 7-day mortality, respectively. The overall percentage of correct prediction in this regard was 88% and 79% in the validation cohorts. Lastly, the AUC in an independent external validation cohort was 0.721 (CI 0.633-0.808) and 0.750 (CI 0.657-0.842), respectively. INTERPRETATION: Radiomics parameters of EAT are strongly associated with mortality in patients with APE. CLINICAL TRIAL NUMBER: Not applicable.

Characteristics of gene expression in epicardial adipose tissue and subcutaneous adipose tissue in patients at risk for heart failure undergoing coronary artery bypass grafting.

BACKGROUND: Epicardial adipose tissue (EAT) surrounds the heart and is hypothesised to play a role in the development of heart failure (HF). In this study, we first investigated the differences in gene expression between epicardial adipose tissue (EAT) and subcutaneous adipose tissue (SAT) in patients undergoing elective coronary artery bypass graft (CABG) surgery (n = 21; 95% male). Secondly, we examined the association between EAT and SAT in patients at risk for HF stage A (n = 12) and in pre-HF patients, who show signs but not symptoms of HF, stage B (n = 9). RESULTS: The study confirmed a distinct separation between EAT and SAT. In EAT 17 clusters of genes were present, of which several novel gene modules are associated with characteristics of HF. Notably, seven gene modules showed significant correlation to measures of HF, such as end diastolic left ventricular posterior wall thickness, e'mean, deceleration time and BMI. One module was particularly distinct in EAT when compared to SAT, featuring key genes such as FLT4, SEMA3A, and PTX3, which are implicated in angiogenesis, inflammation regulation, and tissue repair, suggesting a unique role in EAT linked to left ventricular dysfunction. Genetic expression was compared in EAT across all pre-HF and normal phenotypes, revealing small genetic changes in the form of 18 differentially expressed genes in ACC/AHA Stage A vs. Stage B. CONCLUSIONS: The roles of subcutaneous and epicardial fat are clearly different. We highlight the gene expression difference in search of potential modifiers of HF progress. The true implications of our findings should be corroborated in other studies since HF ACC/AHA stage B patients are common and carry a considerable risk for progression to symptomatic HF.

Oesophagopericardial fistula from mediastinal histoplasmosis presenting as purulent pericarditis with cardiac tamponade.

A man in his early 30s presenting with chest pain was admitted for the management of acute pericarditis and evaluation of a subcarinal mass incidentally noted on chest imaging. Shortly after admission, he developed cardiac tamponade. Emergent pericardiocentesis revealed purulent pericardial fluid with polymicrobial anaerobic bacteria, raising concern for gastrointestinal source and broad intravenous antibiotics were given. The pericardial fluid reaccumulated despite an indwelling pericardial drain and intrapericardial fibrinolytic therapy, necessitating a surgical pericardial window. Concurrent fluoroscopic oesophagram demonstrated oesophageal perforation with fistulous connection to the subcarinal mass and mediastinal drain, suggestive of oesophagopericardial fistula. Pathology from biopsy of the subcarinal mass returned with focal large necrotising granulomas consistent with histoplasmosis. Antifungal treatment was initiated, and the patient was eventually discharged home with nasogastric feeding tube and oral antibiotics and antifungals. This is the first reported case of polymicrobial pericarditis secondary to acquired oesophagopericardial fistula likely induced by mediastinal histoplasma lymphadenitis.

[Redo right ventricular outflow tract repair for destruction of xenopericardial patch with monocusp]. / Povtornaya khirurgicheskaya korrektsiya vynosyashchego trakta pravogo zheludochka u patsientki s destruktsiei ksenoperikardial'noi zaplaty s monostvorkoi.

Tetralogy of Fallot is the most common «blue type¼ heart defect. The goals of surgical correction are closure of ventricular septal defect and reconstruction of right ventricular outflow tract. The results of reconstructions depend on several factors: age, material, management and size of conduit. Some patients may require redo surgery due to dysfunction after primary correction.

Tracheopericardial fistula in lung cancer masquerading as acute myocardial infarction: a case report.

Tracheopericardial fistula is an extremely rare clinical condition caused by lung disease penetrating the tracheal wall and extending to the pericardial cavity, forming a fistula between the airway and the pericardial cavity. Since the pericardial cavity communicates with the respiratory tract, gases, airway secretions and pathogens can enter the cavity, leading to pneumopericardium, effusion and abscess. In severe cases, it can result in cardiac tamponade and cardiogenic shock. Only a few cases of TPF have been reported in the literature. In this report, a 72-year-old man with recurrent lung cancer presented with fever, chest tightness and chest pain. Electrocardiogram showed ST-segment elevation in multiple leads, resembling an acute myocardial infarction. Emergency coronary angiography did not reveal significant stenosis. Further examination with chest computed tomography and bronchoscopy revealed pericardial effusion and a tracheal fistula, leading to the final diagnosis of TPF as a complication of lung cancer. This case aims to enhance understanding and recognition of this clinical entity to reduce misdiagnosis.

Epicardial fat density obtained with computed tomography imaging - more important than volume?

Epicardial adipose tissue (EAT) is a unique fat depot located between the myocardium and the visceral layer of pericardium. It can be further subdivided into pericoronary (PCAT), periatrial (PAAT) and periventricular adipose tissue (PVentAT), each of them exhibiting specific characteristics and association with the underlying tissue. Since no physical barrier separates EAT from the myocardium, this fat tissue can easily interact with the underlying cardiac structure. EAT can be visualized using various imaging modalities. Computed tomography provides not only information on EAT volume, but also on its density. Indeed, EAT density reflected by the recently developed fat attenuation index (FAI) is emerging as a useful index of PCAT inflammation, PAAT inflammation and fibrosis, while the relevance of density of PVentAT is much less known. The emerging data indicates that FAI can be an important diagnostic and prognostic tool in both coronary artery disease and atrial fibrillation. Future studies will demonstrate if it also could be used as a marker of efficacy of therapies and whether FAI PVentAT could indicate ventricular pathologies, such as heart failure. The aim of the review is to present computed tomography derived FAI as an important tool both to study and better understand the epicardial fat and as a potential predictive marker in cardiovascular disorders.

Comparison of autologous venous grafts and three types of extracellular matrix grafts in Peyronie's disease surgery.

Background/aim: Peyronie's disease (PD) is known as a wound-healing disorder for which surgery remains the gold-standard treatment, but studies comparing graft materials are limited in the literature. The aim of this study was to evaluate the mid- and long-term results of patients who underwent surgery for PD with grafting procedures performed by a single experienced surgeon according to graft materials. Materials and methods: Patients who underwent corporoplasty between 2014 and 2020 with grafting procedures performed by a single experienced surgeon were retrospectively reviewed. A total of 115 patients were divided into 4 groups according to the grafting material used: autologous saphenous venous grafts, Group 1 (n = 36); porcine pericardial extracellular matrix grafts (EMGs; XenoGuard, MBP Medical Biomaterial Products GmbH, Neustadt-Glewe, Germany), Group 2 (n = 40); porcine intestinal submucosal EMGs (BioDesign, Cook Medical, Bloomington, IN, USA), Group 3 (n = 36); and bovine pericardial EMGs (Tutopatch, Tutogen Medical, Inc., Alachua, FL, USA), Group 4 (n = 43). Results: The mean operation time for Group 1 was longer than that of the other groups (p < 0.001). When comparing the groups in pairs, it was observed that the duration of postoperative loss of sensation (LOS) was significantly shorter in Group 3 (12.3 ± 5.3 days) and Group 4 (15.1 ± 3.1 days) (p < 0.05). There was a statistically significant difference between Groups 1 and 4 in penile length loss when the groups were compared in pairs (p = 0.017). There was a statistically significant difference between patients with penile curvatures of 0° to 59° and patients with curvatures of ≥60° in terms of duration of postoperative LOS (14.4 ± 5 vs. 16.4 ± 5.8 days, respectively; p = 0.028) and penile length loss (2.6 ± 5 vs. 5.7 ± 6.8 mm, respectively; p = 0.002). Conclusion: The findings suggest that EMGs should be preferred to autologous venous grafts due to reduced postoperative erectile dysfunction, shorter operation time, and shorter recovery time for LOS.

Heart Failure and Obesity: Unraveling Molecular Mechanisms of Excess Adipose Tissue.

Obesity is an ongoing pandemic and is associated with the development of heart failure (HF), and especially HF with preserved ejection fraction. The definition of obesity is currently based on anthropometric measurements but neglects the location and molecular properties of excess fat. Important depots associated with HF development are subcutaneous adipose tissue and visceral adipose tissue, both located in the abdominal region, and epicardial adipose tissue (EAT) surrounding the myocardium. However, mechanisms linking these different adipose tissue depots to HF development are incompletely understood. EAT in particular is of great interest because of its close proximity to the heart. In this review, we therefore focus on the characteristics of different adipose tissue depots and their response to obesity. In addition, we evaluate how different mechanisms associated with EAT expansion potentially contribute to HF and in particular HF with preserved ejection fraction development.

Robotic left intrapericardial upper lobectomy, pericardial reconstruction and diaphragmatic plication.

Primary mediastinal malignant germ cell tumours are rare, comprising only 1-4% of mediastinal tumours, of which 50-70% are non-seminomatous germ cell tumours. Non-seminomatous germ cell tumours typically demonstrate an excellent response to cisplatin-based chemotherapy. However, in some cases, tumours may persistently enlarge despite normal tumour markers following chemotherapy, leading to a rare condition known as growing teratoma syndrome. This poses a significant challenge for thoracic surgeons, especially when associated with infiltration of neighbouring pulmonary structures. Robot-assisted thoracoscopic surgery is not commonly employed in the resection of large mediastinal tumours. We present a case showcasing the robotic approach to complete resection of a sizeable mediastinal tumour originating from the left/main pulmonary artery, en bloc with a left upper lobectomy, pericardial resection, and reconstruction and diaphragmatic plication.

Esophageal-Pericardial and Esophageal-Atrial Fistulae.

Fistulae between the esophagus and the pericardium or the left atrium are rare but feared complications of transcatheter ablations and esophageal procedures and pathologies. Patients may present variably with cardiopulmonary, gastrointestinal, infectious, and/or neurologic symptoms; a high index of suspicion is paramount. The presence of atrial involvement will dictate the approach and extent of the necessary intervention. While mortality is high overall, surgical repair confers the highest likelihood of survival.

SMAD3 mediates the specification of human induced pluripotent stem cell-derived epicardium into progenitors for the cardiac pericyte lineage.

Understanding the molecular mechanisms of epicardial epithelial-to-mesenchymal transition (EMT), particularly in directing cell fate toward epicardial derivatives, is crucial for regenerative medicine using human induced pluripotent stem cell (iPSC)-derived epicardium. Although transforming growth factor ß (TGF-ß) plays a pivotal role in epicardial biology, orchestrating EMT during embryonic development via downstream signaling through SMAD proteins, the function of SMAD proteins in the epicardium in maintaining vascular homeostasis or mediating the differentiation of various epicardial-derived cells (EPDCs) is not yet well understood. Our study reveals that TGF-ß-independent SMAD3 expression autonomously predicts epicardial cell specification and lineage maintenance, acting as a key mediator in promoting the angiogenic-oriented specification of the epicardium into cardiac pericyte progenitors. This finding uncovers a novel role for SMAD3 in the human epicardium, particularly in generating cardiac pericyte progenitors that enhance cardiac microvasculature angiogenesis. This insight opens new avenues for leveraging epicardial biology in developing more effective cardiac regeneration strategies.

Analysis of Fluid-Structure Interaction Mechanisms for a Native Aortic Valve, Patient-Specific Ozaki Procedure, and a Bioprosthetic Valve.

The Ozaki procedure is a surgical technique which avoids to implant foreign aortic valve prostheses in human heart, using the patient's own pericardium. Although this approach has well-identified benefits, it is still a topic of debate in the cardiac surgical community, which prevents its larger use to treat valve pathologies. This is linked to the actual lack of knowledge regarding the dynamics of tissue deformations and surrounding blood flow for this autograft pericardial valve. So far, there is no numerical study examining the coupling between the blood flow characteristics and the Ozaki leaflets dynamics. To fill this gap, we propose here a comprehensive comparison of various performance criteria between a healthy native valve, its pericardium-based counterpart, and a bioprosthetic solution, this is done using a three-dimensional fluid-structure interaction solver. Our findings reveal similar physiological dynamics between the valves but with the emergence of fluttering for the Ozaki leaflets and higher velocity and wall shear stress for the bioprosthetic heart valve.