Reverse Onco-Cardiology: What Is the Evidence for Breast Cancer? A Systematic Review of the Literature.

Breast cancer and cardiovascular diseases (CVD) represent significant global health challenges, with CVD being the leading cause of mortality and breast cancer, showing a complex pattern of incidence and mortality. We explore the intricate interplay between these two seemingly distinct medical conditions, shedding light on their shared risk factors and potential pathophysiological connections. A specific connection between hypertension (HTN), atrial fibrillation (AF), myocardial infarction (MI), and breast cancer was evaluated. HTN is explored in detail, emphasizing the role of aging, menopause, insulin resistance, and obesity as common factors linking HTN and breast cancer. Moreover, an attempt is made to identify the potential impact of antihypertensive medications and highlight the increased risk of breast cancer among those women, with a focus on potential mechanisms. A summary of key findings underscores the need for a multisystem approach to understanding the relationship between CVD and breast cancer is also explored with a highlight for all the gaps in current research, such as the lack of clinical observational data on MI and breast cancer in humans and the need for studies specifically designed for breast cancer. This paper concludes that there should be a focus on potential clinical applications of further investigation in this field, including personalized prevention and screening strategies for women at risk. Overall, the authors attempt to provide a comprehensive overview of the intricate connections between breast cancer and cardiovascular diseases, emphasizing the importance of further research in this evolving field of cardio-oncology.

Cardiac MRI in Autoimmune Diseases: Where Are We Now?

Cardiovascular magnetic resonance imaging (CMR) allows the early diagnosis of various cardiovascular pathophysiologic phenomena in autoimmune diseases. Preliminary studies suggest that CMR holds a promising role in initiating the necessary changes in anti-rheumatic and cardiac treatment among patients with autoimmune diseases and cardiovascular diseases (CVD). It is widely known that the presence of late gadolinium enhancement (LGE) has been related to a worse cardiovascular prognosis. CMR has been documented to be the most valuable tool for diagnosis and risk prediction of cardiac involvement in a sarcoidosis population, while in SLE, the gap between clinical and autopsy diagnosis of the myocardial disease could be narrowed with the implementation of CMR. In different connective tissue diseases, including SLE, LGE has been demonstrated to be present early after the initial diagnosis of SLE. Considering that CMR, including LGE identifies more patients with silent myocardial disease in SLE and other connective tissue diseases than echocardiography, CMR should be the preferred imaging modality, especially in the era of modern techniques with broader availability and expertise. In this review, we summarize the major indications, advantages and limitations of the use of CMR among patients with autoimmune disorders.

Eosinophilic Myocarditis in a Patient With Strongyloides stercoralis Infection.

A 40-year-old woman with a pulmonary embolism, central nervous system infarcts, and eosinophilia was referred for evaluation. Findings on echocardiography and cardiac magnetic resonance were consistent with eosinophilic myocarditis with left ventricular involvement. Further examination led to the diagnosis of Strongyloides stercoralis infection, and treatment with ivermectin and rivaroxaban resulted in clinical, laboratory, and cardiac imaging improvement. (Level of Difficulty: Intermediate.).

Improved regional function after autologous bone marrow-derived stem cell transfer in patients with acute myocardial infarction: a randomized, double-blind strain rate imaging study.

AIMS: To investigate whether intracoronary transfer of bone marrow progenitor cells (BMPCs) early after reperfusion of an acute myocardial infarction improves regional myocardial function in a randomized double-blind, placebo-controlled strain rate imaging study. METHODS AND RESULTS: Regional myocardial deformation was measured using velocity-derived strain rate imaging in 67 STEMI patients randomized 1:1 to intracoronary infusion of BMPC (n = 33) or placebo (n = 34). Myocardial segments were grouped into infarct (n = 232), border (n = 250), and remote (n = 526) based on MRI-delayed enhancement and the perfusion territory of the infarct-related vessel. Four months after revascularization and progenitor cell/placebo transfer, regional myocardial deformation (rate) improved significantly more in the infarct segments of BMPC patients (treatment effect on end-systolic strain: -3.7 +/- 1.0%, P = 0.0003; peak-systolic strain rate: -0.20 +/- 0.07 s(-1), P = 0.0035). These findings were confirmed by a significantly greater improvement of longitudinal mitral valve ring displacement in the infarct walls of BMPC patients (treatment effect: 0.93 mm, P = 0.034). CONCLUSION: Intracoronary infusion of BMPC early after reperfusion of a STEMI improves recuperation of regional myocardial function at 4 months' follow-up. Quantitative assessment of regional systolic function might be more sensitive than global LV ejection fraction for the evaluation of BMPC therapy after STEMI.

Pregnancy in a Patient With Tetralogy of Fallot and Borderline Pulmonary Arterial Hypertension.

Management of pregnancy in patients with complex congenital heart disease and pulmonary arterial hypertension has always been a challenge. We are presenting a patient with complex congenital heart disease and borderline pulmonary arterial hypertension who complicated with pulmonary embolism during pregnancy. (Level of Difficulty: Beginner.).

Autologous bone marrow-derived stem-cell transfer in patients with ST-segment elevation myocardial infarction: double-blind, randomised controlled trial.

BACKGROUND: The benefit of reperfusion therapies for ST-elevation acute myocardial infarction (STEMI) is limited by post-infarction left-ventricular (LV) dysfunction. Our aim was to investigate the effect of autologous bone marrow-derived stem cell (BMSC) transfer in the infarct-related artery on LV function and structure. METHODS: We did a randomised, double-blind, placebo-controlled study in 67 patients from whom we harvested bone marrow 1 day after successful percutaneous coronary intervention for STEMI. We assigned patients optimum medical treatment and infusion of placebo (n=34) or BMSC (n=33). Our primary endpoint was the increase in LV ejection fraction and our secondary endpoints were change in infarct size and regional LV function at 4 months' follow-up, all assessed by MRI. We assessed changes in myocardial perfusion and oxidative metabolism with serial 1-[11C]acetate PET. Analyses were per protocol. This study is registered with , number NCT00264316. FINDINGS: Mean global LV ejection fraction 4 days after percutaneous coronary intervention was 46.9% (SD 8.2) in controls and 48.5% (7.2) in BMSC patients, and increased after 4 months to 49.1% (10.7) and 51.8% (8.8; OR for treatment effect 1.036, 95% CI 0.961-1.118, p=0.36). Compared with placebo infusion, BMSC transfer was associated with a significant reduction in myocardial infarct size (BMSC treatment effect 28%, p=0.036) and a better recovery of regional systolic function. Myocardial perfusion and metabolism increased similarly in both groups. We noted no complications associated with BMSC transfer and all but one patient in the BMSC group completed the 4 months' follow-up. INTERPRETATION: Intracoronary transfer of autologous bone marrow cells within 24 h of optimum reperfusion therapy does not augment recovery of global LV function after myocardial infarction, but could favourably affect infarct remodelling.

Determinants and impact of microvascular obstruction in successfully reperfused ST-segment elevation myocardial infarction. Assessment by magnetic resonance imaging.

Microvascular obstruction (MVO) is an important and independent determinant of post-infarct remodeling. Fifty-two patients with a successfully reperfused ST-segment elevation acute myocardial infarction (MI) were studied with MRI in the first week and at 4 months post-infarction. On early (i.e., 2-5 min) post-contrast MRI, MVO was detected in 32 patients with an MVO to infarct ratio of 36.3 +/- 24.9%. On late (i.e., 10-25 min) post-contrast MRI, MVO was detected in only 27 patients, with an MVO to infarct ratio of 15.9 +/- 13.9%. MVO infarcts (n = 32) were associated with higher cardiac enzymes (troponin I, P = 0.016), and lower pre-revascularization thrombolysis in myocardial infarction (TIMI) flow (P = 0.018) than non-MVO infarcts (n = 20). Infarct size was larger in MVO infarcts (25.0 +/- 14.3 g) than non-MVO infarcts (12.5 +/- 7.9 g), P = 0.0007. Systolic wall thickening in the infarct and peri-infarct area, and left ventricular (LV) ejection fraction (EF) were worse in MVO (46.1 +/- 7.2%) than non-MVO infarcts (50.5 +/- 6.6%, P = 0.038). At 4 months, MVO infarcts showed more adverse remodeling and lack of functional improvement, whereas non-MVO infarcts improved significantly (LV EF at 4 months, MVO, 47.5 +/- 7.8%, P = 0.31; non-MVO, 55.2 +/- 10.3%, P = 0.0028). In the majority of patients with successfully reperfused ST-segment elevation MI, MVO is observed, whose present and maximal extent can be best evaluated on early post-contrast MRI. Presence of MVO is associated with more extensive infarctions, and characterized by greater adverse LV remodeling and lack of functional recovery.

Assessment of ventricular coupling with real-time cine MRI and its value to differentiate constrictive pericarditis from restrictive cardiomyopathy.

The purpose of this study was to evaluate the use of respiratory-related ventricular coupling to differentiate patients with constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). In 18 histologically proven cases of CP, 6 patients with inflammatory pericarditis (IP), 15 RCM patients and 17 normal subjects, real-time cine MRI was performed in the cardiac short-axis (basal half of the ventricles) during operator-guided deep respiration. The images were analyzed for ventricular septal position and shape during early ventricular filling. Early diastolic septal inversion (I) or flattening (F) was found in all CP (I:15,F:3), and in all IP (I:2,F:4), but seldom in normals (F:1) and not in RCM. The septal abnormalities occurred at the onset of inspiration and rapidly disappeared with the next heartbeats. The amount of ventricular coupling was evaluated by quantifying the difference in the maximal septal excursion between inspiration and expiration. This parameter, normalized to the biventricular diameter, was significantly larger in CP (20.0+/-4.5%, P<0.0001) and IP (14.8+/-3.2%, P<0.0001) patients than in normals (7.0+/-2.4%), whereas RCM patients had a trend toward decreased excursion (4.2+/-1.7%, P=0.11). A cut-off value of 11.8% (mean normals +2 SD) enabled to differentiate CP patients from normals and RCM patients completely. Real-time cine MRI can easily depict increased ventricular coupling, which may be helpful to better differentiate between CP and RCM patients, especially in patients with normal or minimally thickened pericardium. The increase in coupling in IP patients is likely caused by decreased compliance of the inflamed pericardial layers.

Real-time cine MRI of ventricular septal motion: a novel approach to assess ventricular coupling.

The purpose of this study was to assess the feasibility of magnetic resonance imaging (MRI) to evaluate in real-time, the effects of respiration in ventricular septal motion and configuration in normal volunteers and cardiac patients. Real-time cine MRI studies, using the steady-state free precession (SSFP) technique, were performed in the cardiac short-axis during operator-guided deep inspiration and expiration in normal volunteers (N = 6), and in patients with constrictive pericarditis (CP; N = 6), restrictive cardiomyopathy (RCM; N = 4), chronic cor pulmonale (N = 5), and pericardial effusion. The respiratory effects on septal position and configuration during early ventricular filling were visually assessed. Results were compared with the short-axis breath-hold cine MRI studies, obtained at end-inspiration. In CP patients, onset of inspiration led to a leftward inversion in four of six patients and flattening of the septum in two of six patients during early ventricular filling. Septal abnormalities progressively disappeared during the following heartbeats. A similar pattern was found in one of six patients with pericardial effusion. The above pattern was absent in RCM patients. Although septal flattening during early inspiration was also found in two of six normal volunteers, flattening was minimal compared to that in CP patients. In all cor pulmonale patients, septal flattening or inversion was present, but this was not influenced by respiratory motion. Real-time cine MRI is a promising technique for determining the influence of respiration on septal motion and might be helpful in differentiating between different causes of impaired ventricular filling.

The eggshell of hawaiianDrosophila: structural and biochemical studies inD. grimshawi and comparison toD. melanogaster.

The eggshell of the Hawaiian speciesDrosophila grimshawi was analyzed in terms of its structure and biochemical composition. It is generally similar toD. melanogaster in radial structure except that the inner endochorion is relatively compact and the outer endochorion is thick (1.9 µm) and traversed by numerous 50-nm-wide aeropyles (not present inD. melanogaster). Regionally the eggshell consists of the various specialized regions, which are: the holey posterior pole; the dorsal ridge; the operculum with very tall imprint borders; the collar with discontinuous outer endochorion; the micropyle with an external eccentric hole and an internal eccentric paracrystalline region; and the four very long respiratory appendages which exhibit tightly covered surface features for underwater plastron respiration. On the basis of the above structural data we suggest that the entireD. grimshawi eggshell (various layers and specialized regions) is the product of at least eight follicle cell subpopulations. In addition, in vitro culturing with3H-proline indicates that the eggshell is made according to a strict developmental program (analogous toD. melanogaster) and consists of several proteins ranging in molecular weight from 14,000 to 37,000 daltons.