Early assessment of ventricular synchronization and function after left bundle-branch-area pacing with right bundle-branch block.

AIM: To evaluate ventricular synchronization and function in patients with right bundle-branch block after left bundle-branch-area pacing (LBBAP) by echocardiography. METHODS: Forty patients who successfully received LBBAP were selected and divided into the right bundle-branch block group (RBBB group) and the non-RBBB group by pre-operation ECG. Echocardiography and follow-up were performed 1 month after operation. Interventricular synchronization was evaluated by tissue Doppler (TDI), tissue mitral annular displacement (TMAD), and interventricular mechanical delay. The tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), tricuspid annulus sidewall systolic velocity (TV-s'), left ventricular global ventricular longitudinal strain (GLS), right ventricular free wall longitudinal strain (LS-RV), standard deviation of left ventricular 18 segments peak time difference (SDt-L) and standard deviation of right ventricular free wall 3 segments peak time difference (SDt-R) were applied to evaluate intraventricular synchronization and ventricular function. RESULTS: The difference of displacement peak time of the tricuspid and mitral valves, namely ΔPTTV-MV measured by TMAD, the difference of systolic time to peak of the tricuspid and mitral valves, namely ΔTsTV-MV measured by TDI, were statistically different between the two groups (P < 0.05). Compared with the non-RBBB group, there were no statistically significant differences in the GLS, RVFAC, LS-RV, TAPSE, TV-s', SDt-L, SDt-R (P > 0.05). CONCLUSION: Echocardiography technology including two-dimensional speckle tracking imaging (2D-STI), TDI, and TMAD can effectively analyze interventricular synchronization, intraventricular synchronization, and ventricular function. Although the movement of the right ventricular myocardium in the RBBB group was slightly later than that of the left ventricular myocardium after LBBAP, LBBAP could still be applied in RBBB patients with pacing indication.

Multiple myeloma with cardiac involvement accompanied by partial superior vena cava obstruction: A case report and literature review.

Multiple myeloma is a malignant proliferative disorder of plasma cells. Extramedullary involvement of the endocardium is rare in multiple myeloma. Here, we reported a 57-year-old male, once was diagnosed with multiple myeloma. The echocardiography reveled multiple solid masses in the right atrium, along with partial obstruction of superior vena cava. The mass resection alleviated the edema of upper limbs and identified the mass as extramedullary plasmablastic transformation and endocardial involvement. We also conducted a literature review and summary analysis of space-occupying lesions in the heart in 12 patients with multiple myeloma (including the current case) in the last 10 years. Echocardiography is the preferred radiologic examination method for diagnosis and follow-up in multiple myeloma with cardiac involvement, and surgical resection is effective for alleviating symptoms.

Transthoracic echocardiography-guided left bundle branch pacing without fluoroscopic guidance: A case report.

This case study demonstrates the feasibility of pacing the left bundle branch and atrial septum under transthoracic echocardiography (TTE) without fluoroscopic guidance. This technique could be useful to guide pacemaker implantation in some patients, especially pregnant women.

Effectiveness of Halo-Pelvic Traction and Thoracoplasty for Pulmonary Artery Pressure and Cardiopulmonary Function in Patients With Severe Spinal Deformity.

STUDY DESIGN: Retrospective review. OBJECTIVE: To evaluate the effectiveness of halo-pelvic traction and thoracoplasty for pulmonary artery pressure (PAP) and cardiopulmonary function in patients with severe spinal deformity. SUMMARY OF BACKGROUND DATA: The effect of severe spinal deformity on pulmonary arterial hypertension, cardiac structure, and function has received little attention before. PATIENTS AND METHODS: A total of 21 patients with severe spinal deformity were included in our study; all patients were examined by echocardiography and pulmonary function test before and after treatment. The correlations between PAP and pulmonary function were examined using Pearson correlation analysis. RESULTS: The PAP decreased from 58.67 ± 20.24 to 39.00 ± 12.51 mm Hg, and the PAP of 42.86% of the patients returned to normal after treatment. Right cardiac enlargement, left ventricular diastolic function, and pulmonary function were improved at the same time. The ratio of left ventricular to right ventricular diameter returned to normal. Moderate correlations (correlation coefficient: -0.513 to -0.559) between PAP and forced vital capacity and forced expiratory volume in the first second were identified. CONCLUSIONS: Pulmonary arterial hypertension, ventricular diastolic function, and pulmonary function were improved after halo-pelvic traction and thoracoplasty. A moderate negative correlation was identified between PAP and pulmonary function: the more pulmonary function improved, the more PAP decreased.

A rare case of severe tricuspid regurgitation caused by detached stent falling into the right ventricle after transjugular intrahepatic portosystemic shunt.

BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) is an important method to alleviate cirrhotic portal hypertension. But the falling and fracture of the stent which detaches into the heart is a potentially fatal threat. CASE PRESENTATION: We present a case of severe tricuspid regurgitation caused by detached stent falling into the right ventricle after transjugular intrahepatic portosystemic shunt. CONCLUSION: Great attention should be paid to the serious complication of stent fracture after TIPS especially when the dual stent technique is used in TIPS.

Plasma Exosomal S1PR5 and CARNS1 as Potential Non-invasive Screening Biomarkers of Coronary Heart Disease.

Background: Early diagnosis and treatment significantly improve the prognosis of coronary heart disease (CHD), but no convenient screening tools are available. This study aims to find potential non-invasive screening biomarkers of coronary heart disease. Method: We performed microarray analysis to investigate the mRNA expression levels in Small extracellular vesicles (sEVs) and screen significantly differentially expressed mRNAs in CHD patients vs. non-CHD patients. We then performed quantitative real-time polymerase chain reaction (qRT-PCR) to validate the microarray results, and we calculated the correlations between expression levels and clinicopathological data. Microarray analysis identified 72 downregulated mRNAs and 31 upregulated mRNAs in CHD patients relative to non-CHD patients. Results: From the study, we found that upregulated sphingosine-1-phosphate receptor 5 (S1PR5) and downregulated carnosine synthase 1 (CARNS1) had the most significant differences between the patient group and the control group. S1PR5 expression was correlated with diabetes, heart rate, triglycerides, total cholesterol, low-density lipoprotein cholesterol, apolipoprotein B, and fasting blood glucose (P < 0.05). CARNS1 level was correlated with uric acid (UA) (P < 0.05). Overexpressed S1PR5 and downregulated CARNS1 were independent risk factors for CHD. The area under the receiver operating characteristic curve (AUC) of S1PR5 was 0.838 for diagnosing CHD; the AUC of CARNS1 was 0.883 for non-CHD; and the AUC of S1PR5 plus CARNS1 was 0.921 for CHD. Conclusions: Microarray analysis showed that upregulated S1PR5 and downregulated CARNS1 in sEVs have the potential to become non-invasive biomarkers for CHD screening.

Mapping Renal Innervations by Renal Nerve Stimulation and Characterizations of Blood Pressure Response Patterns.

Increased sympathetic nervous activity is one of main contributors to pathogenesis and progression of hypertension. Renal denervation (RDN) has been demonstrated as a potential therapy for treatment of hypertension; however, lack of indicators of intra-/post-procedure results in inconsistent clinical outcomes. Renal nerve stimulation (RNS), a simple and promising method, could evoke elevated blood pressure as an intraoperative indicator for RDN. But related researches on patterns of blood pressure responses to RNS are still incomplete. To investigate and categorize the phenotypes of blood pressure response to RNS and heart rate alteration before and after RNS, 24 Chinese Kunming dogs were used to perform RNS from bifurcation to ostium of renal arteries after angiography, and a total of 483 stimulated sites were complete. We identified five different patterns of blood pressure response to RNS in 483 stimulated sites, (1) continuous ascending and finally keeping steady above baseline (26.9%), (2) declining and then rising over baseline (11.8%), (3) declining and then rising but below baseline (14.5%), (4) fluctuating in the vicinity of baseline (39.5%), and (5) continuous declining and finally keeping steady below baseline (7.2%), and found no difference in RR intervals among five blood pressure responses before and after renal nerve stimulation. Renal nerve stimulation could elicit different patterns of blood pressure response, which could potentially assist in distinguishing sympathetic-excitatory sites and sympathetic-inhibitory sites from mixed nerve components, which might help to improve the efficacy of RDN.

CircNPHP4 in monocyte-derived small extracellular vesicles controls heterogeneous adhesion in coronary heart atherosclerotic disease.

Small extracellular vesicles (sEVs)-derived circular RNAs (circRNAs) could regulate gene expression in recipient cells, and dysregulation of sEVs-derived circRNAs has been implicated in several diseases. However, the expression and function of sEVs-derived circRNAs in coronary heart atherosclerotic disease (CAD) remain unknown. In this study, we investigated global changes in the expression patterns of circRNAs in sEVs from CAD-related monocytes and identified circNPHP4 as a significantly upregulated circRNA. Knockdown of circNPHP4 inhibited heterogeneous adhesion between monocytes and coronary artery endothelial cells and reduced ICAM-1 and VCAM-1 expression. Investigations of the underlying mechanisms revealed that circNPHP4 contains a functional miR-1231-binding site. Mutation of the circNPHP4-binding sites in miR-1231 abolished the interaction, as indicated by a luciferase reporter assay. Furthermore, circNPHP4 affected the expression of miR-1231 and its target gene EGFR. Overexpression of miR-1231 blocked the inhibitory effect of circNPHP4 on heterogeneous adhesion. Moreover, downregulation of miR-1231 restored heterogeneous adhesion upon inhibition by circNPHP4 silencing. Additionally, circNPHP4 overexpression was correlated with aggressive clinicopathological characteristics in CAD patients. A multivariate logistic regression model and bootstrapping validation showed that circNPHP4 overexpression had a good risk prediction capability for CAD. The decision curve analysis revealed that using the CAD nomogram that included circNPHP4 overexpression to predict the risk of CAD was beneficial. Our results suggest that sEVs-derived circNPHP4 can serve as a potential target for CAD treatments or as a potential diagnostic marker for CAD patients.

Selective renal denervation guided by renal nerve stimulation: mapping renal nerves for unmet clinical needs.

Renal denervation (RDN) is a well-known innovative therapy for hypertension. However, the effects of global RDN on blood pressure (BP) lowering are quite variable. Insufficient and futile denervation is considered a major factor contributing to the variable results. Mapping renal nerves by renal nerve stimulation (RNS) is the most promising technique to improve the efficacy of RDN. We summarize the clinical and experimental data available regarding RNS-guided RDN and explain the roles of renal efferent nerves, afferent nerves and vagal nerves in BP changes. We further identify five different BP response patterns to RNS and provide an explanation of the underlying neuroanatomical basis.