International Cardiovascular Research Journal
Volume:16 Issue: 3, Sep 2022

Mitral Valve (MV) disease is responsible for a considerable number of open cardiac surgeries. Selecting a befitting prosthetic valve is a matter of consideration. Thus, accurate definition of mitral apparatus characteristics, particularly mitral annulus dimensions, preoperatively can shed some light on the situation. The less invasive nature of three-dimensional Transesophageal Echocardiography (3D-TEE) can turn it into a practical modality for preoperative investigation of mitral anatomy.

The present study aimed to investigate the correlation between the size of mitral annulus attained through 3D-TEE and intraoperative size as well as the valve or ring size finally placed in mitral position.

The study was conducted on 28 patients suffering from MV disease who were candidates for MV surgery. All the patients underwent 3D-TEE. Mitral annulus diameters including anteroposterior and intercommissural diameters were measured delicately by using the Mitral Valve Navigation (MVN) tool. In the midst of surgery, a mitral ring sizer was utilized in order to suggest the proper prosthesis size.

The study results demonstrated that the sizer instrument was strongly associated with the inserted prosthesis size and moderately with echocardiographic annulus diameters. The correlation between the deployed prosthesis size and annulus size obtained by intraoperative sizer and 3D echocardiography was assessed, as well. The results indicated that ring sizer showed a strong positive relationship with the intercommissural echocardiography diameter and a moderate positive relationship with the anteroposterior echocardiography diameter.

The results revealed a good correlation between the echocardiography measurements and intraoperative examination along with the deployed prosthesis size. Thus, 3D-TEE could be considered a practical modality for the preoperative investigation of mitral anatomy.

Heart failure (HF) is a progressive health problem with high mortality and morbidity rates in both developed and developing countries. Patients with HF who develop reverse remodeling during treatment have better outcomes and lower mortality. Real-world data on the reverse remodeling effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor-neprilysin inhibitors (ARNIs) in Indonesians are yet to be available.

This study aimed to compare the reverse cardiac remodeling of patients with heart failure with reduced ejection fraction (HFrEF) treated for six months with an ARNI or ACEI based on the CORE-HF registry.

We conducted a non-experimental, sub-analysis study of the CORE-HF database at the Heart Failure Clinic of Universitas Sebelas Maret Hospital from 2018 to 2021. One group had been treated with ARNIs, while the other was administered with the optimal tolerated ACEI. A six-month follow-up was carried out to determine left ventricle reverse remodeling (LVRR) and functional class alteration as endpoints.

While 89.2% of those in the ACEI group could tolerate the maximum dose, only one person in the ARNI group received the maximum dose, with the majority receiving half the maximum dose (100 mg BID). After six months, LVRR occurred at a similar rate in both groups (26.31% for ARNI and 26.15% for ACEI; P = 0.989). However, the New York Heart Association functional class improved more in the ARNI group (mean 0.95 ± 0.7 vs. 0.62 ± 0.86; P = 0.128).

Despite similar LVRR and functional capacity improvements, a slightly better echocardiography improvement was observed in the ACEI arm. We postulate that full intervention of the renin-angiotensin-aldosterone system should still be the main goal, together with other guideline-directed medical therapies for HF. Hence, costeffective full-dose of ACEi should be chosen for low- to middle-income countries whose ARNI was not easily available yet due to several issues.

Mesenchymal stem cells (MSC) possess specific properties that make them good candidates for cell therapy, especially in organs like the heart with limited regeneration capacity. Generating cardiac myocytes in vitro is an important step toward restoring lost function in cardiovascular diseases.

In this study, we investigated the potential of a human cardiomyocytesconditioned medium to induce cardiogenic differentiation (indicated by GATA4 expression) of rat bone marrow MSCs.

Rat bone marrow MSCs were extracted and cultured. They were characterized based on morphology, adipogenic and cardiogenic differentiation potential, and expression of mesenchymal markers. MSCs were exposed to the conditioned medium (case group) or normal saline for 1, 3, and 7 days. The growth curve, population doubling time, and GATA4 expression were compared between the groups.

MSCs of the case group showed accelerated growth with a lower population doubling time. GATA4 expression as a specific cardiac marker was significantly higher in the case group compared with the controls on day 1. By days 3 and 7, GATA4 expression remained higher, albeit the difference with the control group became less.

Our findings demonstrated that possible cardiac myocyte-derived factors instigate the proliferation and cardiogenic differentiation of MSCs. This study provides a novel bone marrow MSC model for investigating early cardiomyocyte generation, which can open new avenues in the treatment of heart diseases.

Cardiotoxicity, a common complication of chemotherapy, may have irreversible adverse effects on the heart. Anthracycline-based chemotherapy for breast cancer can lead to dilation-hypokinetic cardiomyopathy, eventuating in heart failure. As the primary diagnostic tool for cardiovascular toxicity, echocardiography may be essential in evaluating the heart function of such patients.

This study aimed to identify the most important echocardiography findings for proper and timely diagnosis of cardiotoxicity in patients with HER2-positive breast cancer undergoing anthracycline-based chemotherapy.

Our final analysis included 132 female patients who were HER2-positive and had breast cancer. All of these patients had one pre-chemotherapy echocardiography and at least one echocardiography after three episodes of anthracycline-based chemotherapy. The patients’ age, body mass index, and history of chemotherapy were recorded. Mean alterations from baseline echocardiography to echocardiography after three episodes of chemotherapy were calculated for all parameters evaluated. Data analysis was conducted using the Statistical Package for the Social Sciences v. 26.

Significant changes were seen in three-dimensional left ventricular ejection fraction (LVEF 3D), two-dimensional left ventricular ejection fraction (LVEF 2D), left ventricular global circumferential strain (LVGCS), left ventricular global longitudinal strain (LVGLS), left ventricular end-diastolic volume (LVEDV), stroke volume (SV), left ventricular end-systolic volume (LVESV), right ventricular end-systolic dimension (RVESD) in patients with breast cancer (P < 0.0001). RVESD, LVESV, LVEDV, and SV significantly increased after three chemotherapy episodes, but LVEF (3D and 2D), absolute LVGCS, and absolute LVGLS fell significantly.

LVEF (3D and 2D), LVGCS, LVGLS, LVEDV, LVESV, SV, and RVESD are important echocardiography parameters in diagnosing cardiotoxicity in patients with HER2-positive breast cancer.

Smoking is the leading cause of preventable death. Female smokers bear a greater risk of experiencing an ST-segment elevation myocardial elevation (STEMI) than male smokers.

This study aimed to investigate gender and smoking-related survival differences one-year post-STEMI.

This registry-based cohort study included all STEMI patients of Imam Ali Hospital, Kermanshah, Iran. All eligible adult patients with STEMI were enrolled. Baseline data and one-year post-STEMI data were collected. Cox proportional models were used to estimate crude and full-adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs). All analyses were performed using Stata.

During 2080.9 person-years, 22 patients were lost to follow-up (success rate = 99%). There were 2,279 STEMI patients (22.99% women) during the study period. Men were younger than women (58.50 ± 12.22 vs. 65.26 ± 11.56 years, P ˂ 0.001). In men, smoking was a protective factor against in-hospital mortality in the unadjusted model (HR = 0.49, 95% CI: 0.31 – 0.78, P = 0.002), but was not a protective factor after adjusting for age, hypertension, dyslipidemia, diabetes, creatine kinase-MB, body-mass index, LDL-cholesterol, HDL-cholesterol, glomerular filtration rate, anterior wall MI/LBBB, left ventricular ejection fraction and reperfusion therapy (HR = 0.66, 95% CI: 0.34 – 1.25, P = 0.198).

Although male smokers with STEMI had a lower in-hospital mortality rate, this difference did not persist in the adjusted model. Thus, the smokers’ paradox phenomenon was not proven. The better outcomes of men with STEMI compared to women are probably related to their younger age and fewer risk factors at the time of presentation.

A significant correlation exists between elevated lactate dehydrogenase (LDH) levels and thrombotic events, yet the prognostic value of this biomarker in patients with pulmonary embolism (PE) remains elusive. Finding new biomarkers can help us achieve better risk stratification and treatment strategies to reduce the mortality of PE patients.

We aimed to determine the possible association between serum LDH and the in-hospital mortality of PE patients.

In this cross-sectional study, 217 patients with PE (diagnosed by computed tomography angiography) and a serum LDH level documented within the first 24 hours of admission were included. Our exclusion criteria were hepatic and renal diseases, pregnancy, hemolytic disorders, left ventricular infarction, recent stroke, positive history of active cancer, acute and chronic infections, and reticuloendothelial-related diseases.

The mean age of patients was 63.04 ± 16.81 years; 23 patients (10.6%) died during hospitalization. Multivariate analysis showed that LDH and white blood cells (WBC) were independent predictors of in-hospital mortality; however, this association was insignificant. Univariate analysis showed that higher levels of LDH, WBC, and red cell distribution width (RDW) had a significant association with in-hospital mortality (P < 0.05). The receiver operating characteristics curve showed that an LDH cut-off value of 515 U/l had a sensitivity of 91.3% and specificity of 45.9% in predicting in-hospital mortality (95% CI = 0.636 – 0.761, P = 0.0003).

LDH can be an excellent prognostic marker for predicting in-hospital death in patients with pulmonary embolism.