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Background: Two-dimensional and three-dimensional echocardiographic imaging are commonly used in assessing ischemic mitral regurgitation (IMR) and degenerative mitral regurgitation (DMR) in patients with mitral valve disease. However, the use of 4D echocardiographic imaging has not yet been reported. The objectives of this study were to explore the efficacy of utilizing 4D echocardiographic variables, determine papillary muscle displacement in patients with either IMR or DMR, and compare the differences in papillary muscle displacement between groups. Methods: Thirty-four patients were divided into two groups: Group 1 (with IMR) and Group 2 (with DMR). Using clinical ultrasound software, 4D echocardiographic variables were obtained and compared between the groups. Pearson's product–moment correlation test was used to assess the relationship between the presence of IMR and both papillary muscle displacement and indexed papillary muscle displacement. Results: The mean values for papillary muscle displacement in Groups 1 and 2 were 38 ± 6.7 mm and 31.8 ± 6.1 mm, respectively. Indexed papillary muscle displacement was 22.8 ± 3.7 mm in Group 1 and 18.4 ± 3.5 mm in Group 2. There were statistically significant correlations between the presence of IMR and papillary muscle displacement (p = 0.009) and indexed papillary muscle displacement (p = 0.002). A significant correlation was also observed between IMR and PL (p = 0.001), with mean values of 15.7 ± 3.9 mm in Group 1 and 20.2 ± 5.6 mm in Group 2. Conclusions: Four-dimensional echocardiography is effective in evaluating morphological variations in IMR. It successfully determined papillary muscle displacement in patients undergoing mitral valve surgery and demonstrated a positive correlation between IMR and indexed papillary muscle displacement. [ABSTRACT FROM AUTHOR]

Individuals with bipolar disorder (BD) face a high risk of heart failure and left ventricular (LV) dysfunction. Despite strong evidence that high LV relative wall thickness (RWT) is a risk marker for heart failure, few studies have evaluated LV RWT and aggravating factors in individuals with BD. We recruited 104 participants (52 patients with BD and 52 age- and sex-matched mentally healthy controls) to undergo echocardiographic imaging and biochemistry, high-sensitivity C-reactive protein (hs-CRP), and blood cell count measurements. LV RWT was estimated using the following equation: (2 × LV posterior wall end-diastolic thickness)/LV end-diastolic diameter. Clinical data were obtained through interviews and chart reviews. The BD group exhibited a significantly greater LV RWT (Cohen's d = 0.53, p = 0.003) and a less favorable mitral valve E/A ratio (Cohen's d = 0.54, p = 0.023) and LV global longitudinal strain (Cohen's d = 0.57, p = 0.047) than did the control group. Multiple linear regression revealed that in the BD group, serum triglyceride levels (β = 0.466, p = 0.001), platelet-to-lymphocyte ratios (β = 0.324, p = 0.022), and hs-CRP levels (β = 0.289, p = 0.043) were all significantly and positively associated with LV RWT. This study applied a cross-sectional design, meaning that the direction of causation could not be inferred. Patients with BD are at a risk of heart failure, as indicated by their relatively high LV RWT. Lipid levels and systemic inflammation may explain this unfavorable association. • We studied left ventricular (LV) geometry and risk factors in bipolar disorder (BD). • Patients with BD were at a risk of LV hypertrophy and myocardial dysfunction. • LV wall thickness in BD was associated with triglyceride and low-grade systemic inflammation. • There were sex-specific associations between BD and indices of LV hypertrophy. [ABSTRACT FROM AUTHOR]

BackgroundAortic stenosis (AS) in combination with left ventricular outflow tract obstruction (LVOTO) has occasionally been reported. However, making a precise diagnosis and successfully treating this combination is challenging due to the hemodynamic interaction between the two conditions.Case summaryA 56-year-old male patient who had been diagnosed with severe AS and asymmetric left ventricular hypertrophy underwent aortic valve replacement (AVR) and a conventional septal myectomy. Immediately after the procedure, significant systolic anterior motion and mitral regurgitation developed, necessitating a surgical mitral edge-to-edge repair. Ten days after the procedure, the patient developed hematuria and LVOTO, which was confirmed by echocardiography. Because the LVOTO might have been the cause of the hematuria, the patient underwent alcohol septal ablation, but this had little effect. Three months later, a transapical beating-heart septal myectomy (TA-BSM) was performed in our hospital. Postoperatively, the LVOTO had been significantly ameliorated and the hematuria had resolved.ConclusionFor patients with AS and LVOTO due to a hypertrophic interventricular septum, inadequate amelioration of the LVOTO after AVR may lead to severe hemolytic hematuria. TA-BSM is a minimally invasive, safe, and effective surgical procedure for ameliorating LVOTO in patients with aortic valve prostheses.

Patients with schizophrenia have a high risk of cardiovascular death. Increased cardiac left ventricular (LV) mass has been reported to be associated with heart failure and cardiac mortality. However, few studies have used echocardiographic imaging to evaluate the associations between cardiac LV mass and the clinical characteristics of schizophrenia. We recruited 121 adults to undergo standard and two-dimensional speckle-tracking echocardiography. Cardiac LV mass was determined using the Devereux formula and indexed with reference to the body surface area to obtain the cardiac LV mass index (LVMI). Clinical and demographic data were obtained through interviews and chart review. The results showed that relative to the mentally healthy controls (n = 55), individuals with schizophrenia (n = 66) had significantly higher mean values of cardiac LVMI as well as lower mitral valve E/A ratio, LV ejection fraction, and LV global longitudinal strain. Among the individuals with schizophrenia, cardiac LVMI was positively correlated with the number of acute episodes, and this association remained significant after adjustment for age, age at onset, and body mass index. On the contrary, there were no significant associations between cardiac LVMI and traditional cardiovascular risk factors. Taken together, this study suggests that the burden of psychotic symptoms may contribute to the increased risk of cardiac hypertrophy in individuals with schizophrenia independent of traditional cardiovascular risk factors. Because cardiac hypertrophy is among the major risk factors of heart failure and cardiac mortality, future research must investigate the mechanisms underlying the association between psychosis and increased cardiac LV mass., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Aortic stenosis (AS) in combination with left ventricular outflow tract obstruction (LVOTO) has occasionally been reported. However, making a precise diagnosis and successfully treating this combination is challenging due to the hemodynamic interaction between the two conditions., Case Summary: A 56-year-old male patient who had been diagnosed with severe AS and asymmetric left ventricular hypertrophy underwent aortic valve replacement (AVR) and a conventional septal myectomy. Immediately after the procedure, significant systolic anterior motion and mitral regurgitation developed, necessitating a surgical mitral edge-to-edge repair. Ten days after the procedure, the patient developed hematuria and LVOTO, which was confirmed by echocardiography. Because the LVOTO might have been the cause of the hematuria, the patient underwent alcohol septal ablation, but this had little effect. Three months later, a transapical beating-heart septal myectomy (TA-BSM) was performed in our hospital. Postoperatively, the LVOTO had been significantly ameliorated and the hematuria had resolved., Conclusion: For patients with AS and LVOTO due to a hypertrophic interventricular septum, inadequate amelioration of the LVOTO after AVR may lead to severe hemolytic hematuria. TA-BSM is a minimally invasive, safe, and effective surgical procedure for ameliorating LVOTO in patients with aortic valve prostheses., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Kang, Tian, Zhu, Zhou, Wei and Liu.)