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Introduction: Left atrial appendage occlusion (LAAO) can be performed using diverse anesthetic approaches ranging from moderate sedation (MS) to general anesthesia (GA), and guided by intracardiac echocardiography (ICE) or transesophageal echocardiography (TEE). Prior studies have demonstrated shorter time in lab for heart rhythm procedures performed under MS. The objective of this study was to compare laboratory times, acute procedural outcomes and complication rates for LAAO procedures performed using MS and 4‐dimensional ICE as opposed to GA. Methods and Results: This was a retrospective observational cohort study of 135 consecutive patients who were referred for LAAO to be performed with either GA or MS between June 2022 and April 2024. The primary endpoints were total laboratory time, procedure time, nonprocedure time, and fluoroscopy time. The secondary endpoints were stroke, peri‐device leak (>5 mm), device‐related left atrial thrombus, cardiovascular mortality, and all‐cause mortality at 45 days and 6 months postprocedure, where data were available. The mean age of patients in the study was 78.8 ± 7.8 years and 64.4% were male with no difference between GA and MS. In the MS group, 4D‐ICE was used for intraprocedural imaging in 95.5% of patients and 2 dimensional‐ICE (2D‐ICE) was used in 4.5% of patients. In the GA group, intra‐procedural imaging was done using TEE in 51.5%, 2D‐ICE in 32.4% and 4D‐ICE in 16.2% of cases. Total laboratory time was significantly lower in the MS group compared to the GA group (68.3 ± 23.1 vs 117.1 ± 34.3 min; p < 0.001), due to shorter nonprocedure time (15.2 ± 9.1 vs 63.7 ± 22.0 min; p < 0.001), with no significant difference in procedure time and fluoroscopy time. There was no significant difference in complications at 45 days and 6 months postprocedure. Conclusion: In this single center study, MS reduced total lab time by reducing nonprocedure time when compared to GA for LAAO, without affecting clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The decremental properties of the nodoventricular pathway (NVP) are uncertain. Methods and Results: During short RP supraventricular tachycardia, a His‐refractory premature ventricular contraction (PVC) consistently terminated the tachycardia without atrial capture immediately after the PVC. Whereas a slightly earlier PVC failed to reset the subsequent His but terminated the tachycardia without atrial capture one cycle later. Conclusion: These observations are diagnostic of slow‐fast atrioventricular nodal reentrant tachycardia (AVNRT) with a bystander concealed‐NVP and can be explained by decremental properties in the NVP itself; greater prematurity of the PVC resulted in more decremental conduction over the NVP, causing the AVNRT termination one cycle later. [ABSTRACT FROM AUTHOR]

Introduction: Understanding the spatiotemporal location of the spontaneous termination of ventricular tachycardia (VT) may provide new insights for ablation. To test the hypothesis that spontaneous VT termination most frequently occurs at the VT exit due to source‐sink mismatch and to characterize electrophysiological properties of the sites termination during VT and with extra‐stimulus technique. Methods: Retrospective analysis of intraoperative mapping studies of nine patients with ischemic cardiopathy or repaired tetralogy of Fallot. Simultaneous endocardial and epicardial mapping was performed in both ventricles using a custom mapping array during VT. Electrogram (EGM) characteristics before and at the moment of termination were analyzed including: cycle length oscillations, EGM heterogeneity and a variation in the systolic/diastolic path. The decrements to extra stimulus were analysed for termination sites and other diastolic sites. Results: Nine VTs in seven patients demonstrated spontaneous VT termination. Seven VTs (77.8%) spontaneously terminated in the final third of the systolic interval, one (11.1%) in early diastole and one (11.1%) in mid diastole. Cycle length oscillations (prolongation, shortening, and no change) were seen in equal frequency. Four VTs (44.4%) showed alternans in the local EGM at the site of termination and this was more prevalent than alternans at other sites in the diastolic pathway (p <.001). Only one‐third of VTs showed a change in activation pattern before termination. There was no difference based on etiology. During substrate characterization with extra‐stimulus pacing, sites of spontaneous termination showed greater decrement than other sites of the VT circuit during pacing (43.5 ± 14.5 ms vs. 31.2 ± 31.2 ms; p =.003). Conclusion: The entrance zone rather than the exit is the commonest site for the spontaneous termination of VT in the human heart. These sites tend to demonstrate EGM alternans during VT and greater decrement during extrastimulus pacing. These findings may help guide future studies into improving the success of VT ablation. [ABSTRACT FROM AUTHOR]

Introduction: Due to its unique features, pulsed field ablation (PFA) could potentially overcome some limitations of current radiofrequency (RF) ventricular tachycardia (VT) ablation. However, data on the use of PFA in this setting are currently scarce. Methods: Two patients with ischemic cardiomyopathy and previously failed RF VT ablations were treated with PFA. Results: A total of 18 bipolar applications (case1) and seven bipolar applications (case2) were delivered to the infero‐lateral and infero‐septal areas (case1) and to the apical lateral left ventricular (LV) wall (case2), placing the catheter adjacent to the LV wall in the flower configuration. A rapid cessation of VT and restoration of sinus rhythm were observed during PFA delivery in both cases. Further applications were delivered to achieve complete elimination of late potentials. In case 1, during the in‐hospital stay, ECG monitoring did not show VT recurrences. Six‐month follow‐up was uneventful, with no VT recurrences at ICD interrogation. In case 2, due to postdischarge VT recurrences, a second RF procedure was scheduled 1 month later. The voltage map performed in sinus rhythm showed a low‐voltage zone located at the anterolateral wall, near the previous ablation site. Numerous late potentials were recorded. At the 6‐month follow‐up, no further VT recurrences were documented after RF redo ablation. Conclusion: While the speed of application and potential transmural effect can facilitate the ablation of large diseased endocardial areas, early loss of contact due to difficult pentaspline catheter manipulation in the LV could lead to insufficient contact force and, consequently, inadequate energy penetration. [ABSTRACT FROM AUTHOR]

Introduction: The novel cryoballoon with 28 mm or 31 mm adjustable diameters, aims to achieve a wide antral pulmonary vein isolation (PVI). However, the distribution of antral lesions and their variations based on left atrial (LA) remodeling require further clarification. Methods: We evaluated 22 patients (67 [59.5–74.8] years, 19 males) who underwent PVI of atrial fibrillation (AF) (13 paroxysmal AF [PAF] and 9 non‐PAF) using size‐adjustable cryoballoons. LA electro‐anatomical mapping was performed post‐PVI with three‐dimensional mapping systems. We assessed the shapes of the LA and pulmonary veins (PVs) and the distribution of isolated areas (IAs), comparing the results between PAF and non‐PAF patients. Results: In the left PVs (LPVs), the distance between the PV orifice and IA edge (PVos‐IA) was larger on the roof and posterior segments (~15 mm) but relatively smaller on the anterior segment near the PV ridge (<10 mm). For the right PVs (RPVs), it was more extensive in the posterior segment (10–15 mm). Comparing PAF and non‐PAF, there were no significant differences in the PVos‐IA except for the right posterior‐carina segment, antrum IA (LPVs: 5.9 ± 1.6 vs. 5.8 ± 0.8 cm², p =.81; RPVs: 4.8 ± 2.3 vs. 4.8 ± 1.2 cm², p =.81), distances between the right and left IAs on the LA posterior wall (LAPW), and un‐isolated LAPW area (9.0 ± 4.9 vs. 9.9 ± 2.5 cm², p =.62). No individual PVIs were observed in either group. Two patients exhibited overlapping IAs on the roof, and one patient who underwent 31 mm balloon applications for all PVs exhibited an LAPW isolation. Conclusion: The size‐adjustable cryoballoon achieved a wide antral PVI even in non‐PAF patients. [ABSTRACT FROM AUTHOR]

The article present case study of a 40-year-old female with catheter ablation of narrow QRS regular tachycardia. Topics include the mechanism behind narrow QRS regular tachycardia with ventriculoatrial (VA) dissociation; the differential diagnosis of Atrioventricular nodal reentrant tachycardia (AVNRT); nodoventricular or nodofascicular pathway-mediated orthodromic reciprocating tachycardia and the challenges in differentiating these from junctional tachycardia or AVNRT with bystander pathways.

Background: The therapeutic effects of ertugliflozin, a sodium-glucose cotransporter 2 inhibitor, on cardiovascular outcome are not fully understood. This study aimed to evaluate the efficacy and safety of ertugliflozin on cardiac function in people with type 2 diabetes and pre-heart failure. Methods: We conducted a 24-week randomized, double-blind, placebo-controlled trial involving individuals with type 2 diabetes inadequately controlled with antidiabetic medications. Participants with left ventricular hypertrophy, E/e' >15, or impaired left ventricular global longitudinal strain (LVGLS) were randomized 1:1 to receive either ertugliflozin (5 mg once daily) or a placebo. The primary outcome was the change in LVGLS. Secondary outcomes included changes in left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). Prespecified exploratory outcomes, including angiotensin-converting enzyme 2 (ACE2) and angiotensin (1–7) levels, were also assessed. Results: A total of 102 individuals (mean age, 63.9 ± 9.2 years; 38% women) were included. The ertugliflozin group showed a significant improvement in LVGLS (− 15.5 ± 3.1% to − 16.6 ± 2.8%, P = 0.004) compared to the placebo group (− 16.7 ± 2.7% to − 16.4 ± 2.6%, P = 0.509), with a significant between-group difference (P = 0.013). Improvements in LVMI and LVEF were also observed. Additionally, significant reductions in HbA1c, systolic blood pressure, whole-body and visceral fat, uric acid, proteinuria, N-terminal pro–B-type natriuretic peptide, and lipoprotein(a) were noted. ACE2 and angiotensin (1–7) levels significantly increased in the ertugliflozin group compared to the placebo group and correlated with changes in LVGLS [r = 0.456, P < 0.001 for ACE2; r = 0.541, P < 0.001 for angiotensin (1–7)]. Adverse events were similar between the two groups. Conclusions: This study demonstrated that ertugliflozin has beneficial effects on left ventricular function in individuals with type 2 diabetes and pre-heart failure, and it provided insights into potential underlying mechanisms. Clinical trial registration: ClinicalTrials.gov Identifier: NCT03717194. [ABSTRACT FROM AUTHOR]

Introduction: In multiplexed positron emission tomography (mPET) imaging, physiological and pathological information from different radiotracers can be observed simultaneously in a single dynamic PET scan. The separation of mPET signals within a single PET scan is challenging due to the fact that the PET scanner measures the sum of the PET signals of all the tracers. The conventional multitracer compartment modeling (MTCM) method requires staggered injections and assumes that the arterial input functions (AIFs) of each tracer are known. Methods: In this work, we propose a deep learning-based method to separate triple-tracer PET images without explicitly knowing the AIFs. A dynamic tripletracer noisy MLEM reconstruction was used as the network input, and dynamic single-tracer noisy MLEM reconstructions were used as training labels. Results: A simulation study was performed to evaluate the performance of the proposed framework on triple-tracer ([18F]FDG+82Rb+[94mTc]sestamibi) PET myocardial imaging. The results show that the proposed methodology substantially reduced the noise level compared to the results obtained from single-tracer imaging. Additionally, it achieved lower bias and standard deviation in the separated single-tracer images compared to the MTCM-based method at both the voxel and region of interest (ROI) levels. Discussion: As compared to MTCM separation, the proposed method uses spatiotemporal information for separation, which improves the separation performance at both the voxel and ROI levels. The simulation study also demonstrates the feasibility and potential of the proposed DL-based method for the application to pre-clinical and clinical studies. [ABSTRACT FROM AUTHOR]

Objective: To assess the efficacy of continuous contactless vital signs monitoring with an automated Early Warning System (EWS) in detecting clinical deterioration among patients in general wards. Methods: A prospective observational cohort study was conducted in the medical unit of a tertiary care hospital in India, involving 706 patients over 84,448 monitoring hours. The study used a contactless ballistocardiography system (Dozee system) to continuously monitor heart rate, respiratory rate, and blood pressure. The study assessed total, mean, and median alerts at 24, 48, 72, 96, 120 h, and length of stay (LOS) before patient deterioration or discharge. It analyzed alert sensitivity and specificity, average time from initial alert to deterioration, and healthcare practitioners (HCP) activity. Study was registered with the Clinical Trials Registry-India CTRI/2022/10/046404. Results: Out of 706 patients, 33 (5%) experienced clinical deterioration, while 673 (95%) did not. The deterioration group consistently had a higher number of alerts compared to those who were discharged normally, across all time-points. On average, the time between the initial alert and clinical deterioration was 16 h within the last 24 h preceding the event. The sensitivity of the Dozee-EWS varied between 67% and 94%. HCP spend 10% of their time on vital signs check and documentation. Conclusions: This study suggests that utilizing contactless continuous vital signs monitoring with Dozee-EWS in general ward holds promise for enhancing the early detection of clinical deterioration. Further research is essential to evaluate the effectiveness across a wider range of clinical settings. [ABSTRACT FROM AUTHOR]

Introduction: Tobacco use and exposure to Second-Hand Smoke (SHS) are major health hazards for growing children and adolescents. Smokeless Tobacco (SLT) product consumption is a serious health issue both abroad and in India. Children and young people are more likely to be exposed to Secondhand Smoke (SHS) in India due to high population density. Aim: To assess physical anthropometric parameters and cardiac autonomic function tests among passive smokers and SLT users. Materials and Methods: This cross-sectional study was conducted in the department of Physiology Nootan Medical College and Research Centre, Visnagar from August 2023 to February 2024. The study was comprised of 100 participants including 50 non-smokers who chew tobacco and who have never been a passive smoker in Group-A (SLT) and 50 agematched passive smokers who lived with at least one smoker or frequently interacted with smokers at work for at least three years before conducting this study was included in Group-B (Passive smoke or SHS). Anthropometric measurements were recorded. Cardiac autonomic function tests were done by using a Polyrite recording machine with mode "ECG" in Lead-II position among both groups. Results were expressed as mean±Standard Deviation (SD), and analysed by using unpaired student's t-test. The p-value of <0.05 was considered as statistically significant. Results: Resting (Basal) heart rate was significantly increased in the SLT group (p-value=0.001). Resting Systolic Blood Pressure (SBP) was significantly reduced in the passive smoker group when compared to SLT group (p-value=0.001). It was noted that 30:15 ratio was statistically significant in the passive smokers as compared to that in the SLT group (p-value=0.001). It was also noted that blood pressure response to immediate standing in passive smokers was highly significant (p-value=0.001). Conclusion: The results of present study showed that sympathetic activity was increased and parasympathetic activity was decreased in tobacco users (SLT). The fall of SBP in response to immediate standing among passive smokers is suggestive of decreased central sympathetic activity and baroreceptor reflex sensitivity. [ABSTRACT FROM AUTHOR]

In India, NCDs are responsible for 60% of deaths, with cardiovascular incidents being more prevalent in rural areas.1 Advances in the understanding of cardiac autonomic functioning have led to more accessible and effective strategies for preventing and managing major adverse cardiac events (MACE), even with minimal setup. Hospital based prospective observational study of 150 sample size was carried out on adult subjects over the age 20 years reported to Department of Cardiology, Gandhi Medical College, Bhopal from August 2022 to December 2023. MACE risk was assessed by Framingham risk score in all subjects and correlated with Cardiac Autonomic function testing. Among 150 subjects, 40% were diagnosed with Early CAN, 21.33% with Definite CAN, and 2% with Severe CAN based on Ewing's criteria. Regarding MACE risk, 37.33% were at very high risk, 19.33% at high risk, 15.3% at moderate risk, and 28% at mild risk. Diabetic subjects had early and definite CAN at 40.63% each. Hypertensives primarily had early CAN (21.33%), while smokers had a high rate of Definite CAN (43.75%). A significant positive correlation (R=0.2959, p=0.000237) was found between Mean CAN scores and Mean FRS. Weak positive correlations were observed in some cardiac autonomic function tests (lying to standing up, Valsalva) with FRS, while others showed weak negative correlations. Significant correlations (p<0.05) were noted between CAN scores and FRS parameters like age, diabetes, and smoking. Individual FRS parameters also had a highly significant correlation with CAFTs (P<0.0001). Hence, we conclude that this prospective study, established a positive correlation between Cardiac Autonomic Function Testing (CAFT) and Cardiovascular Risk in adults. Thus, CAFT could be used as a cost-effective and accessible test for even healthcare centers with limited resources for early identification and screening of MACE. [ABSTRACT FROM AUTHOR]

Introduction: Strategies beyond pulmonary vein isolation (PVI) in persistent atrial fibrillation (persAF) are debated. A novel mapping tool provides algorithmic detection of ablation targets based on electrogram (EGM) properties specific to stable localized rotational activations. Methods: The mapping tool was used on 31 patients (20 de novo). The algorithm was used to optimize PVI line placement and guide additional ablations. Targets were detected by calculating local cycle length (L‐CL) and local spread of activation within that L‐CL (Duty Cycle; DC) for EGMs with consistent morphology and activation. At least two left atrial (LA) maps (pre‐PVI and post‐PVI) were acquired in atrial fibrillation (AF) in all patients (except those with AF termination during PVI). Extra‐pulmonary vein (PV) targets were compared between the two LA maps in each patient. Follow‐up included Holter monitoring every 3 months. Results: Patients had a median of 3 extra‐PV drivers/targets. The majority (81%) were localized in the same areas between the two LA maps. All patients had progressive AF organization demonstrated by global activation slowing: histogram peak L‐CL increased from 162 to 171 ms (post‐PVI; p =.0003) than to 175 ms (posttarget ablation; p =.04). Moreover, L‐CL dispersion was reduced by ablation; in 50% their values tended to cluster around two dominant cycles. In de novo patients AF terminated to sinus rhythm or atrial tachycardia (AT) within 48 h postprocedure in 88% of cases, and at 18 months mean follow‐up recurrence occurred in only five (25%) patients (three persAF, two AT). There were no complications. Conclusion: The algorithmic detection of EGMs consistent with localized reentry during sequential mapping of persAF provided reproducible targets for ablation. This allowed personalized PVI and limited, highly‐selective, extra‐PV ablation. Results of this initial experience included progressive organization of AF with ablation and a low recurrence rate after a single procedure. [ABSTRACT FROM AUTHOR]

The effects of methylmercury (MeHg) on exposed populations are a public health problem. In contrast to widely studied neurological damage, few cardiovascular changes have been described. Our group evaluated the cardiotoxicity of a cumulative dose of 70 mg.kg−1 fractioned over a 14-day exposure period in mice (MeHg70 group). The effects of MeHg on proteins relevant to cardiac mitochondrial function were also investigated. The results obtained showed a reduction in oxygen consumption in the two settings. In cardiac tissue samples in oxygraphy studies, this reduction was related to a lower efficiency of complexes II and V, which belong to the oxidative phosphorylation system. In vivo, mice in the MeHg70 group presented lower oxygen consumption and running tolerance, as shown by ergometric analyses. Cardiac stress was evident in the MeHg70 group, as indicated by a marked increase in the level of the mRNA encoding atrial natriuretic peptide. Electrocardiogram studies revealed a lower heart rate at rest in the animals from the MeHg70 group, as well as prolonged left ventricular depolarisation and repolarisation. Through echocardiographic analysis, reductions in the left ventricular ejection fraction and left ventricular wall thickness of approximately 10% and 20%, respectively, were detected. These results indicate that the oral intake of MeHg can decrease cardiac function and oxidative metabolism. This finding highlights the importance of monitoring MeHg levels in humans and animals in contaminated areas, as well as periodically carrying out cardiac function tests. [ABSTRACT FROM AUTHOR]

Understanding the evolving nature of coronary hemodynamics is crucial for early disease detection and monitoring progression. We require digital twins that mimic a patient's circulatory system by integrating continuous physiological data and computing hemodynamic patterns over months. Current models match clinical flow measurements but are limited to single heartbeats. To this end, we introduced the longitudinal hemodynamic mapping framework (LHMF), designed to tackle critical challenges: (1) computational intractability of explicit methods; (2) boundary conditions reflecting varying activity states; and (3) accessible computing resources for clinical translation. We show negligible error (0.0002–0.004%) between LHMF and explicit data of 750 heartbeats. We deployed LHMF across traditional and cloud-based platforms, demonstrating high-throughput simulations on heterogeneous systems. Additionally, we established LHMFC, where hemodynamically similar heartbeats are clustered to avoid redundant simulations, accurately reconstructing longitudinal hemodynamic maps (LHMs). This study captured 3D hemodynamics over 4.5 million heartbeats, paving the way for cardiovascular digital twins. [ABSTRACT FROM AUTHOR]

Aims We aimed to test the hypothesis if combining coronary artery calcium score (Ca-score) as a quantitative anatomical marker of coronary atherosclerosis with high-sensitivity cardiac troponin as a quantitative biochemical marker of myocardial injury provided incremental value in the detection of functionally relevant coronary artery disease (fCAD) and risk stratification. Methods and results Consecutive patients undergoing myocardial perfusion single-photon emission computed tomography (MPS) without prior CAD were enrolled. The diagnosis of fCAD was based on the presence of ischaemia on MPS and coronary angiography; fCAD was centrally adjudicated in the diagnostic and prognostic domain. Diagnostic accuracy was evaluated using the area under the receiver-operating characteristic curve (AUC). The composite of cardiovascular death and non-fatal acute myocardial infarction (AMI) within 730 days was the primary prognostic endpoint. Among 1715 patients eligible for the diagnostic analysis, 399 patients had fCAD. The combination of Ca-score and high-sensitivity cardiac troponin T (hs-cTnT) had good diagnostic accuracy for the diagnosis of fCAD (AUC 0.79, 95% confidence interval (CI) 0.77–0.81), but no incremental value compared with the Ca-score alone (AUC 0.79, 95% CI 0.77–0.81, P = 0.965). Similar results were observed using high-sensitivity cardiac troponin I (AUC 0.80, 95% CI 0.77–0.82) instead of hs-cTnT. Among 1709 patients (99.7%) with available follow-up, 59 patients (3.5%) suffered the composite primary prognostic endpoint (non-fatal AMI, n = 34; CV death, n = 28). Both Ca-score and hs-cTnT had independent prognostic value. Increased risk was restricted to patients with elevation in both markers. Conclusion The combination of the Ca-score with hs-cTnT increases the prognostic accuracy for future events but does not provide incremental value vs. the Ca-score alone for the diagnosis of fCAD. Study registration Clinical trial registration: NCT00470587. [ABSTRACT FROM AUTHOR]

Aims The study aimed, firstly, to validate automatically and visually scored coronary artery calcium (CAC) on low-dose computed tomography (CT) (LDCT) scans with a dedicated calcium scoring CT (CSCT) scan and, secondly, to assess the added value of CAC scored from LDCT scans acquired during [15O]-water-positron emission tomography (PET) myocardial perfusion imaging (MPI) on prediction of major adverse cardiac events (MACE). Methods and results Five hundred seventy-two consecutive patients with suspected coronary artery disease, who underwent [15O]-water-PET MPI with LDCT and a dedicated CSCT scan were included. In the reference CSCT scans, manual CAC scoring was performed, while LDCT scans were scored visually and automatically using deep learning approach. Subsequently, based on CAC score results from CSCT and LDCT scans, each patient's scan was assigned to one out of five cardiovascular risk groups (0, 1–100, 101–400, 401–1000, >1000), and the agreement in risk group classification between CSCT and LDCT scans was investigated. MACE was defined as a composite of all-cause death, non-fatal myocardial infarction, coronary revascularization, and unstable angina. The agreement in risk group classification between reference CSCT manual scoring and visual/automatic LDCT scoring from LDCT was 0.66 [95% confidence interval (CI): 0.62–0.70] and 0.58 (95% CI: 0.53–0.62), respectively. Based on visual and automatic CAC scoring from LDCT scans, patients with CAC > 100 and CAC > 400, respectively, were at increased risk of MACE, independently of ischaemic information from the [15O]-water-PET scan. Conclusion There is a moderate agreement in risk classification between visual and automatic CAC scoring from LDCT and reference CSCT scans. Visual and automatic CAC scoring from LDCT scans improve identification of patients at higher risk of MACE. [ABSTRACT FROM AUTHOR]

Abstract Background The therapeutic effects of ertugliflozin, a sodium-glucose cotransporter 2 inhibitor, on cardiovascular outcome are not fully understood. This study aimed to evaluate the efficacy and safety of ertugliflozin on cardiac function in people with type 2 diabetes and pre-heart failure. Methods We conducted a 24-week randomized, double-blind, placebo-controlled trial involving individuals with type 2 diabetes inadequately controlled with antidiabetic medications. Participants with left ventricular hypertrophy, E/e’ >15, or impaired left ventricular global longitudinal strain (LVGLS) were randomized 1:1 to receive either ertugliflozin (5 mg once daily) or a placebo. The primary outcome was the change in LVGLS. Secondary outcomes included changes in left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF). Prespecified exploratory outcomes, including angiotensin-converting enzyme 2 (ACE2) and angiotensin (1–7) levels, were also assessed. Results A total of 102 individuals (mean age, 63.9 ± 9.2 years; 38% women) were included. The ertugliflozin group showed a significant improvement in LVGLS (− 15.5 ± 3.1% to − 16.6 ± 2.8%, P = 0.004) compared to the placebo group (− 16.7 ± 2.7% to − 16.4 ± 2.6%, P = 0.509), with a significant between-group difference (P = 0.013). Improvements in LVMI and LVEF were also observed. Additionally, significant reductions in HbA1c, systolic blood pressure, whole-body and visceral fat, uric acid, proteinuria, N-terminal pro–B-type natriuretic peptide, and lipoprotein(a) were noted. ACE2 and angiotensin (1–7) levels significantly increased in the ertugliflozin group compared to the placebo group and correlated with changes in LVGLS [r = 0.456, P

Objective To investigate the effect of home exercise rehabilitation on cardiopulmonary function in patients with varying degrees of coronary revascularization. Methods A total of 93 patients who were diagnosed with acute coronary syndrome and underwent percutaneous coronary intervention from September 2020 to September 2022 and received home exercise rehabilitation were selected from the database of Cardiac Rehabilitation Center. According to the residual syntax score (rSS), the patients were divided into rSS

Introduction: Prolonged and repeated exercise performed during an ultraendurance event can induce general and cardiac fatigue known as exerciseinduced cardiac fatigue. Our objective was to find a possible correlation between the cardiac function and the autonomic cardiac function. Methods: During a multistage ultra-endurance event, a female well-trained cyclist underwent daily rest echocardiography and heart rate variability measurements to assess the cardiac function and the cardiac autonomic function. Results: The athlete completed 3,345 km at 65% of her maximum heart rate and 39% of her maximum aerobic power. A progressive improvement of the systolic function for both the left ventricle and the right ventricle was observed during the event. Discussion: Alterations were observed on the cardiac autonomic function with an imbalance between sympathetic and parasympathetic, but there was no sign of a significant correlation between the cardiac function and the autonomic cardiac function and no signs of cardiac fatigue either. Further analysis should be performed on a larger sample to confirm the obtained results. [ABSTRACT FROM AUTHOR]

Purpose: Maternal and postnatal overnutrition has been linked to an increased risk of cardiometabolic diseases in offspring. This study investigated the impact of adult-onset voluntary wheel running to counteract cardiometabolic risks in female offspring exposed to a life-long high-fat, high-sucrose (HFHS) diet. Methods: Dams were fed either an HFHS or a low-fat, low-sucrose (LFLS) diet starting from 8 wk before pregnancy and continuing throughout gestation and lactation. Offspring followed their mothers' diets. At 15 wk of age, they were divided into sedentary (Sed) or voluntary wheel running (Ex) groups, resulting in four groups: LFLS/Sed (n = 10), LFLS/Ex (n = 5), HFHS/Sed (n = 6), HFHS/Ex (n = 5). Cardiac function was assessed at 25 wk, with tissue collection at 26 wk for mitochondrial respiratory function and protein analysis. Data were analyzed using two-way ANOVA. Results: Although maternal HFHS diet did not affect the offspring's body weight at weaning, continuous HFHS feeding postweaning resulted in increased body weight and adiposity, irrespective of the exercise regimen. HFHS/Sed offspring showed increased left ventricular wall thickness and elevated expression of enzymes involved in fatty acid transport (CD36, FABP3), lipogenesis (DGAT), glucose transport (GLUT4), oxidative stress (protein carbonyls, nitrotyrosine), and early senescence markers (p16, p21). Their cardiac mitochondria displayed lower oxidative phosphorylation (OXPHOS) efficiency and reduced expression of OXPHOS complexes and fatty acid metabolism enzymes (ACSL5, CPT1B). However, HFHS/Ex offspringmitigated these effects, aligning more with LFLS/Sed offspring. Conclusions: Adult-onset voluntary wheel running effectively counteracts the detrimental cardiac effects of a lifelong HFHS diet, improving mitochondrial efficiency, reducing oxidative stress, and preventing early senescence. This underscores the significant role of physical activity in mitigating diet-induced cardiometabolic risks. [ABSTRACT FROM AUTHOR]

Introduction: Training in clinical cardiac electrophysiology (CCEP) involves the development of catheter handling skills to safely deliver effective treatment. Objective data from analysis of ablation data for evaluating trainee of CCEP procedures has not previously been possible. Using the artificial intelligence cloud‐based system (CARTONET), we assessed the impact of trainee progress through ablation procedural quality. Methods: Lesion‐ and procedure‐level data from all de novo atrial fibrillation (AF) and cavotricuspid isthmus (CTI) ablations involving first‐year (Y1) or second‐year (Y2) fellows across a full year of fellowship was curated within Cartonet. Lesions were automatically assigned to anatomic locations. Results: Lesion characteristics, including contact force, catheter stability, impedance drop, ablation index value, and interlesion time/distance were similar over each training year. Anatomic location and supervising operator significantly affected catheter stability. The proportion of lesion sets delivered independently and of lesions delivered by the trainee increased steadily from the first quartile of Y1 to the last quartile of Y2. Trainee perception of difficult regions did not correspond to objective measures. Conclusion: Objective ablation data from Cartonet showed that the progression of trainees through CCEP training does not impact lesion‐level measures of treatment efficacy (i.e., catheter stability, impedance drop). Data demonstrates increasing independence over a training fellowship. Analyses like these could be useful to inform individualized training programs and to track trainee's progress. It may also be a useful quality assurance tool for ensuring ongoing consistency of treatment delivered within training institutions. [ABSTRACT FROM AUTHOR]

Background: An accurate display of scar‐related atrial tachycardia (ATs) is a key determinant of ablation success. The efficacy of ripple mapping (RM) in identifying the mechanism and critical isthmus of scar‐related ATs during coherent mapping is unknown. Methods: A total of 97 patients with complex ATs who underwent radiofrequency catheter ablation at our center between October 2018 and September 2022 were included. ATs was mapped using a multielectrode mapping catheter on the CARTO3v7 CONFIDENCE module. Coherent and RM were used to identify the reentrant circuit. Results: The mechanisms of 128 ATs were analyzed retrospectively (84 anatomic‐reentrant ATs and 44 non‐anatomic reentrant ATs). The median AT cycle length was 264 ± 25ms. The correct diagnosis was achieved in 83 ATs (68%) using only coherent mapping. Through coherent mapping plus RM, 114 ATs (84.2%) were correctly diagnosed (68% vs. 89%, p =.019). In non‐anatomical reentrant ATs, 81% of the diagnostic rate was achieved by reviewing both coherent and ripple mapping compared to reviewing coherent mapping alone (81% vs. 52%, p =.03). Reviewing coherent mapping and ripple mapping showed a higher diagnostic rate in patients who underwent cardiac surgery than those with Coherent mapping alone (64% vs. 88%, p =.04). Conclusion: Coherent mapping combined with RM was superior to coherent mapping alone in identifying the mechanism of scar‐related ATs post‐cardiac surgery and non‐anatomic reentrant ATs. [ABSTRACT FROM AUTHOR]

To date, there have been no reports of recording epicardial electrograms at the onset of spontaneous ventricular fibrillation (VF) in patients with Brugada syndrome (BrS). In the case of BrS, unipolar and bipolar electrogram recording on the right ventricular epicardium revealed that dispersion of repolarization with delayed potential was associated with spontaneous occurrence of VF. Phase 2 reentry associated with shortening and dispersion of action potential could have been recorded for the first time in BrS. Epicardial unipolar mapping can guide accurate and appropriate ablation for the elimination of arrhythmia substrate in J wave syndrome. [ABSTRACT FROM AUTHOR]

Background: Ventricular tachycardia (VT) remains a risk in repaired Tetralogy of Fallot (rTOF); however, long‐term benefits of VT ablation have not been established. This study compares the outcomes of rTOF patients with and without VT ablation. Methods: We searched multiple databases examining the outcomes of rTOF patients who had undergone VT ablation compared to those without ablation. Primary outcomes were VT recurrence, sudden cardiac death (SCD), and all‐cause mortality. Subgroup analysis was conducted based on the type of ablation (catheter and surgical). Slow‐conducting anatomical isthmus (SCAI)‐based catheter ablation (CA) was also analyzed separately. The secondary outcome was the risk factors for the pre‐ablation history of VT. Results: Fifteen cohort studies with 1459 patients were included, 21.4% exhibited VTs. SCAI was found in 30.4% of the population, with 3.7% of non‐inducible VT. Factors significantly associated with VT before ablation included a history of ventriculostomy, QRS duration ≥180 ms, fragmented QRS, moderate to severe pulmonary regurgitation, high premature ventricular contractions burden, late gadolinium enhancement, and SCAI. Ablation was only beneficial in reducing VTs recurrence in SCAI‐based CA (risk ratio (RR) 0.11; 95% CI 0.03 to 0.33. p < 0.001; I2 = 0%) with no recurrence in patients with preventive ablation (mean follow‐up time 91.14 ± 77.81 months). The outcomes of VT ablation indicated a favorable trend concerning SCD and all‐cause mortality (RR 0.49 and 0.44, respectively); however, they were statistically insignificant. Conclusions: SCAI‐based CA has significant advantages in reducing VT recurrence in rTOF patients. Risk stratification plays a key role in determining the decision to perform ablation. [ABSTRACT FROM AUTHOR]

This document is an editorial comment on the topic of lung-heart toxicity in a randomized clinical trial of hypofractionated image-guided radiation therapy for breast cancer. The author emphasizes the interconnected physiological importance of the lungs and heart and suggests that future research should consider both organs together. The editorial is based on the author's experience and knowledge, without any conflicts of interest or funding. The document includes a list of references for further reading on related topics. [Extracted from the article]

Objective The purposes of the study were to develop reference ranges and maturation patterns of fetal cardiac function parameters measured by speckle tracking echocardiography (STE) using multiple biometric variables at 17 to 24 weeks' gestation among Thai fetuses and to compare with other previous reports. Study Design The four-chamber view of the fetal heart in 79 healthy fetuses was suitably analyzed by STE to establish the best-fit regression model. The 95% reference intervals and Z -score equations of fetal cardiac function parameters were computed. Results The fractional area change of both ventricles, left ventricular (LV) end-diastolic and end-systolic volumes, LV stroke volume, LV cardiac output (CO), and LV CO per kilogram were all increased according to gestational age (GA) and five fetal biometric measurements. However, the global longitudinal strain, basal-apical length fractional shortening (BAL-FS), BAL annular free wall and septal wall FS, BAL free wall and septal wall annular plane systolic excursions, 24-segment transverse width FS, as well as LV ejection fraction were all independent of GA or other somatic characteristics. There were varying development patterns between fetal right and left ventricles of these cardiac function indices across the gestation period. Conclusion Our study created Z -score and corresponding centile calculators, 5th and 95th centile reference tables, and corresponding graphs and determined the normal evolution across gestation using multiple somatic growth and age variables between 17 and 24 gestational weeks. These nomograms serve as an essential prerequisite for quantitatively evaluating fetal cardiac contractility and allow for precisely detecting early changes in the fetal heart function. Key Points Most fetal cardiac function measurements were correlated with all the independent variables. Fetal ventricular function parameters have their own characteristic maturation changes. Racial variability may not occupy an important place for fetal myocardial function during these GA. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) affects adults and children globally and is a critical health concern. Cardiovascular disease (CVD) was identified over ten years ago as a leading cause of death in children with advanced CKD. Numerous studies that evaluate cardiovascular risk, disease processes, and early markers of CVD in cases with CKD have been published as a result of this observation. Children with CKD have an exceptionally high prevalence of conventional and uremia-related CVD predisposing factors, much like adults do. Objective: The aim was to study the impact of bone markers and other laboratory tests on diastolic cardiac functions in children and adolescent with CKD on regular hemodialysis. Patients and Methods: A cross-sectional observational study was conducted on 40 patients with CKD on regular hemodialysis, from May 2022 to June 2023 in the Pediatric Nephrology and Cardiology Department at Sohag University Hospital. Results: The commonest causes of CKD were congenital anomalies of the kidney and urinary tract (CAKUT) in 77.5% of patients. The mean age of patients was 14.18 ± 4.36 years. Evaluation of cardiac function showed that 57.5% of cases had diastolic dysfunction and 70% of cases had left ventricular hypertrophy (LVH). There was a statistically significant correlation between diastolic dysfunction with anemia and hyperparathyroidism (p<0.05). Hypertension was significantly accompanied by LVH (p=0.045). Conclusion: Our study revealed that the most important factors affecting all parameters of diastolic function were anemia and hyperparathyroidism. Other factors affecting the diastolic function to a lesser extent were hypertension and residual kidney function (RKF). There was a substantial correlation between LVH and hypertension. [ABSTRACT FROM AUTHOR]

Introduction: This study sought to elucidate the impact of vein of Marshall (VOM) chemical ablation on atrial fibrillation (AF) drivers by investigating the changes in CARTOFINDER mappings before and after VOM chemical ablation in patients with persistent AF. Methods: This study included 23 consecutive patients undergoing catheter ablation for long‐persistent AF (>18 months). VOM chemical ablation was performed following pulmonary vein isolation. CARTOFINDER and AF cycle length (AFCL) maps were created in the left atrium (LA) before and after VOM chemical ablation. The LA was divided into 8 segments, and the number of focal activation points with 6 or more repetitions was counted in each segment. Results: The number of focal activation points was largest in the LA appendage (LAA). After VOM chemical ablation, the number of focal activation points in the LA decreased significantly (37 [interquartile range, IQR: 19–55] vs. 15 [IQR: 7–21], p <.001), and median AFCL was significantly prolonged (159 [147–168] vs. 164 [150–173] ms, p <.001). In the assessment of each segment, significant decreases in focal activation points were observed in the inferior, lateral, and anterior segments and LAA. Among the focal activation points disappearing after chemical ablation, the number in the non‐ethanol‐affected area was significantly larger than that in the affected area (13 [8–25] vs. 4 [1–10], p <.001). Conclusions: VOM chemical ablation decreases AF drivers detected by CARTOFINDER. Mechanisms other than direct myocardial damage are considered to contribute the attenuation of AF drivers. [ABSTRACT FROM AUTHOR]

Introduction: Ablation of scar‐related reentrant atrial tachycardia (SRRAT) involves identification and ablation of a critical isthmus. A graph convolutional network (GCN) is a machine learning structure that is well‐suited to analyze the irregularly‐structured data obtained in mapping procedures and may be used to identify potential isthmuses. Methods: Electroanatomic maps from 29 SRRATs were collected, and custom electrogram features assessing key tissue and wavefront properties were calculated for each point. Isthmuses were labeled off‐line. Training data was used to determine the optimal GCN parameters and train the final model. Putative isthmus points were predicted in the training and test populations and grouped into proposed isthmus areas based on density and distance thresholds. The primary outcome was the distance between the centroids of the true and closest proposed isthmus areas. Results: A total of 193 821 points were collected. Thirty isthmuses were detected in 29 tachycardias among 25 patients (median age 65.0, 5 women). The median (IQR) distance between true and the closest proposed isthmus area centroids was 8.2 (3.5, 14.4) mm in the training and 7.3 (2.8, 16.1) mm in the test group. The mean overlap in areas, measured by the Dice coefficient, was 11.5 ± 3.2% in the training group and 13.9 ± 4.6% in the test group. Conclusion: A GCN can be trained to identify isthmus areas in SRRATs and may help identify critical ablation targets. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 21-year-old woman undergoing electrophysiological study for long RP (Refractory Period) tachycardia. It initially suspected atrial tachycardia or atypical atrioventricular nodal reentrant tachycardia (aAVNRT), later confirming slow-slow AVNRT. It is reported that Radiofrequency ablation targeted the AV (atrioventricular) node's right inferior extension, successfully resolving the tachycardia.

Ventricular tachycardia ablation in the post‐surgical patients is complicated by difficult epicardial access. Endocardial‐only ablation may lead to failure which can be prevented by mapping and ablating inside the coronary venous system. Radiofrequency ablation inside the coronary venous system is dependent on anatomical and biophysical factors. Herein we report a ventricular tachycardia case necessitating bipolar ablation between the middle cardiac vein and the left ventricular endocardium. [ABSTRACT FROM AUTHOR]

Assessing cardiac function and diagnosing different heart illnesses rely on accurate left ventricle (LV) identification using cardiac magnetic resonance imaging (MRI). To efficiently and accurately segment the left ventricle from 2D cardiac MRI data, this study introduces a novel method that combines a U-Net model with a MobileNetV3 encoder. The ACDC dataset, which includes MRI images and associated ground truth masks, underwent rigorous preprocessing and hyperparameters were adjusted to improve model performance. The evaluation resulted in an average dice score of 92.13%, with the LV segment receiving a dice score of 96.16%, displaying greater performance compared to previous studies. The combination of MobileNetV3 and U-Net has been proven to be effective for medical image segmentation, thereby enhancing diagnostic procedures and ultimately improving patient outcomes. [ABSTRACT FROM AUTHOR]

Aims Current assessment of myocardial ischaemia from stress perfusion cardiovascular magnetic resonance (SP-CMR) largely relies on visual interpretation. This study investigated the use of high-resolution free-breathing SP-CMR with automated quantitative mapping in the diagnosis of coronary artery disease (CAD). Diagnostic performance was evaluated against invasive coronary angiography (ICA) with fractional flow reserve (FFR) measurement. Methods and results Seven hundred and three patients were recruited for SP-CMR using the research sequence at 3 Tesla. Of those receiving ICA within 6 months, 80 patients had either FFR measurement or identification of a chronic total occlusion (CTO) with inducible perfusion defects seen on SP-CMR. Myocardial blood flow (MBF) maps were automatically generated in-line on the scanner following image acquisition at hyperaemic stress and rest, allowing myocardial perfusion reserve (MPR) calculation. Seventy-five coronary vessels assessed by FFR and 28 vessels with CTO were evaluated at both segmental and coronary territory level. Coronary territory stress MBF and MPR were reduced in FFR-positive (≤0.80) regions [median stress MBF: 1.74 (0.90–2.17) mL/min/g; MPR: 1.67 (1.10–1.89)] compared with FFR-negative regions [stress MBF: 2.50 (2.15–2.95) mL/min/g; MPR 2.35 (2.06–2.54) P < 0.001 for both]. Stress MBF ≤ 1.94 mL/min/g and MPR ≤ 1.97 accurately detected FFR-positive CAD on a per-vessel basis (area under the curve: 0.85 and 0.96, respectively; P < 0.001 for both). Conclusion A novel scanner-integrated high-resolution free-breathing SP-CMR sequence with automated in-line perfusion mapping is presented which accurately detects functionally significant CAD. [ABSTRACT FROM AUTHOR]

Aims Variation in diagnostic performance of single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) has been observed, yet the impact of cardiac size has not been well characterized. We assessed whether low left ventricular volume influences SPECT MPI's ability to detect obstructive coronary artery disease (CAD) and its interaction with age and sex. Methods and results A total of 2066 patients without known CAD (67% male, 64.7 ± 11.2 years) across nine institutions underwent SPECT MPI with solid-state scanners followed by coronary angiography as part of the REgistry of Fast Myocardial Perfusion Imaging with NExt Generation SPECT. Area under receiver-operating characteristic curve (AUC) analyses evaluated the performance of quantitative and visual assessments according to cardiac size [end-diastolic volume (EDV); <20th vs. ≥20th population or sex-specific percentiles], age (<75 vs. ≥75 years), and sex. Significantly decreased performance was observed in patients with low EDV compared with those without (AUC: population 0.72 vs. 0.78, P = 0.03; sex-specific 0.72 vs. 0.79, P = 0.01) and elderly patients compared with younger patients (AUC 0.72 vs. 0.78, P = 0.03), whereas males and females demonstrated similar AUC (0.77 vs. 0.76, P = 0.67). The reduction in accuracy attributed to lower volumes was primarily observed in males (sex-specific threshold: EDV 0.69 vs. 0.79, P = 0.01). Accordingly, a significant decrease in AUC, sensitivity, specificity, and negative predictive value for quantitative and visual assessments was noted in patients with at least two characteristics of low EDV, elderly age, or male sex. Conclusion Detection of CAD with SPECT MPI is negatively impacted by small cardiac size, most notably in elderly and male patients. [ABSTRACT FROM AUTHOR]

Aims Dynamic myocardial computed tomography (CT) perfusion (DM-CTP) can, in combination with coronary CT angiography (CCTA), provide anatomical and functional evaluation of coronary artery disease (CAD). However, normal values of myocardial blood flow (MBF) are needed to identify impaired myocardial blood supply in patients with suspected CAD. We aimed to establish normal values for MBF measured using DM-CTP, to assess the effects of age and sex, and to assess regional distribution of MBF. Methods and results A total of 82 healthy individuals (46 women) aged 45–78 years with normal coronary arteries by CCTA underwent either rest and adenosine stress DM-CTP (n = 30) or adenosine-induced stress DM-CTP only (n = 52). Global and segmental MBF were assessed. Global MBF at rest and during stress were 0.93 ± 0.42 and 3.58 ± 1.14 mL/min/g, respectively. MBF was not different between the sexes (P = 0.88 at rest and P = 0.61 during stress), and no correlation was observed between MBF and age (P = 0.08 at rest and P = 0.82 during stress). Among the 16 myocardial segments, significant intersegmental differences were found (P < 0.01), which was not related to age, sex, or coronary dominance. Conclusion MBF assessed by DM-CTP in healthy individuals with normal coronary arteries displays significant intersegmental heterogeneity which does not seem to be affected by age, sex, or coronary dominance. Normal values of MBF may be helpful in the clinical evaluation of suspected myocardial ischaemia using DM-CTP. [ABSTRACT FROM AUTHOR]

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Objective • Adolescent idiopathic scoliosis (AIS) can lead to right heart dysfunction. Inferior vena cava (IVC) diameter is an essential parameter of the right-heart function, but the relationship between scoliosis and the IVC diameter has not been established. This study aimed to investigate the correlation between the IVC diameter and the severity of AIS. Methods • This retrospective study examined the data from patients admitted to Peking Union Medical College Hospital between January 2000 and June 2014 with a diagnosis of AIS. A preoperative spine full-length standing X-ray was collected. The IVC diameter was measured during the expiration phase as a routine examination. Results • Among the 339 included patients, 269 had thoracic curves, and 311 had at least a thoracic or thoracolumbar curve. Significant correlations between the diameter of IVC and the coronal Cobb angle of main thoracic curves (r=0.142, P = .015) and thoracolumbar curves (r=0.580, P = .015) were observed. Regarding the possible confounding factors, the IVC diameter was also significantly correlated to body weight (r=0.327, P < .001) and body height (r=0.134, P = .014). In the partial correlation analysis correcting for body weight and height, the IVC inner diameter was correlated to the Cobb angle of the thoracic curve (r=0.172, P = .003) and the larger curve of either the thoracic or thoracolumbar curve (r=0.190, P = .001). Discussion • The result of this study implies that even in patients with mild scoliosis, there might already be underlying right heart function changes. Heart function should be taken into more consideration for AIS paitents. For patients with higher IVC diameters, a more throught cardiology assessment should be performed. Conclusion • The IVC diameter is positively correlated with the Cobb angle of thoracic curves or the larger one of thoracic or thoracolumbar curves in patients with AIS. [ABSTRACT FROM AUTHOR]

Objective • The present study aimed to explore the predictive value and prognosis of SYNTAX score, nerve growth factor (NGF), trimethylamino oxide (TMAO), silent information regulator 1 (SIRT1), and apolipoprotein A1 (apoA1) for ischemic heart failure (IHF) patients. Methods • From January 2020 to January 2021, 87 patients diagnosed with IHF in the Sixth Hospital of Wuhan, Affiliated Hospital of Jianghan University, and 42 healthy people were included and analyzed retrospectively. The 87 patients were divided into 3 subgroups according to New York Heart Association (NYHA) heart function classification, as group 1 (n=9, classes I-II heart function), group 2 (n = 7, class III heart function), and group 3 (n = 31, class IV heart function). The levels of left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), left atrium diameter (LAD), NGF, TMAO, SIRT1, SYNTAX score, and apoA1 were compared among these groups. Results • The SIRT1 and apoA1 of patients with classes I-II, III, and IV heart function were significantly lower than that of healthy people in the control group, while TMAO and NGF were significantly higher than those of healthy people (all P < .05). The SYNTAX score of grade I-II, grade III, and grade IV groups was significantly lower than that of the healthy group (P < .05). The two groups had no significant difference in the number of coronary artery lesions (P > .05). The SIRT1 and apoA1 of patients with classes III and IV heart function were significantly lower than that of patients with classes I -II heart function, while TMAO and NGF were significantly higher than those of class I-II people (all P < .05). The SIRT1 and apoA1 of patients with class IV heart function were significantly lower than those of patients with class III heart function, while TMAO and NGF were significantly higher than those of patients with class III heart function (all P < .05). After 1 year follow-up of these IHF patients, 22 patients were readmission because of cardiac events, and 6 patients died in hospital or during follow-up. These 28 patients were allocated to the event group, while the rest 59 patients were allocated to the events-free group. The SIRT1 and apoA1 level in event group was significantly lower than those of event-free group, while the TMAO, SYNTAX score, and NGF level were significantly higher than those of the event-free group (all P < .001). Baseline characters and heart function with significant differences (LVEF, LAD and LVEDD) among these groups, and NGF, TMAO, SIRT1, SYNTAX score and apoA1 were enrolled into Logistic regression. SYNTAX score, NGF, TMAO, SIRT1 and apoA1 were independent risk factors for the prognosis of IHF patients (all P < .05). Conclusion • SIRT1, apoA1, TMAO and NGF serum levels in patients with IHF are abnormally expressed and closely related to cardiac function. The levels of SYNTAX score, NGF, TMAO, SIRT1, and apoA can effectively predict adverse events in patients with IHF. [ABSTRACT FROM AUTHOR]

Introduction: Catheter ablation of ectopy originating from the vicinity of the His bundle can be challenging. Methods and Results: We report a case of a 33‐year‐old man with narrow QRS ectopy with preferential conduction from a para‐Hisian origin to the proximal left fascicles, which was successfully eliminated by radiofrequency ablation in the right coronary cusp, guided by ultrahigh‐resolution mapping of the His bundle, bundle branch, and fascicular electrograms. Conclusion: Some narrow QRS ectopy may originate from the vicinity of the conduction system, instead of the "true" conduction system, and have concealed connections from its origin to the conduction system. [ABSTRACT FROM AUTHOR]

Following myocardial infarction (MI), cardiac tissue undergoes irreversible cellular alterations, with cardiomyocytes being replaced by fibrotic tissue. In order to improve tissue regeneration, a previously characterized chitosan-based cryogel, which was designed by our group, was used. The treatment regimen involved the sequential delivery of the cryogel loaded with specific cytokines and growth factors, followed by a separate injection of pre-differentiated cells. Initially, the cryogel loaded with interleukin-10 and transforming growth factor-β was injected into infarcted tissue immediately after MI induction, targeting the acute inflammatory response. On day four post-MI, a second injection was administered, this time utilizing cryogel loaded with vascular endothelial growth factor and fibroblast growth factor-2, aimed at promoting tissue regeneration and angiogenesis. Subsequently, on day six post-MI, the experimental group received cardiomyocyte-like cells, smooth muscle cells, and endothelial cells. The purpose of these cells, in synergy with cytokines and growth factors, was to repopulate the lost cellular populations, thereby enhancing myocardial repair. The treatment improved myocardial tissue regeneration, increased cardiac output, ejection fraction, and reduced fibrotic regions. Thus, the chitosan-based cryogel, enriched with anti-inflammatory and proangiogenic factors and supplemented with pre-differentiated cells, offers a promising platform for controlled release of therapeutics, promoting substantial tissue repair and regeneration following MI. [ABSTRACT FROM AUTHOR]

This research is aimed at evaluating the efficacy and safety of ablation of ventricular tachyarrhythmias using high-density mapping in patients with non-ischemic etiology. This study analyzed 60 patients with ventricular tachyarrhythmias, using diagnostic tools like electrocardiography and MRI. Treatment involved epicardial ablation following the E. Sosa method, with efficacy evaluated through the SF-36 survey and MRI. Success rates were categorized, and post-treatment care included troponin monitoring and aspirin. Data was analyzed using Excel and Statistika 11.0. Of the 60 patients, 30 underwent surgery at the City Cardiological Center in Almaty and 30 patients were operated on at the National Research Cardiac Surgery Center in Astana. Prior to surgery, all patients underwent a standard clinical diagnostic examination followed by ablation of ventricular tachyarrhythmias using high-density mapping. After six and 12 months from the beginning of the study, all patients underwent a follow-up examination, with an assessment of the effectiveness of the above treatment. After 12 months, follow-up examination of patients showed good results. Left ventricular ejection fraction in patients after 12 months increased from 47 ± 2.4 to 58 ± 4.5%. The end-diastolic diameter of the left ventricle decreased from 61.2 ± 2.31 to 50.1 ± 1.9 mm. In summary, the study highlights the efficacy and safety of high-density mapping ablation in treating ventricular tachyarrhythmias, especially from the right ventricular outflow tract in patients with reduced left ventricular ejection fraction. The success rate of the procedure was 95%. This approach proves beneficial for patients unresponsive to antiarrhythmic therapy, enhancing both the quality of life and potentially reducing mortality in patients with ventricular arrhythmias. [ABSTRACT FROM AUTHOR]

Objectives: The magnetic resonance (MR) 4D flow imaging–derived left atrial (LA) acceleration factor α was recently introduced as a means to non-invasively estimate LA pressure. We aimed to investigate the association of α with the severity of left ventricular (LV) diastolic dysfunction using echocardiography as the reference method. Methods: Echocardiographic assessment of LV diastolic function and 3-T cardiac MR 4D flow imaging were prospectively performed in 94 subjects (44 male/50 female; mean age, 62 ± 12 years). LA early diastolic peak outflow velocity (vE), systolic peak inflow velocity (vS), and early diastolic peak inflow velocity (vD) were evaluated from 4D flow data. α was calculated from α = vE / [(vS + vD) / 2]. Mean parameter values were compared by t-test; diagnostic performance of α in predicting diastolic (dys)function was investigated by receiver operating characteristic curve analysis. Results: Mean α values were 1.17 ± 0.14, 1.20 ± 0.08, 1.33 ± 0.15, 1.77 ± 0.18, and 2.79 ± 0.69 for grade 0 (n = 51), indeterminate (n = 9), grade I (n = 13), grade II (n = 13), and grade III (n = 8) LV diastolic (dys)function, respectively. α differed between subjects with non-advanced (grade < II) and advanced (grade ≥ II) diastolic dysfunction (1.20 ± 0.15 vs. 2.16 ± 0.66, p < 0.001). The area under the curve (AUC) for detection of advanced diastolic dysfunction was 0.998 (95% CI: 0.958–1.000), yielding sensitivity of 100% (95% CI: 84–100%) and specificity of 99% (95% CI: 93–100%) at cut-off α ≥ 1.58. The AUC for differentiating grade III diastolic dysfunction was also 0.998 (95% CI: 0.976–1.000) at cut-off α ≥ 2.14. Conclusion: The 4D flow–derived LA acceleration factor α allows grade II and grade III diastolic dysfunction to be distinguished from non-advanced grades as well as from each other. Clinical relevance statement: As a single continuous parameter, the 4D flow–derived LA acceleration factor α shows potential to simplify the multi-parametric imaging algorithm for diagnosis of advanced LV diastolic dysfunction, thereby identifying patients at increased risk for cardiovascular events. Key Points: • Detection of advanced diastolic dysfunction is typically performed using a complex, multi-parametric approach. • The 4D flow–derived left atrial acceleration factor α alone allows accurate detection of advanced left ventricular diastolic dysfunction. • As a single continuous parameter, the left atrial acceleration factor α could simplify the diagnosis of advanced diastolic dysfunction. [ABSTRACT FROM AUTHOR]

The article focuses on exploring the mechanism behind narrow QRS tachycardia recurrence in a patient years after undergoing "rightward inferior extension" ablation for atrioventricular nodal reentrant tachycardia (AVNRT). Topics include the identification of the tachycardia's origin near the His bundle, unsuccessful ventricular entrainment pacing, and the diagnostic challenges posed by variations in atrio-His intervals during electrophysiological study and ablation procedures.

BACKGROUND: Although sodium-glucose cotransporter-2 inhibitors have been shown to improve cardiovascular outcomes in general, little is presently known about any sex-specific changes that may result from this therapy. We sought to investigate and quantify potential sex-specific changes seen with the sodium-glucose cotransporter-2 inhibitor canagliflozin (CAN) in a swine model of chronic myocardial ischemia. STUDY DESIGN: Eighteen Yorkshire swine underwent left thoracotomy with placement of an ameroid constrictor. Two weeks postop, swine were assigned to receive either control (F = 5 and M = 5) or CAN 300 mg daily (F = 4 and M = 4). After 5 weeks of therapy, swine underwent myocardial functional measurements, and myocardial tissue was sent for proteomic analysis. RESULTS: Functional measurements showed increased cardiac output, stroke volume, ejection fraction, and ischemic myocardial flow at rest in male swine treated with CAN compared with control male swine (all p < 0.05). The female swine treated with CAN had no change in cardiac function as compared with control female swine. Proteomic analysis demonstrated 6 upregulated and 97 downregulated proteins in the CAN female group compared with the control female group. Pathway analysis showed decreases in proteins in the tricarboxylic acidic cycle. The CAN male group had 639 upregulated and 172 downregulated proteins compared with control male group. Pathway analysis showed increases in pathways related to cellular metabolism and decreases in pathways relevant to the development of cardiomyopathy and to oxidative phosphorylation. CONCLUSIONS: Male swine treated with CAN had significant improvements in cardiac function that were not observed in female swine treated with CAN. Moreover, CAN treatment in male swine was associated with significantly more changes in protein expression than in female swine treated with CAN. The increased proteomic changes seen in the CAN male group likely contributed to the more robust changes in cardiac function seen in male swine treated with CAN. [ABSTRACT FROM AUTHOR]

Anabolic androgens are used under medical supervision in treating certain diseases. Athletes up-use them to increase strength and endurance due to their lean body and muscle-building activities but this is prohibited to prevent their side effects. Nowadays females are interested in fantastic shapes affected by social media which encourages them to consume such androgens, especially oxandrolone. This research investigated possible bee venom antagonistic mechanisms to protect and cure body organs and functions against oxandrolone consumption adverse effects. Bee venom is selected due to its natural and unique components with many health-beneficial effects. Through this research oxandrolone overconsumption over time in female rats increased cardiac and ovarian tissue hypertrophy leading to their malfunction confirmed by significantly elevated (p≤0.05) cardiac serum function tests, increased plasma male sex hormone associated with decreased female sex hormones significantly (p≤0.05) in comparison with healthy group. Oxandrolone intake also increased the hematopoiesis to unpredictable levels. Oxandrolone initiated cardiac and ovarian lipolysis, oxidative and serum inflammatory status which arrested anti-oxidative and anti-inflammatory (heme oxygenase1 and nuclear factor (erythroid-derived 2)-like 2) pathways that were confirmed by their gene expression. Contrary bee venom-treated groups in (a protective, curative, and co-administered) manner improved all biochemical and genetic deteriorations caused by oxandrolone consumption significantly (p≤0.05) via antioxidant and anti-inflammatory activities with the most significant improvement recorded in the protective group. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) has been developed for echocardiography1-3, although it has not yet been tested with blinding and randomization. Here we designed a blinded, randomized non-inferiority clinical trial (ClinicalTrials.gov ID: NCT05140642; no outside funding) of AI versus sonographer initial assessment of left ventricular ejection fraction (LVEF) to evaluate the impact of AI in the interpretation workflow. The primary end point was the change in the LVEF between initial AI or sonographer assessment and final cardiologist assessment, evaluated by the proportion of studies with substantial change (more than 5% change). From 3,769 echocardiographic studies screened, 274 studies were excluded owing to poor image quality. The proportion of studies substantially changed was 16.8% in the AI group and 27.2% in the sonographer group (difference of -10.4%, 95% confidence interval: -13.2% to -7.7%, P

Introduction: Exposure to music and temperature variations can influence physiological state and impact human error. This study aims to investigate the combined and independent effects of music and temperature changes on heart rate (HR) and human error. Materials and Methods: This interventional study was conducted on 14 participants (7 men and 7 women) under controlled conditions in 2018. The subjects experienced four types of music (Rock, Rap, Pop, and Iranian traditional music) at the noise pressure level of 75 dB, along with temperatures of 20, 25, and 30 °C independently and in combination, within an acoustic room with controlled temperature conditions. HR and human error rate were measured using a HR meter and a researcher-made text with spelling mistakes, respectively. Results: Using SPSS 19, data analysis revealed that exposure to traditional Iranian and rock music in temperatures deviating by 5 °C from 25 °C was associated with increased errors in detecting spelling mistakes (p < 0.05). Interestingly, traditional and rock music did not significantly affect HR across temperatures of 20, 25, and 30 °C (p > 0.05). Conclusion: Listening to traditional Iranian and rock music in conditions with approximately 5 °C cooler or warmer than room temperature can have a positive and constructive effect on HR and reduce human error. The use of this type of music has potential implications for optimizing environmental conditions, especially in workplaces where such factors are critical.

Traditionally, echocardiography is used for volumetric measurements to aid in assessment of cardiac function. Multiple echocardiographic-based assessment techniques have been developed, such as Doppler ultrasound and deformation imaging (e.g., peak global longitudinal strain (GLS)), which have shown to be clinically relevant. Volumetric changes across the cardiac cycle can be related to deformation, resulting in the Ventricular Strain-Volume/Area Loop. These Loops allow assessment of the dynamic relationship between longitudinal strain change and volumetric change across both systole and diastole. This integrated approach to both systolic and diastolic function assessment may offer additional information in conjunction with traditional, static, measures of cardiac function or structure. The aim of this review is to summarize our current understanding of the Ventricular Strain-Volume/Area Loop, describe how acute and chronic exposure to hemodynamic stimuli alter Loop characteristics, and, finally, to outline the potential clinical value of these Loops in patients with cardiovascular disease. In summary, several studies observed Loop changes in different hemodynamic loading conditions and various (patho)physiological conditions. The diagnostic and prognostic value, and physiological interpretation remain largely unclear and have been addressed only to a limited extent. [ABSTRACT FROM AUTHOR]