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Introduction: Chronic Chagasic Cardiomyopathy (CCC) has an infectious and inflammatory nature. Recent data also suggest an association with altered regulation of glucocorticoid (GC)-mediated circuits failing to control systemic inflammation. However, the involvement of glucocorticoid receptors (GR) and their isoforms have been unexplored. Materials and methods: The expression of GR-α/β isoforms, 11β-hydroxysteroid dehydrogenase type-1 (11β-HSD1), inflammatory cytokines, and the GC-regulated gene tristetraprolin (TTP) in peripheral blood mononuclear cells (PBMCs) as well as GR immunoreactivity in the myocardium from CCC individuals were evaluated by qPCR and immunohistochemistry respectively. Heart control samples with no evidence of structural heart disease and from ischemic cardiomyopathy patients were included. The presence of inflammatory infiltrates and fibrosis were also recorded. Results: GR-α was expressed similarly in the PBMCs from Co and CCC individuals, but 11β-HSD1 expression was increased only in CCC, conjointly with enhanced ratios of IL-6/TTP and IFN-γ/TTP. In the inflamed myocardium from CCC patients, positive GR expression correlated with the intensity of the inflammatory infiltrate and cardiac hypertrophy. Conclusion: The infectious and inflammatory nature of CCC pathology seems strongly connected with the expression of GR in cardiac tissue samples, providing a stimulating background for further studies addressed to elucidate the influence of GR expression and function on CCC pathophysiology and cardiomyocyte hypertrophy. [ABSTRACT FROM AUTHOR] more...

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and fatal disease of the lungs. It is characterized by pulmonary and extrapulmonary comorbidities. So far, little is known as regards the prevalence of cardiovascular comorbidities in IPF patients. This study aims to investigate the prevalence of cardiovascular comorbidities in patients with IPF and correlate it with different radiological and laboratory indices of disease severity. Methods: This prospective case–control study was performed on 134 IPF patients above 18 years. Diagnosis of IPF was based on diagnostic radiologic criteria addressed by ATS guidelines. Patients were recruited from the Pulmonology Department, Assiut University Hospitals, from June 2023 to June 2024. Cardiac comorbidities were assessed by ECG and echocardiography. All patients had C-reactive protein (CRP), Krebs von den Lungen-6 (KL-6), and lipid profile including cholesterol level, triglyceride level, HDL-cholesterol level, and LDL-cholesterol level measured. Patients were divided into two groups: IPF patients with cardiovascular comorbidities and IPF patients without cardiovascular comorbidities. Comparison between both groups as regards clinical, radiological, and laboratory criteria was carried out. Results: The studied group consists predominantly of females (65%). Sixty out of the 134 documented IPF patients had cardiovascular comorbidities (44.7%), cardiomyopathy (mean ± SD: 43.63 ± 10.56), pulmonary hypertension (mean ± SD: 41.67 ± 15.32), ECG-ischemic changes (40.0%), and atrial fibrillation (13.3%). IPF patients with cardiovascular comorbidities vs. patients without had higher radiological HRCT total fibrosis score TFS (P value < 0.001). As regards laboratory serum biomarkers, the group with comorbidities showed significantly higher CRP, KL-6, cholesterol level, triglyceride level, and LDL-cholesterol level (P value < 0.001). Box plot analysis demonstrated significantly higher KL-6 serum level among IPF patients with cardiovascular comorbidities. Sensitivity 90.0%, specificity 94.6%, and accuracy 92.5% were associated with a cutoff value of KL-6 ≥ 299 for prediction of associated cardiovascular comorbidities among the studied IPF group. Conclusions: Dyslipidemia and cardiovascular comorbidities were detected in a large group of IPF patients. These comorbidities were associated with a high HRCT TFS score. High serum levels of CRP and KL-6 were predictors of associated cardiovascular comorbidities in IPF. Trial registration: ClinicalTrials.gov. NCT06539962. [ABSTRACT FROM AUTHOR] more...

Background: This study investigated the impact of preoperative right ventricular (RV) dysfunction and dilatation on survival outcomes following left ventricular surgical restoration (LVSR) in patients with ischemic cardiomyopathy. A retrospective analysis was conducted on 137 patients who underwent LVSR between 2009 and 2021. Results: The results indicated that hospital mortality was significantly associated with older age [OR, 1.10; P = 0.01], higher EuroSCORE II [OR, 1.08, P = 0.03], recent myocardial infarction [OR, 4.24, P = 0.02], lower creatinine clearance [OR, 0.97, P = 0.02], and left ventricle longitudinal [OR, 0.95, P < 0.01] and transverse diameter [OR, 0.95; P < 0.01]. Although RV dysfunction alone did not significantly impact survival (log-rank P = 0.48), a trend toward lower survival rates was observed in patients with concurrent RV dilatation and dysfunction (log-rank P = 0.08). Long-term follow-up revealed no significant reduction in RV diameter after surgery. Multivariable analysis revealed that EuroSCORE II [HR, 1.05; P < 0.01], atrial fibrillation [HR, 3.34; P < 0.01], left ventricular longitudinal diameter [HR, 0.97; P < 0.01], and right ventricular basal diameter [HR, 1.06, P < 0.01] were independent predictors of long-term mortality. Conclusions: This study underscores the importance of comprehensive preoperative evaluation of RV dimensions and function in predicting outcomes after LVSR, emphasizing the need for tailored management strategies for patients with RV abnormalities. [ABSTRACT FROM AUTHOR] more...

A 44-year-old gentleman presented with severe ischemic cardiomyopathy and mitral regurgitation post-inferior myocardial infarction. Echocardiography and magnetic resonance imaging revealed a dilated left ventricle with a large left ventricular aneurysm (9.3 × 9.5 cm) and associated thrombus. Severe mitral regurgitation due to leaflet tethering and a left ventricular ejection fraction (LVEF) of 25% were also seen. The patient underwent successful aneurysmectomy with patch repair and papillary muscle approximation. Following initial weaning from cardiopulmonary bypass, 6 days of postoperative temporary veno-arterial extracorporeal membrane oxygenation support were required. The patient was subsequently discharged on postoperative day sixteen with improved cardiac function (LVEF of 45%) and trace residual mitral regurgitation, highlighting the efficacy of geometric restoration in addressing such mitral regurgitation, avoiding conventional intervention on the mitral valve itself. [ABSTRACT FROM AUTHOR] more...

BACKGROUND: The size and location of an infarct lesion and its clear differentiation from normal tissue are important for clinical diagnosis and precision medicine. This paper is based on the study of radiomic attributes for differentiation of infarct and non-infarct tissue using non-contrast-enhanced cine-mode cardiac magnetic resonance imaging (MRI) data. AIM: The aim of the study was to evaluate the potential use and informative value of radiomics analysis to identify post-infarction lesions in the left ventricular myocardium in patients with ischemic cardiomyopathy (ICM) using non-contrast-enhanced cine-mode cardiac MRI. MATERIALS AND METHODS: Results of contrast-enhanced cardiac MRI were evaluated in 33 patients following surgical treatment for ICM. Texture analysis was performed on 66 lesions in cine-mode cardiac MRI images, and 105 texture attributes were determined for each lesion. Cardiac MRI was performed according to a standard technique using a Vantage Titan 1.5 T MRI scanner (Toshiba). For texture analysis, 3D Slicer version 5.2.2 (Pyradiomics) was used. RESULTS: During the study, attribute collinearity diagrams were plotted, zero-significance attributes were identified, and attribute significance was determined using a gradient boosting algorithm, and the cumulative significance of attributes was estimated as a function of their total number. By identifying low-significance attributes, the least significant parameters that did not affect the overall significance level were determined. When single-valued attributes were extracted, no corresponding attributes were found. Based on the analysis results, an ROC curve was constructed for Lasso logistic regression (Se=57.14%, Sp=71.43%, AUC=0.76). The main result of this study was to determine radiomic attributes that characterized lesions corresponding to post-infarction cardiosclerosis and intact left ventricular wall based on cine-mode cardiac MRI images. CONCLUSIONS: This study demonstrated that radiomics analysis of non-contrast-enhanced cine-mode cardiac MRI images is a promising approach to identify lesions corresponding to myocardial infarction and intact wall. This method may potentially be used to identify lesions of post-infarction cardiosclerosis in patients with ICM without contrast enhancement. more...

Objectives: To identify possible etiology-specific differences in preoperative risk factors for major adverse events during Impella 5.5 support in patients with ischemic (ICM) and nonischemic cardiomyopathy (NICM). Methods: From October 2019 to January 2023, 228 Impella 5.5 devices were inserted at our institution. Patients were stratified into ICM (n = 124) and NICM (n = 104) cohorts. The primary outcome was a composite of death/stroke/new-onset dialysis while actively receiving Impella 5.5 support. Random forests identified preoperative factors predictive of the primary outcome separately for each cohort, with ranking by variable importance. Results: The primary outcome occurred in 42 (34%) patients with ICM and 35 (34%) patients with NICM. Twenty-one (17%) patients with ICM and 21 (20%) patients with NICM died on Impella 5.5; stroke occurred in 12 (9.7%) patients with ICM and 3 (2.9%) patients with NICM, and new-onset dialysis was initiated in 23 (19%) patients with ICM and 24 (23%) patients with NICM while actively receiving Impella 5.5 support. Risk factors reflecting systemic and myocardial cellular injury, end-organ and cardiopulmonary failure, right ventricular dysfunction, and smaller left ventricular dimensions were most predictive of adverse outcomes in both cohorts. Indications for Impella 5.5 and device strategy (bridge to recovery, advanced therapies, or decision) were not top risk factors in either cohort. Conclusions: Risk factors related to preoperative stability, right ventricular dysfunction, and left ventricular size were more predictive of adverse outcomes while actively receiving Impella 5.5 support than indication or device strategy. These factors could help identify high-risk patients who may benefit from additional tailored management to reduce their risk for these impactful adverse outcomes while on Impella 5.5 support. more...

• Meta-analysis covers 2004–2024 data on MSC use in ischemic cardiomyopathy. • Studies assessed the safety and efficacy of MSCs from 3 different tissue origin. • Forty-nine trials with 1408 participants were followed up for 1–10 years. • Eighty deaths (52% of cases) reported post-MSC treatment. • LVEF increase was reported 5.75% (95% CI: 3.38%–8.11%, p < 0.0001) from baseline. This meta-analysis and systematic review compiles comparative data from 2004 to 2024, investigating the safety and efficacy of mesenchymal stem/stromal cells (MSCs) derived from various tissues for the treatment of ischemic cardiomyopathy (ICM) and associated heart failure. In addition, this review highlights the limitations of these interventions and provides valuable insights for future therapeutic approaches. Relevant articles were retrieved from the PubMed® database using targeted keywords. Our inclusion criteria included clinical trials with patients over 18 years of age, case reports and pilot studies. Animal experiments, in vitro studies, correlational and longitudinal studies, and study designs and protocols were excluded. Forty-nine original articles resulted in follow-up reports of 45 trials. MSCs from bone marrow, umbilical cord and adipose tissue were moderately well tolerated. Of the 1408 participants who received MSCs, 33 trials (67.3%) reported the occurrence of death or serious adverse events. These events resulted in 80 deaths (52% of reported cases) following MSC administration. Importantly, 41.3% of these deaths (n = 33) were not considered to be related to the intervention itself, while 40% of these deaths had no reported cause. As the primary outcome, the mean increase in left ventricular ejection fraction (LVEF) from baseline was 5.75% (95% CI: 3.38% –8.11%, p < 0.0001, I2 = 90,9%) in the randomized controlled trials only (n = 24) within the treatment groups and 3.19% (95% CI: 1.63% to 4.75%, p < 0.0001, I2 = 74,17%) in the control groups after the intervention. When the above results were compared using the standardized mean difference (SDM), a significance in favor of the treatment group was also found (SDM = 0.41; 95% CI: 0.19–0.64, p < 0.001, I2 = 71%). Although improvements were also seen in the control groups, 33.3% (n = 15) of the studies showed no significant difference between the control and treatment groups. The 6-minute walking test (6MWT) and New York Heart Association (NYHA) class scores, used for assessing exercise tolerance and quality of life (QoL), respectively, further supported the improvements in the treatment group. These improvements were noted as 62.5% (n = 10) for the 6MWT and 54.5% (n = 12) for the NYHA class scores. According to the risk of bias analysis, 4 trials were of good quality (11.8%), 15 were of fair quality (44.1%), and 15 were of poor quality (44.1%). Major limitations of these studies included small sample size, diagnostic challenges/lack, uncertain cell dosage and potential bias in patient selection. Despite the ongoing debate surrounding cell administration for ICM, there are supporting signs of improved clinical and laboratory outcomes, as well as improved QoL in the MSC-treated groups. However, it is important to recognize the limitations of each study, highlighting the need for larger, controlled trials to validate these findings. [ABSTRACT FROM AUTHOR] more...

Diastolic vortex ring (VR) plays a key role in the blood-pumping function exerted by the left ventricle (LV), with altered VR structures being associated with LV dysfunction. Herein, we sought to characterize the VR diastolic alterations in ischemic cardiomyopathy (ICM) patients with systo-diastolic LV dysfunction, as compared to healthy controls, in order to provide a more comprehensive understanding of LV diastolic function. 4D Flow MRI data were acquired in ICM patients (n = 15) and healthy controls (n = 15). The λ2 method was used to extract VRs during early and late diastolic filling. Geometrical VR features, e.g., circularity index (CI), orientation (α), and inclination with respect to the LV outflow tract (ß), were extracted. Kinetic energy (KE), rate of viscous energy loss ( EL ˙ ), vorticity (W), and volume (V) were computed for each VR; the ratios with the respective quantities computed for the entire LV were derived. At peak E-wave, the VR was less circular (p = 0.032), formed a smaller α with the LV long-axis (p = 0.003) and a greater ß (p = 0.002) in ICM patients as compared to controls. At peak A-wave, CI was significantly increased (p = 0.034), while α was significantly smaller (p = 0.016) and β was significantly increased (p = 0.036) in ICM as compared to controls. At both peak E-wave and peak A-wave, EL ˙ VR / EL ˙ LV , WVR/WLV, and VVR/VLV significantly decreased in ICM patients vs. healthy controls. KEVR/VVR showed a significant decrease in ICM patients with respect to controls at peak E-wave, while VVR remained comparable between normal and pathologic conditions. In the analyzed ICM patients, the diastolic VRs showed alterations in terms of geometry and energetics. These derangements might be attributed to both structural and functional alterations affecting the infarcted wall region and the remote myocardium. [ABSTRACT FROM AUTHOR] more...

• The study investigates the impact of different heart failure (HF) etiologies in HFmrEF. • Ischemic cardiomyopathy (ICM) was the leading HF etiology in HFmrEF in 68.7 %. • ICM was associated with improved prognosis compared to non-ischemic HF etiologies. The study investigates the characteristics and prognostic impact of different heart failure (HF) etiologies in patients with heart failure with mildly reduced ejection fraction (HFmrEF). Data regarding the characterization of patients with HFmrEF and their outcomes is scarce. Consecutive patients with HFmrEF (i.e., left ventricular ejection fraction 41–49 % and signs and/or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. Patients with ischemic cardiomyopathy (ICM) were compared to patients without ischemic cardiomyopathy (non-ICM). The primary endpoint was all-cause mortality at 30 months (median follow-up). Statistical analyses included Kaplan-Meier, multivariable Cox proportional regression analyses and propensity score matching. From a total of 1,832 patients hospitalized with HFmrEF, ICM was the most common HF etiology in 68.7 %, followed by hypertensive (9.7 %) and primary non-ischemic cardiomyopathies (NICM) (8.1 %). Within the entire study cohort, the presence of ICM was not associated with the risk of all-cause mortality (HR = 0.864; 95 % CI 0.723 – 1.031), however after multivariable adjustment (HR = 0.792; 95 % CI 0.646 – 0.972; p = 0.026) and propensity score matching (25.7% vs. 31.4 %; log rank p = 0.050), the presence of ICM was associated with lower risk of all-cause mortality at 30 months compared to patients without ICM. ICM is the most common etiology of HF in HFmrEF and may be associated with favorable outcomes. This may be related to better adherence to pharmacological treatment and improved revascularization strategies for HFmrEF patients with ICM. [ABSTRACT FROM AUTHOR] more...

Recurrent ventricular tachycardia (VT) can be treated by substrate modification of the myocardial scar by catheter ablation during sinus rhythm without VT induction. Better defining this arrhythmic substrate could help improve outcome and reduce ablation burden. The study aimed to limit ablation within postinfarction scar to conduction channels within the scar to reduce VT recurrence. Patients undergoing catheter ablation for recurrent implantable cardioverter-defibrillator therapy for postinfarction VT were recruited at 5 centers. Left ventricular maps were collected on CARTO using a Pentaray catheter. Ripple mapping was used to categorize infarct scar potentials (SPs) by timing. Earliest SPs were ablated sequentially until there was loss of the terminal SPs without their direct ablation. The primary outcome measure was sustained VT episodes as documented by device interrogations at 1 year, which was compared with VT episodes in the year before ablation. The study recruited 50 patients (mean left ventricular ejection fraction, 33% ± 9%), and 37 patients (74%) met the channel ablation end point with successful loss of latest SPs without direct ablation. There were 16 recurrences during 1-year follow-up. There was a 90% reduction in VT burden from 30.2 ± 53.9 to 3.1 ± 7.5 (P <.01) per patient, with a concomitant 88% reduction in appropriate shocks from 2.1 ± 2.7 to 0.2 ± 0.9 (P <.01). There were 8 deaths during follow-up. Those who met the channel ablation end point had no significant difference in mortality, recurrence, or VT burden but had a significantly lower ablation burden of 25.7 ± 4.2 minutes vs 39.9 ± 6.1 minutes (P =.001). Scar channel ablation is feasible by ripple mapping and can be an alternative to more extensive substrate modification techniques. [Display omitted] [ABSTRACT FROM AUTHOR] more...

Personalized management involving heart failure (HF) etiology is crucial for better prognoses. We aim to evaluate the utility of a radiomics nomogram based on gated myocardial perfusion imaging (GMPI) in distinguishing ischemic from non-ischemic origins of HF. A total of 172 heart failure patients with reduced left ventricular ejection fraction (HFrEF) who underwent GMPI scan were divided into training (n = 122) and validation sets (n = 50) based on chronological order of scans. Radiomics features were extracted from the resting GMPI. Four machine learning algorithms were used to construct radiomics models, and the model with the best performances were selected to calculate the Radscore. A radiomics nomogram was constructed based on the Radscore and independent clinical factors. Finally, the model performance was validated using operating characteristic curves, calibration curve, decision curve analysis, integrated discrimination improvement values (IDI), and the net reclassification index (NRI). Three optimal radiomics features were used to build a radiomics model. Total perfusion deficit (TPD) was identified as the independent factors of conventional GMPI metrics for building the GMPI model. In the validation set, the radiomics nomogram integrating the Radscore, age, systolic blood pressure, and TPD significantly outperformed the GMPI model in distinguishing ischemic cardiomyopathy (ICM) from non-ischemic cardiomyopathy (NICM) (AUC 0.853 vs. 0.707, p = 0.038). IDI analysis indicated that the nomogram improved diagnostic accuracy by 28.3% compared to the GMPI model in the validation set. By combining radiomics signatures with clinical indicators, we developed a GMPI-based radiomics nomogram that helps to identify the ischemic etiology of HFrEF. [ABSTRACT FROM AUTHOR] more...

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] more...

• Patients with IHD at baseline had a greater burden of comorbidities and higher incidence of hypertension, coronary artery disease, atrial fibrillation, and chronic kidney disease. • Patients with COVID-19 and IHD exhibit increased rates of AMI, cardiogenic shock, and ventricular arrhythmias. • Despite the higher rates of cardiac complications, in-hospital mortality did not differ between patients with and without ischemic heart disease. Prior research has linked cardiovascular diseases with higher COVID-19 mortality and worse hospital outcomes, particularly in severe heart failure. Large population-based data regarding the impact of pre-existing ischemic heart disease (IHD) on COVID-19 outcomes is not well established. To study the impact of COVID-19 infection on IHD hospital mortality and other outcomes. The study included a patient cohort from the 2020 and 2021 National Inpatient Sample (NIS) database. Propensity score matching was used to match the study cohort (COVID-19 with IHD) to controls (COVID-19 without IHD) using a 1:1 matching ratio. The outcomes analyzed were in-hospital mortality, rates of acute kidney injury (AKI), acute myocardial injury (AMI), cardiogenic shock, cardiac arrest, mechanical ventilation, tracheal intubation, pulmonary embolism (PE), ventricular tachycardia (VT), ventricular fibrillation (VF), length of stay (LOS), and total hospitalization charges. A total of 2,532,652 patients met the inclusion criteria (1,199,008 females [47.3 %), predominantly Caucasian 1,456,203 (57.5 %); mean [SD] age 63, (5.4), including 29,315 (1.1 %) patients with a history of IHD. Following propensity matching, 4,772 COVID-19 patients with and without IHD were matched. IHD patients had higher rates of AMI (adjusted odds ratio (aOR) 3.75, 95 % CI 3.27–4.31, p < 0.001), cardiogenic shock (aOR 2.89, 95 % CI 1.60–5.19, p < 0.001), VT (aOR 3.26, 95 % CI 2.48–4.29, p < 0.001), and VF (aOR 2.23, 95 % CI 1.25–3.99, p < 0.001). The odds ratios of in-hospital mortality, AKI, PE, mechanical ventilation, tracheal intubation, and resource use were not significantly different. A history of IHD does not impact COVID-19 mortality but increases the risk of in-hospital cardiac complications. [ABSTRACT FROM AUTHOR] more...

Introduction: Chronic kidney disease (CKD) is an important cardiovascular risk factor. However, the relationship between CKD and myocardial strain as a parameter of myocardial function is still incompletely understood, particularly in patients with ischemic cardiomyopathy (ICM). Cardiac magnetic resonance imaging (CMR) feature tracking allows to analyze myocardial strain with high reproducibility. Therefore, the aim of the present study was to assess the relationship between CKD and myocardial strain as described by CMR in patients with ICM. Methods: We retrospectively performed CMR-based myocardial strain analysis in 89 patients with ICM and different stages of CKD, classified according to the KDIGO stages. In all patients, global longitudinal strain (GLS), global circumferential strain (GCS) and global radial strain (GRS) analysis of left ventricular myocardium were performed. Furthermore, segmental longitudinal (SLS), circumferential (SCS) and radial strain (SRS) according to the AHA 16/17-segment model was determined. Results: Creatinine levels (GLS: r = 0.46, p < 0.001; GCS: r = 0.34, p = 0.001; GRS: r = − 0.4, p < 0.001), urea levels (GLS: r = 0.34, p = 0.001; GCS: r = 0.30, p = 0.005; GRS: r = − 0.31, p = 0.003) as well as estimated glomerular filtration rate (GLS: r = -0.40, p < 0.001; GCS: r = − 0.27, p = 0.012; GRS r = 0.34, p < 0.001) were significantly associated with global strains as determined by CMR. To further investigate the relationship between CKD and myocardial dysfunction, segmental strain analysis was performed: SLS was progressively impaired with increasing severity of CKD (KDIGO-1: − 11.93 ± 0.34; KDIGO-5: − 7.99 ± 0.38; p < 0.001 for KDIGO-5 vs. KDIGO-1; similar data for SCS and SRS). Interestingly, myocardial strain was impaired with CKD in both segments with and without scarring. Furthermore, in a multivariable analysis, eGFR was independently associated with GLS following adjustment for LV-EF, scar burden, diabetes, hypertension, age, gender, LV mass or LV mass index. Conclusion: CKD is related to impaired LV strain as assessed by CMR in patients with ICM. In our cohort, this relationship is independent of LV-EF, the extent of myocardial scarring, diabetes, hypertension, age, gender, LV mass or LV mass index. [ABSTRACT FROM AUTHOR] more...

The clinical manifestations of ischemic cardiomyopathy (ICM) bear resemblance to dilated cardiomyopathy (DCM), yet their treatments and prognoses are quite different. Early differentiation between these conditions yields positive outcomes, but the gold standard (coronary angiography) is invasive. The potential use of ECG signals based on variational mode decomposition (VMD) as an alternative remains underexplored. An ECG dataset containing 87 subjects (44 DCM, 43 ICM) is pre-processed for denoising and heartbeat division. Firstly, the ECG signal is processed by empirical mode decomposition (EMD) and VMD. And then, five modes are determined by correlation analysis. Secondly, bispectral analysis is conducted on these modes, extracting corresponding bispectral and nonlinear features. Finally, the features are processed using five machine learning classification models, and a comparative assessment of their classification efficacy is facilitated. The results show that the technique proposed provides a better categorization for DCM and ICM using ECG signals compared to previous approaches, with a highest classification accuracy of 98.30%. Moreover, VMD consistently outperforms EMD under diverse conditions such as different modes, leads, and classifiers. The superiority of VMD on ECG analysis is verified. [ABSTRACT FROM AUTHOR] more...

Biomechanics-based patient-specific modeling is a promising approach that has proved invaluable for its clinical potential to assess the adversities caused by ischemic heart disease (IHD). In the present study, we propose a framework to find the passive material properties of the myocardium and the unloaded shape of cardiac ventricles simultaneously in patients diagnosed with ischemic cardiomyopathy (ICM). This was achieved by minimizing the difference between the simulated and the target end-diastolic pressure–volume relationships (EDPVRs) using black-box Bayesian optimization, based on the finite element analysis (FEA). End-diastolic (ED) biventricular geometry and the location of the ischemia were determined from cardiac magnetic resonance (CMR) imaging. We employed our pipeline to model the cardiac ventricles of three patients aged between 57 and 66 years, with and without the inclusion of valves. An excellent agreement between the simulated and the target EDPVRs has been reached. Our results revealed that the incorporation of valvular springs typically leads to lower hyperelastic parameters for both healthy and ischemic myocardium, as well as a higher fiber Green strain in the viable regions compared to models without valvular stiffness. Furthermore, the addition of valve-related effects did not result in significant changes in myofiber stress after optimization. We concluded that more accurate results could be obtained when cardiac valves were considered in modeling ventricles. The present novel and practical methodology paves the way for developing digital twins of ischemic cardiac ventricles, providing a non-invasive assessment for designing optimal personalized therapies in precision medicine. [ABSTRACT FROM AUTHOR] more...

We explored N6-methyladenosine (m6A) RNA methylation as one of the gene regulatory mechanisms in heart failure (HF) biology. Understanding the different physiological mechanisms will facilitate the prevention and individualized treatment of HF. The Gene Expression Omnibus (GEO) database served as the source of the data. In GSE116250, differential analysis between ischemic cardiomyopathy (ICM), dilated cardiomyopathy (DCM) and controls yielded differentially expressed m6A regulators. Differential analysis between HF and controls in GSE131296 identifies m6A-modified genes and then performs enrichment analysis. Protein–protein interaction (PPI) network analysis was performed for the differentially expressed ICM- or DCM-associated genes in GSE116250 and GSE55296, respectively. Finally, the diagnostic genes for ICM and DCM were predicted using receiver operating characteristic (ROC) curve. YTHDC1, HNRNPC and HNRNPA2B1 were significantly downregulated in GSE116250 in DCM and ICM compared with controls. A total of 195 genes were identified in GSE131296 as subject to m6A alteration. These genes may play a role in HF through the MAPK signaling pathway and p53 signaling pathway. PPI network analysis identified CCL5, CXCR4 and CCL2 as key genes for ICM and IL-6 as a key gene for DCM. Through ROC curves, we identified m6A-modified APLP1, KLF2 as potential diagnostic genes for ICM, and m6A-modified FGF7, FREM1 and C14orf132 as potential diagnostic genes for DCM. Our findings support m6A modifying mechanisms in HF etiology that contribute to the treatment of HF. Thus, our data suggest that m6A methylation may be an interesting target for therapeutic intervention. [ABSTRACT FROM AUTHOR] more...

IntroductionAcute myocardial infarction (AMI) is a critical condition that can lead to ischemic cardiomyopathy (ICM), a subsequent heart failure state characterized by compromised cardiac function.MethodsThis study investigates the role of mitophagy in the transition from AMI to ICM. We analyzed AMI and ICM datasets from GEO, identifying mitophagy-related differentially expressed genes (MRDEGs) through databases like GeneCards and Molecular Signatures Database, followed by functional enrichment and Protein-Protein Interaction analyses. Logistic regression, Support Vector Machine, and LASSO (Least Absolute Shrinkage and Selection Operator) were employed to pinpoint key MRDEGs and develop diagnostic models, with risk stratification performed using LASSO scores. Subgroup analyses included functional enrichment and immune infiltration analysis, along with protein domain predictions and the integration of regulatory networks involving Transcription Factors, miRNAs, and RNA-Binding Proteins, leading to drug target identification. ResultsThe TGFβ pathway showed significant differences between high- and low-risk groups in AMI and ICM. Notably, in the AMI low-risk group, MRDEGs correlated positively with activated CD4+ T cells and negatively with Type 17 T helper cells, while in the AMI high-risk group, RPS11 showed a positive correlation with natural killer cells. In ICM, MRPS5 demonstrated a negative correlation with activated CD4+ T cells in the low-risk group and with memory B cells, mast cells, and dendritic cells in the high-risk group. The diagnostic accuracy of RPS11 was validated with an area under the curve (AUC) of 0.794 across diverse experimental approaches including blood samples, animal models, and myocardial hypoxia/reoxygenation models.ConclusionsThis study underscores the critical role of mitophagy in the transition from AMI to ICM, highlighting RPS11 as a highly significant biomarker with promising diagnostic potential and therapeutic implications. more...

Ischemic cardiomyopathy (ICM) is a special type or end stage of coronary heart disease or other irreversible ischemic myocardial injury. Inflammatory damage to coronary vessels is a crucial factor in causing stenosis or occlusion of coronary arteries, resulting in myocardial ischemia and hypoxia, but it is also an aspect of cardioprotection that is often overlooked. This review discusses the mechanisms of vascular injury during ICM, in which inflammation and oxidative stress interact and trigger cell death as the cause of coronary microvascular injury. Imbalances in endoplasmic reticulum function and mitochondrial quality control are important potential drivers of inflammation and oxidative stress. In addition, many studies have confirmed the therapeutic effects of Chinese herbal medicines and their natural monomeric components on vascular injuries. Their mitochondrial quality control and endoplasmic reticulum protection mechanisms as well as their role in combating improvements in vascular endothelial function and attenuating vascular injury are also summarized, with a perspective to provide a reference for pathologic understanding, drug research, and clinical application of ICM-associated coronary microvascular injury. more...

Abstract Background The leading cause of death in patients with ischemic cardiomyopathy is sudden cardiac death caused by ventricular arrhythmias. Accurate determination of arrhythmic risk in these patients is vital to allow clinicians to take appropriate preventive measures. Objective To review and summarize the literature on electrocardiographic imaging (ECGi) metrics that could be used to predict arrhythmic risk in patients with ischemic cardiomyopathy. Methods A comprehensive literature search was performed to retrieve research articles on non‐invasive electrocardiographic mapping techniques. Inclusion criteria of the studies required the involvement of patients with ischemic cardiomyopathy or ischemic heart disease. Results A total of 17 papers were identified, five of which specifically utilized ECGi to acquire metrics associated with an increased risk of ventricular arrhythmia (VA). ECGi metrics, including activation time, repolarization time, activation‐recovery interval, and voltage amplitude, were distinguishable between patients with ischemic cardiomyopathy, patients with a history of VA, and healthy controls. Conclusion ECGi allows non‐invasive measurement of metrics which are associated with an increased risk of ventricular arrhythmias in patients with ischemic cardiomyopathy. ECGi may be a useful tool for risk assessment in these patients. Prospective studies are warranted for further validation and prediction of clinical endpoints. more...

Abstract Background Integration of preprocedural imaging techniques in ventricular tachycardia (VT) ablation may improve the identification of arrhythmogenic substrates, particularly relevant for patients with nonischemic cardiomyopathy (NICM) with sub‐optimal outcomes. We assessed the impact of advanced preprocedural imaging on the safety and long‐term efficacy of radiofrequency catheter ablation (RCA) for VT, comparing patients with NICM and ischemic cardiomyopathy (ICM). Methods In this prospective, single‐center study, consecutive patients referred for scar‐related VT ablation underwent multidetector computed tomography (MDCT) and late gadolinium enhancement cardiac magnetic resonance (LGE‐CMR). Images were segmented with ADAS 3D software and integrated into mapping systems. Substrate map collection targeted the imaging‐predicted area of interest and the ablation aimed at eliminating all local abnormal ventricular activities. Procedural safety was evaluated with 30‐day mortality. Long‐term efficacy was assessed by survival free from appropriate ICD shocks at 36 months. Results 102 patients were included (67 ± 11 years, 94% male; 75 ICM, 27 NICM). All patients underwent MDCT and 35% also underwent LGE‐CMR. Procedural safety (4% 30‐day mortality, p = .95) and 36‐month efficacy were similar in both groups (88.0% vs. 74.1%, HR 2.09; p = .13 in ICM and NICM). Efficacy was higher in patients when VT activation mapping with VT isthmus ablation complemented substrate ablation compared to substrate‐based ablation alone (94.5% vs. 80.6%, HR 4.00; p more...

IntroductionSubcutaneous ICD (S-ICD) is an alternative to a transvenous implantable cardioverter-defibrillator (TV-ICD) system in selected patients not in need of pacing or resynchronization. Currently, little is known about the effectiveness and safety of S-ICD in patients with ischemic cardiomyopathy (ICM). The aim of our study was to describe the clinical features and the drivers of S-ICD implantation among patients with ICM, as well as the clinical performance of S-ICD vs. TV-ICD among this subset of patients during a long-term follow-up.Materials and methodsAll ICM patients with both S-ICD and TV-ICD implanted and followed at Monaldi Hospital from January 1, 2015, to January 1, 2024, were evaluated; among them, only ICD recipients with no pacing indication were included. We collected clinical and anamnestic characteristics, as well as ICD inappropriate therapies, ICD-related complications and infections.ResultsA total of 243 ICM patients (mean age 63.0 ± 11.0, male 86.0%) implanted with TV-ICD (n: 129, 53.1%) and S-ICD (n: 114, 46.9%) followed at our center for a median follow-up of 66.9 [39.4–96.4] months were included in the study. Kaplan–Meier analysis revealed no significant difference in the risk of inappropriate ICD therapies (log-rank p = 0.137) or ICD-related complications (log-rank p = 0.055) between S-ICD and TV-ICD groups. TV-ICD patients showed a significantly higher risk of ICD-related infections compared to those in the S-ICD group (log-rank p = 0.048). At multivariate logistic regression analysis, the only independent predictors of S-ICD implantation were female sex [OR: 52.62; p more...

IntroductionChronic Chagasic Cardiomyopathy (CCC) has an infectious and inflammatory nature. Recent data also suggest an association with altered regulation of glucocorticoid (GC)-mediated circuits failing to control systemic inflammation. However, the involvement of glucocorticoid receptors (GR) and their isoforms have been unexplored.Materials and methodsThe expression of GR-α/β isoforms, 11β-hydroxysteroid dehydrogenase type-1 (11β-HSD1), inflammatory cytokines, and the GC-regulated gene tristetraprolin (TTP) in peripheral blood mononuclear cells (PBMCs) as well as GR immunoreactivity in the myocardium from CCC individuals were evaluated by qPCR and immunohistochemistry respectively. Heart control samples with no evidence of structural heart disease and from ischemic cardiomyopathy patients were included. The presence of inflammatory infiltrates and fibrosis were also recorded.ResultsGR-α was expressed similarly in the PBMCs from Co and CCC individuals, but 11β-HSD1 expression was increased only in CCC, conjointly with enhanced ratios of IL-6/TTP and IFN-γ/TTP. In the inflamed myocardium from CCC patients, positive GR expression correlated with the intensity of the inflammatory infiltrate and cardiac hypertrophy.ConclusionThe infectious and inflammatory nature of CCC pathology seems strongly connected with the expression of GR in cardiac tissue samples, providing a stimulating background for further studies addressed to elucidate the influence of GR expression and function on CCC pathophysiology and cardiomyocyte hypertrophy. more...

Abstract Background It is widely recognized that the right ventricle plays a significant role in the prognosis of numerous diseases. However, the assessment of right ventricular function (RV) has not been given much attention until recently. This study used speckle-tracking echocardiography (STE) to assess RV functions in ischemic cardiomyopathy (ICM) patients. Results This study included 74 patients diagnosed with ischemic cardiomyopathy (ICM) and an ejection fraction (EF) of less than 50%. Although all the selected patients had normal RV systolic function by tricuspid annular plane systolic excursion (TAPSE), a considerable percentage of them had subtle RV systolic dysfunction, which could be identified by right ventricular free wall longitudinal strain (RV FWLS) (36.5%) and right ventricular global longitudinal strain (RV GLS) (55.4%). Moreover, the mean RV FWLS was significantly higher than RV GLS (− 20.4 ± 5.08% vs. − 17.5 ± 6.89%), respectively. Advanced left ventricle (LV) adverse remodeling was associated with subtle RV dysfunction. Using multivariate regression analysis, increased E/e' (p = 0.016, CI 1.135–3.423) and RV myocardial performance index (MPI) (p = 0.007, CI 0.000–0.007) were identified as independent factors of impaired RV FWLS with the greatest effectiveness. Conclusion When standard RV measures are normal in patients with ICM, RV systolic strain analysis offers an incremental utility to detect subtle abnormalities in RV function, especially in resource-constrained settings where cardiac magnetic resonance (CMR) is not practical. more...

Shuai Guo,1,&ast; Zhaoting Gong,1,&ast; Xiaona Sun,2 Fei Gao,1 Xiang Li,1 Xiaolin Zu,1 Chao Qu,1 Hongliang Zhang,3 Hai Gao1 1Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Cardiology, Laizhou City People’s Hospital, Laizhou, People’s Republic of China; 3Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hai Gao, Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China, Email gaohai1221@mail.ccmu.edu.cn Hongliang Zhang, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100037, People’s Republic of China, Email 13810694497@163.comBackground: Ischemic cardiomyopathy (ICM) significantly contributes to global disease burden, while the role of ferroptosis in ICM remains underexplored.Methods: We identified differentially expressed ferroptosis-related genes (DEFRGs) by analyzing the GSE57338 dataset and cross-referencing with FerrDb. Consensus clustering was then used to identify ferroptosis-associated clusters within the ICM samples. A ferroptosis-specific predictive signature was developed using the least absolute shrinkage and selection operator (LASSO) method and validated with the GSE5406 dataset. Additionally, quantitative real-time PCR (qRT-PCR) experiments were performed to validate the 11 feature genes in a rat ICM model.Results: We identified 15 DEFRGs in GSE57338, which distinguished two patient clusters with distinct ferroptosis gene expression, pathway enrichment profiles, and metabolic characteristics. All DEFRGs were upregulated in cluster 2. Potential therapeutic targets were also identified for different ICM patient clusters. The 11-gene predictive signature (TXNRD1, STEAP3, STAT3, SCL2A1, PLIN2, NQO1, NNMT, IL33, ENPP2, ARRDC3, ALOX5) showed robust predictive power in both training and validation sets. High-risk patients exhibited increased infiltration of CD8+ T cells, CD4+ naïve T cells, M0/M1 macrophages, and resting mast cells, along with significant enrichment in epithelial mesenchymal transition and interferon responses. Low-risk patients had higher infiltration of regulatory T cells and monocytes. Results of qPCR analysis confirmed the bioinformatic analysis, validating the expression of the 11 feature genes in the rat ICM model.Conclusion: We identified two ferroptosis-related clusters in ICM patients and developed a predictive signature based on ferroptosis-related genes. Our findings highlight the importance of ferroptosis in ICM and offer new insights for its diagnosis and treatment.Keywords: ischemic cardiomyopathy, ferroptosis, bioinformatics analysis, predictive signature more...

It is relevant to study of angiogenesis mediators and the mobilization of early endothelial progenitor cells (EPС) from bone marrow into the blood in patients with coronary heart disease (CHD), suffering and not suffering from ischemic cardiomyopathy (ICMP).СHD patients: 30 people with ICMP and 22 people without ICMP, 15 healthy donors. The content of early EPС (VEGFR2+CD34+CD14+) was determined in the blood and bone marrow by flow cytofluorometry, the concentration of MSP-1, SDF-1, VEGF-A – by multiplex analysis, of HIF-1α – by ELISA.Тhe content of SDF-1 and HIF-1α in peripheral blood in patients with CHD without cardiomyopathy was higher than in healthy individuals (respectively 60.00 (50.00-80.00) pg/mL and 6.00 (5.00-6.20) ng/mL versus 30.00 (5.00-45.00) pg/mL, p = 0.049 and 4.60 (3.28-5.11) ng/mL, p = 0.049), with ICMP corresponded to the norm. Тhe concentration of SDF-1 in the bone marrow was higher, and the level of HIF-1α was less than their content in the bloodstream, regardless of the presence of ICMP (respectively 130.0 (90.0-170.0) pg/mL, p = 0.005 and 0.97 (0.80-1.11) ng/mL, p < 0.001). The level of MCP-1 in the blood varied within the normal range in patients with CHD of both study groups (190.0 (168.0-215.0) pg/mL), and in the bone marrow was higher only in patients with ICMP (406.5 (265.0-583.0) pg/mL, p = 0.028). Regardless of ICMP presence, the content of VEGF-A in the blood of patients with CHD corresponded to the norm (3.80 (1.00-6.50) pg/mL) and in myeloid tissue. The number of EPC was increased in the blood of patients with CHD without cardiomyopathy (0.70 (0.46-1.23) and 0.19 (0.13-0.32) %, p < 0.001) and corresponded to their number in the bone marrow. And in patients with ICMP, normal values of the indicator were recorded in the blood with the accumulation of EPC in myeloid tissue (0.57 (0.45-0.98) %, p = 0.019).The development of ICMP is associated with the accumulation of early EPC in myeloid tissue due to their increased retention by an excess of MCP-1 in the bone marrow with weak involvement in the bloodstream due to the lack of a surplus of SDF-1 and HIF-1a in the blood. more...

Background: It is widely recognized that the right ventricle plays a significant role in the prognosis of numerous diseases. However, the assessment of right ventricular function (RV) has not been given much attention until recently. This study used speckle-tracking echocardiography (STE) to assess RV functions in ischemic cardiomyopathy (ICM) patients. Results: This study included 74 patients diagnosed with ischemic cardiomyopathy (ICM) and an ejection fraction (EF) of less than 50%. Although all the selected patients had normal RV systolic function by tricuspid annular plane systolic excursion (TAPSE), a considerable percentage of them had subtle RV systolic dysfunction, which could be identified by right ventricular free wall longitudinal strain (RV FWLS) (36.5%) and right ventricular global longitudinal strain (RV GLS) (55.4%). Moreover, the mean RV FWLS was significantly higher than RV GLS (− 20.4 ± 5.08% vs. − 17.5 ± 6.89%), respectively. Advanced left ventricle (LV) adverse remodeling was associated with subtle RV dysfunction. Using multivariate regression analysis, increased E/e' (p = 0.016, CI 1.135–3.423) and RV myocardial performance index (MPI) (p = 0.007, CI 0.000–0.007) were identified as independent factors of impaired RV FWLS with the greatest effectiveness. Conclusion: When standard RV measures are normal in patients with ICM, RV systolic strain analysis offers an incremental utility to detect subtle abnormalities in RV function, especially in resource-constrained settings where cardiac magnetic resonance (CMR) is not practical. [ABSTRACT FROM AUTHOR] more...

Objectives: To document the real-world experience with the use of pneumatic pulsatile mechanical circulatory support (MCS) with the PulseCath iVAC2L during high-risk percutaneous coronary interventions (HR-PCIs). Background: The use of MCS in HR-PCIs may reduce the rate of major adverse cardiovascular events (MACEs) at 90 days. The PulseCath iVAC2L is a short-term pulsatile transaortic left ventricular (LV) assist device that has been in use since 2014. The iVAC2L Registry tracks its safety and efficacy in a variety of hospitals worldwide. Methods: The iVAC2L Registry is a multicenter, observational registry that aggregates clinical data from patients treated with the iVAC2L worldwide. A total of 293 consecutive cases were retrospectively collected and analyzed. Estimated rates of in-hospital clinical endpoints were described. All-cause mortality was used as the primary endpoint and other outcomes of interest were used as secondary endpoints. The rates obtained were reported and contextualized. Results: The in-hospital rate of all-cause mortality was 1.0%, MACE was 3.1%. Severe hypotension occurred in 8.9% of patients. Major bleeding and major vascular complications occurred in 1.0% and 2.1%, respectively. Acute myocardial infarction occurred in 0.7% of patients. Cerebrovascular events occurred in 1.4% of patients. Cardiac arrest occurred in 1.7% of patients. A statistically significant improvement in blood pressure was observed with iVAC2L activation. Conclusions: The results of the present study suggest that the iVAC2L is capable of improving hemodynamics with a low rate of adverse events. However, confirmatory studies are needed to validate these findings. [ABSTRACT FROM AUTHOR] more...

Background This study was conducted to evaluate whether myocardial viability assessed with cardiac magnetic resonance (CMR) affected long-term clinical outcomes after coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy (ICMP). Methods Preoperative CMR with late gadolinium enhancement (LGE) was performed in 103 patients (64.9 ± 10.1 years, male:female = 82:21) with 3-vessel disease and left ventricular dysfunction (ejection fraction ≤ 0.35). Transmural extent of LGE was evaluated on a 16-segment model, and transmurality was graded on a 5-point scale: grades—0, absence; 1, 1 to 25%; 2, 26 to 50%; 3, 51 to 75%; 4, 76 to 100%. Median follow-up duration was 65.5 months (interquartile range = 27.5–95.3 months). Primary endpoint was the composite of all-cause mortality or hospitalization for congestive heart failure. Results Operative mortality was 1.9%. During the follow-up, all-cause mortality and readmission for congestive heart failure occurred in 29 and 8 patients, respectively. The cumulative incidence of the primary endpoint was 31.3 and 46.8% at 5 and 10 years, respectively. Multivariable analysis demonstrated that the number of segments with LGE grade 4 was a significant risk factor (hazard ratio 1.42, 95% confidence interval 1.10–1.83, p = 0.007) for the primary endpoint among the variables assessed by CMR. Other risk factors included age, dialysis, chronic obstructive pulmonary disease, and EuroSCORE II. Conclusion The number of myocardial segments with transmurality of LGE >75% might be a prognostic factor associated with the composite of all-cause mortality or hospitalization for congestive heart failure after CABG in patients with 3-vessel disease and ICMP. [ABSTRACT FROM AUTHOR] more...

Little is known regarding which patients with ischemic cardiomyopathy (ICM) should be considered for prophylactic therapies, such as an implantable cardioverter-defibrillator (ICD), in the primary percutaneous intervention era. The aim of this study was to investigate the influence of non-sustained ventricular tachycardia (NSVT) on major adverse cardiac events (MACE) in heart failure with reduced ejection fraction (HFrEF) patients. We retrospectively analyzed patients of ICM and non-ICM who underwent ICD implantation at our institute from October 2006 to August 2020. MACE were defined as composite outcome of cardiovascular death, heart failure hospitalization, and appropriate ICD therapies. A total of 167 patients were enrolled [male, 138 (83 %); age, 62.1 ± 11.7 years; left ventricular ejection fraction, 23.5 ± 6.1 %; left ventricular diastolic diameter, 67.4 ± 9.0 mm; atrial fibrillation, 47 (28 %); NSVT, 124 (74 %); use of class III antiarrhythmic drugs, 55 (33 %); ischemic cardiomyopathy, 56 (34 %); cardiac resynchronization therapy, 73 (44 %)]. The median follow-up duration was 61 months. MACE occurred with 71 patients (43 %). When comparing baseline characteristics of the patients, left ventricular ejection fraction (p = 0.02) and atrial fibrillation (p = 0.04) were significantly associated with MACE. The multivariable Cox analysis for the target variable MACE identified atrial fibrillation (hazard ratio 2.00; 95 % confidence index 1.18–3.37; p = 0.01) as an independent predictor for MACE. Prior NSVT before ICD implantation was not an independent predictor of future MACE in patients with HFrEF with primary prophylactic ICD. In contrast, atrial fibrillation was associated with worse prognosis. To predict the prognosis of patients with primary prophylactic ICD, these factors should be assessed as comprehensive risk stratification factors for MACE. [Display omitted] • Long-term prophylactic implantable cardioverter defibrillator outcomes are poor. • Non-sustained ventricular tachycardia does not influence long-term outcomes. • Atrial fibrillation is associated with worse outcomes. [ABSTRACT FROM AUTHOR] more...

Background: Ischemic cardiomyopathy (ICM) is a common condition that leads to left ventricular (LV) functional remodeling and poor prognosis. Extracorporeal membrane oxygenation (ECMO) can provide temporary circulatory support and facilitate percutaneous coronary intervention (PCI) in patients with ICM and hemodynamic instability. However, the impact of ECMO-assisted PCI on LV functional remodeling and clinical outcomes in ICM patients is unclear. Methods: We retrospectively analyzed 76 patients with ICM who underwent ECMO-assisted PCI at our institution between January 2013 and December 2022. We assessed the changes in LV functional remodeling using echocardiography at baseline and 12 months after the procedure. We also evaluated the incidence of major adverse cardiac and cerebrovascular events (MACCEs) and ECMO-related complications during hospitalization and at one-year follow-up. Results: The mean baseline left ventricular ejection fraction (LVEF) was 29.98 ± 2.65%. The rate of complete revascularization was 58%. The median duration of ECMO support was 38.99 hours. The most common ECMO-related complications were bleeding (8%) and lower extremity ischemia (5%). The one-year mortality rate was 30%. The overall freedom from MACCEs at 12 months was 59% (95% confidence interval (CI): 49–71%). LVEF increased significantly after the procedure from baseline to 6 months, yet decreased slightly at 12 months, although it was still higher than the baseline value. Wall motion score index (WMSI), end-diastolic volume index (EDVI), and end-systolic volume index (ESVI) decreased significantly from baseline to 12 months, indicating an improvement in LV function and a reduction in LV size. Conclusions: In a high-volume tertiary center with extensive experience in advanced heart failure therapies and a dedicated ECMO team, ECMO-assisted PCI demonstrated feasibility and safety in patients with ischemic cardiomyopathy. However, the rate of complete revascularization was modest at 58%. Despite the high-risk profile of the patients, ECMO-assisted PCI was associated with a significant improvement in LV functional remodeling and a favorable 12-month survival rate. Further prospective studies are needed to confirm these findings and to identify the optimal patient and device selection criteria for ECMO-assisted PCI. [ABSTRACT FROM AUTHOR] more...

Revascularization in patients with left ventricular (LV) dysfunction has been a subject of ongoing uncertainty and conflicting results. This is further complicated by factors including viability, severity of LV dysfunction, and method of revascularization using percutaneous coronary intervention (PCI) versus coronary-artery bypass grafting (CABG). The purpose of this meta-analysis is to evaluate the association of coronary revascularization with outcomes in patients with ischemic LV dysfunction. A literature search was conducted for studies reporting on cardiovascular outcomes after revascularization compared to optimal medical therapy (OMT) in patients with ischemic LV dysfunction. A total of 23 studies with 10,110 participants met inclusion criteria. Revascularization was significantly associated with lower all-cause mortality and CV mortality compared to OMT. The association was statistically significant regardless of severity of LV dysfunction or method of revascularization. Subgroup analysis demonstrated that revascularization was significantly associated with lower all-cause and CV mortality compared to OMT for patients with viable myocardium and mixed cohorts with variable viability, but not patients without viable myocardium. Revascularization was not associated with a significant difference in risk of heart failure (HF) hospitalization or acute myocardial infarction (AMI) compared to OMT. Revascularization in patients with ischemic LV dysfunction is associated with lower risk of all-cause and CV mortality independent of severity of LV dysfunction or method of revascularization. Revascularization is not associated with lower risk of mortality in patients without evidence of viable myocardium and is not associated with lower risk of AMI or HF hospitalization. • Revascularization in patients with ischemic LV dysfunction is associated with lower risk of all-cause and CV mortality independent of severity of LV dysfunction or method of revascularization. • Revascularization is not associated with lower risk of mortality in patients without evidence of viable myocardium and is not associated with lower risk of AMI or HF hospitalization. [ABSTRACT FROM AUTHOR] more...

Aim. To evaluate the heart morphological features and the significance of the non-ischemic myocardial contrast pattern in medium-term prognosis of continued left ventricular (LV) remodeling after surgery in patients with ischemic cardiomyopathy.Material and methods. The results of paramagnetic contrast-enhanced cardiac magnetic resonance imaging (MRI) were analyzed in 31 patients with ischemic cardiomyopathy with an average age of 58,4±7,6 years before complex surgical treatment. The heart morphological features and non-ischemic contrast pattern in the myocardial segments remote from the infarction area according to contrast-enhanced MRI were assessed.Results. Patients with a non-ischemic contrast pattern had higher left atrial volume index (p=0,02), LV end-systolic index (p=0,03), and right ventricular sizes (p=0,01). A relationship was found between the left atrial volume index and cardiac remodeling in the postoperative period (p more...

Objective To investigate the association between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and the incidence of new-onset atrial fibrillation (AF) in patients with ischemic heart failure. Methods This study involved 120 patients with ischemic heart failure, characterized by sinus rhythm and a reduced ejection fraction (EF < 40%). NT-proBNP levels were measured at baseline, 6 months, and 12 months. At the 12-month follow-up, patients underwent 12-lead electrocardiography (EKG) or Holter monitoring to identify new-onset AF. Patients were classified into an AF group (n=44) and a non-AF group (n=76). Clinical characteristics and echocardiographic data were reviewed. Receiver operating characteristic (ROC) curves were employed to ascertain the optimal NT-proBNP threshold for predicting new-onset AF, and logistic regression analysis was used to evaluate the prognostic impact of NT-proBNP levels. Results New-onset AF was detected in 36.7% of the cohort. Significant elevations in functional capacity (NYHA class), NT-proBNP levels, E/A ratio, E/E' ratio, pulmonary artery systolic pressure (PASP), pulmonary capillary wedge pressure (PCWP), left atrial volume (LAV), and left atrial volume index (LAVI) were observed in the AF group compared to the non-AF group (P more...

Dilated cardiomyopathy (DCM) encompasses various acquired or genetic diseases sharing a common phenotype. The understanding of pathogenetic mechanisms and the determination of the functional effects of each etiology may allow for tailoring different therapeutic strategies. MicroRNAs (miRNAs) have emerged as key regulators in cardiovascular diseases, including DCM. However, their specific roles in different DCM etiologies remain elusive. Here, we applied mRNA-seq and miRNA-seq to identify the gene and miRNA signature from myocardial biopsies from four patients with DCM caused by volume overload (VCM) and four with ischemic DCM (ICM). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were used for differentially expressed genes (DEGs). The miRNA–mRNA interactions were identified by Pearson correlation analysis and miRNA target-prediction programs. mRNA-seq and miRNA-seq were validated by qRT-PCR and miRNA–mRNA interactions were validated by luciferase assays. We found 112 mRNAs and five miRNAs dysregulated in VCM vs. ICM. DEGs were positively enriched for pathways related to the extracellular matrix (ECM), mitochondrial respiration, cardiac muscle contraction, and fatty acid metabolism in VCM vs. ICM and negatively enriched for immune-response-related pathways, JAK-STAT, and NF-kappa B signaling. We identified four pairs of negatively correlated miRNA–mRNA: miR-218-5p-DDX6, miR-218-5p-TTC39C, miR-218-5p-SEMA4A, and miR-494-3p-SGMS2. Our study revealed novel miRNA–mRNA interaction networks and signaling pathways for VCM and ICM, providing novel insights into the development of these DCM etiologies. [ABSTRACT FROM AUTHOR] more...

Patients who undergo coronary artery bypass graft (CABG) surgery in ischemic cardiomyopathy have a survival advantage over medical therapy at 10 years. The survival advantage of CABG over medical therapy is due to its ability to reduce future myocardial infarction, and by conferring electrical stability. The presence of myocardial viability does not provide a differential survival advantage for CABG over medical therapy. Presence of angina and inducible ischemia are also less predictive of outcome. Moreover, CABG is associated with significant early mortality. Hence, careful patient selection is more important for reducing the early mortality and improving the long-term outcome than relying on results of myocardial viability. Younger patients with good exercise tolerance benefit the most, while patients who are frail and patients with renal dysfunction and dysfunctional right ventricle seem to have very high operative mortality. Elderly patients, because of poor life expectancy, do not benefit from CABG, but the age cutoff is not clear. Patients also need to have revascularizable targets, but this decision is often based on experience of the surgical team and heart team discussion. These recommendations are irrespective of the myocardial viability tests. Optimal medical treatment remains the cornerstone for management of ischemic cardiomyopathy. [ABSTRACT FROM AUTHOR] more...

There is no consensus regarding mitral valve management during surgical ventricular restoration (SVR) for ischemic cardiomyopathy. We compared the impact of SVR with mitral valve repair (MVr) vs replacement (MVR) on postoperative outcomes and long-term survival in ischemic cardiomyopathy and mitral regurgitation patients. This study included 112 patients who underwent SVR from 2009 to 2018 with MVr (n = 75) or MVR (n = 37). Patients who had MVR had higher Euro SCORE II, dyspnea class, a lower ejection fraction, higher pulmonary artery systolic pressure, higher grade of preoperative mitral and tricuspid regurgitation, and higher end-diastolic and end-systolic diameters. Intra-aortic balloon pump was more commonly used in patients with MVR. Hospital mortality occurred in 7 (9.33%) patients in the MVr group vs 3 (8.11%) in the MVR group (P >.99). Freedom from rehospitalization at 1, 5, and 7 years was 87%, 76%, and 70% in the MVr group and 83%, 61%, and 52% in the MVR group (P =.191). Survival at 1, 5, and 7 years was 88%, 78%, and 74% in the MVr group and 88%, 56%, and 56% in the MVR group (P =.027). Adjusted survival did not differ between groups. MVr or MVR are valid options in patients undergoing SVR, with good long-term outcomes. [ABSTRACT FROM AUTHOR] more...

Ischemic heart disease, which is one of the top killers worldwide, encompasses a series of heart problems stemming from a compromised coronary blood supply to the myocardium. The severity of the disease ranges from an unstable manifestation of ischemic symptoms, such as unstable angina, to myocardial death, that is, the immediate life-threatening condition of myocardial infarction. Even though patients may survive myocardial infarction, the resulting ischemia-reperfusion injury triggers a cascade of inflammatory reactions and oxidative stress that poses a significant threat to myocardial function following successful revascularization. Moreover, despite evidence suggesting the presence of cardiac stem cells, the fact that cardiomyocytes are terminally differentiated and cannot significantly regenerate after injury accounts for the subsequent progression to ischemic cardiomyopathy and ischemic heart failure, despite the current advancements in cardiac medicine. In the last two decades, researchers have realized the possibility of utilizing stem cell plasticity for therapeutic purposes. Indeed, stem cells of different origin, such as bone-marrow- and adipose-derived mesenchymal stem cells, circulation-derived progenitor cells, and induced pluripotent stem cells, have all been shown to play therapeutic roles in ischemic heart disease. In addition, the discovery of stem-cell-associated paracrine effects has triggered intense investigations into the actions of exosomes. Notwithstanding the seemingly promising outcomes from both experimental and clinical studies regarding the therapeutic use of stem cells against ischemic heart disease, positive results from fraud or false data interpretation need to be taken into consideration. The current review is aimed at overviewing the therapeutic application of stem cells in different categories of ischemic heart disease, including relevant experimental and clinical outcomes, as well as the proposed mechanisms underpinning such observations. [ABSTRACT FROM AUTHOR] more...

Background: Heart failure (HF) is a chronic disease with a poor prognosis, making it extremely important to assess the prognosis of patients with HF for accurate treatment. Secreted modular calcium-binding protein 2 (SMOC2) is a cysteine-rich acidic secreted protein that plays a pathophysiological role in many diseases, including regulation of vascular growth factor activity. It has previously been found that SMOC2 plays an essential role in cardiac fibrosis in our previous preclinical study, but whether it can be used as a clinical marker in heart failure patients remains unclear. The purpose of this research was to evaluate the correlation between plasma levels of SMOC2 and the prognosis for individuals with HF. Methods: HF patients diagnosed with ischemic cardiomyopathy were enrolled from January to December 2021. Baseline plasma levels of SMOC2 were measured after demographic and clinical features were collected. Linear and nonlinear multivariate Cox regression models were used to determine the association between plasma SMOC2 and patient outcomes during follow-up. All analysis was performed using SPSS, EmpowerStats, and R software. Results: The study included 188 patients, and the average follow-up time was 489.5± 88.3 days. The plasma SMOC2 concentrations were positively correlated with N-terminal pro-B-type Natriuretic Peptide (NT-proBNP), left ventricular end-diastolic diameter (LVEDd), and length of hospital stay and were negatively correlated with left ventricular ejection fraction (LVEF) at baseline. A total of 53 patients (28.2%) were rehospitalized due to cardiac deterioration, 14 (7.4%) died, and 37 (19.7%) developed malignant arrhythmias. A fully adjusted multivariate COX regression model showed that SMOC2 is associated with readmission (HR = 1.02, 95% CI:1.012– 1.655). A significant increase in rehospitalization risk was observed in group Q2 (HR =1.064, 95% CI: 1.037, 3.662, p=0.005) and group Q3 (HR =1.085, 95% CI:1.086, 3.792, p=0.009) in comparison with group Q1. The p for trend also shows a linear correlation across the three models (P < 0.001). SMOC2 was associated with the severity of HF in patients, but not with all-cause deaths and arrhythmias during follow-up. Conclusion: Plasma SMOC2 is associated with the severity of HF and readmission rate, and is a good predictor of the risk of readmission in patients. [ABSTRACT FROM AUTHOR] more...

BackgroundMechanical circulatory support (MCS), temporary or durable, is essential in patients with acute heart failure presenting in cardiogenic shock (CS). MCS is fundamental in patients with advanced heart failure when used as a bridge to decision, transplant or left ventricular recovery. Limited data on acute-on-chronic heart failure (HF) patients exists in the era of axillary mechanical circulatory support with the Impella 5.5. We describe a case of chronic ischemic cardiomyopathy, HF-CS, in a patient who underwent Impella placement, medical optimization, and explant, now with sustained normalization in ejection fraction.Case summaryA Caucasian female in her 50 s was referred to our center for evaluation for advanced therapies, including transplantation or durable left ventricular assist device placement. Her initial ejection fraction was 30% with comorbidities including multivessel coronary artery disease revascularized with 3 vessel bypass grafting ten years prior, type 2 diabetes (A1c 8.6%), and peripheral vascular disease. During her evaluation, she had acute decompensation leading to cardiogenic shock and required hospitalization with inotrope initiation, which was unable to be weaned. She was approved for organ transplant and listed; however, she required escalation of support and eventual placement of right axillary Impella 5.5. While on Impella support, her vasoactive needs reduced, and she was found to have left ventricular recovery and tolerated the initiation of guideline medical therapy. After three weeks of support, the Impella was weaned and explanted, and the patient was discharged. She remains stable with a sustained ejection fraction of greater than 50% with NYHA class 1 functional status at follow-up. One year later, the patient showed sustained myocardial recovery with guideline-directed medical therapy (GDMT).ConclusionOur case highlights a unique approach in patients with long-standing (>5 years) heart failure who may benefit from early consideration for axillary support and concomitant optimization with guideline-directed medical therapy to assess for explant and native heart recovery. more...

Ischemic cardiomyopathy (ICM) affect millions of patients globally. Decellularized extracellular matrix materials (dECM) have components, microstructure and mechanical properties similar to healthy cardiac tissues, and can be manufactured into various forms of implantable biomaterials including injectable hydrogels or epicardial patches, which have been extensively reported to attenuate pathological left ventricular remodeling and maintain heart function. Recently, dECM medical devices for ICM treatment have been approved for clinical use or studied in clinical trials, exhibiting considerable translation potential. Cells, growth factors and other bioactive agents have been incorporated with different dECM materials to improve the therapeutic outcomes. In addition, more detailed aspects of the biological effects and mechanisms of dECM treatment are being revealed. This review summarized recent advances in dECM materials from variable sources for cardiac repair, including extraction of extracellular matrix, cell integration, smart manufacturing of injectable hydrogels and cardiac patch materials, and their therapeutic applications. Besides, this review provides an outlook on the cutting-edge development directions in the field. more...

The persistent challenge of ventricular tachycardia (VT) ablation lies in the elevated morbidity and mortality due to the underlying disease progression and the complexity of the arrhythmogenic substrate. As imaging methods are evolving, substrate-based VT ablation is moving closer to the realm of precision medicine. more...