Medicine › Cardiology and Cardiovascular Medicine

Cardiovascular Function and Risk Factors

Works Count: 101917

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This cluster of papers focuses on recommendations and updates for cardiac chamber quantification by echocardiography in adults, with a particular emphasis on evaluating left ventricular diastolic function. It also explores the association of obesity, diabetic cardiomyopathy, and cardiac metabolism with heart failure. The papers cover the use of advanced imaging techniques such as strain imaging and speckle tracking echocardiography to assess cardiac mechanics and function.

Keywords

Echocardiography; Chamber Quantification; Diastolic Function; Heart Failure; Obesity; Cardiac Metabolism; Left Ventricular Function; Strain Imaging; Diabetic Cardiomyopathy; Cardiovascular Risk

Obesity and Cardiovascular Disease

2009-05-01

Carl J. Lavie , Richard V. Milani , Héctor O. Ventura

A Novel Paradigm for Heart Failure With Preserved Ejection Fraction

2013-05-15

Walter J. Paulus , Carsten Tschöpe

Pathological hypertrophy and cardiac interstitium. Fibrosis and renin-angiotensin-aldosterone system.

1991-06-01

K. T. Weber , Christian G. Brilla

Left ventricular hypertrophy (LVH) is the major risk factor associated with myocardial failure. An explanation for why a presumptive adaptation such as LVH would prove pathological has been elusive. Insights … Left ventricular hypertrophy (LVH) is the major risk factor associated with myocardial failure. An explanation for why a presumptive adaptation such as LVH would prove pathological has been elusive. Insights into the impairment in contractility of the hypertrophied myocardium have been sought in the biochemistry of cardiac myocyte contraction. Equally compelling is a consideration of abnormalities in myocardial structure that impair organ contractile function while preserving myocyte contractility. For example, in the LVH that accompanies hypertension, the extracellular space is frequently the site of an abnormal accumulation of fibrillar collagen. This reactive and progressive interstitial and perivascular fibrosis accounts for abnormal myocardial stiffness and ultimately ventricular dysfunction and is likely a result of cardiac fibroblast growth and enhanced collagen synthesis. The disproportionate involvement of this nonmyocyte cell, however, is not a uniform accompaniment to myocyte hypertrophy and LVH, suggesting that the growth of myocyte and nonmyocyte cells is independent of each other. This has now been demonstrated in in vivo studies of experimental hypertension in which the abnormal fibrous tissue response was found in the hypertensive, hypertrophied left ventricle as well as in the normotensive, nonhypertrophied right ventricle. These findings further suggest that a circulating substance that gained access to the common coronary circulation of the ventricles was involved. This hypothesis has been tested in various animal models in which plasma concentrations of angiotensin II and aldosterone were varied. Based on morphometric and morphological findings, it can be concluded that arterial hypertension (i.e., an elevation in coronary perfusion pressure) together with elevated circulating aldosterone are associated with cardiac fibroblast involvement and the resultant heterogeneity in tissue structure. Nonmyocyte cells of the cardiac interstitium represent an important determinant of pathological LVH. The mechanisms that invoke short- (e.g., collagen metabolism) and long-term (e.g., mitosis) responses of cardiac fibroblasts require further investigation and integration of in vitro with in vivo studies. The stage is set, however, to prevent pathological LVH resulting from myocardial fibrosis as well as to reverse it.

Simple Scoring Scheme for Calculating the Risk of Acute Coronary Events Based on the 10-Year Follow-Up of the Prospective Cardiovascular Münster (PROCAM) Study

2002-01-22

Gerd Assmann , Paul Cullen , H. Schulte

Background — The absolute risk of an acute coronary event depends on the totality of risk factors exhibited by an individual, the so-called global risk profile. Although several scoring schemes … Background — The absolute risk of an acute coronary event depends on the totality of risk factors exhibited by an individual, the so-called global risk profile. Although several scoring schemes have been suggested to calculate this profile, many omit information on important variables such as family history of coronary heart disease or LDL cholesterol. Methods and Results — Based on 325 acute coronary events occurring within 10 years of follow-up among 5389 men 35 to 65 years of age at recruitment into the Pro spective Ca rdiovascular Mü nster (PROCAM) study, we developed a Cox proportional hazards model using the following 8 independent risk variables, ranked in order of importance: age, LDL cholesterol, smoking, HDL cholesterol, systolic blood pressure, family history of premature myocardial infarction, diabetes mellitus, and triglycerides. We then derived a simple point scoring system based on the β-coefficients of this model. The accuracy of this point scoring scheme was comparable to coronary event prediction when the continuous variables themselves were used. The scoring system accurately predicted observed coronary events with an area under the receiver-operating characteristics curve of 82.4% compared with 82.9% for the Cox model with continuous variables. Conclusions — Our scoring system is a simple and accurate way of predicting global risk of myocardial infarction in clinical practice and will therefore allow more accurate targeting of preventive therapy.

Assessment of Mitral Annulus Velocity by Doppler Tissue Imaging in the Evaluation of Left Ventricular Diastolic Function

1997-08-01

Daewon Sohn , In-Ho Chai , Dongjun Lee +7 more

Doppler Tissue Imaging: A Noninvasive Technique for Evaluation of Left Ventricular Relaxation and Estimation of Filling Pressures

1997-11-01

Sherif F. Nagueh , Katherine J. Middleton , Helen A. Kopelen +2 more

Ventricular remodeling after myocardial infarction. Experimental observations and clinical implications.

1990-04-01

Marc A. Pfeffer , Eugene Braunwald

An acute myocardial infarction, particularly one that is large and transmural, can produce alterations in the topography of both the infarcted and noninfarcted regions of the ventricle. This remodeling can … An acute myocardial infarction, particularly one that is large and transmural, can produce alterations in the topography of both the infarcted and noninfarcted regions of the ventricle. This remodeling can importantly affect the function of the ventricle and the prognosis for survival. In the early period, infarct expansion has been recognized by echocardiography as a lengthening of the noncontractile region. The noninfarcted region also undergoes an important lengthening that is consistent with a secondary volume-overload hypertrophy and that can be progressive. The extent of ventricular enlargement after infarction is related to the magnitude of the initial damage to the myocardium and, although an increase in cavity size tends to restore stroke volume despite a persistently depressed ejection fraction, ventricular dilation has been associated with a reduction in survival. The process of ventricular enlargement can be influenced by three interdependent factors, that is, infarct size, infarct healing, and ventricular wall stresses. A most effective way to prevent or minimize the increase in ventricular size after infarction and the consequent adverse effect on prognosis is to limit the initial insult. Acute reperfusion therapy has been consistently shown to result in a reduction in ventricular volume. The reestablishment of blood flow to the infarcted region, even beyond the time frame for myocyte salvage, has beneficial effects in attenuating ventricular enlargement. The process of scarification can be interfered with during the acute infarct period by the administration of glucocorticosteroids and nonsteroidal antiinflammatory agents, which result in thinner infarcts and greater degrees of infarct expansion. Modification of distending or deforming forces can importantly influence ventricular enlargement. Even short-term augmentations in afterload have deleterious long-term effects on ventricular topography. Conversely, judicious use of nitroglycerin seems to be associated with an attenuation of infarct expansion and long-term improvement in clinical outcome. Long-term therapy with an angiotensin converting enzyme inhibitor can favorably alter the loading conditions on the left ventricle and reduce progressive ventricular enlargement as demonstrated in both experimental and clinical studies. With the former therapy, this attenuation of ventricular enlargement was associated with a prolongation in survival. The long-term clinical consequences of long-term angiotensin converting enzyme inhibitor therapy after myocardial infarction is currently being evaluated. Although studies directed at attenuating left ventricular remodeling after infarction are in the early stages, it does seem that this will be an important area in which future research might improve long-term outcome after infarction.

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Left ventricular mass and body size in normotensive children and adults: Assessment of allometric relations and impact of overweight

1992-11-01

Giovanni de Simone , Stephen R. Daniels , R.B. Devereux +4 more

Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method.

1977-04-01

R DEVEREUX , Nathaniel Reichek

An accurte echocardiographic (E) method for determination of left ventricular mass (LVM) was derived from systematic analysis of the relationship between the antemortem left ventricular echogram and postmortem anatomic LVM … An accurte echocardiographic (E) method for determination of left ventricular mass (LVM) was derived from systematic analysis of the relationship between the antemortem left ventricular echogram and postmortem anatomic LVM in 34 adults with a wide range of anatomic LVM (101-505 g). No subject had massive myocardial infarction, ventricular aneurysm, severe right ventricular volume overload or hypertrophic cardiography. The best method for LVM-E identified combined cube function geometry with a modified convention for determination of left ventricular internal dimension (LVID), posterior wall thickness (PWT), and interventricular septal thickness (IVST), which excluded the thickness of endocardial echo lines from wall thicknesses and included the thickness of left septal and posterior wall endocardial echo lines in LVID (Penn Convention, P). By this method, anatomic LVM = 1.04 ([LVIDp + PWTp + IVSTp]3--[LVIDp]3) -- 14 g; r = 0.96, SD= 29 g, N= 34. Standard echo measurements gave less accurate results, as did previously reported methods for LVM-E. LVM-Dp is an accurate, widely applicable method for the study of left ventricular hypertrophy.

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Clinical Utility of Doppler Echocardiography and Tissue Doppler Imaging in the Estimation of Left Ventricular Filling Pressures

2000-10-10

Steve R. Ommen , R A Nishimura , C. P. Appleton +4 more

Noninvasive assessment of diastolic filling by Doppler echocardiography provides important information about left ventricular (LV) status in selected subsets of patients. This study was designed to assess whether mitral annular … Noninvasive assessment of diastolic filling by Doppler echocardiography provides important information about left ventricular (LV) status in selected subsets of patients. This study was designed to assess whether mitral annular velocities as assessed by tissue Doppler imaging are associated with invasive measures of diastolic LV performance and whether additional information is gained over traditional Doppler variables.One hundred consecutive patients referred for cardiac catheterization underwent simultaneous Doppler interrogation. Invasive measurements of LV pressures were obtained with micromanometer-tipped catheters, and the mean LV diastolic pressure (M-LVDP) was used as a surrogate for mean left atrial pressure. Doppler signals from the mitral inflow, pulmonary venous inflow, and TDI of the mitral annulus were obtained. Isolated parameters of transmitral flow correlated with M-LVDP only when ejection fraction <50%. The ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/E') showed a better correlation with M-LVDP than did other Doppler variables for all levels of systolic function. E/E' <8 accurately predicted normal M-LVDP, and E/E' >15 identified increased M-LVDP. Wide variability was present in those with E/E' of 8 to 15. A subset of those patients with E/E' 8 to 15 could be further defined by use of other Doppler data.The combination of tissue Doppler imaging of the mitral annulus and mitral inflow velocity curves provides better estimates of LV filling pressures than other methods (pulmonary vein, preload reduction). However, accurate prediction of filling pressures for an individual patient requires a stepwise approach incorporating all available data.

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Relation of transmitral flow velocity patterns to left ventricular diastolic function: New insights from a combined hemodynamic and Doppler echocardiographic study

1988-08-01

Christopher P. Appleton , Liv K. Hatle , Richard L. Popp

Obesity and the Risk of Heart Failure

2002-08-01

Satish Kenchaiah , Jane C. Evans , Daniel Levy +5 more

Extreme obesity is recognized to be a risk factor for heart failure. It is unclear whether overweight and lesser degrees of obesity also pose a risk.We investigated the relation between … Extreme obesity is recognized to be a risk factor for heart failure. It is unclear whether overweight and lesser degrees of obesity also pose a risk.We investigated the relation between the body-mass index (the weight in kilograms divided by the square of the height in meters) and the incidence of heart failure among 5881 participants in the Framingham Heart Study (mean age, 55 years; 54 percent women). With the use of Cox proportional-hazards models, the body-mass index was evaluated both as a continuous variable and as a categorical variable (normal, 18.5 to 24.9; overweight, 25.0 to 29.9; and obese, 30.0 or more).During follow-up (mean, 14 years), heart failure developed in 496 subjects (258 women and 238 men). After adjustment for established risk factors, there was an increase in the risk of heart failure of 5 percent for men and 7 percent for women for each increment of 1 in body-mass index. As compared with subjects with a normal body-mass index, obese subjects had a doubling of the risk of heart failure. For women, the hazard ratio was 2.12 (95 percent confidence interval, 1.51 to 2.97); for men, the hazard ratio was 1.90 (95 percent confidence interval, 1.30 to 2.79). A graded increase in the risk of heart failure was observed across categories of body-mass index. The hazard ratios per increase in category were 1.46 in women (95 percent confidence interval, 1.23 to 1.72) and 1.37 in men (95 percent confidence interval, 1.13 to 1.67).In our large, community-based sample, increased body-mass index was associated with an increased risk of heart failure. Given the high prevalence of obesity in the United States, strategies to promote optimal body weight may reduce the population burden of heart failure.

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Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): Effects on mortality at 1 year

1995-07-01

Klas Malmberg , Lars Rydén , Suad Efendić +5 more

Problems in echocardiographic volume determinations: Echocardiographic-angiographic correlations in the presence or absence of asynergy

1976-01-01

Louis E. Teichholz , Thomas H. Kreulen , Michael V. Herman +1 more

Burden of Systolic and Diastolic Ventricular Dysfunction in the Community

2003-01-08

Margaret M. Redfield , Steven J. Jacobsen , John C. Burnett +3 more

<h3>Context</h3> Approximately half of patients with overt congestive heart failure (CHF) have diastolic dysfunction without reduced ejection fraction (EF). Yet, the prevalence of diastolic dysfunction and its relation to systolic … <h3>Context</h3> Approximately half of patients with overt congestive heart failure (CHF) have diastolic dysfunction without reduced ejection fraction (EF). Yet, the prevalence of diastolic dysfunction and its relation to systolic dysfunction and CHF in the community remain undefined. <h3>Objectives</h3> To determine the prevalence of CHF and preclinical diastolic dysfunction and systolic dysfunction in the community and determine if diastolic dysfunction is predictive of all-cause mortality. <h3>Design, Setting, Participants</h3> Cross-sectional survey of 2042 randomly selected residents of Olmsted County, Minnesota, aged 45 years or older from June 1997 through September 2000. <h3>Main Outcome Measures</h3> Doppler echocardiographic assessment of systolic and diastolic function. Presence of CHF diagnosis by review of medical records with designation as validated CHF if Framingham criteria are satisfied. Subjects without a CHF diagnosis but with diastolic or systolic dysfunction were considered as having either preclinical diastolic or preclinical systolic dysfunction. <h3>Results</h3> The prevalence of validated CHF was 2.2% (95% confidence interval [CI], 1.6%-2.8%) with 44% having an EF higher than 50%. Overall, 20.8% (95% CI, 19.0%-22.7%) of the population had mild diastolic dysfunction, 6.6% (95% CI, 5.5%-7.8%) had moderate diastolic dysfunction, and 0.7% (95% CI, 0.3%-1.1%) had severe diastolic dysfunction with 5.6% (95% CI, 4.5%-6.7%) of the population having moderate or severe diastolic dysfunction with normal EF. The prevalence of any systolic dysfunction (EF ≤50%) was 6.0% (95% CI, 5.0%-7.1%) with moderate or severe systolic dysfunction (EF ≤40%) being present in 2.0% (95% CI, 1.4%-2.5%). CHF was much more common among those with systolic or diastolic dysfunction than in those with normal ventricular function. However, even among those with moderate or severe diastolic or systolic dysfunction, less than half had recognized CHF. In multivariate analysis, controlling for age, sex, and EF, mild diastolic dysfunction (hazard ratio, 8.31 [95% CI, 3.00-23.1],<i>P</i><.001) and moderate or severe diastolic dysfunction (hazard ratio, 10.17 [95% CI, 3.28-31.0],<i>P</i><.001) were predictive of all-cause mortality. <h3>Conclusions</h3> In the community, systolic dysfunction is frequently present in individuals without recognized CHF. Furthermore, diastolic dysfunction as rigorously defined by comprehensive Doppler techniques is common, often not accompanied by recognized CHF, and associated with marked increases in all-cause mortality.

Echocardiographic assessment of left ventricular hypertrophy: Comparison to necropsy findings

1986-02-01

Richard B. Devereux , Daniel R. Alonso , Elizabeth M. Lutas +4 more

An updated coronary risk profile. A statement for health professionals.

1991-01-01

Keaven M. Anderson , P W Wilson , Patricia M. Odell +1 more

HomeCirculationVol. 83, No. 1An updated coronary risk profile. A statement for health professionals. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBAn updated coronary risk … HomeCirculationVol. 83, No. 1An updated coronary risk profile. A statement for health professionals. Free AccessAbstractPDF/EPUBAboutView PDFSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessAbstractPDF/EPUBAn updated coronary risk profile. A statement for health professionals. K M Anderson, P W Wilson, P M Odell and W B Kannel K M AndersonK M Anderson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P W WilsonP W Wilson Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. , P M OdellP M Odell Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. and W B KannelW B Kannel Office of Scientific Affairs, American Heart Association, Dallas, TX 75231. Originally published1 Jan 1991https://doi.org/10.1161/01.CIR.83.1.356Circulation. 1991;83:356–362 Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hespe C, Giskes K, Harris M and Peiris D (2022) Findings and lessons learnt implementing a cardiovascular disease quality improvement program in Australian primary care: a mixed method evaluation, BMC Health Services Research, 10.1186/s12913-021-07310-6, 22:1, Online publication date: 1-Dec-2022. Lemke E, Vetter V, Berger N, Banszerus V, König M and Demuth I (2022) Cardiovascular health is associated with the epigenetic clock in the Berlin Aging Study II (BASE-II), Mechanisms of Ageing and Development, 10.1016/j.mad.2021.111616, 201, (111616), Online publication date: 1-Jan-2022. Wong N, Budoff M, Ferdinand K, Graham I, Michos E, Reddy T, Shapiro M and Toth P (2022) Atherosclerotic cardiovascular disease risk assessment: An American Society for Preventive Cardiology clinical practice statement, American Journal of Preventive Cardiology, 10.1016/j.ajpc.2022.100335, 10, (100335), Online publication date: 1-Jun-2022. Coller J, Gong F, McGrady M, Shiel L, Liew D, Stewart S, Owen A, Krum H, Reid C, Prior D and Campbell D (2021) Risk factors for asymptomatic echocardiographic abnormalities that predict symptomatic heart failure, ESC Heart Failure, 10.1002/ehf2.13695, 9:1, (196-212), Online publication date: 1-Feb-2022. Mittal M, McEniery C, Supramaniam P, Cardozo L, Savvas M, Panay N and Hamoda H (2022) Impact of micronised progesterone and medroxyprogesterone acetate in combination with transdermal oestradiol on cardiovascular markers in women diagnosed with premature ovarian insufficiency or an early menopause: a randomised pilot trial, Maturitas, 10.1016/j.maturitas.2022.01.012, 161, (18-26), Online publication date: 1-Jul-2022. Adikari D, Gharleghi R, Zhang S, Jorm L, Sowmya A, Moses D, Ooi S and Beier S (2022) A new and automated risk prediction of coronary artery disease using clinical endpoints and medical imaging-derived patient-specific insights: protocol for the retrospective GeoCAD cohort study, BMJ Open, 10.1136/bmjopen-2021-054881, 12:6, (e054881), Online publication date: 1-Jun-2022. Disouza J, Patil K, Kakade P and Patravale V (2022) Dietary Fibers and Nutraceuticals in Prevention of Hypertension Research Anthology on Recent Advancements in Ethnopharmacology and Nutraceuticals, 10.4018/978-1-6684-3546-5.ch040, (778-809) Barton T, Low D, Bakker E, Janssen T, de Groot S, van der Woude L and Thijssen D (2021) Traditional Cardiovascular Risk Factors Strongly Underestimate the 5-Year Occurrence of Cardiovascular Morbidity and Mortality in Spinal Cord Injured Individuals, Archives of Physical Medicine and Rehabilitation, 10.1016/j.apmr.2020.07.013, 102:1, (27-34), Online publication date: 1-Jan-2021. Sadat Halder M and Kumar De S (2021) A RETROSPECTIVE COHORT STUDY TO UNDERSTAND THE AGE, GENDER AND RISK FACTORS PATTERN IN PATIENTS ATTENDING FOR CARDIAC REHABILITATION (CR) AFTER CORONARY ARTERY BYPASS GRAFTING (CABG) SURGERY, INDIAN JOURNAL OF APPLIED RESEARCH, 10.36106/ijar/5702089, (57-60), Online publication date: 1-Jul-2021. Black J, Campbell J, Parker S, Sharman J, Nelson M, Otahal P, Hamilton G and Marwick T (2021) Absolute risk assessment for guiding cardiovascular risk management in a chest pain clinic, Medical Journal of Australia, 10.5694/mja2.50960, 214:6, (266-271), Online publication date: 1-Apr-2021. Wen J (2021) Stem Cell Therapies for Cardiac Disease: Which Cell Types Are the Best ICBBS 2021: 2021 10th International Conference on Bioinformatics and Biomedical Science, 10.1145/3498731.3498762, 9781450384308, (196-203), Online publication date: 29-Oct-2021. Mishra P, Mishra B, Lyytikäinen L, Hilvo M, Juonala M, Kähönen M, Hutri-Kähönen N, Fotiadis D, Raitakari O, Laaksonen R and Lehtimäki T (2021) Assessment of plasma ceramides as predictor for subclinical atherosclerosis, Atherosclerosis Plus, 10.1016/j.athplu.2021.09.005, 45, (25-31), Online publication date: 1-Nov-2021. Okami Y, Ueshima H, Nakamura Y, Kondo K, Kadota A, Okuda N, Ohkubo T, Miyamatsu N, Okamura T, Miura K and Okayama A (2021) Risk Factors That Most Accurately Predict Coronary Artery Disease Based on the Duration of Follow-up ― NIPPON DATA80 ―, Circulation Journal, 10.1253/circj.CJ-20-0739, 85:6, (908-913), Online publication date: 25-May-2021. Wilson R, Aminian A and Tahrani A (2021) Metabolic surgery: A clinical update, Diabetes, Obesity and Metabolism, 10.1111/dom.14235, 23:S1, (63-83), Online publication date: 1-Feb-2021. Steger A, Dommasch M, Müller A, Sinnecker D, Huster K, Gotzler T, Gotzler O, Hapfelmeier A, Ulm K, Barthel P, Hnatkova K, Laugwitz K, Malik M and Schmidt G (2020) Polyscore of autonomic parameters for risk stratification of the elderly general population: the Polyscore study, EP Europace, 10.1093/europace/euaa359, 23:5, (789-796), Online publication date: 21-May-2021. Li Y, Sperrin M, Ashcroft D and van Staa T (2021) Consistency of ranking was evaluated as new measure for prediction model stability: longitudinal cohort study, Journal of Clinical Epidemiology, 10.1016/j.jclinepi.2021.06.026, 138, (168-177), Online publication date: 1-Oct-2021. Albaugh V, Kindel T, Nissen S and Aminian A (2021) Cardiovascular Risk Reduction Following Metabolic and Bariatric Surgery, Surgical Clinics of North America, 10.1016/j.suc.2020.12.012, 101:2, (269-294), Online publication date: 1-Apr-2021. Eftychidis I, Sakellari I, Anagnostopoulos A and Gavriilaki E (2021) Endothelial dysfunction and vascular complications after allogeneic hematopoietic cell transplantation: an expert analysis, Expert Review of Hematology, 10.1080/17474086.2021.1968823, 14:9, (831-840), Online publication date: 2-Sep-2021. Vaes B, Indestege P, Serneels T, Hegendörfer E, van Peet P, Poortvliet R, Wallemacq P, Gussekloo J and Degryse J (2020) Biomarkers versus traditional risk factors to predict cardiovascular events in very old adults: cross-validated prospective cohort study, BMJ Open, 10.1136/bmjopen-2019-035809, 10:6, (e035809), Online publication date: 1-Jun-2020. Wong N (2020) Cardiovascular risk assessment: The foundation of preventive cardiology, American Journal of Preventive Cardiology, 10.1016/j.ajpc.2020.100008, 1, (100008), Online publication date: 1-Mar-2020. Anžič Drofenik A, Vrtovec M, Božič Mijovski M, Sever M, Preložnik Zupan I, Kejžar N and Blinc A (2020) Progression of coronary calcium burden and carotid stiffness in patients with essential thrombocythemia associated with JAK2 V617F mutation, Atherosclerosis, 10.1016/j.atherosclerosis.2020.01.001, 296, (25-31), Online publication date: 1-Mar-2020. van Bussel E, Hoevenaar-Blom M, Poortvliet R, Gussekloo J, van Dalen J, van Gool W, Richard E and Moll van Charante E (2020) Predictive value of traditional risk factors for cardiovascular disease in older people: A systematic review, Preventive Medicine, 10.1016/j.ypmed.2020.105986, 132, (105986), Online publication date: 1-Mar-2020. Kim Y, Noh K, Byun S, Lee S, Kim T, Sunwoo L, Lee K, Kang S, Park K and Park S (2020) Effects of Hypertension, Diabetes, and Smoking on Age and Sex Prediction from Retinal Fundus Images, Scientific Reports, 10.1038/s41598-020-61519-9, 10:1, Online publication date: 1-Dec-2020. Palazón-Bru A, Ferri-Rufete D, Mares-García E, Durazo-Arvizu R, Divisón-Garrote J, Carbayo-Herencia J, Artigao-Rodenas L, Simarro-Rueda M, Molina-Escribano F, Ponce-García I, Gil-Guillén V and Pérez-Sempere Á (2020) Clusters of Cardiovascular Risk Factors and Their Impact on the 20-Year Cardiovascular Risk in a General Population, Journal of Cardiovascular Nursing, 10.1097/JCN.0000000000000637, 35:2, (210-216), Online publication date: 1-Mar-2020. Jamthikar A, Gupta D, Saba L, Khanna N, Viskovic K, Mavrogeni S, Laird J, Sattar N, Johri A, Pareek G, Miner M, Sfikakis P, Protogerou A, Viswanathan V, Sharma A, Kitas G, Nicolaides A, Kolluri R and Suri J (2020) Artificial intelligence framework for predictive cardiovascular and stroke risk assessment models: A narrative review of integrated approaches using carotid ultrasound, Computers in Biology and Medicine, 10.1016/j.compbiomed.2020.104043, 126, (104043), Online publication date: 1-Nov-2020. Torralbas-Ortega J, Paños-Martínez M, Patró-Moncunill E, Santiago-Barragán A, Cobo J, Escayola-Maranges A, Granero-Lázaro A and Marti-Mestre M (2020) Efficacy of a Short Psychoeducational Group Intervention for the Prevention of Cardiovascular Risk in Patients With Severe Mental Disorder, Journal of Nervous & Mental Disease, 10.1097/NMD.0000000000001081, 208:3, (222-229), Online publication date: 1-Mar-2020. Wang J, Smail-Crevier R, Nannarone M, Manuel D, MacQueen G, Patten S, Lashewicz B and Schmitz N (2020) The accuracy of depression risk perception in high risk Canadians, Journal of Affective Disorders, 10.1016/j.jad.2020.01.099, 265, (410-415), Online publication date: 1-Mar-2020. Vuksan V, Sievenpiper J, Jovanovski E, Jenkins A, Komishon A, Au-Yeung F, Zurbau A, Ho H, Li D and Smircic-Duvnjak L (2020) Effect of soluble-viscous dietary fibre on coronary heart disease risk score across 3 population health categories: data from randomized, double-blind, placebo-controlled trials, Applied Physiology, Nutrition, and Metabolism, 10.1139/apnm-2019-0728, 45:7, (801-804), Online publication date: 1-Jul-2020. Warner E, Nannarone M, Smail-Crevier R, Manuel D, Lashewicz B, Patten S, Schmitz N, MacQueen G and Wang J (2020) The relationship between depression risk perception and self-help behaviours in high risk Canadians: a cross-sectional study, BMC Public Health, 10.1186/s12889-020-08983-0, 20:1, Online publication date: 1-Dec-2020. Wallisch C, Heinze G, Rinner C, Mundigler G, Winkelmayer W and Dunkler D (2020) Re-estimation improved the performance of two Framingham cardiovascular risk equations and the Pooled Cohort equations: A nationwide registry analysis, Scientific Reports, 10.1038/s41598-020-64629-6, 10:1, Online publication date: 1-Dec-2020. Kim J, Yu M, Kim Y, Min S, Ha J, Lee J, Kim D, Oh K, Joo K, Ahn C, Kim Y and Lee H (2019) Ratio of triglyceride to high-density lipoprotein cholesterol and risk of major cardiovascular events in kidney transplant recipients, Clinical and Experimental Nephrology, 10.1007/s10157-019-01776-9, 23:12, (1407-1417), Online publication date: 1-Dec-2019. Gomez-Sanchez L, Gomez-Marcos M, Patino-Alonso M, Recio-Rodriguez J, Gomez-Sanchez M, González-Sánchez J, Alonso-Domínguez R, Sánchez-Aguadero N, Maderuelo-Fernandez J, Ramos R, Garcia-Ortiz L and Rodriguez-Sanchez E (2019) Reclassification by applying the Framingham equation 30 years to subjects with intermediate cardiovascular risk. MARK study, Medicina Clínica (English Edition), 10.1016/j.medcle.2019.01.035, 153:9, (351-356), Online publication date: 1-Nov-2019. Lee K, Yong H, Lee J, Kang E and Na J (2018) Is the epicardial adipose tissue area on non-ECG gated low-dose chest CT useful for predicting coronary atherosclerosis in an asymptomatic population considered for lung cancer screening?, European Radiology, 10.1007/s00330-018-5562-4, 29:2, (932-940), Online publication date: 1-Feb-2019. Gibson C, Kerneis M, Yee M, Daaboul Y, Korjian S, Mehr A, Tricoci P, Alexander J, Kastelein J, Mehran R, Bode C, Lewis B, Mehta R, Duffy D, Feaster J, Halabi M, Angiolillo D, Duerschmied D, Ophuis T and Merkely B (2019) The CSL112-2001 trial: Safety and tolerability of multiple doses of CSL112 (apolipoprotein A-I [human]), an intravenous formulation of plasma-derived apolipoprotein A-I, among subjects with moderate renal impairment after acute myocardial infarction, American Heart Journal, 10.1016/j.ahj.2018.11.008, 208, (81-90), Online publication date: 1-Feb-2019. ter Wee M and Lissenberg-Witte B (2019) To Predict or not to Predict? A Quick Guide on How to Conduct Medical Research, 10.1007/978-90-368-2248-0_7, (189-227), . Wang J, MacQueen G, Patten S, Manuel D, Lashewicz B and Schmitz N (2019) A randomized controlled trial to examine the impacts of disclosing personalized depression risk information on the outcomes of individuals who are at high risk of developing major depression: a research protocol, BMC Psychiatry, 10.1186/s12888-019-2270-9, 19:1, Online publication date: 1-Dec-2019. Gavriilaki E, Gkaliagkousi E, Sakellari I, Anyfanti P, Douma S and Anagnostopoulos A (2019) Early Prediction of Cardiovascular Risk after Hematopoietic Cell Transplantation: Are We There Yet?, Biology of Blood and Marrow Transplantation, 10.1016/j.bbmt.2019.07.012, 25:10, (e310-e316), Online publication date: 1-Oct-2019. Sarfo F, Nichols M, Gebregziabher M, Tagge R, Asibey S, Jenkins C and Ovbiagele B (2019) Evaluation of Vascular Event Risk while on Long-term Anti-retroviral Suppressive Therapy [EVERLAST]: Protocol for a prospective observational study, eNeurologicalSci, 10.1016/j.ensci.2019.100189, 15, (100189), Online publication date: 1-Jun-2019. van Bronswijk S, Lemmens L, Keefe J, Huibers M, DeRubeis R and Peeters F (2018) A prognostic index for long-term outcome after successful acute phase cognitive therapy and interpersonal psychotherapy for major depressive disorder, Depression and Anxiety, 10.1002/da.22868, 36:3, (252-261), Online publication date: 1-Mar-2019. Dimberg L, Eriksson B and Hashem M (2019) Myocardial infarction and death findings from a 22-year follow-up of a cohort of 980 employed Swedish men, Public Health, 10.1016/j.puhe.2019.07.006, 175, (148-155), Online publication date: 1-Oct-2019. Cifkova R (2019) Arterial Hypertension and Cardiovascular Risk Management of Hypertension, 10.1007/978-3-319-92946-0_3, (57-74), . Rojas C, Ramírez H, Salazar L, Kalergis A, Gálvez A and Escobar‐Vera J (2019) Characterization of LDLR rs5925 and PCSK9 rs505151 genetic variants frequencies in healthy subjects from northern Chile: Influence on plasma lipid levels , Journal of Clinical Laboratory Analysis, 10.1002/jcla.23001, 33:9, Online publication date: 1-Nov-2019. Kotalik A, Eaton A, Lian Q, Serrano C, Connett J and Neaton J (2019) A win ratio approach to the re-analysis of Multiple Risk Factor Intervention Trial, Clinical Trials, 10.1177/1740774519868233, 16:6, (626-634), Online publication date: 1-Dec-2019. An Y, Yun S, Yang I, Kim D and Yang D (2019) Predictive Performance of Ultrasound-Determined Non-Alcoholic Fatty Pancreas Disease Severity for Intermediate and High Risk of Coronary Heart Disease, Journal of the Korean Society of Radiology, 10.3348/jksr.2019.80.6.1190, 80:6, (1190), . Sakaki J, Melough M, Lee S, Pounis G and Chun O (2019) Polyphenol-Rich Diets in Cardiovascular Disease Prevention Analysis in Nutrition Research, 10.1016/B978-0-12-814556-2.00010-5, (259-298), . Gomez-Sanchez L, Gomez-Marcos M, Patino-Alonso M, Recio-Rodriguez J, Gomez-Sanchez M, González-Sánchez J, Alonso-Domínguez R, Sánchez-Aguadero N, Maderuelo-Fernandez J, Ramos R, Garcia-Ortiz L and Rodriguez-Sanchez E (2019) Reclassification by applying the Framingham equation 30 years to subjects with intermediate cardiovascular risk. MARK study, Medicina Clínica, 10.1016/j.medcli.2019.01.033, 153:9, (351-356), Online publication date: 1-Nov-2019. Chen G, Gao L and Li X (2019) Effects of exercise training on cardiovascular risk factors in kidney transplant recipients: a systematic review and meta-analysis, Renal Failure, 10.1080/0886022X.2019.1611602, 41:1, (408-418), Online publication date: 1-Jan-2019. Rosenblit P (2019) Extreme Atherosclerotic Cardiovascular Disease (ASCVD) Risk Recognition, Current Diabetes Reports, 10.1007/s11892-019-1178-6, 19:8, Online publication date: 1-Aug-2019. Disouza J, Patil K, Kakade P and Patravale V (2019) Dietary Fibers and Nutraceuticals in Prevention of Hypertension Nutraceutical and Functional Foods in Disease Prevention, 10.4018/978-1-5225-3267-5.ch007, (192-232) Charles‐Schoeman C, DeMasi R, Valdez H, Soma K, Hwang L, Boy M, Biswas P and McInnes I (2019) Risk Factors for Major Adverse Cardiovascular Events in Phase III and Long‐Term Extension Studies of Tofacitinib in Patients With Rheumatoid Arthritis , Arthritis & Rheumatology, 10.1002/art.40911, 71:9, (1450-1459), Online publication date: 1-Sep-2019. Sánchez-Acevedo M, Acosta-Chí Z, Sabino-Moxo B, Márquez-Domínguez J and Canton-Croda R (2019) Big Data Analysis for Cardiovascular Diseases Coronary and Cardiothoracic Critical Care, 10.4018/978-1-5225-8185-7.ch004, (60-77) Plante T, Juraschek S, Zakai N, Tracy R and Cushman M (2019) Comparison of Frequency of Atherosclerotic Cardiovascular Disease Events Among Primary and Secondary Prevention Subgroups of the Systolic Blood Pressure Intervention Trial, The American Journal of Cardiology, 10.1016/j.amjcard.2019.08.028, 124:11, (1701-1706), Online publication date: 1-Dec-2019. Nakas G, Bechlioulis A, Marini A, Vakalis K, Bougiakli M, Giannitsi S, Nikolaou K, Antoniadou E, Kotsia A, Gartzonika K, Chasiotis G, Bairaktari E, Katsouras C, Triantis G, Sionis D, Michalis L and Naka K (2019) The importance of characteristics of angina symptoms for the prediction of coronary artery disease in a cohort of stable patients in the modern era, Hellenic Journal of Cardiology, 10.1016/j.hjc.2018.06.003, 60:4, (241-246), Online publication date: 1-Jul-2019. Buettner R and Schunter M (2019) Efficient machine learning based detection of heart disease 2019 IEEE International Conference on E-health Networking, Application & Services (HealthCom), 10.1109/HealthCom46333.2019.9009429, 978-1-7281-0402-7, (1-6) Albarqouni L, Doust J, Magliano D, Barr E, Shaw J and Glasziou P (2019) External validation and comparison of four cardiovascular risk prediction models with data from the Australian Diabetes, Obesity and Lifestyle study, Medical Journal of Australia, 10.5694/mja2.12061, 210:4, (161-167), Online publication date: 1-Mar-2019. Liu Y, Li Q, Chen S, Wang X, Zhou Y, Tan N and Chen J (2018) A Simple Modified Framingham Scoring System to Predict Obstructive Coronary Artery Disease, Journal of Cardiovascular Translational Research, 10.1007/s12265-018-9837-6, 11:6, (495-502), Online publication date: 1-Dec-2018. Hermansson J and Kahan T (2017) Systematic Review of Validity Assessments of Framingham Risk Score Results in Health Economic Modelling of Lipid-Modifying Therapies in Europe, PharmacoEconomics, 10.1007/s40273-017-0578-1, 36:2, (205-213), Online publication date: 1-Feb-2018. Morieri M, Guardigni V, Sanz J, Dalla Nora E, Soavi C, Zuliani G, Sighinolfi L and Passaro A (2018) Adipokines levels in HIV infected patients: lipocalin-2 and fatty acid binding protein-4 as possible markers of HIV and antiretroviral therapy-related adipose tissue inflammation, BMC Infectious Diseases, 10.1186/s12879-017-2925-4, 18:1, Online publication date: 1-Dec-2018. Mai H, Pham T, Nguyen D and Dutkiewicz E (2018) Non-Laboratory-Based Risk Factors for Automated Heart Disease Detection 2018 12th International Symposium on Medical Information and Communication Technology (ISMICT), 10.1109/ISMICT.2018.8573706, 978-1-5386-3389-2, (1-6) Addington J, Goldstein B, Wang J, Kennedy S, Bray S, Lebel C, Hassel S, Marshall C and MacQueen G (2018) Youth at-risk for serious mental illness: methods of the PROCAN study, BMC Psychiatry, 10.1186/s12888-018-1801-0, 18:1, Online publication date: 1-Dec-2018. Ignjatović A, Stojanović M, Milošević Z and Anđelković Apostolović M (2017) Progress of statistical analysis in biomedical research through the historical review of the development of the Framingham score, Irish Journal of Medical Science (1971 -), 10.1007/s11845-017-1718-5, 187:3, (639-645), Online publication date: 1-Aug-2018. Brotons Cuixart C, Alemán Sánchez J, Banegas Banegas J, Fondón León C, Lobos-Bejarano J, Martín Rioboó E, Navarro Pérez J, Orozco-Beltrán D and Villar Álvarez F (2018) Recomendaciones preventivas cardiovasculares. Actualización PAPPS 2018, Atención Primaria, 10.1016/S0212-6567(18)30360-3, 50, (4-28), Online publication date: 1-May-2018. Nguyen T, Waits G and Soliman E (2018) The Role of Resting Electrocardiogram in Screening for Primary Prevention of Cardiovascular Diseases in High-Risk Groups, Current Cardiovascular Risk Reports, 10.1007/s12170-018-0572-y, 12:3, Online publication date: 1-Mar-2018. Spacek M, Zemanek D, Hutyra M, Sluka M and Taborsky M (2018) Vulnerable atherosclerotic plaque - a review of current concepts and advanced imaging, Biomedical Papers, 10.5507/bp.2018.004, 162:1, (10-17), Online publication date: 27-Mar-2018. LaFleur R and Goshko L (2018) The Uncertainty of Cardiovascular Disease Risk Calculation—What is the Best Risk Model for the Individual?, Journal of Engineering and Science in Medical Diagnostics and Therapy, 10.1115/1.4039103, 1:2, Online publication date: 1-May-2018. Yatsuya H (2018) OBSOLETE: Risk Prediction Reference Module in Biomedical Sciences, 10.1016/B978-0-12-801238-3.99611-9, . Chiavaroli L, Nishi S, Khan T, Braunstein C, Glenn A, Mejia S, Rahelić D, Kahleová H, Salas-Salvadó J, Jenkins D, Kendall C and Sievenpiper J (2018) Portfolio Dietary Pattern and Cardiovascular Disease: A Systematic Review and Meta-analysis of Controlled Trials, Progress in Cardiovascular Diseases, 10.1016/j.pcad.2018.05.004, 61:1, (43-53), Online publication date: 1-May-2018. Yatsuya H (2018) Risk Prediction Encyclopedia of Cardiovascular Research and Medicine, 10.1016/B978-0-12-809657-4.99611-X, (315-318), . Most J, Gilmore L, Smith S, Han H, Ravussin E and Redman L (2018) Significant improvement in cardiometabolic health in healthy nonobese individuals during caloric restriction-induced weight loss and weight loss maintenance, American Journal of Physiology-Endocrinology and Metabolism, 10.1152/ajpendo.00261.2017, 314:4, (E396-E405), Online publication date: 1-Apr-2018. Molina J, Grund B, Gordin F, Williams I, Schechter M, Losso M, Law M, Ekong E, Mwelase N, Skoutelis A, Wiselka M, Vandekerckhove L, Benfield T, Munroe D, Lundgren J and Neaton J (2018) Which HIV-infected adults with high CD4 T-cell counts benefit most from immediate initiation of antiretroviral therapy? A post-hoc subgroup analysis of the START trial, The Lancet HIV, 10.1016/S2352-3018(18)30003-1, 5:4, (e172-e180), Online publication date: 1-Apr-2018. Lin J, Evans C, Johnson E, Redmond N, Coppola E and Smith N (2018) Nontraditional Risk Factors in Cardiovascular Disease Risk Assessment, JAMA, 10.1001/jama.2018.4242, 320:3, (281), Online publication date: 17-Jul-2018. Ng R, Kornas K, Sutradhar R, Wodchis W and Rosella L (2018) The current application of the Royston-Parmar model for prognostic modeling in health research: a scoping review, Diagnostic and Prognostic Research, 10.1186/s41512-018-0026-5, 2:1, Online publication date: 1-Dec-2018. Kunstmann S and Gainza I (2018) HERRAMIENTAS PARA LA ESTIMACIÓN DEL RIESGO CARDIOVASCULAR, Revista Médica Clínica Las Condes, 10.1016/j.rmclc.2017.11.010, 29:1, (6-11), Online publication date: 1-Jan-2018. Leshno M, Goldbourt U, Pinchuk I and Lichtenberg D (2017) The cardiovascular benefits of indiscriminate supplementation of omega-3 fatty acids; meta-analysis and decision-making approach, International Journal of Food Sciences and Nutrition, 10.1080/09637486.2017.1402868, 69:5, (549-556), Online publication date: 4-Jul-2018. Kapwata T and Manda S (2018) Geographic assessment of access to health care in patients with cardiovascular disease in South Africa, BMC Health Services Research, 10.1186/s12913-018-3006-0, 18:1, Online publication date: 1-Dec-2018. Muccini C, Galli L, Poli A, Carbone A, Maillard M, Giusti M, Spagnuolo V, Bigoloni A, Guffanti M, Gianotti N, Lazzarin A and Castagna A (2018) Brief Report: Hyperbilirubinemia Is Associated With a Decreased Risk of Carotid Atherosclerosis in HIV-Infected Patients on Virological Suppression, JAIDS Journal of Acquired Immune Deficiency Syndromes, 10.1097/QAI.0000000000001854, 79:5, (617-623), Online publication date: 15-Dec-2018. Sánchez-Acevedo M, Acosta-Chí Z, Sabino-Moxo B, Márquez-Domínguez J and Canton-Croda R (2018) Big Data Analysis for Cardiovascular Diseases Big Data Management and the Internet of Things for Improved Health Systems, 10.4018/978-1-5225-5222-2.ch007, (102-119) Triant V, Perez J, Regan S, Massaro J, Meigs J, Grinspoon S and D'Agostino R (2018) Cardiovascular Risk Prediction Functions Underestimate Risk in HIV Infection, Circulation, 137:21, (2203-2214), Online publication date: 22-May-2018. Huang X, Wang X, Zou Y, Chen S, Zhang R, Li L, Yu B and Hou J (2017) Impact of Cigarette Smoking and Smoking Cessation on Stent Changes as Determined by Optical Coherence Tomography After Sirolimus Stent Implantation, The American Journal of Cardiology, 10.1016/j.amjcard.2017.07.011, 120:8, (1279-1284), Online publication date: 1-Oct-2017. Basu S, Sussman J and Hayward R (2017) Black-White Cardiovascular Disease Disparities After Target-Based Versus Personalized Benefit–Based Lipid and Blood Pressure Treatment, MDM Policy & Practice, 10.1177/2381468317725741, 2:2, (238146831772574), Online publication date: 1-Jul-2017. Gómez Gerique J, Ferreira Gonzalez I, Rubio Herrera M, Lora Pablos D, Martín Ballesteros B, García Sardina R and Gómez de la Cámara A (2017) Improvement of serum lipids concentration in a general population historical cohort. Why?, Clínica e Investigación en Arteriosclerosis, 10.1016/j.arteri.2017.07.001, 29:6, (239-247), Online publication date: 1-Nov-2017. Marini A, Naka K, Vakalis K, Bechlioulis A, Bougiakli M, Giannitsi S, Nikolaou K, Antoniadou E, Gartzonika C, Chasiotis G, Bairaktari E, Katsouras C, Triantis G, Sionis D and Michalis L (2017) Extent of coronary artery disease in patients undergoing angiography for stable or acute coronary syndromes, Hellenic Journal of Cardiology, 10.1016/j.hjc.2016.08.004, 58:2, (115-121), Online publication date: 1-Mar-2017. Roberto V, Bisan A, Fabrizio P, Francesco R and Emanuela S (2017) Replacement Meal: Effectiveness of a Soluble Powder Rich in Fibers and at Low Glycemic Index in Overweight but Not in Obese Patients, Food and Nutrition Sciences, 10.4236/fns.2017.86041, 08:06, (591-597), . Cichocki M, Fernandes K, Castro-Alves D and Gomes M (2017) ATIVIDADE FÍSICA E MODULAÇÃO DO RISCO CARDIOVASCULAR, Revista Brasileira de Medicina do Esporte, 10.1590/1517-869220172301159475, 23:1, (21-25), Online publication date: 1-Feb-2017. Zomer E, Leach R, Trimmer C, Lobstein T, Morris S, James W and Finer N (2016) Effectiveness and cost-effectiveness of interventions that cause weight loss and reduce the risk of cardiovascular disease, Diabetes, Obesity and Metabolism, 10.1111/dom.12792, 19:1, (118-124), Online publication date: 1-Jan-2017. Jenkins D, Boucher B, Ashbury F, Sloan M, Brown P, El-Sohemy A, Hanley A, Willett W, Paquette M, de Souza R, Ireland C, Kwan N, Jenkins A, Pichika S and Kreiger N (2017) Effect of Current Dietary Recommendations on Weight Loss and Cardiovascular Risk Factors, Journal of the American College of Cardiology, 10.1016/j.jacc.2016.10.089, 69:9, (1103-1112), Online publication date: 1-Mar-2017. Nian S, Feng L, Zhao Y, Luo F, Zhang S, Li D, Xu W, Zhang X, Ye D and Bai X (2017) Combination of susceptibility gene and traditional risk factors might enhance the performance of coronary heart disease screening strategy, Oncotarget, 10.18632/oncotarget.16692, 8:40, (69005-69011), Online publication date: 15-Sep-2017. Viramontes O, Swendeman D and Moreno G (2016) Efficacy of Behavioral Interventions on Biological Outcomes for Cardiovascular Disease Risk Reduction among Latinos: a Review of the Literature, Journal of Racial and Ethnic Health Disparities, 10.1007/s40615-016-0242-z, 4:3, (418-424), Online publication date: 1-Jun-2017. Most J, Tosti V, Redman L and Fontana L (2017) Calorie restriction in humans: An update, Ageing Research Reviews, 10.1016/j.arr.2016.08.005, 39, (36-45), Online publication date: 1-Oct-2017. Redfern J, Hyun K, Atkins E, Chow C, Briffa T, Patel B, Zwar N, Usherwood T, Li Q, Patel A and Peiris D (2017) Utilisation of Medicare-funded schemes for people with cardiovascular disease, Australian Journal of Primary Health, 10.1071/PY16166, 23:5, (482), . Lee S, Yun S, Kim D, Jo H and Park Y (2017) Severity of nonalcoholic fatty liver disease on sonography and risk of coronary heart disease, Journal of Clinical Ultrasound, 10.1002/jcu.22472, 45:7, (391-399), Online publication date: 1-Sep-2017. Elsayed H and Syed L (2017) An automatic early risk classification of hard coronary heart diseases using framingham scoring model ICC '17: Second International Conference on Internet of Things, Data and Cloud Computing, 10.1145/3018896.3036384, 9781450347747, (1-8), Online publication date: 22-Mar-2017. Beckstead J (2016) The Bifocal Lens Model and Equation, Medical Decision Making, 10.1177/0272989X16674196, 37:1, (35-45), Online publication date: 1-Jan-2017. Zakiev E, Nikiforov N and Orekhov A (2017) Cell-Based Models for Development of Antiatherosclerotic Therapies, BioMed Research International, 10.1155/

Diabetes and Atherosclerosis

2002-05-15

Joshua A. Beckman , Mark A. Creager , Peter Libby

ContextComplications of atherosclerosis cause most morbidity and mortality in patients with diabetes mellitus. Despite the frequency and severity of disease, proven medical therapy remains incompletely understood and underused.ObjectiveTo review the … ContextComplications of atherosclerosis cause most morbidity and mortality in patients with diabetes mellitus. Despite the frequency and severity of disease, proven medical therapy remains incompletely understood and underused.ObjectiveTo review the epidemiology, pathophysiology, and medical and invasive treatment of atherosclerosis in patients with diabetes mellitus.Data SourcesUsing the index terms diabetes mellitus, myocardial infarction, peripheral vascular diseases, cerebrovascular accident, endothelium, vascular smooth muscle, platelets, thrombosis, cholesterol, hypertension, hyperglycemia, insulin, angioplasty, and coronary artery bypass, we searched the MEDLINE and EMBASE databases from 1976 to 2001. Additional data sources included bibliographies of identified articles and preliminary data presented at recent cardiology conferences.Study SelectionWe selected original investigations and reviews of the epidemiology, pathophysiology, and therapy of atherosclerosis in diabetes. We selected randomized, double-blind, controlled studies, when available, to support therapeutic recommendations. Criteria for data inclusion (168 of 396) included publication in a peer-reviewed journal or presentation at a national cardiovascular society–sponsored meeting.Data ExtractionData quality was determined by publication in peer-reviewed literature. Data extraction was performed by one of the authors.Data SynthesisDiabetes mellitus markedly increases the risk of myocardial infarction, stroke, amputation, and death. The metabolic abnormalities caused by diabetes induce vascular dysfunction that predisposes this patient population to atherosclerosis. Blood pressure control, lipid-lowering therapy, angiotensin-converting enzyme inhibition, and antiplatelet drugs significantly reduce the risk of cardiovascular events. Although diabetic patients undergo revascularization procedures because of acute coronary syndromes or critical limb ischemia, the outcomes are less favorable than in nondiabetic cohorts.ConclusionsSince most patients with diabetes die from complications of atherosclerosis, they should receive intensive preventive interventions proven to reduce their cardiovascular risk.

Diabetic Cardiomyopathy Revisited

2007-06-25

Sihem Boudina , E. Dale Abel

Diabetes mellitus increases the risk of heart failure independently of underlying coronary artery disease, and many believe that diabetes leads to cardiomyopathy. The underlying pathogenesis is partially understood. Several factors … Diabetes mellitus increases the risk of heart failure independently of underlying coronary artery disease, and many believe that diabetes leads to cardiomyopathy. The underlying pathogenesis is partially understood. Several factors may contribute to the development of cardiac dysfunction in the absence of coronary artery disease in diabetes mellitus. This review discusses the latest findings in diabetic humans and in animal models and reviews emerging new mechanisms that may be involved in the development and progression of cardiac dysfunction in diabetes.

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Diabetes and cardiovascular disease. The Framingham study

1979-05-11

William B. Kannel

Based on 20 years of surveillance of the Framingham cohort relating subsequent cardiovascular events to prior evidence of diabetes, a twofold to threefold increased risk of clinical atherosclerotic disease was … Based on 20 years of surveillance of the Framingham cohort relating subsequent cardiovascular events to prior evidence of diabetes, a twofold to threefold increased risk of clinical atherosclerotic disease was reported. The relative impact was greatest for intermittent claudication (IC) and congestive heart failure (CHF) and least for coronary heart disease (CHD), which was, nevertheless, on an absolute scale the chief sequela. The relative impact was substantially greater for women than for men. For each of the cardiovascular diseases (CVD), morbidity and mortality were higher for diabetic women than for nondiabetic men. After adjustment for other associated risk factors, the relative impact of diabetes on CHD, IC, or stroke incidence was the same for women as for men; for CVD death and CHF, it was greater for women. Cardiovascular mortality was actually about as great for diabetic women as for diabetic men.

Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography

2008-08-04

Sherif F. Nagueh , C. P. Appleton , Thierry Gillebert +7 more

The assessment of left ventricular (LV) diastolic function should be an integral part of a routine examination, particularly in patients presenting with dyspnea or heart failure. About half of patients … The assessment of left ventricular (LV) diastolic function should be an integral part of a routine examination, particularly in patients presenting with dyspnea or heart failure. About half of patients with new diagnoses of heart failure have normal or near normal global ejection fractions (EFs). These patients are diagnosed with “diastolic heart failure” or “heart failure with preserved EF.”1 The assessment of LV diastolic function and filling pressures is of paramount clinical importance to distinguish this syndrome from other diseases such as pulmonary disease resulting in dyspnea, to assess prognosis, and to identify underlying cardiac disease and its best treatment. LV filling pressures as measured invasively include mean pulmonary wedge pressure or mean left atrial (LA) pressure (both in the absence of mitral stenosis), LV end-diastolic pressure (LVEDP; the pressure at the onset of the QRS complex or after A-wave pressure), and pre-A LV diastolic pressure (Figure 1).Although these pressures are different in absolute terms, they are closely related, and they change in a predictable progression with myocardial disease, such that LVEDP increases prior to the rise in mean LA pressure. Figure 1 The 4 phases of diastole are marked in relation to high-fidelity pressure recordings from the left atrium (LA) and left ventricle (LV) in anesthetized dogs. The first pressure crossover corresponds to the end of isovolumic relaxation and mitral valve opening. In the first phase, left atrial pressure exceeds left ventricular pressure, accelerating mitral flow. Peak mitral E roughly corresponds to the second crossover. Thereafter, left ventricular pressure exceeds left atrial pressure, decelerating mitral flow. These two phases correspond to rapid filling. This is followed by slow filling, with almost no pressure differences. During atrial contraction, left atrial pressure again exceeds left ventricular pressure. The solid arrow points to left ventricular minimal pressure, the dotted arrow to left ventricular …

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Multiple Range and Multiple F Tests

1955-03-01

David B. Duncan

Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements.

1978-12-01

David J. Sahn , A N Demaria , Joseph Kisslo +1 more

Four hundred M-mode echocardiographic surveys were distributed to determine interobserver variability in M-mode echocardiographic measurements. This was done with a view toward examining the need and determining the criteria for … Four hundred M-mode echocardiographic surveys were distributed to determine interobserver variability in M-mode echocardiographic measurements. This was done with a view toward examining the need and determining the criteria for standardization of measurement. Each survey consisted of five M-mode echocardiograms with a calibration marker, measured by the survey participants anonymously. The echoes were judged of adequate quality for measurement of structures. Seventy-six of the 400 (19%) were returned, allowing comparison of interobserver variability as well as examination of the measurement criteria which were used. Mean measurements and percent uncertainty were derived for each structure for each criterion of measurement. For example, for the aorta, 33% of examiners measured the aorta as an outer/inner or leading edge dimension, and 20% measured it as an outer/outer dimension. The percent uncertainty for the measurement (1.97 SD divided by the mean) showed a mean of 13.8% for the 25 packets of five echoes measured using the former criteria and 24.2% using the latter criteria. For ventricular chamber and cavity measurements, almost one-half of the examiners used the peak of the QRS and one-half of the examiners used the onset of the QRS for determining end-diastole. Estimates of the percent of measurement uncertainty for the septum, posterior wall and left ventricular cavity dimension in this study were 10--25%. They were much higher (40--70%) for the right ventricular cavity and right ventricular anterior wall. The survey shows significant interobserver and interlaboratory variation in measurement when examining the same echoes and indicates a need for ongoing education, quality control and standardization of measurement criteria. Recommendations for new criteria for measurement of M-mode echocardiograms are offered.

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Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, Developed in Conjunction with the European Association of Echocardiography, a Branch of the European Society of Cardiology

2005-12-01

Roberto M. Lang , Michelle Bierig , Richard B. Devereux +7 more

Wall stress and patterns of hypertrophy in the human left ventricle.

1975-07-01

William Grossman , David R. Jones , Lambert P. McLaurin

It is generally recognized that chronic left ventricular (LV) pressure overload results primarily in wall thickening and concentric hypertrophy, while chronic LV volume overload is characterized by chamber enlargement and … It is generally recognized that chronic left ventricular (LV) pressure overload results primarily in wall thickening and concentric hypertrophy, while chronic LV volume overload is characterized by chamber enlargement and an eccentric pattern of hypertrophy. To assess the potential role of the hemodynamic factors which might account for these different patterns of hypertrophy, we measured LV wall stresses throughout the cardiac cycle in 30 patients studied at the time of cardiac catheterization. The study group consisted of 6 subjects with LV pressure overload, 18 with LV volume overload, and 6 with no evidence of heart disease (control). LV pressure, meridional wall stress (sigman), wall thickness (h), and radius (R) were measured in each patient throughout the cardiac cycle. For patients with pressure overload, LV peak systolic and end diastolic pressures were significantly increased (220 plus or minus 6/23 plus or minus 3 mm Hg) compared to control (117 plus or minus 7/10 plus or minus 1 mm Hg, P less than 0.01 for each). However, peak systolic and end diastolic (sigman) were normal (161 plus or minus 24/23 plus or minus 3 times 10-3 dyn/cm-2) compared to control (151 plus or minus 14/17 plus or minus 2 times 10-3 dyn/cm-2, NS), reflecting the fact that the pressure overload was exactly counterbalanced by increased wall thickness (1.5 plus or minus 0.1 cm for pressure overload vs. 0.8 plus or minus 0.1 cm for control, P less than 0.01). For patients with volume overload, peak systolic (sigman) was not significantly different from control, but end diastolic (sigmam) was consistently higher than normal (41 plus or minus 3 times 10-3 dyn/cm-2 for volume overload, 17 plus or minus 2 times 10-3 dyn/cm-2 for control, P less than 0.01). LV pressure overload was associated with concentric hypertrophy, and an increased value for the ratio of wall thickness to radius (h/R ratio). In contrast, LV volume overload was associated with eccentric hypertrophy, and a normal h/R ratio. These data suggest the hypothesis that hypertrophy develops to normalize systolic but not diastolic wall stress. We propose that increased systolic tension development by myocardial fibers results in fiber thickening just sufficient to return the systolic stress (force per unit cross-sectional area) to normal. In contrast, increased resting or diastolic tension appears to result in gradual fiber elongation or lengthening which improves efficiency of the ventricular chamber but cannot normalize the diastolic wall stress.

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How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology

2007-04-11

Walter J. Paulus , Carsten Tschöpe , John E. Sanderson +7 more

Diastolic heart failure (DHF) currently accounts for more than 50% of all heart failure patients. DHF is also referred to as heart failure with normal left ventricular (LV) ejection fraction … Diastolic heart failure (DHF) currently accounts for more than 50% of all heart failure patients. DHF is also referred to as heart failure with normal left ventricular (LV) ejection fraction (HFNEF) to indicate that HFNEF could be a precursor of heart failure with reduced LVEF. Because of improved cardiac imaging and because of widespread clinical use of plasma levels of natriuretic peptides, diagnostic criteria for HFNEF needed to be updated. The diagnosis of HFNEF requires the following conditions to be satisfied: (i) signs or symptoms of heart failure; (ii) normal or mildly abnormal systolic LV function; (iii) evidence of diastolic LV dysfunction. Normal or mildly abnormal systolic LV function implies both an LVEF > 50% and an LV end-diastolic volume index (LVEDVI) <97 mL/m2. Diagnostic evidence of diastolic LV dysfunction can be obtained invasively (LV end-diastolic pressure >16 mmHg or mean pulmonary capillary wedge pressure >12 mmHg) or non-invasively by tissue Doppler (TD) (E/E′ > 15). If TD yields an E/E′ ratio suggestive of diastolic LV dysfunction (15 > E/E′ > 8), additional non-invasive investigations are required for diagnostic evidence of diastolic LV dysfunction. These can consist of blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, electrocardiographic evidence of atrial fibrillation, or plasma levels of natriuretic peptides. If plasma levels of natriuretic peptides are elevated, diagnostic evidence of diastolic LV dysfunction also requires additional non-invasive investigations such as TD, blood flow Doppler of mitral valve or pulmonary veins, echo measures of LV mass index or left atrial volume index, or electrocardiographic evidence of atrial fibrillation. A similar strategy with focus on a high negative predictive value of successive investigations is proposed for the exclusion of HFNEF in patients with breathlessness and no signs of congestion. The updated strategies for the diagnosis and exclusion of HFNEF are useful not only for individual patient management but also for patient recruitment in future clinical trials exploring therapies for HFNEF.

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Myocardial Fatty Acid Metabolism in Health and Disease

2010-01-01

Gary D. Lopaschuk , John R. Ussher , Clifford D.L. Folmes +2 more

There is a constant high demand for energy to sustain the continuous contractile activity of the heart, which is met primarily by the beta-oxidation of long-chain fatty acids. The control … There is a constant high demand for energy to sustain the continuous contractile activity of the heart, which is met primarily by the beta-oxidation of long-chain fatty acids. The control of fatty acid beta-oxidation is complex and is aimed at ensuring that the supply and oxidation of the fatty acids is sufficient to meet the energy demands of the heart. The metabolism of fatty acids via beta-oxidation is not regulated in isolation; rather, it occurs in response to alterations in contractile work, the presence of competing substrates (i.e., glucose, lactate, ketones, amino acids), changes in hormonal milieu, and limitations in oxygen supply. Alterations in fatty acid metabolism can contribute to cardiac pathology. For instance, the excessive uptake and beta-oxidation of fatty acids in obesity and diabetes can compromise cardiac function. Furthermore, alterations in fatty acid beta-oxidation both during and after ischemia and in the failing heart can also contribute to cardiac pathology. This paper reviews the regulation of myocardial fatty acid beta-oxidation and how alterations in fatty acid beta-oxidation can contribute to heart disease. The implications of inhibiting fatty acid beta-oxidation as a potential novel therapeutic approach for the treatment of various forms of heart disease are also discussed.

Role of diabetes in congestive heart failure: The Framingham study

1974-07-01

William B. Kannel , Marthana C. Hjortland , William P. Castelli

Recommendations for chamber quantification☆

2006-02-04

Roberto M. Lang , Michelle Bierig , R DEVEREUX +7 more

Quantification of cardiac chamber size, ventricular mass and function ranks among the most clinically important and most frequently requested tasks of echocardiography. Over the last decades, echocardiographic methods and techniques … Quantification of cardiac chamber size, ventricular mass and function ranks among the most clinically important and most frequently requested tasks of echocardiography. Over the last decades, echocardiographic methods and techniques have improved and expanded dramatically, due to the introduction of higher frequency transducers, harmonic imaging, fully digital machines, left-sided contrast agents, and other technological advancements. Furthermore, echocardiography due to its portability and versatility is now used in emergency rooms, operating rooms, and intensive care units. Standardization of measurements in echocardiography has been inconsistent and less successful, compared to other imaging techniques and consequently, echocardiographic measurements are sometimes perceived as less reliable. Therefore, the American Society of Echocardiography, working together with the European Association of Echocardiography, a branch of the European Society of Cardiology, has critically reviewed the literature and updated the recommendations for quantifying cardiac chambers using echocardiography. This document reviews the technical aspects on how to perform quantitative chamber measurements of morphology and function, which is a component of every complete echocardiographic examination.

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ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC

2012-05-19

John J.V. McMurray , Stamatis Adamopoulos , Stefan D. Anker +7 more

ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 : The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 … ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 : The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC

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Recommendations for quantification of Doppler echocardiography: A report from the Doppler quantification task force of the nomenclature and standards committee of the American Society of Echocardiography

2002-02-01

Miguel A. Quiñones , Catherine M Otto , Marcus F. Stoddard +2 more

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The Failing Heart — An Engine Out of Fuel

2007-03-14

Stefan Neubauer

Abnormalities of cardiac energy metabolism make an important contribution to chronic heart failure. This review summarizes the main events in cardiac energy metabolism, discusses abnormalities in these metabolic processes in … Abnormalities of cardiac energy metabolism make an important contribution to chronic heart failure. This review summarizes the main events in cardiac energy metabolism, discusses abnormalities in these metabolic processes in heart failure, and looks to future treatments of heart failure that entail correction of the metabolic defects.

Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial

2005-10-01

John Dormandy , B Charbonnel , D.J.A. Eckland +7 more

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Epidemiology of Heart Failure

2013-08-29

Véronique L. Roger

Heart failure (HF) has been singled out as an epidemic and is a staggering clinical and public health problem, associated with significant mortality, morbidity, and healthcare expenditures, particularly among those … Heart failure (HF) has been singled out as an epidemic and is a staggering clinical and public health problem, associated with significant mortality, morbidity, and healthcare expenditures, particularly among those aged ≥65 years. The case mix of HF is changing over time with a growing proportion of cases presenting with preserved ejection fraction for which there is no specific treatment. Despite progress in reducing HF-related mortality, hospitalizations for HF remain frequent and rates of readmissions continue to rise. To prevent hospitalizations, a comprehensive characterization of predictors of readmission in patients with HF is imperative and must integrate the impact of multimorbidity related to coexisting conditions. New models of patient-centered care that draw on community-based resources to support HF patients with complex coexisting conditions are needed to decrease hospitalizations.

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Guidelines for the Echocardiographic Assessment of the Right Heart in Adults: A Report from the American Society of Echocardiography

2010-06-24

Lawrence Rudski , Wyman W. Lai , Jonathan Afilalo +6 more

New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function--a study in normals and dilated cardiomyopathy.

1995-12-01

Chuwa Tei , Lieng H. Ling , D.O. Hodge +5 more

Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

2016-03-30

Sherif F. Nagueh , Otto A. Smiseth , Christopher P. Appleton +7 more

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Mortality from Coronary Heart Disease in Subjects with Type 2 Diabetes and in Nondiabetic Subjects with and without Prior Myocardial Infarction

1998-07-23

Steven M. Haffner , Seppo Lehto , Tapani Rönnemaa +2 more

Type 2 (non-insulin-dependent) diabetes is associated with a marked increase in the risk of coronary heart disease. It has been debated whether patients with diabetes who have not had myocardial … Type 2 (non-insulin-dependent) diabetes is associated with a marked increase in the risk of coronary heart disease. It has been debated whether patients with diabetes who have not had myocardial infarctions should be treated as aggressively for cardiovascular risk factors as patients who have had myocardial infarctions.

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Prognostic Implications of Echocardiographically Determined Left Ventricular Mass in the Framingham Heart Study

1990-05-31

Daniel Levy , Robert J. Garrison , Daniel D. Savage +2 more

A pattern of left ventricular hypertrophy evident on the electrocardiogram is a harbinger of morbidity and mortality from cardiovascular disease. Echocardiography permits the noninvasive determination of left ventricular mass and … A pattern of left ventricular hypertrophy evident on the electrocardiogram is a harbinger of morbidity and mortality from cardiovascular disease. Echocardiography permits the noninvasive determination of left ventricular mass and the examination of its role as a precursor of morbidity and mortality. We examined the relation of left ventricular mass to the incidence of cardiovascular disease, mortality from cardiovascular disease, and mortality from all causes in 3220 subjects enrolled in the Framingham Heart Study who were 40 years of age or older and free of clinically apparent cardiovascular disease, in whom left ventricular mass was determined echocardiographically.

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Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

2016-07-15

Sherif F. Nagueh , Otto A. Smiseth , Christopher P. Appleton +7 more

Echocardiographic assessment of left ventricular (LV) diastolic function is an integral part of the routine evaluation of patients presenting with symptoms of dyspnea or heart failure. The 2009 American Society … Echocardiographic assessment of left ventricular (LV) diastolic function is an integral part of the routine evaluation of patients presenting with symptoms of dyspnea or heart failure. The 2009 American Society of Echocardiography (ASE) and European Association of Echocardiography (now European Association of Cardiovascular Imaging [EACVI]) guidelines for diastolic function assessment were comprehensive, including several two-dimensional (2D) and Doppler parameters to grade diastolic dysfunction and to estimate LV filling pressures.1 Notwithstanding, the inclusion of many parameters in the guidelines was perceived to render diastolic function assessment too complex, because several readers have interpreted the guidelines as mandating all the listed parameters in the document to fall within specified values before assigning a specific grade. The primary goal of this update is to simplify the approach and thus increase the utility of the guidelines in daily clinical practice. LV diastolic dysfunction is usually the result of impaired LV relaxation with or without …

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Heart Disease and Stroke Statistics—2006 Update

2006-01-12

Thomas Thom , Nancy Haase , Wayne D. Rosamond +7 more

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Heart Disease and Stroke Statistics—2010 Update

2009-12-18

Donald M. Lloyd‐Jones , Robert J. Adams , Todd M. Brown +7 more

Heart Disease and Stroke Statistics—2007 Update

2006-12-29

Wayne D. Rosamond , Katherine M. Flegal , Gary Friday +7 more

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ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

2005-09-14

Sharon A. Hunt , William T. Abraham , Marshall H. Chin +7 more

It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced and tested in the detection, … It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced and tested in the detection, management, or prevention of disease states.Rigorous and expert analysis of the available data documenting relative benefits and risks of those procedures and therapies can produce helpful guidelines that improve the effectiveness of care, optimize patient outcomes, and favorably affect the overall cost of care by focusing resources on the most effective strategies.The American College of Cardiology (ACC) and the American Heart Association (AHA) have jointly engaged in the production of such guidelines in the area of cardiovascular disease since 1980.This effort is directed by the ACC/AHA Task Force on Practice Guidelines, whose charge is to develop and revise practice guidelines for important cardiovascular diseases and procedures.Experts in the subject under consideration are selected from both organizations and charged with examining subject-specific data and writing or updating these guidelines.The process includes additional representatives from other medical practitioner and specialty groups where appropriate.Writing groups are specifically charged to perform a formal literature review, weigh the strength of evidence for or against a particular treatment or procedure, and include estimates of expected health outcomes where data exist.Patient-specific modifiers, comorbidities, and issues of patient preference that might influence the choice of particular tests or therapies are considered, as are frequency of follow-up and cost-effectiveness.When available, information from studies on cost will be considered; however, review of data on efficacy and clinical out-e156

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Heart Disease and Stroke Statistics—2009 Update

2008-12-16

Donald M. Lloyd‐Jones , Robert J. Adams , Mercedes R. Carnethon +7 more

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Association between insulin resistance and the development of cardiovascular disease

2018-08-31

Valeska Ormazábal , Soumyalekshmi Nair , Omar Elfeky +3 more

For many years, cardiovascular disease (CVD) has been the leading cause of death around the world. Often associated with CVD are comorbidities such as obesity, abnormal lipid profiles and insulin … For many years, cardiovascular disease (CVD) has been the leading cause of death around the world. Often associated with CVD are comorbidities such as obesity, abnormal lipid profiles and insulin resistance. Insulin is a key hormone that functions as a regulator of cellular metabolism in many tissues in the human body. Insulin resistance is defined as a decrease in tissue response to insulin stimulation thus insulin resistance is characterized by defects in uptake and oxidation of glucose, a decrease in glycogen synthesis, and, to a lesser extent, the ability to suppress lipid oxidation. Literature widely suggests that free fatty acids are the predominant substrate used in the adult myocardium for ATP production, however, the cardiac metabolic network is highly flexible and can use other substrates, such as glucose, lactate or amino acids. During insulin resistance, several metabolic alterations induce the development of cardiovascular disease. For instance, insulin resistance can induce an imbalance in glucose metabolism that generates chronic hyperglycemia, which in turn triggers oxidative stress and causes an inflammatory response that leads to cell damage. Insulin resistance can also alter systemic lipid metabolism which then leads to the development of dyslipidemia and the well-known lipid triad: (1) high levels of plasma triglycerides, (2) low levels of high-density lipoprotein, and (3) the appearance of small dense low-density lipoproteins. This triad, along with endothelial dysfunction, which can also be induced by aberrant insulin signaling, contribute to atherosclerotic plaque formation. Regarding the systemic consequences associated with insulin resistance and the metabolic cardiac alterations, it can be concluded that insulin resistance in the myocardium generates damage by at least three different mechanisms: (1) signal transduction alteration, (2) impaired regulation of substrate metabolism, and (3) altered delivery of substrates to the myocardium. The aim of this review is to discuss the mechanisms associated with insulin resistance and the development of CVD. New therapies focused on decreasing insulin resistance may contribute to a decrease in both CVD and atherosclerotic plaque generation.

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Recommendations for Quantitation of the Left Ventricle by Two-Dimensional Echocardiography

1989-09-01

Nelson B. Schiller , Pravin M. Shah , Michael H. Crawford +7 more

Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography

2009-02-01

Sherif F. Nagueh , Christopher P. Appleton , Thierry Gillebert +7 more

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Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging

2015-02-23

Roberto M. Lang , Luigi P. Badano , Victor Mor‐Avi +7 more

The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously … The rapid technological developments of the past decade and the changes in echocardiographic practice brought about by these developments have resulted in the need for updated recommendations to the previously published guidelines for cardiac chamber quantification, which was the goal of the joint writing group assembled by the American Society of Echocardiography and the European Association of Cardiovascular Imaging. This document provides updated normal values for all four cardiac chambers, including three-dimensional echocardiography and myocardial deformation, when possible, on the basis of considerably larger numbers of normal subjects, compiled from multiple databases. In addition, this document attempts to eliminate several minor discrepancies that existed between previously published guidelines.

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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure

2016-05-20

Piotr Ponikowski , Adriaan A. Voors , Stefan D. Anker +7 more

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Left atrial and ventricular strain and extracellular volume fraction in patients with paroxysmal and persistent atrial fibrillation

2025-06-25

Masafumi Takafuji , Masaki Ishida , Yoshihiko Kagawa +7 more | The International Journal of Cardiovascular Imaging

The impact of experimental designs & system sloppiness on the personalisation process: A cardiovascular perspective

2025-06-24

Harry Saxton , Daniel J. Taylor , Gabriele Faulkner +6 more | PLoS ONE

To employ a reduced-order cardiovascular model as a digital twin for personalised medicine, it is essential to understand how uncertainties in the model’s input parameters affect its outputs. The aim … To employ a reduced-order cardiovascular model as a digital twin for personalised medicine, it is essential to understand how uncertainties in the model’s input parameters affect its outputs. The aim is to identify a set of input parameters that can serve as clinical biomarkers, providing insight into a patient’s physiological state. Given the challenge of finding useful clinical data, careful consideration must be given to the experimental design used to acquire patient-specific input parameters. Model sloppiness—where numerous parameter combinations have minimal impact on model predictions, whilst only a few parameters significantly influence outcomes—is a critical concept in this context. In this paper, we conduct the first quantification of a cardiovascular system’s sloppiness to elucidate the structure of the input parameter space. By utilising Sobol indices and examining various synthetic cardiovascular measures with increasing invasiveness, we uncover how the personalisation process and the cardiovascular system’s sloppiness are contingent upon the chosen experimental design. Our findings reveal that continuous clinical measures induce system sloppiness and increase the number of personalisable biomarkers, whereas discrete clinical measurements produce a non-sloppy system with a reduced number of biomarkers. This study underscores the necessity for careful consideration of available clinical data as differing measurement sets can significantly impact model personalisation.

The role of myocardial fibrosis in the diabetic cardiomyopathy

2025-06-24

Jinghui Sun , Ruiling Zhou , Mi Liu +1 more | Diabetology & Metabolic Syndrome

Diabetic cardiomyopathy (DCM), a main cardiovascular complication of diabetes mellitus, can eventually develop into heart failure and seriously affect the prognosis of diabetic patients. Myocardial fibrosis (MF) is the main … Diabetic cardiomyopathy (DCM), a main cardiovascular complication of diabetes mellitus, can eventually develop into heart failure and seriously affect the prognosis of diabetic patients. Myocardial fibrosis (MF) is the main factor causing ventricular wall stiffness and heart failure in DCM. Early control of MF in DCM is of great significance to prevent or postpone the progression of DCM to heart failure. In this review, we systematically analyzed the relevant studies on diabetic MF in recent years, explored the formation mechanism of MF in the pathological process of DCM, and summarized and analyzed in detail the current studies with antifibrotic treatment for DCM, so as to provide guidance for the development of prevention and treatment strategies for MF in DCM.

Interplay of coronary dominance and biventricular function: insights from speckle tracking echocardiography

2025-06-24

Laila Mohamad Elmaghawry , Eman Seddik , Eslam Mohammed +3 more | Cardiology Plus

Background and purpose: The relationship between coronary anatomy and ventricular function is not fully understood, particularly in the context of normal coronary dominance (CD) patterns. This study aims to use … Background and purpose: The relationship between coronary anatomy and ventricular function is not fully understood, particularly in the context of normal coronary dominance (CD) patterns. This study aims to use speckle tracking echocardiography (STE) to investigate biventricular function across various CD patterns. The main goal of the study is to detect and measure variations in biventricular function associated with normal CD patterns using STE. Methods: This cross-sectional study included 91 individuals with confirmed normal coronary angiography findings. Among them, 56 had right coronary dominance (RCD), 24 had left coronary dominance (LCD), and 11 had co-coronary dominance (CCD). Conventional echo-Doppler imaging and STE were used to assess left ventricular (LV) and right ventricular (RV) functions. The correlation between the CD patterns and ventricular function indices was assessed. Results: The mean age was 50.25 ± 11.03 years, with 50.5% females. No significant differences were found in demographics, risk factors, or RV function. Conventional LV function indices showed no variance, but LV global longitudinal strain (GLS) was significantly higher in LCD and CCD than in RCD (P < 0.001). The LCD pattern correlated with LV GLS ( r = −0.55, P = 0.005) and emerged as its sole independent predictor (P < 0.001). This suggests a strong association between the LCD pattern and enhanced LV GLS. Conclusions: This study highlights the potential influence of normal CD patterns on ventricular function, as assessed by STE. The LV was functionally dominant in the context of normal anatomical LCD. Meanwhile, the CD pattern had an insignificant effect on RV function.

EXPRESS: Exploring the Nexus between Myocardial Microcirculation Perfusion and Contractile Mechanics in Nonobstructive Hypertrophic Cardiomyopathy

2025-06-24

Jing Nan , Lina Guan , Chao Yuan +2 more | Journal of Investigative Medicine

This study quantitatively analyzed myocardial microcirculation perfusion in nonobstructive hypertrophic cardiomyopathy (HCM) patients and evaluated their mechanical properties. A total of 56 individuals were involved, consisting of 28 nonobstructive HCM … This study quantitatively analyzed myocardial microcirculation perfusion in nonobstructive hypertrophic cardiomyopathy (HCM) patients and evaluated their mechanical properties. A total of 56 individuals were involved, consisting of 28 nonobstructive HCM patients and an equal number of healthy volunteers. Each participant underwent comprehensive diagnostic procedures, including two-dimensional echocardiography, contrast-enhanced myocardial ultrasound (MCE), and two-dimensional speckle tracking imaging (2D-STI). Nonobstructive HCM patients were further classified into two groups based on the extent of myocardial hypertrophy: hypertrophic segmental myocardium (HS) and nonhypertrophic segmental myocardium (NHS). The study's findings indicated no significant differences in essential demographic factors such as age, height, and weight between the nonobstructive HCM and control groups. However, significant disparities were observed in myocardial perfusion and mechanical properties between these groups, particularly in aspects such as myocardial thickness (MT), tricuspid regurgitation (TR), and left atrial volume (LAV). Notably, the myocardial global longitudinal strain (GLS) is significantly decreased in patients with nonobstructive HCM, whereas the global circumferential strain (GCS) changes are not easily discernible. A notable positive correlation existed within the HS between myocardial perfusion parameters and mechanical properties. The study concluded that myocardial microcirculation perfusion and GLS are impaired in nonobstructive HCM patients, with more pronounced damage in HS, closely associated with alterations in myocardial mechanical characteristics.

[Association of plasma 8-hydroxy-2'-deoxyguanosine with left ventricular diastolic dysfunction in asymptomatic patients with type 2 diabetes].

2025-06-24

H. J. Yang , Hong Shu , Qi Hou +2 more | PubMed

Objective: To explore the predictive value of mitochondrial oxidative stress biomarkers 8-hydroxy-2'-deoxyguanosine (8-OHdG) and mitochondrial DNA (mtDNA) copy number in asymptomatic type 2 diabetes mellitus (T2DM) patient with left ventricular … Objective: To explore the predictive value of mitochondrial oxidative stress biomarkers 8-hydroxy-2'-deoxyguanosine (8-OHdG) and mitochondrial DNA (mtDNA) copy number in asymptomatic type 2 diabetes mellitus (T2DM) patient with left ventricular diastolic dysfunction. Methods: This was a cross-sectional study. T2DM patients without cardiovascular symptoms who were admitted to the Department of Endocrinology, the Third Affiliated Hospital of Soochow University between April 2018 and May 2022 were enrolled. According to the HFA-PEFF score, the enrolled patients were divided into three groups: the T2DM group (HFA-PEFF score ≤1), the left ventricular diastolic dysfunction suspected positive group (HFA-PEFF score 2-4), and the left ventricular diastolic dysfunction positive group (HFA-PEFF score ≥5). Multivariate logistic regression was performed to evaluate the association of plasma 8-OHdG level and mtDNA copy number with left ventricular diastolic dysfunction in patients with T2DM. Receiver operating characteristic curves were constructed to evaluate the predictive ability of plasma 8-OHdG level and its combination with baseline clinical data for left ventricular diastolic dysfunction in T2DM patients, and stratified analysis was performed by sex, age, diabetes duration and hemoglobin A1c levels. Results: A total of 163 T2DM patients without cardiovascular symptoms, aged (54.0±8.7) years, including 93 males (57.1%), were enrolled. Compared with T2DM group, patients in left ventricular diastolic dysfunction suspected positive and positive groups (44.59 (27.72, 55.58) μg/L vs. 93.23 (59.58, 129.80) μg/L vs. 101.91 (71.39, 137.39) μg/L, P<0.05) had significantly higher plasma 8-OHdG levels, while mtDNA copy number showed no statistically significant differences among the three groups (both P>0.05). Multivariate logistic regression analysis showed that after adjusting for confounder factors, elevated plasma 8-OHdG level were independently associated with both suspected positive left ventricular diastolic dysfunction (OR=1.036, 95%CI 1.019-1.053, P<0.001) and positive left ventricular diastolic dysfunction (OR=1.035, 95%CI 1.018-1.053, P<0.001). mtDNA copy number showed no significant association with T2DM accompanied by left ventricular diastolic dysfunction (P>0.05). Stratified analysis indicated that elevated plasma 8-OHdG level was significantly associated with left ventricular diastolic dysfunction in different age, sex, diabetes course and hemoglobin A1c levels subgroups (all P<0.05). The receiver operating characteristic curves indicated that the combination of baseline clinical data with 8-OhdG level (AUC=0.871, 95%CI 0.814-0.928, P<0.001) is more effective in predicting asymptomatic left ventricular diastolic dysfunction in T2DM patients than 8-OHdG (AUC=0.783, 95%CI 0.704-0.861, P<0.001) or baseline clinical data (AUC=0.736, 95%CI 0.647-0.826, P=0.001) alone. Conclusion: The mitochondrial oxidative stress biomarker 8-OHdG combined with baseline clinical data has good predictive value for asymptomatic left ventricular diastolic dysfunction in T2DM patients, and is expected to be a biomarker to identify diabetes mellitus with asymptomatic diastolic dysfunction.

ConUDiff: diffusion model with contrastive pretraining and uncertain region optimization for segmentation of left ventricle from echocardiography

2025-06-24

Guohuan Zhang , Lei Zhang , Xiaoying Fu +4 more | Pattern Analysis and Applications

Effects of Cardiac Contractility Modulation on Right Ventricular and Left Atrial Strain in Patients with Chronic Heart Failure

2025-06-24

Cornelia Raab , Peter Roehl , Matthias Wiora +1 more | Journal of Clinical Medicine

Background: Cardiac contractility modulation (CCM) is an established therapy for patients with heart failure with a reduced ejection fraction (HFrEF) who are still symptomatic despite guideline-directed medical therapy. It has … Background: Cardiac contractility modulation (CCM) is an established therapy for patients with heart failure with a reduced ejection fraction (HFrEF) who are still symptomatic despite guideline-directed medical therapy. It has been described previously that CCM leads to both an improvement of heart failure symptoms as well as of the parameters of left ventricular (LV) function, including LVEF and global longitudinal strain (GLS). However, so far there are no reports describing the effects of CCM on right ventricular (RV) or left atrial (LA) function, respectively. This might be of particular interest as RV global strain (RV GS) and LA strain are important prognostic parameters in heart failure. Methods: Adult patients with heart failure with reduced left ventricular function (LVEF <45%) and a QRS complex <130 ms despite guideline-directed medical therapy and with an indication for CCM were eligible for inclusion into this study. Patients receive a follow-up examination every 3 months, including a standardized echocardiographic examination with a special focus on strain analysis. While the effects of CCM on LV global longitudinal strain have been described before, this analysis reports the findings on the RV and LA strain. Results: Between 30.12.2021 and 10.09.2024, 22 patients were prospectively included in the study. CCM implantation was performed in 19 patients. Under active CCM therapy, there was an improvement in right ventricular global strain (CCM: −13.7 ± 4.5 vs. no CCM: −10.1 ± 5.0; p < 0.05), free wall strain (CCM: −14.6 ± 7.3 vs. no CCM: −10.3 ± 10.2; p < 0.05), left atrium strain rate (CCM: 19.7 ± 1.0 vs. no CCM: 15.3 ± 10.2; p < 0.05), and left atrium strain contraction (CCM: −11.5 ± 7.0 vs. no CCM: −7.1 ± 8.5; p < 0.05), whereas there was no difference in left atrium strain conduit (CCM: −9.0 ± 5.0 vs. no CCM: −8.1 ± 5.4; n.s.). To determine which of these parameters are linked to an improvement of quality of life, as seen in the Kansas City Heart Failure Questionnaire (KCCQ), a regression analysis was performed. It turned out that only the parameters of left atrial (LA) strain (LAS_R and LAS_CT) were significantly associated with improved quality of life, while other echocardiographic parameters, such as LV-EF, LV-GLS, and RV-GS, showed no clear association. Conclusions: CCM therapy is not only associated with improvements of left ventricular function but also restores right ventricular and left atrial strain in patients with HFrEF. Regarding the improvement in quality of life, the increase of LA strain seems to be of special importance.

Strain echocardiography for perioperative assessment of the left ventricle and left atrium in patients undergoing coronary artery bypass surgery

2025-06-23

И.В. Кокшенева , L. I. Kaplenko , Е.П. Голубев +5 more | Russian Journal of Cardiology and Cardiovascular Surgery

Objective. To evaluate the left ventricle (LV) and left atrium (LA)strain in early and mid-term postoperative period after CABG, and to analyze the effect on the risk of postoperative complications. … Objective. To evaluate the left ventricle (LV) and left atrium (LA)strain in early and mid-term postoperative period after CABG, and to analyze the effect on the risk of postoperative complications. Material and methods. The study included 84 patients with coronary artery disease who underwent CABG. The study cohort consisted of 82 (80%) men and 21 (20%) women aged 62.9±1.0 years. LV and LA strain and strain rate was analyzed before surgery, after 7 days and in mid-term (1 year) period after CABG. Humoral markers (CRP, TNF-α, IL-6, IL-8, Bcl-2, cytochrome C, SOD, troponin-I, MB-creatinephosphokinase) were estimated before surgery, 6 and 24 hours after CABG. Results. CABG is associated with significant early postoperative reduction in LV and LA strain. A year after surgery, these indicators returned to preoperative values and improved later. Reduced mechanical function of the left atrium, increased LA stiffness before surgery and in early postoperative period predict the risk of atrial fibrillation after CABG. The following preoperative factors associated with atrial fibrillation were established: LASr <9%, LAScd <7%, LA stiffness >0.7. Postoperative indicators associated with atrial fibrillation were established: LAScd <4%, LASct <4%, LASRr <0.4 s–1, LASRcd <0.4 s–1, LA stiffness >0.9. Conclusion. Strain-echocardiography is accurate diagnostic tool for assessing overall LV systolic function and LA mechanics. Strain-echocardiography can detect subclinical myocardial dysfunction and should be primary tool for preoperative and postoperative assessment of left ventricular and left atrium function in patients undergoing CABG.

Inflammation-related 5-hydroxymethylation signatures as markers for clinical presentations of coronary artery disease

2025-06-23

Jing Xu , Hangyu Chen , Jingang Yang +7 more | Cardiovascular Diabetology

JACC Data Report

2025-06-23

Brandon W. Yan , Adith S. Arun , Lesley H. Curtis +6 more | Journal of the American College of Cardiology

Tirzepatide in Obesity-Related Heart Failure With Preserved EF

2025-06-23

Laurent Fauchier , Lisa Lochon , Thibault Lenormand | Journal of the American College of Cardiology

Head to head comparison of left atrial and ventricular strain at rest in the prediction of exercise-induced elevated left ventricular filling pressure in patients without obvious myocardial ischemia

2025-06-23

Tsutomu Takagi | Journal of Echocardiography

Distinct role of minimal and maximal left atrial volumes in assessing LV filling pressures and prognosis in chronic heart failure

2025-06-23

Federico Fortuni , Paolo Biagioli , Anna Mengoni +5 more | The International Journal of Cardiovascular Imaging

Artificial Intelligence for Detection of Prognostically Significant Left Ventricular Dysfunction From Echocardiography

2025-06-23

David Playford , Simon Stewart , Andrew Watts +3 more | JACC Advances

Echocardiographic Assessment of Cardiac Function in Mouse Models of Heart Disease

2025-06-22

Nadia Salerno , Assunta Di Costanzo , Fabiola Marino +7 more | International Journal of Molecular Sciences

Echocardiography is a cornerstone technique for evaluating cardiac function in preclinical research using murine models. This review provides a comprehensive overview of the echocardiographic approaches employed to assess ventricular function … Echocardiography is a cornerstone technique for evaluating cardiac function in preclinical research using murine models. This review provides a comprehensive overview of the echocardiographic approaches employed to assess ventricular function in mouse models of heart disease, highlighting methodological principles, technical challenges, and the translational relevance of findings. Various echocardiographic modalities enable the precise evaluation of systolic and diastolic function. This article emphasizes standardization in image acquisition and analysis to minimize inter-operator variability and ensure reproducibility. It details echocardiographic parameters and strain imaging across commonly used mouse models of non-ischemic dilated cardiomyopathy, diabetic cardiomyopathy, hypertensive heart disease, and ischemic heart disease. Furthermore, it explores the advantages and limitations of anesthesia, probe positioning, and physiological monitoring during imaging. The integration of advanced imaging technologies such as Speckle-Tracking Echocardiography (STE), Three-Dimensional (3-D), and Four-Dimensional (4-D) echocardiography is discussed as a promising avenue for enhancing data quality and improving the translational potential of preclinical cardiac studies.

The Effect of Metabolic Syndrome and its Individual Components on the Duration of the QTc Interval in Different Gene Carriers of the Nitric Oxide Synthase 1 Adapter Protein Gene in Patients with Schizophrenia

2025-06-22

S. А. Galkin , Elena G. Kornetova , Irina A. Mednova +3 more | Psikhiatriya

Background : it has now been established that genetic factors play an important role in the pathogenesis of schizophrenia, metabolic syndrome, and cardiovascular diseases. Taking into account the literature data … Background : it has now been established that genetic factors play an important role in the pathogenesis of schizophrenia, metabolic syndrome, and cardiovascular diseases. Taking into account the literature data and our own scientific background, the general pattern of the pathogenesis of these disorders may be an imbalance in the work of nitric oxide synthase. The aim was to study the effect of metabolic syndrome and its individual components on the duration of the QTc interval in schizophrenia patients with different variants of NOS1AP gene carriage. Patients and Methods : 168 patients with schizophrenia aged 18–55 years were examined. The components of the metabolic syndrome were determined according to the criteria of the International Diabetes Federation from 2005. At the time of admission to the hospital, a standard 12-lead electrocardiogram recording was performed. The calculation of the QTc interval was carried out using the Bazett formula. The components of the metabolic syndrome were determined by colorimetric enzymatic method. Three single nucleotide polymorphic variants of the NOS1AP gene (rs12029454, rs10494366 and rs12143842) were selected for genotyping. Results : it was found that abdominal obesity had a significant effect on the QTc interval only in the case of carrying the GG rs12029454 genotype. The presence of arterial hypertension increased the duration of the QTc interval in patients with the genotype GG rs12029454, TT rs10494366 and TT rs12143842. It was also found that hypertriglyceridemia is an additional factor affecting the QTc interval in patients carrying the GG rs12029454 genotype. Conclusion : the results of the study confirmed our hypothesis that the nature of the relationship between the duration of the QTc interval and the components of the metabolic syndrome differs among different variants of the NOS1AP gene in patients with schizophrenia.

Metabolic alterations in heart failure

2025-06-21

Christoph Maack | Nature Reviews Cardiology

Differential Cardiac Remodeling in Overweight and Obesity: Insights from Noninvasive Imaging

2025-06-21

Wenjun Liu , Shanshan Li , Yue Yu +7 more | Obesity Facts

Backgrounds Weight gain is associated with cardiac abnormalities, but the differences in cardiac remodeling between overweight and obesity (O&O) remain unclear. This study explored the structural and functional cardiac changes … Backgrounds Weight gain is associated with cardiac abnormalities, but the differences in cardiac remodeling between overweight and obesity (O&O) remain unclear. This study explored the structural and functional cardiac changes associated with O&O using noninvasive imaging. Methods A retrospective study included participants from August 2021 to July 2023. Clinical data, laboratory results, and echocardiography reports were collected, and cardiac magnetic resonance (CMR) imaging underwent post-processing. Cardiac structural and functional parameters were compared among healthy weight, overweight, and obesity groups, and their relationships with body mass index (BMI) were analyzed. Results A total of 275 participants were included. Significant differences in left ventricular end-diastolic/systolic diameters, left atrial diameter, left ventricular ejection fraction (LVEF), and stroke volume (LVSV) index were observed between O&O and healthy weight groups (P<0.05). However, no significant differences were found between overweight and obesity groups for left ventricular septal (LVS) thickness, posterior wall (LVPW) thickness, cardiac index, or end-systolic volume index (P>0.05). Multivariable regression showed a positive correlation between BMI and cardiac structural/functional indicators (P<0.05), with greater changes in obesity. Loess spline analysis revealed that cardiac remodeling was more pronounced during the overweight stage. Conclusions Both O&O are associated with larger cardiac dimensions, increased myocardial mass, and impaired function. Cardiac remodeling accelerates during the overweight stage, emphasizing the need for early detection and intervention in overweight individuals to mitigate future health risks.

Sex-Specific Differences in LPS-Induced Rapid Myocardial Dysfunction

2025-06-21

Brianna I. Harvey , Arris M. Yoniles , Andrea Monsivais +4 more | International Journal of Molecular Sciences

Cardiac dysfunction is a severe complication of sepsis that significantly increases mortality in affected patients. Previous studies have shown better myocardial responses with preserved cardiac function in female animals compared … Cardiac dysfunction is a severe complication of sepsis that significantly increases mortality in affected patients. Previous studies have shown better myocardial responses with preserved cardiac function in female animals compared to males following lipopolysaccharide (LPS)-induced sepsis. Our published findings have revealed that females exhibited less cardiac dysfunction than males when exposed to equivalent doses of tumor necrosis factor (TNF)α, which is markedly elevated in both heart tissue and serum following LPS. These raise the question of whether the observed sex differences in LPS-induced myocardial dysfunction are a direct effect of LPS or a secondary consequence mediated by inflammatory cytokines, like TNFα. In this study, we aimed to uncover sex differences in LPS-caused direct effects on cardiac function. To do so, isolated hearts from aged-matched adult male and female mice were subjected to LPS infusion using a Langendorff method. Left ventricular developed pressure (LVDP) was continuously recorded. The female estrous cycle was determined via vaginal smear. The oxidative phosphorylation (OXPHOS) pathway and estrogen receptors (ERs) were determined in heart tissue using Western blot. We found that males exhibited worse LV function than females following the infusion of LPS at 5.0 mg/kg body weight. However, no significant differences in cardiac function and expression of ERs were observed between female groups at different estrous stages. Interestingly, LV function returned to baseline after the initial depression of LVDP during the rapid response to LPS and then depressed again following the 50 min LPS infusion. Protein levels of OXPHOS were altered differently between male and female hearts after 50 min LPS infusion. Our data demonstrate that male hearts exhibit higher sensitivity to LPS-induced rapid cardiac dysfunction compared to females, although estrogen may have a minimal influence on LPS-induced rapid functional depression. Sex differences may exist in myocardial mitochondrial responses to direct LPS insult via the OXPHOS pathway.

Vascular (dys)function in the failing heart

2025-06-21

Luca Liberale , Dirk J. Duncker , Derek J. Hausenloy +5 more | Nature Reviews Cardiology

Mechano-energetic uncoupling in heart failure

2025-06-21

Dunja Aksentijević , Simon Sedej , Jérémy Fauconnier +7 more | Nature Reviews Cardiology

Finasteride: risk of suicidality and depression

2025-06-21

| Reactions Weekly

The value of the HFA‐PEFF and H2FPEF scores in determining the phenotypes and comorbidity burden in heart failure with preserved ejection fraction

2025-06-20

Selda Murat , Murat Çaylı , Halit Emre Yalvaç +4 more | Clinical Physiology and Functional Imaging

Abstract Background The HFA‐PEFF and H2FPEF scores are widely used for diagnosing heart failure with preserved ejection fraction (HFpEF). However, HFpEF is a heterogeneous condition with multiple phenotypes influenced by … Abstract Background The HFA‐PEFF and H2FPEF scores are widely used for diagnosing heart failure with preserved ejection fraction (HFpEF). However, HFpEF is a heterogeneous condition with multiple phenotypes influenced by comorbidities and etiologies. Objectives This study aimed to evaluate the performance and agreement of these scoring systems across different HFpEF phenotypes and identify additional echocardiographic and clinical parameters that may improve phenotyping. Methods A total of 194 HFpEF patients were classified into three phenotypes: (1) common metabolic group, (2) atrial fibrillation (AF)‐predominant group, and (3) hypertension with left ventricular hypertrophy group. The clinical, laboratory, and echocardiographic characteristics of these phenotypes were analyzed. The agreement and performance between HFA‐PEFF and H2FPEF scores for phenotypes in HFpEF patients were assessed. Results A total of 194 HFpEF patients were included. While 92.3% of patients had a high HFA‐PEFF score, only 42.8% had a high H2FPEF score. The agreement between these scoring methods was low across all phenotypes. Phenotype‐specific differences were observed: interventricular septal thickness was highest in phenotype 3, systolic pulmonary artery pressure (SPAP) was highest in phenotype 2, and left atrial reservoir strain (LASr) and right ventricular free wall longitudinal strain (RV‐FWLS) were lowest in phenotype 2. Conclusion The HFA‐PEFF and H2FPEF scores showed limited agreement in distinguishing HFpEF phenotypes. Additional echocardiographic parameters such as IVS thickness, SPAP, LASr, and RV‐FWLS may enhance phenotypic differentiation and improve HFpEF classification. A more refined diagnostic approach incorporating these parameters could guide personalized treatment strategies.

Dynamic evaluation of atrial fibrillation risk factors using multiple sensors of implantable cardioverter defibrillators

2025-06-20

Carmelo La Greca , Andrea Dell’Aquila , A Prezioso +7 more | IJC Heart & Vasculature

Optimizing Medical Therapy Using Remote Monitoring and Artificial Intelligence in Patients With Heart Failure

2025-06-19

Raj M. Khandwalla , Alex Shvartser , Raymond Zimmer +7 more | JACC Heart Failure

La reserva del reservorio. Evaluación funcional por Strain 2D de la aurícula izquierda en reposo y esfuerzo

2025-06-19

Diana Romero Zertuche , Rosina Arbucci , Daniela Sevilla +5 more | Revista Argentina de Cardiología

Introducción: El estudio ecocardiográfico de la función global auricular izquierda, según guías, se basa en la medición de dimensiones, áreas, volúmenes y la función diastólica mediante la interrogación con Doppler … Introducción: El estudio ecocardiográfico de la función global auricular izquierda, según guías, se basa en la medición de dimensiones, áreas, volúmenes y la función diastólica mediante la interrogación con Doppler pulsado. Su importancia es trascendental, ya que su dilatación ha demostrado ser un predictor de eventos cardiovasculares adversos. Con el advenimiento de las nuevas técnicas ecocardiográficas es posible evaluar la mecánica de la deformación de la pared auricular (strain) con curvas que identifican la función de reservorio, conducto y contracción. Sin embargo, aún no hay consenso para definir el valor de strain auricular izquierdo, determinado mediante speckle tracking, en pacientes normales y su respuesta con el ejercicio. Objetivos: Establecer el valor de referencia de strain auricular izquierdo en pacientes sanos en reposo y durante el pico de un ecoestrés de esfuerzo. Además, analizar la relación de la deformación con la E/e´ para determinar los cambios de rigidez auricular. Metodología: Estudio descriptivo, prospectivo, observacional. Se incluyeron los pacientes mayores de 18 años, sanos, sin factores de riesgo cardiovascular, ni antecedentes patológicos a los que se realizó un ecoestrés con ejercicio entre enero y marzo 2017. Se utilizó un Vivid E 95 (GE Healthcare), con transductor 5MS MHz, con adquisición de las imágenes con un frame rate entre 60-70 en reposo y entre 80-90 en el esfuerzo. Los loops se obtuvieron en las vistas de 4 cámaras y 2 cámaras, tanto en reposo como a la máxima carga de ejercicio y se analizaron offline (EchoPac Version 201). Para la medición de strain, se trazaron los bordes de la AI, a 1 mm de distancia del anillo de la válvula mitral, y se ajustó de manera manual el ancho de la zona de interés en relación con el espesor de la pared auricular. Se consideraron los 6 segmentos por cada vista y se analizó el valor promedio de la curva correspondiente al reservorio por ser la más representativa y reproducible. Para el valor de rigidez auricular se calculó el promedio E/e´/strain AI × 100. En el análisis estadístico, las variables categóricas se expresan como porcentaje y las cuantitativas como media ± DS y se comparan con la prueba de t para muestras pareadas. Se consideró significativa una p < 0,05. Resultados: De 34 pacientes con criterios de inclusión se excluyeron a 3 por mala ventana ecocardiográfica en reposo y 2 en el esfuerzo. De los 29 pacientes analizados (factibilidad total 85%), 16 fueron hombres con una media de edad de la población de 50 ± 10,6 años. La variabilidad intraobservador del cálculo del reservorio en reposo y esfuerzo fue del 2,2 % ± 1,6 y 2,3% ± 2,5 e interobservador de 6% ± 7 y 4,6% ± 4, respectivamente. Conclusiones: En una población normal resultó factible evaluar la función del reservorio de la aurícula izquierda en reposo y durante el esfuerzo máximo con un incremento significativo de la deformación, sin cambios de la rigidez auricular.

An Innovative Artificial Intelligence Classification Model for Non-Ischemic Cardiomyopathy Utilizing Cardiac Biomechanics Derived from Magnetic Resonance Imaging

2025-06-19

Fu Li , Peifang Zhang , Liuquan Cheng +6 more | Bioengineering

Significant challenges persist in diagnosing non-ischemic cardiomyopathies (NICMs) owing to early morphological overlap and subtle functional changes. While cardiac magnetic resonance (CMR) offers gold-standard structural assessment, current morphology-based AI models … Significant challenges persist in diagnosing non-ischemic cardiomyopathies (NICMs) owing to early morphological overlap and subtle functional changes. While cardiac magnetic resonance (CMR) offers gold-standard structural assessment, current morphology-based AI models frequently overlook key biomechanical dysfunctions like diastolic/systolic abnormalities. To address this, we propose a dual-path hybrid deep learning framework based on CNN-LSTM and MLP, integrating anatomical features from cine CMR with biomechanical markers derived from intraventricular pressure gradients (IVPGs), significantly enhancing NICM subtype classification by capturing subtle biomechanical dysfunctions overlooked by traditional morphological models. Our dual-path architecture combines a CNN-LSTM encoder for cine CMR analysis and an MLP encoder for IVPG time-series data, followed by feature fusion and dense classification layers. Trained on a multicenter dataset of 1196 patients and externally validated on 137 patients from a distinct institution, the model achieved a superior performance (internal AUC: 0.974; external AUC: 0.962), outperforming ResNet50, VGG16, and radiomics-based SVM. Ablation studies confirmed IVPGs' significant contribution, while gradient saliency and gradient-weighted class activation mapping (Grad-CAM) visualizations proved the model pays attention to physiologically relevant cardiac regions and phases. The framework maintained robust generalizability across imaging protocols and institutions with minimal performance degradation. By synergizing biomechanical insights with deep learning, our approach offers an interpretable, data-efficient solution for early NICM detection and subtype differentiation, holding strong translational potential for clinical practice.

Prevalence and Clinical Characteristics of Diabetes Mellitus in Young Patients with St?Segment Elevation Myocardial Infarction: A Cross-Sectional Study from Central India

2025-06-19

Rupa Rajbhandari Singh , Sunil Washimkar | International Journal of Science and Research (IJSR)

The relationship between right ventricular functions and early clinical events during hospitalization and after discharge in patients with low ejection fraction heart failure

2025-06-19

Mehdi Onac , Ali Kılınç , Ahmad Huraibat +2 more | Frontiers in Cardiovascular Medicine

Background and aim Right ventricular dysfunction is an independent predictor of poor prognosis in the patients with left ventricle failure. In this study, it is aimed to investigate the relationship … Background and aim Right ventricular dysfunction is an independent predictor of poor prognosis in the patients with left ventricle failure. In this study, it is aimed to investigate the relationship between RV functions and early clinical events in hospital and after discharge in patients who were followed up for heart failure with a low ejection fraction and were hospitalized with the diagnosis of heart failure. Materials and methods Seventy patients with a left ventricular ejection fraction below 45% who were hospitalized due to decompensated heart failure were enrolled in this study. They were stabilized after medical treatment and discharged. Thereafter, they were followed up for 6 months in terms of clinical events. Image windows used as standard in the 2D echocardiography technique were recorded while the related technique was being performed. Results Composite adverse events were observed in 45 patients (64.3%), while composite adverse events were not observed in 25 patients (35.7%). Relation between the independent risk factors and composite adverse events were analyzed with binary logistic regression analysis. Receiver Operating Characteristic (ROC) analysis was performed to determine the distinctive performance of right ventricular (RV) Global Longitudinal Strain (GLS) and RV Free Wall Strain (FWS) parameters in the prediction of mortality in patients. RV Global LS ( p &lt; 0.001) and RV Free W Strain ( p &lt; 0.001) were determined as distinguishing factors related with mortality. Conclusion We found that RV GLS and RV fwLS are closely related. Moreover, both measurements were correlated not only with parameters reflecting RV systolic function, but also with parameters reflecting LV function.

Dimensiones del ventrículo derecho según un criterio de medición más allá del “talle único”

2025-06-19

Sarah Blissett , Lawrence Rudski | Revista Argentina de Cardiología

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A computational model to study hemodynamics during atrial fibrillation

2025-06-18

Felix Plappert , Pim J. A. Oomen , Clara E Jones +5 more | bioRxiv (Cold Spring Harbor Laboratory)

Abstract Atrial fibrillation (AF) is associated with reduced cardiac output, which is correlated with increased symptomatic burden and declined quality of life. Predicting hemodynamic effects of AF remains challenging due … Abstract Atrial fibrillation (AF) is associated with reduced cardiac output, which is correlated with increased symptomatic burden and declined quality of life. Predicting hemodynamic effects of AF remains challenging due to the complex interplay of multiple contributing mechanisms. Computational modeling offers a valuable tool for simulating hemodynamics. However, existing models are lacking the capabilities to both replicate beat-to-beat hemodynamic variations during AF while being well suited for fitting to clinical data. In this study, we present a computational model comprising: 1) an electrical subsystem that generates uncoordinated atrial and irregular ventricular activation times characteristic of AF, and 2) a mechanical subsystem that simulates hemodynamics using a reduced order model. The model was fitted to replicate individual hemodynamic measurements from 17 patients in the SMURF study during both normal sinus rhythm (NSR) and AF. The fitted model matched a large majority (75%) of blood pressure and intracardiac pressure measurements in both NSR and AF with absolute simulation errors well below 10 mmHg. Furthermore, a large majority of left atrial and left ventricular ejection fraction measurements during NSR were matched with absolute simulation errors well below 10%. The model consistently underestimated right ventricular diastolic pressure during NSR while overestimating right ventricular systolic and mean left atrial pressures during AF. The presented approach of modeling atrial activity in AF as uncoordinated atrial contractions, rather than no atrial contraction, achieved lower overall absolute simulation errors when fitting to individual patients. This computationally efficient model provides a platform for future investigations of patient-specific hemodynamics during AF.

Introducing a harmonic balance Navier-Stokes finite element solver to accelerate cardiovascular simulations

2025-06-18

NULL AUTHOR_ID | Physical Review Fluids

Chronotropic Incompetence and Cardiovascular Outcomes in Patients With Heart Failure With Preserved Ejection Fraction

2025-06-18

Ting‐Tse Lin , Tzu‐Yang Chen , Jen‐Fang Cheng +2 more | Journal of the American Heart Association

Background Chronotropic incompetence is common in older people and contributes to heart failure with preserved ejection fraction (HFpEF). This prospective study investigated the impact of chronotropic incompetence on cardiovascular outcomes … Background Chronotropic incompetence is common in older people and contributes to heart failure with preserved ejection fraction (HFpEF). This prospective study investigated the impact of chronotropic incompetence on cardiovascular outcomes in patients with HFpEF. Methods and Results From November 2019 to December 2022, 359 subjects undergoing invasive cardiopulmonary exercise testing for heart failure symptoms were enrolled. After excluding those without HFpEF (resting pulmonary capillary wedge pressure <15 mm Hg or exercise pulmonary capillary wedge pressure <25 mm Hg), 113 patients were followed long term. Outcomes included hospitalization for HF and cardiovascular death. Associations between exercise hemodynamic parameters and outcomes were evaluated using Cox regression analysis. Among the 113 patients, 85 (75.2%) had chronotropic incompetence; these patients were older (71 versus 66 years) and more often female (61% versus 28%) compared with those without chronotropic incompetence. At peak exercise, patients with chronotropic incompetence exhibited lower left atrial (LA) booster strain, impaired right ventricle–arterial coupling, reduced systemic vascular resistance, cardiac output, stroke volume, peak oxygen consumption, and respiratory exchange ratio, along with a steeper minute ventilation/carbon dioxide production slope. They also had higher pulmonary capillary wedge pressure (36±10 versus 26±11mm Hg, P =0.012). Over a median follow‐up of 22.6 months, 20 patients (17.7%) experienced cardiovascular events. Multivariate analysis identified chronotropic incompetence (hazard ratio [HR], 1.725 [95% CI, 1.212–2.413]) and an elevated pulmonary capillary wedge pressure/cardiac output slope (HR, 1.829 [95% CI, 1.331–2.382]) as predictors of adverse outcomes. Conclusions In HFpEF, chronotropic incompetence is associated with elevated filling pressures, impaired ventilatory efficiency, and reduced exercise capacity, contributing to hospitalization for HF and cardiovascular death. Recognizing chronotropic incompetence may help predict poor prognosis in HFpEF.

Atrial dysfunction: a contrast-free marker for HFpEF in obese diabetics—insights from comprehensive CMR and serum biomarker analyses

2025-06-18

Rebecca Beyer , Maximilian Müller , Patrick Doeblin +7 more | Cardiovascular Diabetology

Abstract Background The diagnostic criteria for HFpEF remain inconsistently defined, further confounded by comorbidities such as obesity and type 2 diabetes mellitus (T2DM), which are thought to contribute to its … Abstract Background The diagnostic criteria for HFpEF remain inconsistently defined, further confounded by comorbidities such as obesity and type 2 diabetes mellitus (T2DM), which are thought to contribute to its pathogenesis via chronic pro-inflammatory mechanisms. This study aimed to evaluate the relationship between advanced cardiac magnetic resonance (CMR) imaging and pro-fibrotic and inflammatory serum biomarkers, assessing their potential to discriminate HFpEF from associated comorbid conditions. Methods This was an exploratory analysis of a prospective cohort study of 35 obese/overweight participants (mean age 64 ± 8 years, 23% females), including 16 with T2DM, 13 with HFpEF (NYHA II–III) and T2DM, and 6 healthy controls. All subjects underwent comprehensive contrast-enhanced CMR at a 3 T scanner (Philips Ingenia, The Netherlands), including assessment of left ventricular and left atrial (LA) volumetry and function, myocardial perfusion reserve (MPR), and diffuse fibrosis imaging (ECV). Obtained serum biomarkers were Pentraxin-3, Galectin-3 and Interleukin-1 Receptor-Like 1 (IL1RL1). Statistical analyses included one-way ANOVA, Tukey test, Pearson’s correlation, regression and receiver operating characteristic analyses, and intra-class correlation. Results In multivariable regression, impaired measures of LA structure and function emerged as the only independent discriminators of HFpEF, with LA maximum volume showing an OR of 1.13 (95% CI 1.05–1.28), reservoir strain of 0.71 (95% CI 0.44–0.89), conduit strain of 0.57 (95% CI 0.32–0.82) and booster strain of 0.70 (95% CI 0.48–0.89) per unit increase. No differences in MPR nor ECV were observed between the groups. While serum biomarkers Galectin-3 and Pentraxin-3 were significantly higher in HFpEF vs. obese controls (16.1 ng/ml ± 3.8 ng/ml vs. 10.6 ng/ml ± 3.7 ng/ml, p = 0.011, and 0.84 ng/ml ± 0.67 ng/ml vs. 0.21 ng/ml ± 0.05 ng/ml, p = 0.031, respectively), these biomarkers remained within normal limits and showed only moderate correlations with CMR metrics. Highest inter-study reproducibility was seen in MPR (ICC: 0.94), LA Reservoir Strain (ICC: 0.84) and serum biomarkers (ICC: 0.087–0.93). Conclusion CMR markers of diffuse fibrosis and microvascular dysfunction may not differentiate HFpEF from obese or diabetic controls. However, left atrial function assessment may evolve to be a reproducible and practical CMR marker, effectively distinguishing HFpEF independent of fibrotic remodeling.

A normal heart doesn’t fail: rethinking HFpEF in acute settings

2025-06-18

Maria Giulia Bellicini | Internal and Emergency Medicine

Relevancia de la grasa epicárdica en la enfermedad cardíaca

2025-06-18

Jorge Palacio , Carolina Ocampo , Carlos A. González +2 more | Revista Colombiana de Cardiología

Left Ventricular Ejection Fraction Reserve and Its Association with Myocardial Perfusion, Coronary Calcification, and Strain in Type 2 Diabetes Without Overt Cardiovascular Disease

2025-06-17

A Chebli , Ida Kirstine Bull Rasmussen , Anne-Cathrine Skriver-Møller +7 more | Research Square (Research Square)

<title>Abstract</title> <bold>Background</bold>: Type 2 diabetes (T2D) is a major risk factor for cardiovascular disease (CVD), but the relationships between myocardial function, microvascular function, and atherosclerotic burden remain underexplored in asymptomatic … <title>Abstract</title> <bold>Background</bold>: Type 2 diabetes (T2D) is a major risk factor for cardiovascular disease (CVD), but the relationships between myocardial function, microvascular function, and atherosclerotic burden remain underexplored in asymptomatic individuals. This study investigates the associations between left ventricular ejection fraction (LVEF)-reserve, myocardial flow reserve (MFR), perfusion defects, coronary artery calcium score (CACS), and global longitudinal strain (GLS) in individuals with T2D but without overt CVD. <bold>Methods</bold>: Cross-sectional analysis of 871 individuals with T2D without overt CVD, recruited between 2020-2023. All underwent cardiac 82-Rubidium PET/CT to assess LVEF-reserve, MFR, perfusion defects, and CACS. GLS was measured using echocardiography. Associations were examined using linear regression adjusted for cardiovascular risk factors. <bold>Results</bold>: Mean (SD) age was 64.9 (±9.0) years, diabetes duration was 13.9 (±8.4) years, and 262 (30%) were women. Higher MFR was associated with higher LVEF-reserve (β = 1.64, 95% CI: 1.18 to 2.11, p<0.001). Individuals with CACS > 300 had lower LVEF-reserve than those with CACS ≤ 300 (β = -1.31, 95% CI: -2.01 to -0.60, p<0.001). Presence of Perfusion defects were associated with lower LVEF-reserve (β = -1.58, 95% CI: -2.32 to -0.85, p<0.001). LVEF-reserve was not associated with GLS (p=0.28). Sensitivity analysis excluding 248 participants with perfusion defects confirmed the association between MFR and LVEF-reserve (β = 1.52 (95% CI: 1.01, 2.04), p<0.001). <bold>Conclusions: </bold>In individuals with T2D without overt CVD, lower MFR, presence of perfusion defects, and CACS >300 were associated with lower LVEF-reserve. Underscoring a potential role of microvascular dysfunction in subclinical systolic impairment.

The relationship of previously known type 2 diabetes mellitus and newly diagnosed type 2 diabetes mellitus to clinical outcomes in patients with non-ST elevation myocardial infarction

2025-06-17

Novi R. Ma’shum | Gaceta Médica de Caracas

Background: Cardiovascular disease (CVD) remains the leading global cause of morbidity and mortality, accounting for 17.9 million deaths annually (32 %of all deaths). Type 2 Diabetes Mellitus (T2DM) is a … Background: Cardiovascular disease (CVD) remains the leading global cause of morbidity and mortality, accounting for 17.9 million deaths annually (32 %of all deaths). Type 2 Diabetes Mellitus (T2DM) is a common comorbidity in CVD and significantly worsens outcomes. Over 20 % of patients treated for suspected Acute Coronary Syndrome (ACS) have T2DM, which doubles in-hospital mortality and increases the risk of Major Adverse Cardiac and Cerebrovascular Events (MACCE). This study investigates the association between diabetes status and MACCE incidence in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI), along with the severity of coronary lesions.

Effects of trimetazidine on cardiac function and ventricular remodeling in patients with ischemic cardiomyopathy: a systematic review and meta-analysis

2025-06-17

Wenjing Shi , Juan Cui , Chunyan Chen | General Thoracic and Cardiovascular Surgery

Left ventricular systolic longitudinal strain in mechanically ventilated patients in the intensive care unit: assessment of global and chamber reproducibility

2025-06-17

Matías Pécora , P Pastorini , Roberto Farolini +2 more | Intensive Care Medicine Experimental

Abstract Introduction In the intensive care unit (ICU), left ventricular systolic function is traditionally assessed by measuring the left ventricular ejection fraction (LVEF). Recently, left ventricular global systolic longitudinal strain … Abstract Introduction In the intensive care unit (ICU), left ventricular systolic function is traditionally assessed by measuring the left ventricular ejection fraction (LVEF). Recently, left ventricular global systolic longitudinal strain (SL-S) has emerged as a more sensitive marker of myocardial function in this setting. However, obtaining high-quality echocardiographic images remains a significant challenge, particularly in patients undergoing invasive mechanical ventilation (IMV), and data on the feasibility and reproducibility of these measurements in critically ill patients are limited. Objective To assess the feasibility and reproducibility (both global and per chamber) of SL-S and LVEF (both manual and automatic) in ICU patients under IMV. Materials and methods Thirty ICU patients receiving IMV were randomly selected. The feasibility and reproducibility of SL-S (global and per chamber) and LVEF were assessed using both manual and automatic methods. The analysis was performed using the intraclass correlation coefficient (ICC) with its 95% confidence interval (CI), and Bland–Altman analysis (BA), which reported the mean difference and limits of agreement (lower–upper limits of agreement). Results SL-S was feasible in 70% of patients and demonstrated excellent intra- and interobserver reproducibility for both manual and automatic methods. Intraobserver reproducibility for automatic SL-S: ICC 0.97 (CI: 0.94–0.99), BA 0.26 (−1.89 to 2.40) and interobserver reproducibility: ICC 0.96 (CI: 0.92–0.98), and BA 0.53 (−2.41 to 3.47). The reproducibility of manual SL-S was comparable to automatic measurements. Additionally, the reproducibility per chamber was excellent. LVEF was feasible in 80% of patients. Manual LVEF (Simpson’s biplane) reproducibility demonstrated good reproducibility: intraobserver ICC: 0.82 (CI: 0.48–0.93), BA −5.00 (−19.70 to 9.70); interobserver ICC 0.78 (CI: 0.55–0.91), BA 7.50 (−5.40 to 20.40). Automatic LVEF (auto-LVEF) demonstrated excellent reproducibility: intraobserver ICC: 0.94 (CI: 0.86–0.98), BA −0.95 (−10.02 to 8.13); and interobserver ICC: 0.94 (CI: 0.87–0.97), BA 1.75 (−6.38 to 10.33). Conclusion SL-S (global and per chamber) and auto-LVEF were feasible and showed excellent reproducibility. LVEF demonstrated the highest feasibility, while SL-S exhibited the greatest reproducibility. These parameters may represent a useful tool in the evaluation of LV function in ICU patients under IMV.

The Cardiac and Hemodynamic Effects of Ketone Bodies Are Abnormal in Patients With Type 1 Diabetes: A Randomized Controlled Trial

2025-06-17

Kristoffer Berg‐Hansen , Maj Bangshaab , Nigopan Gopalasingam +5 more | Diabetes

Impaired cardiac ketone oxidative capacity is a possible disease mechanism in the development of diabetic cardiomyopathy. We examined whether the cardiovascular effects of ketone bodies are different in patients with … Impaired cardiac ketone oxidative capacity is a possible disease mechanism in the development of diabetic cardiomyopathy. We examined whether the cardiovascular effects of ketone bodies are different in patients with type 1 diabetes (T1D) compared with healthy control individuals. In a single-blind study with a crossover design, nine patients with T1D and eight age-matched, healthy control study participants were randomized to receive a 3-h infusion of 3-hydroxybutyrate (3-OHB) or tonicity-matched saline in random order, separated by a 1-h washout period. Assessor-blinded echocardiographic evaluation of cardiovascular function was performed at baseline and after 150 min of each intervention. Circulating 3-OHB increased during 3-OHB infusion versus placebo in healthy control participants, with a similar increase in patients with T1D. In the control group, 3-OHB infusion increased cardiac output by 1.9 ± 0.4 L/min but only by 0.5 ± 0.1 L/min in patients with T1D. Stroke volume increased by 14 ± 5 mL and left ventricular (LV) ejection fraction by 3 ± 1 percentage points in healthy control participants; there was no change in these parameters in patients with T1D. During 3-OHB infusion in patients with T1D, LV global wasted work increased and LV global work efficiency decreased. In conclusion, patients with T1D had an abnormal cardiovascular response to 3-OHB infusion. Diabetic cardiomyopathy in patients may involve impaired cardiac ketone metabolism. Article Highlights The diabetic heart has reduced ketone utilization due to impaired ketolytic enzyme activity. In a randomized, controlled, crossover trial, we investigated whether the cardiac response to 3-hydroxybutyrate infusion is impaired in type 1 diabetes. The response on cardiac output was blunted by 80% in type 1 diabetes, with no improvement in systolic function and left ventricular work efficiency was reduced. These findings suggest impaired cardiac ketone metabolism may have clinical significance and could contribute to diabetic cardiomyopathy.

Assessment of left ventricular function in patients with diabetic nephropathy using two-dimensional speckle-tracking echocardiography

2025-06-16

Xiunan Zhang , Cuiping Jiang , Zhibin Ye +2 more | Frontiers in Endocrinology

Objective To assess cardiac function using two-dimensional speckle-tracking echocardiography (2D-STI) in diabetic nephropathy (DN) patients and investigate the relationship between albuminuria and early cardiac systolic and diastolic dysfunction, along with … Objective To assess cardiac function using two-dimensional speckle-tracking echocardiography (2D-STI) in diabetic nephropathy (DN) patients and investigate the relationship between albuminuria and early cardiac systolic and diastolic dysfunction, along with associated risk factors based on clinical indicators. Methods A total of 75 patients with DN, 100 patients with diabetes mellitus (DM), and 37 healthy controls were recruited. Clinical data were collected, and conventional echocardiography as well as 2D-STI were performed on all participants. Results 2D-STI findings revealed a significant increased occurrence rate of subclinical left ventricular systolic dysfunction [global longitudinal strain values (GLS) &lt;18%], among diabetic patients compared to healthy controls. Furthermore, the proportion of GLS&lt;18% occurrence was higher in the DN group compared to the DM group (p&lt;0.001) and especially higher in the massive albuminuria group than that in the microalbuminuria group ( p &lt;0.001). The results demonstrated that albuminuria, eGFR&lt;60 ml/min/1.73 m 2 , and total cholesterol were identified as significant risk factors for the development of subclinical left ventricular systolic insufficiency in diabetic patients. However, when considering only patients with DN and adjusting for covariates, it was found that only total cholesterol remained statistically significant ( p &lt; 0.05). Conclusion The higher cholesterol levels in patients with DN are associated with a greater risk of subclinical left ventricular systolic dysfunction reflected by a decrease in GLS assayed with 2D-STI. Critical relevance statement GLS measured by 2D-STI combined with clinical indexes to evaluate and predict subclinical left ventricular systolic function in patients with DM, providing reference for early prevention and treatment of cardiac dysfunction in patients with DN.

Unresolved Challenges in MAFLD-ACLF Risk Stratification: A Critical Appraisal

2025-06-16

Renu Sah , Ankita Mathur , Venkata Dileep Kumar Veldi | The American Journal of Gastroenterology

Early Echocardiographic Markers in Heart Failure with Preserved Ejection Fraction

2025-06-16

Annamaria Tavernese , Vincenzo Rizza , Valeria Cammalleri +7 more | Journal of Cardiovascular Development and Disease

Heart failure with preserved ejection fraction (HFpEF) represents nearly half of all heart failure cases and remains diagnostically challenging due to its heterogeneous pathophysiology and often subtle myocardial dysfunction. Conventional … Heart failure with preserved ejection fraction (HFpEF) represents nearly half of all heart failure cases and remains diagnostically challenging due to its heterogeneous pathophysiology and often subtle myocardial dysfunction. Conventional echocardiographic parameters, such as left ventricular ejection fraction (LVEF) and the left atrial volume index (LAVI), frequently fail to detect early functional changes. Advanced echocardiographic techniques have emerged as valuable tools for early diagnosis and risk stratification. Global Longitudinal Strain (GLS) allows for the identification of subclinical systolic dysfunction, even with preserved LVEF. Left Atrial Strain (LAS), particularly reservoir and pump strain, provides sensitive markers of diastolic function and elevated filling pressures, offering additional diagnostic and prognostic insights. Myocardial Work (MW), through non-invasive pressure-strain loops, enables load-independent assessment of contractility, while Right Ventricular Free Wall Longitudinal Strain (RVFWLS) captures early right heart involvement, often present in advanced HFpEF. The integration of these advanced parameters can enhance diagnostic precision and guide personalized treatment strategies. This review highlights the current evidence and clinical applications of strain-based imaging in HFpEF, underscoring the importance of a multiparametric, pathophysiology-oriented approach in heart failure evaluation.

Correlation between vitamin D level and left ventricular myocardial function demonstrated by speckle tracking echocardiography among β-thalassemia major children

2025-06-16

Eman Abdelrahman , Ahmed Mahmoud Ezzat , Lina Abdelhady Mohammed +2 more | European Journal of Pediatrics

Abstract Vitamin D deficiency is a recognized complication of β-thalassemia major (β-TM), impacting cardiac function. Speckle tracking echocardiography (STE) offers a sensitive assessment of myocardial deformation, particularly global longitudinal strain … Abstract Vitamin D deficiency is a recognized complication of β-thalassemia major (β-TM), impacting cardiac function. Speckle tracking echocardiography (STE) offers a sensitive assessment of myocardial deformation, particularly global longitudinal strain (GLS). This study aimed to assess the association between vitamin D levels and LV function in β-TM children and to evaluate the impact of vitamin D supplementation on cardiac parameters. Seventy-five β-TM children underwent vitamin D level assessment, conventional echocardiography, and STE. Patients with vitamin D deficiency/insufficiency (25-OHD3 < 30 ng/ml) received vitamin D supplementation (4000–5000 IU/day). Follow-up assessments were conducted after vitamin D normalization. Vitamin D insufficiency (81.3%) and deficiency (18.7%) were prevalent. Vitamin D levels were inversely correlated with age and disease duration ( p < 0.001) and positively correlated with transfusion/chelation therapy onset. Conventional echocardiography showed an inverse correlation between vitamin D level and left ventricular end diastolic diameter ( p < 0.001) and deceleration time ( p = 0.003). STE revealed a positive correlation between vitamin D and GLS ( p < 0.001). Vitamin D supplementation significantly increased median vitamin D levels (from 16.0 to 39.0 ng/ml, p < 0.001) and improved STE parameters, including AP4L, AP3L, AP2L, and GLS ( p < 0.001), indicating enhanced myocardial function. Conclusion : Vitamin D deficiency in β-TM children was correlated with impaired cardiac function. Vitamin D supplementation significantly improved cardiac function. Regular monitoring and maintenance of adequate vitamin D levels are crucial for preventing adverse cardiac effects. What is Known: • β-Thalassemia major is frequently complicated by cardiac dysfunction, a major contributor to mortality .• Cardiac iron overload is a primary driver of cardiac dysfunction in β-TM . What is New: • Vitamin D deficiency leads to impaired cardiac function, beyond iron overload, in β-TM children .• Vitamin D supplementation could improve cardiac function in β-thalassemia major patients .