Left atrial volume index (LAVI), left atrial reservoir function through left atrial reservoir strain (LASr), and B-lines in lung ultrasound serve as supplementary indicators of left ventricular filling pressures. This study analyzes the interrelation between LAVI, LASr, and B-lines in both resting and peak vasodilator stress.
Dipyridamole stress echocardiography (SE) was conducted on 252 individuals (180 males, 71%, age 65 years ± 10 years) with chronic coronary syndromes. LAVI was quantified using the biplane disk summation method; LASr was obtained using 2-dimensional speckle tracking echocardiography; B-lines were evaluated through a simplified 4-site scan in the third intercostal space during lung ultrasound.
During SE, a reduction in LAVI (26 ml/m2 ± 14 ml/m2 vs. 24 ml/m2 ± 12 ml/m2, P < 0.001) and an increase in LASr from rest (33% ± 8% vs. 38% ± 10%, P < 0.001) were respectively observed from rest to stress. B-lines were increased significantly during SE, from 19 (7.5%) to 29 (11.5%), P < 0.001. A substantial, inverse linear correlation was identified between LAVI and LASr both at rest (r = –0.301, P < 0.001) and peak stress (r = –0.279, P < 0.001). At group analysis, peak B-lines showed a direct correlation with peak LAVI (r = 0.151, P = 0.017) and an inverse correlation with peak LASr (r = –0.234, P < 0.001). In individual assessments, 9.7% (20/207) of patients displayed stress B-lines with normal LAVI and preserved LASr, while 20% (9/45) exhibited stress B-lines with abnormalities in both LAVI and LASr.
Vasodilator SE with combined left atrial and volume assessment, related to pulmonary congestion, is feasible with a high success rate. Pulmonary congestion is more frequent with dilated left atrium with reduced atrial contractile reserve (ClinicalTrials.gov identifier: NCT030.49995; NCT050.81115).
Left ventricular (LV) hypertrophy (LVH) is a common and relevant complication of arterial hypertension (AH) and 12-lead electrocardiogram (ECG) is widely used for its preliminary assessment. The aim of the study was to compare the correlations of four ECG-derived criteria of LVH and left atrial (LA) anteroposterior diameter with LVH assessed by echocardiography and expressed as left ventricular mass (LVM) index (LVMI) in search of the most accurate preliminary indicator of LVH.
The study included 61 subjects with AH [age (year) 69 ± 10, 17 females] and 27 without AH, (age 40 ± 9, 10 females) evaluated with 12-lead ECG and transthoracic echocardiography (TTE). As the ECG-based criteria of LVH Sokolow-Lyon index (SLI), Cornell voltage (CV), Cornell product (CP), and Romhilt-Estes point score (RES) system were evaluated. The ECG indices and LA diameter were correlated with LVMI and correlations coefficients were compared.
Among ECG-LVH indicators SLI showed the closest correlation with LVMI [rank correlation coefficients (rho) = 0.38, P < 0.0001], followed by CV and CP with rho = 0.33, P = 0.002 and rho = 0.32, P = 0.002, respectively, whereas RES did not correlate significantly with LVMI. The strongest correlation with LVMI was found for the LA diameter with rho = 0.73 and P < 0.0001, showing an even stronger correlation in women—rho = 0.8 (P < 0.0001) vs. rho = 0.65 (P < 0.0001) in men. In the multivariate analysis, the LA was the only independent predictor of the increased LVMI with R2 = 0.52, P < 0.0001.
LA diameter outperformed significantly the ECG indices as far as the correlation with LVMI was concerned and emerged as the only independent predictor of mild and moderate LVH in hypertensive patients. Among the ECG criteria, the strongest correlation was shown for SLI, followed by CV and CP indices.
The deleterious consequences of alcohol consumption are extensively documented across various dimensions of human health, encompassing somatic disorders such as nervous system impairments, digestive system abnormalities, and circulatory dysfunctions, in addition to socio-psychological aspects. Within the domain of cardiology, a substantial portion of the ongoing scientific discourse centers on elucidating the toxic dose of alcohol. Presented herewith are the findings from a comprehensive review of the latest publications pertinent to this crucial issue.
[Names] => Piotr Hamala, Karina Wierzbowska-Drabik [Doi] => 10.37349/ec.2023.00003 [Published] => August 18, 2023 [Viewed] => 773 [Downloaded] => 11 [Subject] => Review [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/ec.2023.00003 [Inline] => 1 [Type] => 1 [Issue] => 1 [Topic] => 138 [TitleAbbr] => Explor Cardiol. [Pages] => 2023;1:15–25 [Recommend] => 0 [Keywords] => Alcohol, alcohol dose, alcohol cardiomyopathy, toxic cardiomyopathy [DetailTitle] => Common cardiovascular target for a wide gamut of contemporary health problems – thrombotic and arrhythmic sides of an inflammatory coin [DetailUrl] => https://www.explorationpub.com/Journals/ec/Special_Issues/138 [Id] => 10123 [ris] => https://www.explorationpub.com/uploads/Article/A10123/a502be553ef392c86d9cfe561fa79b9c.ris [bib] => https://www.explorationpub.com/uploads/Article/A10123/e4e5ca79e84b8b0a76e3bfca4cf4bac0.bib [ens] => [Cited] => 1 [Cited_Time] => 2024-04-19 [CitethisArticle] => Hamala P, Wierzbowska-Drabik K. Alcohol—dose question and the weakest link in a chemical interplay. Explor Cardiol. 2023;1:15–25. https://doi.org/10.37349/ec.2023.00003 [Jindex] => 0 [CName] => PiotrHamala,KarinaWierzbowska-Drabik, [CEmail] => piotrhamala@gmail.com,wierzbowska@ptkardio.pl, [Ris_Time] => 2023-08-09 03:29:56 [Bib_Time] => 2023-08-09 03:29:56 [KeysWordContens] => Alcohol—dose question and the weakest link in a chemical interplay, Alcohol, alcohol dose, alcohol cardiomyopathy, toxic cardiomyopathy, The deleterious consequences of alcohol consumption are extensively documented across various dimensions of human health, encompassing somatic disorders such as nervous system impairments, digestive system abnormalities, and circulatory dysfunctions, in addition to socio-psychological aspects. Within the domain of cardiology, a substantial portion of the ongoing scientific discourse centers on elucidating the toxic dose of alcohol. Presented herewith are the findings from a comprehensive review of the latest publications pertinent to this crucial issue. ,Piotr Hamala, Karina Wierzbowska-Drabik [PublishedText] => Published [IsEdit] => 0 [AccountId] => 46 [Zh] => 1 ) [4] => Array ( [ArticleId] => 727 [Create_Time] => 2023-08-31 [zipUrl] => https://www.explorationpub.com/uploads/zip/202309/20230920070213.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A10124/10124.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A10124/10124.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A10124/10124_cover.png [JournalsId] => 15 [Title] => Left ventricular systolic function and initial exercise capacity—their importance for results of cardiac rehabilitation after acute coronary syndrome [Abstract] => Aim: The aim of this study was to compare initial and final exercise tolerance and to evaluate the determinants of exercise capacity improvement—after three weeks of inpatient cardiac rehabilit [AbstractComplete] =>The aim of this study was to compare initial and final exercise tolerance and to evaluate the determinants of exercise capacity improvement—after three weeks of inpatient cardiac rehabilitation.
A cohort of 494 patients after acute coronary syndrome (ACS), treated with primary coronary angioplasty (age 60 years ± 10 years, 27.5% women) was studied retrospectively. Possible correlations between improvement and age, gender, body mass index (BMI), left ventricular ejection fraction (LVEF) and the initial exercise capacity (EXT1) were assessed.
The highest percentage of patients with improvement (43.6%) was in the medium tercile of LVEF (> 42% but ≤ 50%) and was more likely in the medium tercile of initial exercise tolerance [> 5.7 but ≤ 8.4 metabolic equivalent of tasks (METs)]. Receiver-operator characteristic (ROC) curves were developed and the following cut-off values were found: for LVEF > 43% (this value had 69.6% sensitivity in predicting improvement; the chance of improvement was 2.67 higher than in patients with LVEF ≤ 43%); for EXT1 ≤ 8.4 METs (this value had 70.8% sensitivity, the chance of improvement was 1.86 higher than in the other subgroup). No significant relationship between improvement and gender, age or BMI was found.
The combination of LVEF > 43% and EXT1 ≤ 8.4 METs relates to the highest probability of exercise tolerance improvement after cardiac rehabilitation.
Alcohol drinks, especially wine, have been described since 6,000 B.C. For many years in modern medicine, wine in moderation has been considered healthy for cardiovascular prevention, i.e., recommended by nutrition committees. Some regional guidelines still recommend one to two standard drinks per day. By the very recent (January 2023), World Health Organization and Canadian Guidance on alcohol emphasize that any alcoholic drink is hazardous to the health and the safe amount is zero. The risk starts with every single drop. It was also nicely summarized in the manuscript “Alcohol-dose question and the weakest link in a chemical interplay” (Explor Cardiol. 2023;1:15–25. doi: 10.37349/ec.2023.00003) especially from the standpoint of a researcher in the cardiovascular arena. The newest recommendations are based on observational studies and their meta-analysis, therefore establishing associations, pointing out that alcohol may somewhat prevent cardiovascular diseases and diabetes type 2, but with a significant increase in non-cardiovascular morbidity and mortality, especially cancers. Previous recommendations, therefore, may be obsolete as they were based on studies where abstainers from alcoholic beverages had inherent higher risks. The current controversy with conflicting guidelines for alcoholic beverage consumption in the era of precision medicine may stimulate more fundamental investigations up to genetic ones and find the cause-effect relations. In the era of precision medicine, it may come closer to discovering the causes of cancers and many other diseases, enabling predictions of reactions to alcoholic beverages by each person, not just in the population.
[Names] => Miodrag Ostojic ... Dusko Vulic [Doi] => 10.37349/ec.2023.00005 [Published] => August 31, 2023 [Viewed] => 421 [Downloaded] => 16 [Subject] => Perspective [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/ec.2023.00005 [Inline] => 1 [Type] => 1 [Issue] => 1 [Topic] => 0 [TitleAbbr] => Explor Cardiol. [Pages] => 2023;1:35–41 [Recommend] => 0 [Keywords] => Alcoholic beverages, red wine, cardiovascular mortality, non-cardiovascular mortality [DetailTitle] => [DetailUrl] => [Id] => 10125 [ris] => https://www.explorationpub.com/uploads/Article/A10125/5d2b6f05cef82fa9023b24859bc214da.ris [bib] => https://www.explorationpub.com/uploads/Article/A10125/b136ea8278d26fd42a9c94f609dcabf5.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Ostojic M, Djajic V, Kovacevic-Preradovic T, Vulic D. Alcohol zero: the end, the beginning of the end, or just the end of the beginning? Explor Cardiol. 2023;1:35–41. https://doi.org/10.37349/ec.2023.00005 [Jindex] => 0 [CName] => MiodragOstojic, [CEmail] => mostojic2011@gmail.com, [Ris_Time] => 2023-08-29 00:37:07 [Bib_Time] => 2023-08-29 00:37:07 [KeysWordContens] => Alcohol zero: the end, the beginning of the end, or just the end of the beginning?, Alcoholic beverages, red wine, cardiovascular mortality, non-cardiovascular mortality, Alcohol drinks, especially wine, have been described since 6,000 B.C. For many years in modern medicine, wine in moderation has been considered healthy for cardiovascular prevention, i.e., recommended by nutrition committees. Some regional guidelines still recommend one to two standard drinks per day. By the very recent (January 2023), World Health Organization and Canadian Guidance on alcohol emphasize that any alcoholic drink is hazardous to the health and the safe amount is zero. The risk starts with every single drop. It was also nicely summarized in the manuscript “Alcohol-dose question and the weakest link in a chemical interplay” (Explor Cardiol. 2023;1:15–25. doi: 10.37349/ec.2023.00003) especially from the standpoint of a researcher in the cardiovascular arena. The newest recommendations are based on observational studies and their meta-analysis, therefore establishing associations, pointing out that alcohol may somewhat prevent cardiovascular diseases and diabetes type 2, but with a significant increase in non-cardiovascular morbidity and mortality, especially cancers. Previous recommendations, therefore, may be obsolete as they were based on studies where abstainers from alcoholic beverages had inherent higher risks. The current controversy with conflicting guidelines for alcoholic beverage consumption in the era of precision medicine may stimulate more fundamental investigations up to genetic ones and find the cause-effect relations. In the era of precision medicine, it may come closer to discovering the causes of cancers and many other diseases, enabling predictions of reactions to alcoholic beverages by each person, not just in the population. ,Miodrag Ostojic ... Dusko Vulic [PublishedText] => Published [IsEdit] => 0 [AccountId] => 80 [Zh] => 1 ) [6] => Array ( [ArticleId] => 731 [Create_Time] => 2023-08-31 [zipUrl] => https://www.explorationpub.com/uploads/zip/202309/20230920062040.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A10126/10126.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A10126/10126.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A10126/10126_cover.png [JournalsId] => 15 [Title] => Normal physiologic coronary flow velocity gradient across the left anterior descending artery in healthy asymptomatic subjects [Abstract] => Aim: Coronary flow velocity (CFV) can be obtained with transthoracic echocardiography (TTE) in the left anterior descending coronary artery (LAD). The physiologic flow velocity gradient across th [AbstractComplete] =>Coronary flow velocity (CFV) can be obtained with transthoracic echocardiography (TTE) in the left anterior descending coronary artery (LAD). The physiologic flow velocity gradient across the different segments of LAD has not been established. This study aims to assess the normal values of resting CFV in proximal, mid, and distal LAD.
In a single center, prospective, observational study design, TTE was attempted on 110 consecutive, asymptomatic middle-aged subjects (age = 55 years, 46% males) with a low likelihood of coronary artery disease (< 5%). Resting CFV in the LAD was assessed with high-end machines, dedicated coronary pre-set, and high-frequency transducers by pulsed-wave Doppler under color-Doppler guidance in the proximal, mid, and distal segments.
The technical success rate for CFV imaging was lowest for the proximal (101/110, 92%), intermediate for mid (106/110, 96%), and highest for the distal segment (108/110, 98%). All 3 segments were interpretable in 101 subjects. CFV was highest in proximal segments (38.6 cm/s ± 3.9 cm/s), intermediate in mid segments (34.3 cm/s ± 6.04 cm/s, P < 0.01 vs. proximal), and lowest in distal segments (28.1 cm/s ± 1.7 cm/s, P < 0.01 vs. proximal and vs. mid).
A resting evaluation of CFV-LAD can be obtained by TTE in the large majority of consecutive subjects referred to the echocardiography laboratory. Feasibility is highest for distal and lowest for proximal-LAD segments. There is a clear physiologic gradient of CFV with decreasing values, of about 10% for each step, going from proximal to mid and distal segments of LAD. When resting CFV is considered, the site of the sampling is important to obtain comparable and physiologically meaningful data.
Transthoracic echocardiography (TTE) is the first-line imaging test for patients with chronic coronary syndrome (CCS) and the cornerstone of risk stratification is left ventricular (LV) ejection fraction (EF). Aim of the study was to investigate the value of TTE supplemented with strain echocardiography (STE) and lung ultrasound (LUS) to assess the risk of patients with CCS.
In a prospective, single-center, observational study, from November 2020 to December 2022, 529 consecutive patients with CCS were recruited. All patients were evaluated at rest. A single vendor machine (GE Vivid E95) was used. EF with biplane Simpson’s method (abnormal cut-off < 50%), LV global longitudinal strain (GLS%, abnormal cut-off ≤ 16.2% by receiver-operating characteristics analysis) by STE, and B-line score (abnormal cut-off ≥ 2) by LUS (4-site simplified scan) were assessed. Integrated TTE score ranged from 0 (all 3 parameters normal) to 3 (all parameters abnormal). All patients were followed-up and a composite endpoint was considered, including all-cause death, acute coronary syndrome (ACS), and myocardial revascularization.
During a follow-up of 14.2 months ± 8.3 months, 72 events occurred: 10 deaths, 11 ACSs, and 51 myocardial revascularizations. In multivariable analysis, B lines [hazard ratio (HR) 1.76, 95% confidence Interval (CI) 1.05–2.97; P = 0.03], and GLS ≤ 16.2% (HR 2.0, 95% CI 1.17–3.45; P = 0.01) were independent predictors of events. EF < 50% was a significant predictor in univariate, but not in multivariable analysis. Event rate at 2 years increased from score 0 (8%), to score 1 (21%), 2 (23%), and 3 (40%), P < 0.0001.
TTE with left ventricular ejection fraction (LVEF) can be usefully integrated with STE for GLS, and LUS for B-lines, for better prediction of outcome in CCS. The 3 parameters can be obtained in every echo lab with basic technology, no harm, no risk, and no stress.
The clinical manifestations of COVID-19 which mainly involve the respiratory system may however affect also cardiovascular system. There are a lot and still increasing numbers of reports revealing cardiovascular complications of COVID-19, which may occur in the acute phase as well as during longer follow-up period. The most clinically important diseases include: pulmonary embolism (PE), myocarditis, and acute coronary syndromes (ACS) as well as arrhythmias with the very common atrial fibrillation (AF) and pericarditis. In this review, cardiac imaging options in patients with and after coronavirus infection are presented, showing potential utility for expanding and improving the full and accurate diagnosis of potential complications. Echocardiography, magnetic resonance imaging, and computed tomography (CT) are considered in turn, highlighting their best advantages in patients affected by COVID.
[Names] => Iwona Duraj ... Karina Wierzbowska-Drabik [Doi] => 10.37349/ec.2023.00008 [Published] => October 30, 2023 [Viewed] => 590 [Downloaded] => 13 [Subject] => Review [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/ec.2023.00008 [Inline] => 1 [Type] => 1 [Issue] => 2 [Topic] => 0 [TitleAbbr] => Explor Cardiol. [Pages] => 2023;1:59–71 [Recommend] => 0 [Keywords] => Coronavirus disease 2019, cardiovascular disease, imaging, echocardiography, magnetic resonance imaging, computed tomography [DetailTitle] => [DetailUrl] => [Id] => 10128 [ris] => https://www.explorationpub.com/uploads/Article/A10128/de5d22ab708dd01ce89bd9d2b16449ba.ris [bib] => https://www.explorationpub.com/uploads/Article/A10128/6e7f794569381f8559a7967628d81263.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Duraj I, Kilarska M, Pawlos A, Wierzbowska-Drabik K. Cardiovascular imaging in COVID-19: insights into features and complications. Explor Cardiol. 2023;1:59–71.https://doi.org/10.37349/ec.2023.00008 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2023-10-27 02:14:01 [Bib_Time] => 2023-10-27 02:14:01 [KeysWordContens] => Cardiovascular imaging in COVID-19: insights into features and complications, Coronavirus disease 2019, cardiovascular disease, imaging, echocardiography, magnetic resonance imaging, computed tomography, The clinical manifestations of COVID-19 which mainly involve the respiratory system may however affect also cardiovascular system. There are a lot and still increasing numbers of reports revealing cardiovascular complications of COVID-19, which may occur in the acute phase as well as during longer follow-up period. The most clinically important diseases include: pulmonary embolism (PE), myocarditis, and acute coronary syndromes (ACS) as well as arrhythmias with the very common atrial fibrillation (AF) and pericarditis. In this review, cardiac imaging options in patients with and after coronavirus infection are presented, showing potential utility for expanding and improving the full and accurate diagnosis of potential complications. Echocardiography, magnetic resonance imaging, and computed tomography (CT) are considered in turn, highlighting their best advantages in patients affected by COVID. ,Iwona Duraj ... Karina Wierzbowska-Drabik [PublishedText] => Published [IsEdit] => 0 [AccountId] => 88 [Zh] => 1 ) [9] => Array ( [ArticleId] => 904 [Create_Time] => 2023-11-01 [zipUrl] => https://www.explorationpub.com/uploads/zip/202311/20231101020339.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A10129/10129.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A10129/10129.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A10129/10129_cover.png [JournalsId] => 15 [Title] => Mitral valve prolapse—arrhythmic faces of the valve disease [Abstract] => Mitral valve prolapse (MVP) is a relatively common mitral valvulopathy and the most common cause of isolated primary mitral regurgitation (MR) requiring surgical repair. It affects about 1–3% of t [AbstractComplete] =>Mitral valve prolapse (MVP) is a relatively common mitral valvulopathy and the most common cause of isolated primary mitral regurgitation (MR) requiring surgical repair. It affects about 1–3% of the general population. Although MVP is viewed as a benign condition, the association between MVP and sudden cardiac death (SCD) has been proven. Patients with MVP have a three times higher risk of SCD than the general population. The underlying mechanisms and predictors of arrhythmias, which occur in patients with MVP, are still poorly understood. However, some echocardiographic features such as mitral annulus disjunction (MAD), bileaflet MVP (biMVP), and papillary muscle (PM) fibrosis were frequently linked with increased number of arrhythmic events and are referred to as “arrhythmogenic” or “malignant”. Arrhythmogenic MVP (AMVP) has also been associated with other factors such as female sex, polymorphic premature ventricular contraction (PVC), abnormalities of T-waves, and Pickelhaube sign on tissue Doppler tracing of the lateral part of the mitral annulus. Cardiac magnetic resonance (CMR) imaging and speckle tracking echocardiography are new tools showing significant potential for detection of malignant features of AMVP. This paper presents various data coming from electrocardiography (ECG) analysis, echocardiography, and other imaging techniques as well as compilation of the recent studies on the subject of MVP.
[Names] => Maria Możdżan ... Karina Wierzbowska-Drabik [Doi] => 10.37349/ec.2023.00009 [Published] => October 31, 2023 [Viewed] => 1004 [Downloaded] => 48 [Subject] => Review [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/ec.2023.00009 [Inline] => 1 [Type] => 1 [Issue] => 2 [Topic] => 138 [TitleAbbr] => Explor Cardiol. [Pages] => 2023;1:72–87 [Recommend] => 0 [Keywords] => Mitral valve prolapse, arrhythmogenic mitral valve prolapse, arrhythmia, sudden cardiac death, mitral annulus disjunction, bileaflet mitral valve prolapse, Pickelhaube sign, late enhancement in magnetic resonance imaging [DetailTitle] => Common cardiovascular target for a wide gamut of contemporary health problems – thrombotic and arrhythmic sides of an inflammatory coin [DetailUrl] => https://www.explorationpub.com/Journals/ec/Special_Issues/138 [Id] => 10129 [ris] => https://www.explorationpub.com/uploads/Article/A10129/e3a93162f768f9b2317b330c7cb8278f.ris [bib] => https://www.explorationpub.com/uploads/Article/A10129/a123f842b04aadb1550e2a6ae8f082d6.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Możdżan M, Możdżan M, Duraj I, Możdżan Z, Staciwa M, Broncel M, et al. Mitral valve prolapse—arrhythmic faces of the valve disease. Explor Cardiol. 2023;1:72–87. https://doi.org/10.37349/ec.2023.00009 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2023-10-30 02:29:19 [Bib_Time] => 2023-10-30 02:29:19 [KeysWordContens] => Mitral valve prolapse—arrhythmic faces of the valve disease, Mitral valve prolapse, arrhythmogenic mitral valve prolapse, arrhythmia, sudden cardiac death, mitral annulus disjunction, bileaflet mitral valve prolapse, Pickelhaube sign, late enhancement in magnetic resonance imaging, Mitral valve prolapse (MVP) is a relatively common mitral valvulopathy and the most common cause of isolated primary mitral regurgitation (MR) requiring surgical repair. It affects about 1–3% of the general population. Although MVP is viewed as a benign condition, the association between MVP and sudden cardiac death (SCD) has been proven. Patients with MVP have a three times higher risk of SCD than the general population. The underlying mechanisms and predictors of arrhythmias, which occur in patients with MVP, are still poorly understood. However, some echocardiographic features such as mitral annulus disjunction (MAD), bileaflet MVP (biMVP), and papillary muscle (PM) fibrosis were frequently linked with increased number of arrhythmic events and are referred to as “arrhythmogenic” or “malignant”. Arrhythmogenic MVP (AMVP) has also been associated with other factors such as female sex, polymorphic premature ventricular contraction (PVC), abnormalities of T-waves, and Pickelhaube sign on tissue Doppler tracing of the lateral part of the mitral annulus. Cardiac magnetic resonance (CMR) imaging and speckle tracking echocardiography are new tools showing significant potential for detection of malignant features of AMVP. This paper presents various data coming from electrocardiography (ECG) analysis, echocardiography, and other imaging techniques as well as compilation of the recent studies on the subject of MVP. ,Maria Możdżan ... Karina Wierzbowska-Drabik [PublishedText] => Published [IsEdit] => 0 [AccountId] => 46 [Zh] => 1 ) [10] => Array ( [ArticleId] => 910 [Create_Time] => 2023-11-01 [zipUrl] => https://www.explorationpub.com/uploads/zip/202311/20231101020047.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A101210/101210.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A101210/101210.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A101210/101210_cover.png [JournalsId] => 15 [Title] => Echocardiographic predictors of outcomes in hypertrophic cardiomyopathy [Abstract] => The use of echocardiography, a straightforward and widely available technique, allows for a comprehensive assessment of the patient with hypertrophic cardiomyopathy (HCM) under both resting and stre [AbstractComplete] =>The use of echocardiography, a straightforward and widely available technique, allows for a comprehensive assessment of the patient with hypertrophic cardiomyopathy (HCM) under both resting and stress conditions. The true prevalence of HCM has been redefined over time by this imaging approach, which has also made it feasible to pinpoint parameters that clinicians may use to stratify patients at risk for adverse cardiovascular events. The current and emerging prognostic predictors in HCM, assessed with transthoracic echocardiography at rest and during provocation, are discussed in this review.
[Names] => Annamaria Del Franco ... Iacopo Olivotto [Doi] => 10.37349/ec.2023.00010 [Published] => October 31, 2023 [Viewed] => 689 [Downloaded] => 25 [Subject] => Review [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/ec.2023.00010 [Inline] => 1 [Type] => 1 [Issue] => 2 [Topic] => 138 [TitleAbbr] => Explor Cardiol. [Pages] => 2023;1:88–102 [Recommend] => 0 [Keywords] => Prognosis, hypertrophic cardiomyopathy, resting and exercise echocardiography [DetailTitle] => Common cardiovascular target for a wide gamut of contemporary health problems – thrombotic and arrhythmic sides of an inflammatory coin [DetailUrl] => https://www.explorationpub.com/Journals/ec/Special_Issues/138 [Id] => 101210 [ris] => https://www.explorationpub.com/uploads/Article/A101210/f6c86664698e8e1c4251798b6d0c5a17.ris [bib] => https://www.explorationpub.com/uploads/Article/A101210/649c8c281372986e333984e28b763775.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Del Franco A, Pálinkás ED, Panichella G, Olivotto I. Echocardiographic predictors of outcomes in hypertrophic cardiomyopathy. Explor Cardiol. 2023;1:88–102. https://doi.org/10.37349/ec.2023.00010 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2023-10-31 08:52:02 [Bib_Time] => 2023-10-31 08:52:02 [KeysWordContens] => Echocardiographic predictors of outcomes in hypertrophic cardiomyopathy, Prognosis, hypertrophic cardiomyopathy, resting and exercise echocardiography, The use of echocardiography, a straightforward and widely available technique, allows for a comprehensive assessment of the patient with hypertrophic cardiomyopathy (HCM) under both resting and stress conditions. The true prevalence of HCM has been redefined over time by this imaging approach, which has also made it feasible to pinpoint parameters that clinicians may use to stratify patients at risk for adverse cardiovascular events. The current and emerging prognostic predictors in HCM, assessed with transthoracic echocardiography at rest and during provocation, are discussed in this review. ,Annamaria Del Franco ... Iacopo Olivotto [PublishedText] => Published [IsEdit] => 0 [AccountId] => 80 [Zh] => 1 ) [11] => Array ( [ArticleId] => 911 [Create_Time] => 2023-11-01 [zipUrl] => https://www.explorationpub.com/uploads/zip/202311/20231101012114.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A101211/101211.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A101211/101211.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A101211/101211_cover.png [JournalsId] => 15 [Title] => Coronary external diameter index for assessing coronary artery involvement in Kawasaki disease [Abstract] => Aim: Transthoracic echocardiography is commonly used to assess coronary artery dilatation in Kawasaki disease (KD). However, existing criteria often miss early abnormalities. This study examines [AbstractComplete] =>Transthoracic echocardiography is commonly used to assess coronary artery dilatation in Kawasaki disease (KD). However, existing criteria often miss early abnormalities. This study examines the utility of a new parameter, coronary external diameter index (CEDi), for early diagnosis and monitoring in KD.
CEDi of left main (LM) and right coronary artery (RCA), calculated as the ratio of coronary artery external diameter (i.e., the distance between the outer coronary edges measured in the proximal segment of the artery) and the diameter of the aortic annulus, was evaluated in 34 patients (age 23 mouths ± 13 months) with KD at the hospital admission and after 2 weeks and 8 weeks of treatment. The control group consisted of 210 healthy children aged 20 months ± 13.4 months. Z-score charts for LM and RCA coronary external diameter (CED) were obtained.
Compared with controls, KD patients had a markedly higher mean value of LM CEDi (0.53 ± 0.06 vs. 0.33 ± 0.04; P < 0.0001) and RCA CEDi (0.48 ± 0.05 vs. 0.31 ± 0.04; P < 0.0001) at hospital admission. By ROC analysis, LM CEDi of 0.41, and RCA coronary artery thickness index (CATi) of 0.39 were the best cut-offs to confirm the clinical diagnosis of KD, both exhibiting 100% sensitivity and specificity. Mean LM CEDi and RCA CEDi values decreased significantly (P < 0.0001) after 2 weeks of follow-up and were similar to controls (P = 0.53 and P = 0.12, respectively) 8 weeks after admission.
In patients with KD, CEDi of LM and RCA is an accurate parameter to evaluate coronary artery involvement in the early phase of the illness and during follow-up.
Congenital heart defects (CHD) represent the most frequent congenital anomalies among newborns, as well as the leading cause of spontaneous abortion, stillbirth, neonatal and infant death. CHD have been recognized as multifactorial diseases, with environmental contaminants as potential contributors to the etiopathogenesis of CHD. Toxic elements, such as arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg) are known to be associated with adverse reproductive outcomes and certain congenital anomalies, however their association with the risk for CHD remains inconsistent. This review summarizes the updated evidence on the CHD-associated risk related to exposure to As, Cd, Hg, Pb during pregnancy, reporting the main findings from epidemiological and experimental studies and the underlying molecular mechanisms. Additionally, being diet the major source of these elements in the general population, after having identified the main vectors of toxic metals in food, possible remediation strategies to reduce diet-related risks are also described. Among these, a novel, consumer-centered approach in developing new foods is discussed, considering not only the nutritional characteristics of edible compounds foods are made up of, but also their organoleptic features, making the food even more appealing to the consumer. Overall, current data support the association of maternal exposure to As and Pb with increased risk for CHD, although significant associations have only been observed for total and/or specific subgroups. On the other hand, the evidence of association for Cd and Hg exposure in pregnancy with CHD in the offspring remains, yet, quite speculative. Further large prospective cohort studies and insights into the molecular and biomolecular processes of these relationships are warranted to further explore and/or verify these findings.
[Names] => Francesca Gorini, Alessandro Tonacci [Doi] => 10.37349/ec.2023.00012 [Published] => November 13, 2023 [Viewed] => 668 [Downloaded] => 16 [Subject] => Review [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/ec.2023.00012 [Inline] => 1 [Type] => 1 [Issue] => 3 [Topic] => 177 [TitleAbbr] => Explor Cardiol. [Pages] => 2023;1:114–140 [Recommend] => 0 [Keywords] => Congenital heart defects, exposure, functional foods, pregnancy, risk, toxic metals [DetailTitle] => Environmental Cardiology [DetailUrl] => https://www.explorationpub.com/Journals/ec/Special_Issues/177 [Id] => 101212 [ris] => https://www.explorationpub.com/uploads/Article/A101212/68a17fc47ac073a2c03646ba2a03cc55.ris [bib] => https://www.explorationpub.com/uploads/Article/A101212/e182f0257c92eec7af6670cf41250a46.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Gorini F, Tonacci A. Toxic metals in pregnancy and congenital heart defects. Insights and new perspectives for a technology-driven reduction in food sources. Explor Cardiol. 2023;1:114–40. https://doi.org/10.37349/ec.2023.00012 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2023-11-09 09:26:47 [Bib_Time] => 2023-11-09 09:26:47 [KeysWordContens] => Toxic metals in pregnancy and congenital heart defects. Insights and new perspectives for a technology-driven reduction in food sources, Congenital heart defects, exposure, functional foods, pregnancy, risk, toxic metals, Congenital heart defects (CHD) represent the most frequent congenital anomalies among newborns, as well as the leading cause of spontaneous abortion, stillbirth, neonatal and infant death. CHD have been recognized as multifactorial diseases, with environmental contaminants as potential contributors to the etiopathogenesis of CHD. Toxic elements, such as arsenic (As), cadmium (Cd), lead (Pb), and mercury (Hg) are known to be associated with adverse reproductive outcomes and certain congenital anomalies, however their association with the risk for CHD remains inconsistent. This review summarizes the updated evidence on the CHD-associated risk related to exposure to As, Cd, Hg, Pb during pregnancy, reporting the main findings from epidemiological and experimental studies and the underlying molecular mechanisms. Additionally, being diet the major source of these elements in the general population, after having identified the main vectors of toxic metals in food, possible remediation strategies to reduce diet-related risks are also described. Among these, a novel, consumer-centered approach in developing new foods is discussed, considering not only the nutritional characteristics of edible compounds foods are made up of, but also their organoleptic features, making the food even more appealing to the consumer. Overall, current data support the association of maternal exposure to As and Pb with increased risk for CHD, although significant associations have only been observed for total and/or specific subgroups. On the other hand, the evidence of association for Cd and Hg exposure in pregnancy with CHD in the offspring remains, yet, quite speculative. Further large prospective cohort studies and insights into the molecular and biomolecular processes of these relationships are warranted to further explore and/or verify these findings. ,Francesca Gorini, Alessandro Tonacci [PublishedText] => Published [IsEdit] => 0 [AccountId] => 80 [Zh] => 1 ) [13] => Array ( [ArticleId] => 985 [Create_Time] => 2023-12-11 [zipUrl] => https://www.explorationpub.com/uploads/zip/202312/20231228032217.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A101213/101213.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A101213/101213.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A101213/101213_cover.png [JournalsId] => 15 [Title] => Low-doses ionizing radiation exposure: an emerging causal risk factor for cardiovascular disease [Abstract] => [AbstractComplete] => [Names] => Maria Grazia Andreassi [Doi] => 10.37349/ec.2023.00013 [Published] => December 11, 2023 [Viewed] => 501 [Downloaded] => 11 [Subject] => Commentary [Year] => 2023 [CiteUrl] => https://doi.org/10.37349/ec.2023.00013 [Inline] => 1 [Type] => 1 [Issue] => 3 [Topic] => 177 [TitleAbbr] => Explor Cardiol. [Pages] => 2023;1:141–147 [Recommend] => 0 [Keywords] => Ionizing radiation, cardiovascular disease, medical exposure, telomere, deoxyribonucleic acid damage response, senescence-associated secretory phenotype [DetailTitle] => Environmental Cardiology [DetailUrl] => https://www.explorationpub.com/Journals/ec/Special_Issues/177 [Id] => 101213 [ris] => https://www.explorationpub.com/uploads/Article/A101213/edfe327ca672182f71be1c452eef673f.ris [bib] => https://www.explorationpub.com/uploads/Article/A101213/773c8195858c460966d5e3de8f3c035e.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Andreassi MG. Low-doses ionizing radiation exposure: an emerging causal risk factor for cardiovascular disease. Explor Cardiol. 2023;1:141–7. https://doi.org/10.37349/ec.2023.00013 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2023-12-28 03:22:17 [Bib_Time] => 2023-12-28 03:22:17 [KeysWordContens] => Low-doses ionizing radiation exposure: an emerging causal risk factor for cardiovascular disease, Ionizing radiation, cardiovascular disease, medical exposure, telomere, deoxyribonucleic acid damage response, senescence-associated secretory phenotype,,Maria Grazia Andreassi [PublishedText] => Published [IsEdit] => 0 [AccountId] => 85 [Zh] => 1 ) [14] => Array ( [ArticleId] => 1047 [Create_Time] => 2023-12-27 [zipUrl] => https://www.explorationpub.com/uploads/zip/202312/20231229063305.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A101214/101214.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A101214/101214.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A101214/101214_cover.png [JournalsId] => 15 [Title] => Viral infections in cardiometabolic risk and disease between old acquaintances and new enemies [Abstract] => Atherosclerosis is a chronic disease, characterized by chronic inflammation, endothelial dysfunction, and lipid deposition in the vessel. Although many major, well-identified risk factors for athero [AbstractComplete] =>Atherosclerosis is a chronic disease, characterized by chronic inflammation, endothelial dysfunction, and lipid deposition in the vessel. Although many major, well-identified risk factors for atherosclerosis [e.g., hyperlipidemia, hypertension, type 2 diabetes (T2D), smoking habit, and obesity] explain a lot about the risk, there is a considerable number of patients who develop atherosclerotic damage and undergo adverse events without presenting any of these established modifiable risk factors. This observation has stimulated an urgent need to expand knowledge towards the identification of additional, less established risk factors that may help in the assessment of risk and fill the gap of knowledge in the cardiovascular (CV) setting. Among them, the hypothesis of a possible relationship between viral infectious agents and atherosclerosis has risen since the early 1900s. However, there is still a great deal of debate regarding the onset and progression of CV disease in relation to the roles of the pathogens (as active inducers or bystanders), host genomic counterparts, and environmental triggers, affecting both virus abundance and the composition of viral communities. Accordingly, the aim of this review is to discuss the current state of knowledge on infectious agents in the atherosclerotic process, with particular focus on two environmental-related viruses, as examples of familiar (influenza) and unfamiliar [severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)] disease triggers.
[Names] => Cristina Vassalle [Doi] => 10.37349/ec.2023.00014 [Published] => December 27, 2023 [Viewed] => 598 [Downloaded] => 10 [Subject] => Review [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/ec.2023.00014 [Inline] => 1 [Type] => 1 [Issue] => 3 [Topic] => 177 [TitleAbbr] => Explor Cardiol. [Pages] => 2023;1:148–179 [Recommend] => 0 [Keywords] => Atherosclerosis, type 2 diabetes, viral infection, severe acute respiratory syndrome coronavirus-2, cardiometabolic risk, cardiometabolic disease, ischemic heart disease, non-traditional cardiovascular risk factors [DetailTitle] => Environmental Cardiology [DetailUrl] => https://www.explorationpub.com/Journals/ec/Special_Issues/177 [Id] => 101214 [ris] => https://www.explorationpub.com/uploads/Article/A101214/34e7758c70e1b48b279a19f2932ee021.ris [bib] => https://www.explorationpub.com/uploads/Article/A101214/e7e8a2333c12a58942132ac52cc68c7d.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Vassalle C. Viral infections in cardiometabolic risk and disease between old acquaintances and new enemies. Explor Cardiol. 2023;1:148–79. https://doi.org/10.37349/ec.2023.00014 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2023-12-28 05:26:30 [Bib_Time] => 2023-12-28 01:17:51 [KeysWordContens] => Viral infections in cardiometabolic risk and disease between old acquaintances and new enemies, Atherosclerosis, type 2 diabetes, viral infection, severe acute respiratory syndrome coronavirus-2, cardiometabolic risk, cardiometabolic disease, ischemic heart disease, non-traditional cardiovascular risk factors, Atherosclerosis is a chronic disease, characterized by chronic inflammation, endothelial dysfunction, and lipid deposition in the vessel. Although many major, well-identified risk factors for atherosclerosis [e.g., hyperlipidemia, hypertension, type 2 diabetes (T2D), smoking habit, and obesity] explain a lot about the risk, there is a considerable number of patients who develop atherosclerotic damage and undergo adverse events without presenting any of these established modifiable risk factors. This observation has stimulated an urgent need to expand knowledge towards the identification of additional, less established risk factors that may help in the assessment of risk and fill the gap of knowledge in the cardiovascular (CV) setting. Among them, the hypothesis of a possible relationship between viral infectious agents and atherosclerosis has risen since the early 1900s. However, there is still a great deal of debate regarding the onset and progression of CV disease in relation to the roles of the pathogens (as active inducers or bystanders), host genomic counterparts, and environmental triggers, affecting both virus abundance and the composition of viral communities. Accordingly, the aim of this review is to discuss the current state of knowledge on infectious agents in the atherosclerotic process, with particular focus on two environmental-related viruses, as examples of familiar (influenza) and unfamiliar [severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)] disease triggers. ,Cristina Vassalle [PublishedText] => Published [IsEdit] => 0 [AccountId] => 76 [Zh] => 1 ) [15] => Array ( [ArticleId] => 1062 [Create_Time] => 2023-12-29 [zipUrl] => https://www.explorationpub.com/uploads/zip/202312/20231229063349.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A101215/101215.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A101215/101215.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A101215/101215_cover.png [JournalsId] => 15 [Title] => Why and when should be lipoprotein(a) level measured? [Abstract] => Lipoprotein(a) [Lp(a)] is composed of a low-density lipoprotein (LDL) and glycoprotein (a)—apo(a). The size and concentration of Lp(a) in serum can vary among individuals and is determined by gene [AbstractComplete] =>Lipoprotein(a) [Lp(a)] is composed of a low-density lipoprotein (LDL) and glycoprotein (a)—apolipoprotein(a) [apo(a)]. The size and concentration of Lp(a) in serum can vary among individuals and is determined by genetic factors. The environmental factors, diet, and physical activity have a negligible effect on Lp(a) level. Observational, epidemiological, and genetic studies improved that high levels of Lp(a) > 50 mg/dL (> 125 nmol/L) have been associated with an increased risk of myocardial infarction (MI), stroke, and calcific aortic valve stenosis (CAVS). It is recommended to measure Lp(a) at least once in adults to identify individuals with a high cardiovascular risk. This screening is particularly important in certain populations, including: youth with a history of ischemic stroke or a family history of premature atherosclerotic cardiovascular disease (CVD; ASCVD) or high Lp(a), individuals with recurrent cardiovascular events despite optimal hypolipemic treatment and no other identifiable risk factors or patients with familial hypercholesterolemia (FH). Considering Lp(a) levels in the evaluation of cardiovascular risk can provide valuable information for risk stratification and management decisions. However, it’s important to note that the treatments of elevated level of Lp(a) are limited. In recent years, there has been ongoing research and development of new drugs targeting Lp(a): pelacarsen—antisense oligonucleotide (ASO), and olpasiran—a small interfering RNA (siRNA).
[Names] => Miłosz Broncel, Marlena Broncel [Doi] => 10.37349/ec.2023.00015 [Published] => December 29, 2023 [Viewed] => 432 [Downloaded] => 20 [Subject] => Review [Year] => 2023 [CiteUrl] => https://api.crossref.org/works/10.37349/ec.2023.00015 [Inline] => 1 [Type] => 1 [Issue] => 3 [Topic] => 138 [TitleAbbr] => Explor Cardiol. [Pages] => 2023;1:180–192 [Recommend] => 0 [Keywords] => Lipoprotein(a), olpasiran, pelacarsen, stroke, calcific aortic valve stenosis, myocardial infarction, diabetes [DetailTitle] => Common cardiovascular target for a wide gamut of contemporary health problems – thrombotic and arrhythmic sides of an inflammatory coin [DetailUrl] => https://www.explorationpub.com/Journals/ec/Special_Issues/138 [Id] => 101215 [ris] => https://www.explorationpub.com/uploads/Article/A101215/fd07e863614f027c387139520b6070c6.ris [bib] => https://www.explorationpub.com/uploads/Article/A101215/9c1b5ba656df37c5991fffa888e8a0b6.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Broncel M, Broncel M. Why and when should be lipoprotein(a) level measured? Explor Cardiol. 2023;1:180–92. https://doi.org/10.37349/ec.2023.00015 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2023-12-28 02:28:30 [Bib_Time] => 2023-12-29 00:34:50 [KeysWordContens] => Why and when should be lipoprotein(a) level measured?, Lipoprotein(a), olpasiran, pelacarsen, stroke, calcific aortic valve stenosis, myocardial infarction, diabetes, Lipoprotein(a) [Lp(a)] is composed of a low-density lipoprotein (LDL) and glycoprotein (a)—apolipoprotein(a) [apo(a)]. The size and concentration of Lp(a) in serum can vary among individuals and is determined by genetic factors. The environmental factors, diet, and physical activity have a negligible effect on Lp(a) level. Observational, epidemiological, and genetic studies improved that high levels of Lp(a) > 50 mg/dL (> 125 nmol/L) have been associated with an increased risk of myocardial infarction (MI), stroke, and calcific aortic valve stenosis (CAVS). It is recommended to measure Lp(a) at least once in adults to identify individuals with a high cardiovascular risk. This screening is particularly important in certain populations, including: youth with a history of ischemic stroke or a family history of premature atherosclerotic cardiovascular disease (CVD; ASCVD) or high Lp(a), individuals with recurrent cardiovascular events despite optimal hypolipemic treatment and no other identifiable risk factors or patients with familial hypercholesterolemia (FH). Considering Lp(a) levels in the evaluation of cardiovascular risk can provide valuable information for risk stratification and management decisions. However, it’s important to note that the treatments of elevated level of Lp(a) are limited. In recent years, there has been ongoing research and development of new drugs targeting Lp(a): pelacarsen—antisense oligonucleotide (ASO), and olpasiran—a small interfering RNA (siRNA). ,Miłosz Broncel, Marlena Broncel [PublishedText] => Published [IsEdit] => 0 [AccountId] => 46 [Zh] => 1 ) [16] => Array ( [ArticleId] => 1096 [Create_Time] => 2024-02-04 [zipUrl] => https://www.explorationpub.com/uploads/zip/202402/20240204034724.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A101216/101216.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A101216/101216.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A101216/101216_cover.png [JournalsId] => 15 [Title] => Coronary vasospasm testing: escape from the cath lab! [Abstract] => Coronary vasospasm stands as a widely acknowledged and frequent culprit behind chest pain, acute coronary syndrome, and sudden cardiac death, yet it remains a challenging diagnosis. Current guidelin [AbstractComplete] =>Coronary vasospasm stands as a widely acknowledged and frequent culprit behind chest pain, acute coronary syndrome, and sudden cardiac death, yet it remains a challenging diagnosis. Current guidelines recommend invasive coronary function testing to assess pathophysiology and mechanisms and to define treatment. In reality, this protocol is rarely applied, because it necessitates extended occupation of the cath lab, repetitive administration of nephrotoxic iodine contrast agents, the need for repeated testing on both coronary arteries leading to considerable radiation exposure, and significant direct expenses. The promising perspective for vasospasm testing is a noninvasive approach with advanced echocardiographic techniques, such as transthoracic Doppler echocardiography, with more sensitive indicators of ischemia. Hyperventilation and exercise tests are used for vasospasm directed testing, with assessment of the new parameters: coronary flow velocities and reserve, allowing to see deeper into macro and microvascular pathophysiology. Association between coronary flow, global longitudinal strain and microvascular dysfunction (MVD) and impaired values at hyperemia was previously demonstrated. Reduction in coronary flow velocity (CFV) despite heightened myocardial oxygen consumption and double product during hyperventilation are indicative of coronary vasospasm. Normal coronary angiography finding in patients with documented evidence of ischemia should initiate additional diagnostic testing in order to increase the yield of specific diagnosis in patients with suspected vasospasm, which could help to personalize treatment and prognosis. In order to achieve this, non-invasive provocative stress echocardiography tests should be included in the diagnostic workup. This approach, characterized by its simplicity, feasibility, safety, and efficacy, is currently undergoing extensive testing on a large scale.
[Names] => Ana Djordjevic Dikic ... Vojislav Giga [Doi] => 10.37349/ec.2024.00016 [Published] => February 04, 2024 [Viewed] => 364 [Downloaded] => 23 [Subject] => Perspective [Year] => 2024 [CiteUrl] => https://api.crossref.org/works/10.37349/ec.2024.00016 [Inline] => 1 [Type] => 1 [Issue] => 1 [Topic] => 0 [TitleAbbr] => Explor Cardiol. [Pages] => 2024;2:1–8 [Recommend] => 0 [Keywords] => Vasospasm, ischemia with non-obstructive coronary arteries, stress echocardiography [DetailTitle] => [DetailUrl] => [Id] => 101216 [ris] => https://www.explorationpub.com/uploads/Article/A101216/e046573faf55f8d22c67a0fcd916eac3.ris [bib] => https://www.explorationpub.com/uploads/Article/A101216/b22a9bc4d2d3afe7e335dc3078814247.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Djordjevic Dikic A, Dedic S, Boskovic N, Giga V. Coronary vasospasm testing: escape from the cath lab! Explor Cardiol. 2024;2:1–8. https://doi.org/10.37349/ec.2024.00016 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2024-02-05 08:41:10 [Bib_Time] => 2024-01-31 02:18:42 [KeysWordContens] => Coronary vasospasm testing: escape from the cath lab!, Vasospasm, ischemia with non-obstructive coronary arteries, stress echocardiography, Coronary vasospasm stands as a widely acknowledged and frequent culprit behind chest pain, acute coronary syndrome, and sudden cardiac death, yet it remains a challenging diagnosis. Current guidelines recommend invasive coronary function testing to assess pathophysiology and mechanisms and to define treatment. In reality, this protocol is rarely applied, because it necessitates extended occupation of the cath lab, repetitive administration of nephrotoxic iodine contrast agents, the need for repeated testing on both coronary arteries leading to considerable radiation exposure, and significant direct expenses. The promising perspective for vasospasm testing is a noninvasive approach with advanced echocardiographic techniques, such as transthoracic Doppler echocardiography, with more sensitive indicators of ischemia. Hyperventilation and exercise tests are used for vasospasm directed testing, with assessment of the new parameters: coronary flow velocities and reserve, allowing to see deeper into macro and microvascular pathophysiology. Association between coronary flow, global longitudinal strain and microvascular dysfunction (MVD) and impaired values at hyperemia was previously demonstrated. Reduction in coronary flow velocity (CFV) despite heightened myocardial oxygen consumption and double product during hyperventilation are indicative of coronary vasospasm. Normal coronary angiography finding in patients with documented evidence of ischemia should initiate additional diagnostic testing in order to increase the yield of specific diagnosis in patients with suspected vasospasm, which could help to personalize treatment and prognosis. In order to achieve this, non-invasive provocative stress echocardiography tests should be included in the diagnostic workup. This approach, characterized by its simplicity, feasibility, safety, and efficacy, is currently undergoing extensive testing on a large scale. ,Ana Djordjevic Dikic ... Vojislav Giga [PublishedText] => Published [IsEdit] => 0 [AccountId] => 88 [Zh] => 1 ) [17] => Array ( [ArticleId] => 1101 [Create_Time] => 2024-02-04 [zipUrl] => https://www.explorationpub.com/uploads/zip/202402/20240204003356.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A101217/101217.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A101217/101217.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A101217/101217_cover.png [JournalsId] => 15 [Title] => Feasibility of coronary flow velocity reserve during semi-supine exercise echocardiography: a single center study of 3,014 patients [Abstract] => Aim: There is a lack of studies that analyzed factors influencing on feasibility of coronary flow velocity reserve (CFVR) during exercise stress echocardiography (SE). The aim of the study was to [AbstractComplete] =>There is a lack of studies that analyzed factors influencing on feasibility of coronary flow velocity reserve (CFVR) during exercise stress echocardiography (SE). The aim of the study was to define the feasibility of assessment of CFVR during exercise through SE depending on experience, techniques, and clinical factors.
This is a single-center study. SE was performed using three generations of echo systems in five consecutive cohorts of patients by experienced and novice specialists. All patients performed a supine bicycle testing. CFVR was calculated in the middle/middle-distal parts of the left anterior descending artery (LAD). Three different adjustment settings were used for LAD visualization.
The study included 3,014 patients (59 years old ± 11 years old, 54% males). Age [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.96–0.99, P < 0.01], body mass index (BMI; OR 0.95, 95% CI 0.91–0.98, P < 0.003), rest heart rate (OR 0.98, 95% CI 0.97–0.99, P < 0.0005) and doctor’s experience (OR 2.7, 95% CI 1.57–4.53, P < 0.0003) were independent factors that influence on feasibility. The feasibility of CFVR assessment during exercise SE in the whole population by experienced doctors was 89.4%. The feasibility of CFVR assessment of LAD in obese patients performed by experienced doctors using modern echo machines and new techniques was high (86.0%).
Coronary artery velocity reserve during supine exercise SE is a feasible, non-invasive available tool. The new generation echo machine and the new techniques provide a good feasibility of CFVR assessment, even in novice doctors. Despite a lower level of possibility to assess CFVR in obese patients or with a higher resting heart rate, this method is feasible in a great majority of such patients.
Myocardial bridging is a congenital defect characterized by the course of a segment of the coronary arteries within the heart muscle most frequently affecting the left anterior descending coronary artery (LAD). Patients with myocardial bridging may present with episodes of exertional anginal chest pain. The gold standard for non-invasive diagnosis of myocardial bridge is coronary computed tomography angiography (CCTA), which allows anatomical characterization. Coronary flow velocity reserve (CFVR) of the LAD on stress echocardiography (SE) can play an important role in the diagnosis of myocardial bridging of the LAD; a relationship between CVFR-LAD and coronary inflammation by estimating the attenuation of peri-coronary adipose tissue at CCTA has been demonstrated in patients without obstructive ischaemic heart disease. Therefore, coronary inflammation localized to the LAD has been assessed in patients diagnosed with myocardial bridging of the LAD and previous SE with CFVR-LAD in a case series.
[Names] => Domenico Tuttolomondo ... Nicola Gaibazzi [Doi] => 10.37349/ec.2024.00019 [Published] => February 29, 2024 [Viewed] => 321 [Downloaded] => 13 [Subject] => Perspective [Year] => 2024 [CiteUrl] => https://api.crossref.org/works/10.37349/ec.2024.00019 [Inline] => 1 [Type] => 1 [Issue] => 1 [Topic] => 0 [TitleAbbr] => Explor Cardiol. [Pages] => 2024;2:31–39 [Recommend] => 0 [Keywords] => Myocardial bridge, stress echocardiography, fat attenuation [DetailTitle] => [DetailUrl] => [Id] => 101219 [ris] => https://www.explorationpub.com/uploads/Article/A101219/e718f259aa285c2b994f9f075f5d2b5c.ris [bib] => https://www.explorationpub.com/uploads/Article/A101219/30be9c24fe9c91da4ce8e4ef0cd178c5.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Tuttolomondo D, Dey D, Slomka PJ, Pizzi C, Bergamaschi L, Gaibazzi N. Coronary myocardial bridge imaging by stress-echocardiography and coronary adipose tissue attenuation on computed tomography angiography. Explor Cardiol. 2024;2:31–9. https://doi.org/10.37349/ec.2024.00019 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2024-02-27 03:28:58 [Bib_Time] => 2024-02-27 03:28:58 [KeysWordContens] => Coronary myocardial bridge imaging by stress-echocardiography and coronary adipose tissue attenuation on computed tomography angiography, Myocardial bridge, stress echocardiography, fat attenuation, Myocardial bridging is a congenital defect characterized by the course of a segment of the coronary arteries within the heart muscle most frequently affecting the left anterior descending coronary artery (LAD). Patients with myocardial bridging may present with episodes of exertional anginal chest pain. The gold standard for non-invasive diagnosis of myocardial bridge is coronary computed tomography angiography (CCTA), which allows anatomical characterization. Coronary flow velocity reserve (CFVR) of the LAD on stress echocardiography (SE) can play an important role in the diagnosis of myocardial bridging of the LAD; a relationship between CVFR-LAD and coronary inflammation by estimating the attenuation of peri-coronary adipose tissue at CCTA has been demonstrated in patients without obstructive ischaemic heart disease. Therefore, coronary inflammation localized to the LAD has been assessed in patients diagnosed with myocardial bridging of the LAD and previous SE with CFVR-LAD in a case series. ,Domenico Tuttolomondo ... Nicola Gaibazzi [PublishedText] => Published [IsEdit] => 0 [AccountId] => 87 [Zh] => 1 ) [19] => Array ( [ArticleId] => 1200 [Create_Time] => 2024-04-07 [zipUrl] => https://www.explorationpub.com/uploads/zip/202404/20240407014358.zip [xmlUrl] => https://www.explorationpub.com/uploads/Article/A101220/101220.xml [pdfUrl] => https://www.explorationpub.com/uploads/Article/A101220/101220.pdf [coverUrl] => https://www.explorationpub.com/uploads/Article/A101220/101220_cover.png [JournalsId] => 15 [Title] => Role of cardio-ankle vascular index as a predictor of left ventricular hypertrophy in the evaluation of pediatric hypertension [Abstract] => Aim: Cardio-ankle vascular index (CAVI) is a marker of arterial stiffness independent of blood pressure (BP) at the time of measurement. This work sought to evaluate the association of CAVI with [AbstractComplete] =>Cardio-ankle vascular index (CAVI) is a marker of arterial stiffness independent of blood pressure (BP) at the time of measurement. This work sought to evaluate the association of CAVI with left ventricular hypertrophy (LVH), a marker of long-standing hypertension (HTN) in the pediatric population.
CAVI values from 236 children being evaluated for HTN were compared with their BP grade (normal, elevated, stage I HTN, and stage II HTN) in accordance with clinical guidelines. CAVI values were correlated to the presence of LVH and lipid profiles. One hundred seven of the studied patients had transthoracic echocardiograms available for comparison, and 126 had available lipid results. CAVI means between the groups were compared using analysis of variance.
There was no significant difference in CAVI values between the BP groups [median/interquartile range: normal BP (4.95/4.4–5.7), elevated BP (5.1/4.5–5.6), stage I/II HTN (5.0/4.3–5.5)]. Mean CAVI value was higher in the group that had LVH (5.53, standard deviation = 1.4 vs. 5.1, standard deviation = 1; P = 0.13) but was not statistically significant. However, higher mean CAVI value in children ≥ 15 years was significantly associated with the presence of LVH (5.9, standard deviation = 1.8 vs. 5.2 standard deviation = 0.8; P = 0.018).
In post-pubertal children, CAVI may be a good predictor of LVH from long-standing HTN. This tool could prove useful in screening for the presence of atherosclerotic changes and provide opportunity for intervention/improved long-term outcomes.
The DNA of the atheroma is hypermethylated relative to adjacent healthy vascular tissue. A significant portion of hypermethylated loci in the atheroma DNA map to genes related to macrophage function. Reversing macrophage DNA methylation to physiological levels by targeting DNA methyltransferase (DNMT) activity may therefore slow atherogenesis. Here, the anti-inflammatory and anti-atherogenic activity of macrophage-targeted DNMT inhibitor SGI-1027 were tested.
SGI-1027 was encapsulated into human serum albumin (HSA) nanoparticle (HSANP) functionalized with the PP1 peptide, a macrophage scavenger receptor 1 ligand, fused to a FLAG epitope (S-HSANP-FLAGPP1).
Nanoparticle physico-chemical characteristics predicted good marginalization towards the vascular wall, although SGI-1027 encapsulation efficiency was relatively low (~23%). S-HSANP-FLAGPP1 were rapidly internalized compared to non-functionalized and, surprisingly, functionalized void controls, and induced a shift towards an anti-inflammatory profile of secreted cytokines in human THP-1 macrophages. S-HSANP-FLAGPP1 colonized the atheroma and induced a significant ~44% reduction of atherosclerosis burden in the aortic tree of apolipoprotein E (ApoE)-null mice compared to controls. A reduction in aortic root atherosclerosis was observed, although primarily induced by HSANP irrespective of loading or functionalization. No alteration of body weight, non-vascular tissue gross histology, plasma glucose, triglyceride or cholesterol were observed. HSA whether free or structured in nanoparticles, induced a 3–4-fold increase in high-density lipoprotein (HDL) compared to vehicle.
Unexpectedly, effects that were likely non-epigenetic and induced by HSA per se were observed. HSANP loaded with SGI-1027 were anti-atherogenic but in an anatomical location-dependent fashion. SGI-1027 displayed a novel anti-inflammatory activity in non-proliferating THP-1 cells, implying that those effects are likely unrelated to DNMT inhibition. HSA elevated HDL per se, thus underlining a possible additional advantage of HSA-based nanocarriers.
The pattern and severity of coronary artery calcification (CAC) can influence prognosis and outcome in percutaneous coronary intervention. An objective assessment of CAC during invasive angiography may provide additional prognostic information. This study aimed to assess the correlation between the angiographic Birmingham calcium score (BCS) and the Agatston coronary calcium score (CCS) performed as part of single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI).
In this retrospective observational study, patients undergoing SPECT-MPI and invasive coronary angiography as part of their routine management were included. BCS was calculated by reviewing angiography images in retrospect by an observer blinded to the SPECT-MPI calcium score. Spearman’s correlation was used to analyze the correlation between BCS and SPECT-MPI. Receiver operating characteristic curve was used to detect cut-off for BCS that would detect clinically significant CAC [> 400 Agatston units (AU)]. Kaplan-Meier was used to report on outcomes at 5 years follow-up.
In this cohort of 151 patients, there was a positive correlation between BCS and CCS [Spearman correlation coefficient (r) = 0.558, P < 0.001]. Cumulative BCS of 1 was able to identify clinically significant CAC [area under the curve 0.788, 95% confidence interval (CI) 0.714–0.863]. Cumulative BCS ≥ 3 was associated with major adverse outcomes at 5 years follow-up (log rank P = 0.013).
BCS correlates well with established higher CCS. Application of BCS during invasive coronary angiography will aid risk stratification, management, and follow-up with no extra patient involvement, radiation, or costs.
Drawing insights from a spectrum of in vitro, in vivo experimental, and clinical studies, this review illuminates the underlying mechanism by which iodinated contrast media (ICM) exerts an indirect genotoxic effect. The mechanism involves the photoelectric effect induced by iodine molecules, thereby augmenting radiation attenuation and subsequently elevating the locally absorbed radiation dose. The ensuing generation of secondary electrons from each photoelectric absorption interaction triggers molecular reactions, culminating in discernible DNA damage, notably in the form of DNA double-strand breaks. A convergence of evidence from in vitro, experimental, and clinical investigations underscores a consistent pattern: the addition of iodine contrast linearly heightens the absorbed radiation dose and associated DNA damage. This quantification was evident through alterations in attenuation and the manifestation of double-strand breaks in circulating lymphocytes, serving as an intermediate endpoint and a potential long-term indicator of cancer. The observed surplus of DNA damage in contrast-enhanced images compared to non-contrast images ranged notably from +30% to +200%. This broad range accentuates a substantial amplification effect on radiation-induced damage, particularly noteworthy at clinically relevant iodine doses. Crucially, this effect remains unaffected by brands or manufacturers and exhibits a robust, exclusive correlation with the concentration of iodine in the bloodstream. The significant augmentation of absorbed dose and genotoxic impact of X-rays due to the use of contrast agents warrants critical attention within the medical community. This often-unacknowledged genotoxic influence may play a pivotal role in elevating cancer risks among patients undergoing radiation-based procedures, necessitating a reconsideration of risk assessment protocols and clinical practices.
[Names] => Chiara Iacconi ... Enrica Ciofini [Doi] => 10.37349/ec.2024.00023 [Published] => April 19, 2024 [Viewed] => 24 [Downloaded] => 2 [Subject] => Review [Year] => 2024 [CiteUrl] => https://api.crossref.org/works/10.37349/ec.2024.00023 [Inline] => 1 [Type] => 0 [Issue] => [Topic] => 0 [TitleAbbr] => Explor Cardiol. [Pages] => 2024;2:79–87 [Recommend] => 0 [Keywords] => Cancer, DNA damage, iodine, radiation [DetailTitle] => [DetailUrl] => [Id] => 101223 [ris] => https://www.explorationpub.com/uploads/Article/A101223/4871b2454c157bff6f08f8a644a5d620.ris [bib] => https://www.explorationpub.com/uploads/Article/A101223/8be269c9e68f2fbc305c355a91067b70.bib [ens] => [Cited] => 0 [Cited_Time] => [CitethisArticle] => Iacconi C, Xiarcou M, Piagneri V, Ciofini E. Impact of iodinated contrast media on X-ray-induced DNA damage: a comprehensive review. Explor Cardiol. 2024;2:79–87. https://doi.org/10.37349/ec.2024.00023 [Jindex] => 0 [CName] => [CEmail] => [Ris_Time] => 2024-04-17 07:02:19 [Bib_Time] => 2024-04-17 07:02:19 [KeysWordContens] => Impact of iodinated contrast media on X-ray-induced DNA damage: a comprehensive review, Cancer, DNA damage, iodine, radiation, Drawing insights from a spectrum of in vitro, in vivo experimental, and clinical studies, this review illuminates the underlying mechanism by which iodinated contrast media (ICM) exerts an indirect genotoxic effect. The mechanism involves the photoelectric effect induced by iodine molecules, thereby augmenting radiation attenuation and subsequently elevating the locally absorbed radiation dose. The ensuing generation of secondary electrons from each photoelectric absorption interaction triggers molecular reactions, culminating in discernible DNA damage, notably in the form of DNA double-strand breaks. A convergence of evidence from in vitro, experimental, and clinical investigations underscores a consistent pattern: the addition of iodine contrast linearly heightens the absorbed radiation dose and associated DNA damage. This quantification was evident through alterations in attenuation and the manifestation of double-strand breaks in circulating lymphocytes, serving as an intermediate endpoint and a potential long-term indicator of cancer. The observed surplus of DNA damage in contrast-enhanced images compared to non-contrast images ranged notably from +30% to +200%. This broad range accentuates a substantial amplification effect on radiation-induced damage, particularly noteworthy at clinically relevant iodine doses. Crucially, this effect remains unaffected by brands or manufacturers and exhibits a robust, exclusive correlation with the concentration of iodine in the bloodstream. The significant augmentation of absorbed dose and genotoxic impact of X-rays due to the use of contrast agents warrants critical attention within the medical community. This often-unacknowledged genotoxic influence may play a pivotal role in elevating cancer risks among patients undergoing radiation-based procedures, necessitating a reconsideration of risk assessment protocols and clinical practices. ,Chiara Iacconi ... Enrica Ciofini [PublishedText] => Published [IsEdit] => 0 [AccountId] => 22 [Zh] => 0 ) )