Assessment of Myocardial Fibrosis in Hypertrophic Cardiomyopathy by Cardiac Magnetic Resonance: Modalities and Clinical Applications

&lt;p&gt;Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease caused by mutations in sarcomeric contractile proteins, characterized by cardiomyocytes disarray, interstitial fibrosis, increased arteriolar wall thickness and scarring.&lt;/p&gt;&lt;p&gt;Fibrosis could represent a substrate for the generation of malignant ventricular tachyarrhythmias, which represent the current pathway for sudden cardiac death and is responsible for passive diastolic dysfunction, that is the leading cause of dyspnea.&lt;/p&gt;&lt;p&gt;The aim of this review is to depict the increasingly role of cardiac magnetic resonance (CMR) for assessment of myocardial fibrosis in HCM. This article will briefly review the current status of the novel CMR techniques (the Late Gadolinium Enhancement and the emerging T1 mapping) for identification, characterization and quantization of myocardial fibrosis in HCM.&lt;/p&gt;&lt;p&gt;In addition, this review will discuss the most recent acquisition techniques, the new parameters and their possible clinical utility in diagnosis, therapeutic management and prognosis in HCM.&lt;/p&gt;</jats:p

Myocardial fibrosis and diastolic dysfunction in patients on chronic haemodialysis

BACKGROUND: Left ventricular (LV) diastolic dysfunction is linked to myocardial collagen content in many cardiac diseases. There are no data regarding such relationship in patients with end-stage renal disease (ESRD) undergoing haemodialysis. METHODS: Twenty-five patients with ESRD undergoing haemodialysis were studied by echocardiography. LV diastolic function was investigated by Doppler echocardiography, by analysing LV filling velocities at rest and during loading manoeuvres, which represent an estimate of LV filling pressure. According to the Doppler pattern, LV filling pressure in a given patient was judged to be normal or slightly increased or to be moderately or severely increased. The presence of myocardial fibrosis was estimated by ultrasound tissue characterization with integrated backscatter, which in diastole correlates with the collagen content of the myocardium. RESULTS: Integrated backscatter was higher in patients with moderate or severely increased than in patients with normal or slightly increased LV filling pressure (integrated backscatter: 51.0 +/- 9.8 vs 41.6 +/- 5.6%; P = 0.008). Integrated backscatter was a strong and independent determinant of diastolic dysfunction (odds ratio = 1.212; P = 0.040). CONCLUSION: Our data support the hypothesis that, in a selected population of patients with ESRD undergoing haemodialysis, myocardial fibrosis is associated with LV diastolic myocardial propertie

Left bundle branch pacing and cardiac remodeling in HF patients with type 2 diabetes mellitus: epigenetic pathways and clinical outcomes

BackgroundLeft bundle branch (LBB) pacing could achieve cardiac resynchronization therapy (CRT) in patients who cannot be resynchronized via the placement of the left ventricle (LV) lead into the coronary sinus. LBB pacing could improve cardiovascular outcomes in heart failure (HF) patients with LBB block who are affected by type 2 diabetes mellitus (T2DM).Study hypothesisLBB pacing could increase the number of CRT responders and lead to the best clinical outcomes in HF patients with T2DM, inducing cardiac remodeling and improving left ventricle ejection fraction (LVEF) via microRNA (miR) modulation.MethodsIn a multicenter observational study, we enrolled 334 HF patients with LBB block and an indication to receive LBB pacing for CRT. In these patients, we evaluated the CRT responder rate, clinical outcomes, and miR expression at 1 year of follow-up.ResultsAt 1 year of follow-up, we had 223 responders (66.8%), 132 hospitalizations for HF (39.5%), 24 cardiac deaths (7.2%), and 37 all-cause deaths (11.1%), with a higher rate of HF hospitalizations (77 (69.4%) vs 55 (24.7%), p &lt; 0.05), and cardiac deaths (13 (11.7% vs 11 (4.9%), p &lt; 0.05) in non-responders vs responders. At the end of follow-up, we found the lowest expression of miR-26, miR-29, miR-30, miR-92, and miR-145 in LBB-pacing non-responders vs responders (p &lt; 0.05), and a direct correlation between miR-30 (0.340, [0.833–1.915]; p 0.001), the 6-minute-walking test (6MWT; 0.168, [0.008–0.060]; p 0.011), angiotensin-receptor-neprilysin inhibitors (ARNI; 0.157, [0.183–4.877]; p 0.035), sodium-glucose-transporter-2 inhibitors (0.245, [2.242–7.283]; p 0.001), and LVEF improvements. C reactive protein (CRP) inversely correlated with LVEF improvement (−0.220, [-(0.066–0.263)]; p 0.001). ARNI (1.373, CI 95% [1.007–1.872], p 0.045), miR-30 (2.713, CI 95% [1.543–4.769], p 0.001), and 6MWT (1.288, CI 95% [1.084–1.998], p 0.001) were predictors of LBB pacing responders at 1 year of follow-up.ConclusionLBB-pacing responders evidenced miR modulation, which was linked to significant improvement of the cardiac pump. Specifically, miR-30 was linked to cardiac pump improvement and predicted responders at 1 year of follow-up in patients with T2DM

Percutaneous treatment of patients with heart diseases: selection, guidance and follow-up. A review

Aortic stenosis and mitral regurgitation, patent foramen ovale, interatrial septal defect, atrial fibrillation and perivalvular leak, are now amenable to percutaneous treatment. These percutaneous procedures require the use of Transthoracic (TTE), Transesophageal (TEE) and/or Intracardiac echocardiography (ICE). This paper provides an overview of the different percutaneous interventions, trying to provide a systematic and comprehensive approach for selection, guidance and follow-up of patients undergoing these procedures, illustrating the key role of 2D echocardiography

Valutazione delle relazioni tra le pressioni di riempimento ventricolare sinistro e la fibrosi miocardica nei pazienti con ipertensione arteriosa non complicata

Introduzione. Studi recenti hanno evidenziato la presenza di aumento delle pressioni di riempimento del ventricolo sinistro in fasi molto precoci di coinvolgimento cardiaco in pazienti con ipertensione arteriosa. Scopo dello studio. Lo scopo dello studio è di esplorare le relazioni tra la fibrosi miocardica e le pressioni di riempimento ventricolare sinistro nei pazienti con ipertensione arteriosa non complicata. Metodi . Abbiamo arruolato consecutivamente 14 pazienti con ipertensione arteriosa sistemica non complicata (età media 64± 10 anni) con rapporto transmitralico E/A 13 o rapporto E/e' 34 ml/m2) erano presenti nel 75% dei pazienti con LGE ed assenti nei pazienti senza LGE (p=0.01). Il tempo di decelerazione dell'onda E (348.5 ± 79 vs 269.3 ± 47.8 msec; p=0.03) e LAVI (32.9 ± 4.2 vs 25.1 ± 4.1 ml/m2, p=0.007) erano significativamente maggiori nel gruppo di pazienti con LGE rispetto al gruppo di pazienti senza LGE. La frazione di eiezione non era significativamente diversa nel gruppo di pazienti con e senza LGE, mentre il valore s' medio era significativamente inferiore nel gruppo di pazienti con LGE rispetto al gruppo di pazienti senza LGE (0.06 ± 0.001 vs 0.08 ± 0.02 m/sec, p= 0.02). Lo strain globale longitudinale, invece, sebbene inferiore nei pazienti con LGE rispetto ai pazienti senza LGE, non era significativamente differente nei due gruppi. Con un'analisi di regressione lineare multipla stepwise, abbiamo identificato il valore s' medio come principale predittore (r parziale = - 0.75; p = 0.003) di E/e' nei pazienti con ipertensione arteriosa non complicata. Conclusioni. Il 29% dei pazienti con ipertensione arteriosa non complicata mostra LGE alla MRI, con patterns di distribuzione diversi. I pazienti con LGE mostrano un maggior grado di disfunzione diastolica e di compromissione subclinica della funzione sistolica del ventricolo sinistro rispetto ai pazienti senza evidenza di LGE

Abstract 19346: Peak Oxygen Consumption Predicts Outcome in Hypertrophic Cardiomyopathy

Introduction: Peak oxygen consumption (VO 2 ) has a strong and independent prognostic value in systolic heart failure; in contrast no data support its prognostic role in hypertrophic cardiomyopathy (HCM). Hypothesis: We assess if peak VO 2 is a long-term predictor of outcome in HCM. Methods: We studied 92 HCM patients (40±15 years). Peak VO 2 was expressed as percentage (%) of the predicted value. Follow up was 76±57 months. The primary composite endpoint (CE) was atrial fibrillation, progression to NYHA class III or IV, myotomy-myectomy (MM), heart transplantation (HT) and cardiac death. An ancillary endpoint (HFE) included markers of heart failure (progression to NYHA class III or IV, MM and HT). Results: At baseline, 62% of patients were asymptomatic, 35% NYHA class II and 3% NYHA class III; 26% had left ventricular outflow tract obstruction. During follow up, 30 patients met CE with 43 events. By multivariate Cox survival analysis, we analyzed 2 models, using the CE, and in turn HFE. For CE, maximal left atrial diameter (LAD) (HR: 1.12; 95% CI: 1.04 to 1.22), maximal wall thickness (MWT) (HR: 0.14; 95% CI: 1.04 to 1.23) and % predicted peak VO 2 (HR: -0.03; 95% CI: 0.95 to 0.99) independently predicted outcome (overall, p&lt;0.0001). For HFE, maximal LAD (HR:0.31; 95% CI: 1.09 to 1.70), MWT (HR: 0.35; 95% CI: 1.08 to 1.84) and % predicted peak VO 2 (HR: -0.06; 95% CI: 0.89 to 0.98) independently predicted outcome (overall, p&lt;0.0001). Only 19% of mildly symptomatic or asymptomatic patients with % predicted peak VO 2 &gt;80% had events, as opposed to 53% of them with % predicted peak VO 2 &lt; 55% (p= 0.04). Event-free survival for both endpoints was significantly lower in patients with % predicted peak VO 2 &lt; 55% as compared to those with it between 55 and 80 and &gt;80% , Figure. Conclusion: In mildly or asymptomatic patients severe exercise intolerance may precede clinical deterioration. In HCM, peak VO 2 provides excellent risk stratification with a high event rate in patients with % predicted value &lt;55%. </jats:p

Multimodality Cardiovascular Imaging of Cardiotoxicity Due to Cancer Therapy

Cancer therapies have revolutionized patient survival rates, yet they come with the risk of cardiotoxicity, necessitating effective monitoring and management. The existing guidelines offer a limited empirical basis for practical approaches in various clinical scenarios. This article explores the intricate relationship between cancer therapy and the cardiovascular system, highlighting the role of advanced multimodality imaging in monitoring patients before, during, and after cancer treatment. This review outlines the cardiovascular effects of different cancer therapy classes, offering a comprehensive understanding of their dose- and time-dependent impacts. This paper delves into diverse imaging modalities such as echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, and nuclear imaging, detailing their strengths and limitations in various conditions due to cancer treatment, such as cardiac dysfunction, myocarditis, coronary artery disease, Takotsubo cardiomyopathy, pulmonary hypertension, arterial hypertension, valvular heart diseases, and heart failure with preserved ejection fraction. Moreover, it underscores the significance of long-term follow-up for cancer survivors and discusses future directions