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

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

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

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. 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. 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. 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

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

Vericiguat: The Fifth Harmony of Heart Failure with Reduced Ejection Fraction

Heart failure with reduced ejection fraction is a chronic and progressive syndrome that continues to be a substantial financial burden for health systems in Western countries. Despite remarkable advances in pharmacologic and device-based therapy over the last few years, patients with heart failure with reduced ejection fraction have a high residual risk of adverse outcomes, even when treated with optimal guideline-directed medical therapy and in a clinically stable state. Worsening heart failure episodes represent a critical event in the heart failure trajectory, carrying high residual risk at discharge and dismal short- or long-term prognosis. Recently, vericiguat, a soluble guanylate cyclase stimulator, has been proposed as a novel drug whose use is already associated with a reduction in heart failure-related hospitalizations in patients in guideline-directed medical therapy. In this review, we summarized the pathophysiology of the nitric oxide-soluble guanylate cyclase-cyclic guanosine monophosphate cascade in patients with heart failure with reduced ejection fraction, the pharmacology of vericiguat as well as the evidence regarding their use in patients with HFrEF. Finally, tips and tricks for its use in standard clinical practice are provided

The Effects of Device-Based Cardiac Contractility Modulation Therapy on Left Ventricle Global Longitudinal Strain and Myocardial Mechano-Energetic Efficiency in Patients with Heart Failure with Reduced Ejection Fraction

Background: Virtually all patients with heart failure with reduced ejection fraction have a reduction of myocardial mechano-energetic efficiency (MEE). Cardiac contractility modulation (CCM) is a novel therapy for the treatment of patients with HFrEF, in whom it improves the quality of life and functional capacity, reduces hospitalizations, and induces biventricular reverse remodeling. However, the effects of CCM on MEE and global longitudinal strain (GLS) are still unknown; therefore, this study aims to evaluate whether CCM therapy can improve the MEE of patients with HFrEF. Methods: We enrolled 25 patients with HFrEF who received an Optimizer Smart implant (the device that develops CCM therapy) between January 2018 and January 2021. Clinical and echocardiographic evaluations were performed in all patients 24 h before and six months after CCM therapy. Results: At six months, follow-up patients who underwent CCM therapy showed an increase of left ventricular ejection fraction (30.8 ± 7.1 vs. 36.1 ± 6.9%; p = 0.032) as well a rise of GLS 10.3 ± 2.7 vs. −12.9 ± 4.2; p = 0.018), of MEE (32.2 ± 10.1 vs. 38.6 ± 7.6 mL/s; p = 0.013) and of MEE index (18.4 ± 6.3 vs. 24.3 ± 6.7 mL/s/g; p = 0.022). Conclusions: CCM therapy increased left ventricular performance, improving left ventricular ejection fraction, GLS, as well as MEE and MEEi