Cardiac Magnetic Resonance as Risk Stratification Tool in Non-Ischemic Dilated Cardiomyopathy Referred for Implantable Cardioverter Defibrillator Therapy—State of Art and Perspectives

Non-ischemic dilated cardiomyopathy (DCM) is a disease characterized by left ventricular dilation and systolic dysfunction. Patients with DCM are at higher risk for ventricular arrhythmias and sudden cardiac death (SCD). According to current international guidelines, left ventricular ejection fraction (LVEF) <= 35% represents the main indication for prophylactic implantable cardioverter defibrillator (ICD) implantation in patients with DCM. However, LVEF lacks sensitivity and specificity as a risk marker for SCD. It has been seen that the majority of patients with DCM do not actually benefit from the ICD implantation and, on the contrary, that many patients at risk of SCD are not identified as they have preserved or mildly depressed LVEF. Therefore, the use of LVEF as unique decision parameter does not maximize the benefit of ICD therapy. Multiple risk factors used in combination could likely predict SCD risk better than any single risk parameter. Several predictors have been proposed including genetic variants, electric indexes, and volumetric parameters of LV. Cardiac magnetic resonance (CMR) can improve risk stratification thanks to tissue characterization sequences such as LGE sequence, parametric mapping, and feature tracking. This review evaluates the role of CMR as a risk stratification tool in DCM patients referred for ICD

A huge Morgagni hernia with compression of the right ventricle

A 21 year old male with no relevant medical history presented to our Institution for further assessments of a right paracardiac mass founded on a chest X-ray. Chest computed tomography revealed a wide median defect of the diaphragm at the level of xiphoid process of the sternum, with the herniation of omental fat tissue in the mediastinum. Cardiac magnetic resonance confirmed the presence of a huge hernia originating from the foramen of Morgagni (sterno-costal hiatus), displacing the heart leftwards and posteriorly and compressing the right ventricle (RV), giving to it a tubular shape.The signal characteristics were typical of fat tissue, with hyperintense signal in T1 and T2 weighted black blood images and homogeneus signal suppression on STIR T2 black blood images. Short axis real time cine images, performed during deep inspiration, showed an early diastolic ventricular septal bounce, with flattening of the interventricular septum during mid-late diastole: they represented signs of diastolic dysfunction of the right ventricle, resembling a sort of “pseudo-constrictive” pathophysiological model. The patient was thus referred to surgical repair of the diaphragmatic defect. Keywords: Morgagni hernia, Heart compression, Diastolic dysfunction, Cardiac magnetic resonance, Computed tomograph

Using AI to decode the behavioral responses of an insect to chemical stimuli: towards machine-animal computational technologies

Orthoptera are insects with excellent olfactory sense abilities due to their antennae richly equipped with receptors. This makes them interesting model organisms to be used as biosensors for environmental and agricultural monitoring. Herein, we investigated if the house cricket Acheta domesticus can be used to detect different chemical cues by examining the movements of their antennae and attempting to identify specific antennal displays associated to different chemical cues exposed (e.g., sucrose or ammonia powder). A neural network based on state-of-the-art techniques (i.e., SLEAP) for pose estimation was built to identify the proximal and distal ends of the antennae. The network was optimised via grid search, resulting in a mean Average Precision (mAP) of 83.74%. To classify the stimulus type, another network was employed to take in a series of keypoint sequences, and output the stimulus classification. To find the best one-dimensional convolutional and recurrent neural networks, a genetic algorithm-based optimisation method was used. These networks were validated with iterated K-fold validation, obtaining an average accuracy of 45.33% for the former and 44% for the latter. Notably, we published and introduced the first dataset on cricket recordings that relate this animal’s behaviour to chemical stimuli. Overall, this study proposes a novel and simple automated method that can be extended to other animals for the creation of Biohybrid Intelligent Sensing Systems (e.g., automated video-analysis of an organism’s behaviour) to be exploited in various ecological scenarios

Multimodality imaging approach to paradoxical embolism: a cauliflower mass on the Eustachian valve

The Eustachian valve was first described by Bartolomeo Eustachio (Italian anatomist) at 1552. It is an embryological remnant of the inferior vena cava valve that prenatally directs the oxygenated blood from inferior vena cava across the patent foramen ovale (PFO) into systemic circulation. Generally, following birth, after the closure of the foramen ovale it gradually regresses and not have a specific function, but it may persist in some patients as a floating membrane in the right atrium (RA), a nonpathological functionless structure.1 The prevalence of Eustachian valve in the normal population is unknown. Generally, it is an incidental finding without any significant pathophysiological consequences, but in some particular cases, unfortunately, it can become the site of thrombus formation and paradoxical embolic source.1 In our case report we describe a particular case of paradoxical systemic embolism due to a giant cauliflower thrombus on Eustachian valve, which caused ischemic stroke, pulmonary embolism and splenic infarctio

Left atrial appendage occlusion in patients with atrial fibrillation: focus on current evidence and commercially available devices

Atrial fibrillation is the most common cardiac arrhythmia and is associated with morbidity and mortality due to cerebral or systemic embolization, with cardiac thrombi mainly forming in the left atrial appendage (LAA). Anticoagulation is the treatment of choice; however, in patients who do not tolerate anticoagulation, LAA occlusion (LAAO) is a valid alternative. Over the last decade, many different LAAO devices have been developed and tested in trials, providing good clinical results. The purpose of this paper is to make an overview of the current state of the art of LAAO procedure, with a focus on available devices and future perspectives

The Postoperative Paradoxical Septum (POPS): A Comprehensive Review on Physio-Pathological Mechanisms

: The interventricular septum (IVS) is a core myocardial structure involved in biventricular coupling and performance. Physiologically, during systole, it moves symmetrically toward the center of the left ventricle (LV) and opposite during diastole. Several pathological conditions produce a reversal or paradoxical septal motion, such as after uncomplicated cardiac surgery (CS). The postoperative paradoxical septum (POPS) was observed in a high rate of cases, representing a unicum in the panorama of paradoxical septa as it does not induce significant ventricular morpho-functional alterations nor negative clinical impact. Although it was previously considered a postoperative event, evidence suggests that it might also appear during surgery and gradually resolve over time. The mechanism behind this phenomenon is still debated. In this article, we will provide a comprehensive review of the various theories generated over the past fifty years to explain its pathological basis. Finally, we will attempt to give a heuristic interpretation of the biventricular postoperative motion pattern based on the switch of the ventricular anchor points

Percutaneous Tricuspid Valve Repair

Tricuspid regurgitation (TR) negatively affects patient outcomes. Surgical tricuspid valve repair/replacement carries a high operative risk and is not a viable option for many high-risk patients. Percutaneous approaches provide an attractive alternative solution for such patients since they represent a valid alternative to open heart surgery without the significant risks carried by surgery. A number of percutaneous devices are currently under clinical development. This review will discuss about the latest development in the field of percutaneous tricuspid valve repair with possible future developments

Transcatheter aortic valve replacement in aortic stenosis and cardiac amyloidosis: a systematic review and meta‐analysis

Abstract Aims Aortic stenosis (AS) and cardiac amyloidosis (CA) are typical diseases of the elderly. Up to 16% of older adults with severe AS referred to transcatheter aortic valve replacement (TAVR) have a concomitant diagnosis of CA. CA‐AS population suffers from reduced functional capacity and worse prognosis than AS patients. As the prognostic impact of TAVR in patients with CA‐AS has been historically questioned and in light of recently published evidence, we aim to provide a comprehensive synthesis of the efficacy and safety of TAVR in CA‐AS patients. Methods and results We performed a systematic review and meta‐analysis of studies: (i) evaluating mortality with TAVR as compared with medical therapy in CA‐AS patients and (ii) reporting complications and clinical outcomes of TAVR in CA‐AS patients as compared with patients with AS alone. A total of seven observational studies were identified: four reported mortality with TAVR, and four reported complications and clinical outcomes after TAVR of patients with CA‐AS compared with AS alone patients. In patients with CA‐AS, the risk of mortality was lower with TAVR (n = 44) as compared with medical therapy (n = 36) [odds ratio (OR) 0.23, 95% confidence interval (CI) 0.07–0.73, I2 = 0%, P = 0.001, number needed to treat = 3]. The safety profile of TAVR seems to be similar in patients with CA‐AS (n = 75) as compared with those with AS alone (n = 536), with comparable risks of stroke, vascular complications, life‐threatening bleeding, acute kidney injury, and 30 day mortality, although CA‐AS was associated with a trend towards an increased risk of permanent pacemaker implantation (OR 1.76, 95% CI 0.91–4.09, I2 = 0%, P = 0.085). CA is associated with a numerically higher rate of long‐term mortality and rehospitalizations following TAVR in patients with CA‐AS as compared with those with AS alone. Conclusions TAVR is an effective and safe procedure in CA‐AS patients, with a substantial survival benefit as compared with medical therapy, and a safety profile comparable with patients with AS alone except for a trend towards higher risk of permanent pacemaker implantation