In-depth cardiovascular and pulmonary assessments in children with multisystem inflammatory syndrome after SARS-CoV-2 infection: a case series study

Objective To perform an in-depth assessment of cardiovascular and pulmonary outcomes in a series of 5 post discharged multisystem inflammatory syndrome (MIS-C) survivors. Methods Data were collected ≅1.9 month after hospital discharge at a tertiary hospital in São Paulo, Brazil. All patients (7-18 years; 3 females) fulfilled the MIS-C diagnosis according to CDC. The battery of tests included: 13 N-ammonia PET-CT imaging, standard echocardiography, brachial flow-mediated dilation using a Doppler ultrasound, cardiopulmonary exercise test, and blood markers. Results Upon PET-CT scans, two patients exhibited severe perfusion defect developed in the left ventricular cavity suggesting extensive myocardial ischemia, and one patient showed persistent mild pericardial effusion. Other two patients had endothelial dysfunction. All patients exhibited abnormal cardiopulmonary reserve during exercise (e.g., low VO2peak). Three patients had abnormal values for D-dimer and fibrinogen. Conclusion This study reveals novel pathological findings in MIS-C patients, which may help optimize treatment protocols in this condition.

Electrocardiographic and Echocardiographic Insights From a Prospective Registry of Asian Elite Athletes

Background: Asian representation in sport is increasing, yet there remains a lack of reference values for the Asian athlete's heart. Consequently, current guidelines for cardiovascular screening recommend using Caucasian athletes' norms to evaluate Asian athletes. This study aims to outline electrocardiographic and echocardiographic characteristics of the Asian athlete's heart using a Singaporean prospective registry of Southeast (SE) Asian athletes.Methods and Results: One hundred and fifty elite athletes, mean age of 26.1 ± 5.7 years (50% males, 88% Chinese), were evaluated using a questionnaire, 12-lead electrocardiogram (ECG) and transthoracic echocardiogram. All ECGs were analyzed using the 2017 International Recommendations. Echocardiographic data were presented by gender and sporting discipline. The prevalence of abnormal ECGs among SE Asian athletes was 6.7%—higher than reported figures for Caucasian athletes. The abnormal ECGs comprised mainly anterior T wave inversions (ATWI) beyond lead V2, predominantly in female athletes from mixed/endurance sport (9.3% prevalence amongst females). None had echocardiographic structural abnormalities. Male athletes had reduced global longitudinal strain compared to females (−18.7 ± 1.6 vs. −20.7 ± 2.1%, p < 0.001). Overall, SE Asian athletes had smaller left ventricular cavity sizes and wall thickness compared to non-Asian athletes.Conclusion: SE Asian athletes have higher abnormal ECG rates compared to Caucasian athletes, and also demonstrate structural differences that should be accounted for when interpreting their echocardiograms compared to athletes of other ethnicities.

Noncompaction of left ventricle - a rare cardiomyopathy

Non-compaction of left ventricular (NCLV) is a rare cardiomyopathy of unknown origin characterized by prominent ventricular trabeculations and deep intertrabecular sinusoids, in communication with the left ventricular cavity. The NCLV results due to failure of compaction during foetal development. In this study, five children were diagnosed with NCLV out of 135 cases of cardiomyopathy and the youngest case was diagnosed at 27th day of life. Congestive cardiac failure presenting as tachycardia and tachypnea were common clinical manifestations. Early detection of NCLV helps patients to get timely treatment. NCLV should be considered as one of the differential diagnosis amongst cases of cardiomyopathy.

Evaluation of the efficiency of a new pulsatile flow‑generating circulatory-assist system in rotary blood pumps. Research on a mathematical model

Objective: to study the effect of a pulsatile flow-generation (PFG) device on the basic hemodynamic parameters of the circulatory system using a mathematical model.Results. Modelling and simulation showed that the use of PFG significantly (76%) increases aortic pulse pressure. The proposed mathematical model adequately describes the dynamics of the circulatory system and metabolism (oxygen debt) on physical activity in normal conditions and heart failure, and the use of non-pulsatile and pulsatile circulatory-assist systems. The mathematical model also shows that the use of PFG device blocks the development of rarefaction in the left ventricular cavity associated with a mismatch of blood inflow and outflow in diastolic phase when there is need to increase systemic blood flow by increasing the rotary pump speed.

Observation of Clinical Efficacy of Parylene-Coated Occluder Based on Electronic Image of Visual Sensor in the Treatment of Congenital Heart Disease

With the acceleration of people’s life rhythm, the incidence of congenital heart disease is getting higher and higher. This study mainly explores the clinical efficacy observation of parylene-coated occluders based on the electronic image of the visual sensor in the treatment of congenital heart disease. The patient takes a supine position and observes whether the target structure (left ventricular cavity) information is separated from the capture area during rotation, and the angle of the probe is adjusted to ensure that as much target structure information as possible can be obtained during the two-dimensional image acquisition. During the three-dimensional ultrasound sampling process, a total of 60 coaxial images were collected within the range of 180°. To reflect the effect of virtual reality, it is necessary to provide users with interactive operation tools. This research provides two methods, mouse interaction and keyboard interaction. Through these two methods, the effect of the basic virtual endoscope is realized. Xtion’s image registration process is completed inside its PS1080 system-level chip, and all sensor information, color images, and depth images are transmitted to the user host through the USB interface. For example, the point of view can be placed in the heart, because the simulation occlusion must first find a suitable section to better observe and judge the occlusion effect. Therefore, this study uses the mouse interaction method to change the cutting by dragging and rotating the mouse. In the process of releasing the occluder, the parylene-coated occluder can be released after the X-ray and ultrasound examination results are satisfactory, and the delivery long sheath and catheter can be sprinkled and compressed to stop the bleeding. During the operation, the ASD measured by two-dimensional ultrasound after balloon inflation was 24.17 ± 7.94 mm, and the anterior and posterior diameter was 21.30 ± 6.54 mm. This research is helpful for the qualitative and quantitative diagnosis of congenital heart disease.

Echocardiographic Profile of Hypertrophic Cardiomyopathy – A Single-Centre, Observational study

Background: Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disease of left ventricular hypertrophy (LVH). Phenotypic expression varies widely from subclinical hypertrophy to gross asymmetric septal hypertrophy causing left ventricular outflow tract (LVOT) obstruction. On top of genetic and phenotypic heterogeneity, the prevalence of different types of HCM may have geographical, as well as, ethnic variation. Methods: This observational study was carried out during 2010 to 2020 to determine the echocardiographic profile of HCM in Bangladeshi population. All patients undergoing transthoracic echocardiography (TTE) in a private consultation centre of Dhaka, Bangladesh were included. HCM was defined as the presence of a maximal end-diastolic wall thickness of e”15 mm anywhere in the left ventricle (LV), in the absence of another cause of hypertrophy in adults. HCM was further classified according to the pattern of myocardial hypertrophy and presence or absence of LVOT, or mid-left ventricular cavity obstruction. Results: Out of 76 cases, non-obstructive HCM was the commonest type (65.8%), followed by HCM causing LVOT obstruction (13.2%), HCM causing mid-LV cavity obstruction (10.5%), and the apical variety ( 10.5%). Asymmetric septal hypertrophy (ASH) was found in 42.1%, systolic anterior motion (SAM) of anterior mitral leaflet (AML) in 14.5%, mitral regurgitation (MR) in 50%, left ventricular systolic dysfunction in 5.3%, and raised pulmonary artery systolic pressure (PASP) in 15.8% of cases. Maximum LV wall thickness ≥30 mm was found in 66 out of 76 cases. Conclusion: The study highlights the clinically useful profile of HCM in Bangladeshi population based on conventional echocardiography. Further studies involving clinical, newer echocardiographic modalities and genetic analyses are warranted to discover the additional information in this ethnicity. Cardiovasc j 2021; 14(1): 5-11

Cardiac Magnetic Resonance Reveals Incipient Cardiomyopathy Traits in Adult Patients With Phenylketonuria

Background Phenylketonuria is the most common inborn error of amino acid metabolism, where oxidative stress and collateral metabolic abnormalities are likely to cause cardiac structural and functional modifications. We aim herein to characterize the cardiac phenotype of adult subjects with phenylketonuria using advanced cardiac imaging. Methods and Results Thirty‐nine adult patients with phenylketonuria (age, 30.5±8.7 years; 10‐year mean phenylalanine concentration, 924±330 µmol/L) and 39 age‐ and sex‐matched healthy controls were investigated. Participants underwent a comprehensive cardiac magnetic resonance and echocardiography examination. Ten‐year mean plasma levels of phenylalanine and tyrosine were used to quantify disease activity and adherence to treatment. Patients with phenylketonuria had thinner left ventricular walls (septal end‐diastolic thickness, 7.0±17 versus 8.8±1.7 mm [ P <0.001]; lateral thickness, 6.1±1.4 versus 6.8±1.2 mm [ P =0.004]), more dilated left ventricular cavity (end‐diastolic volume, 87±14 versus 80±14 mL/m 2 [ P =0.0178]; end‐systolic volume, 36±9 versus 29±8 mL/m 2 [ P <0.001]), lower ejection fraction (59±6% versus 64±6% [ P <0.001]), reduced systolic deformation (global circumferential strain, −29.9±4.2 % versus −32.2±5.0 % [ P =0.027]), and lower left ventricular mass (38.2±7.9 versus 47.8±11.0 g/m 2 [ P <0.001]). T1 native values were decreased (936±53 versus 996±26 ms [ P <0.001]), with particular low values in patients with phenylalanine >1200 µmol/L (909±48 ms). Both mean phenylalanine ( P =0.013) and tyrosine ( P =0.035) levels were independently correlated with T1; and in a multiple regression model, higher phenylalanine levels and higher left ventricular mass associate with lower T1. Conclusions Cardiac phenotype of adult patients with phenylketonuria reveals some traits of an early‐stage cardiomyopathy. Regular cardiology follow‐up, tighter therapeutic control, and prophylaxis of cardiovascular risk factors, in particular dyslipidemia, are recommended.

Can mechanical circulatory support be an effective treatment for HFpEF patients?

Heart failure with preserved ejection fraction (HFpEF) is increasing in prevalence and represents approximately 50% of all heart failure (HF) patients. Patients with this complex clinical scenario, characterized by high filling pressures, and reduced cardiac output (CO) associated with progressive multi-organ involvement, have so far not experienced any significant improvement in quality of life or survival with traditional HF treatment. Left ventricular assist devices (LVAD) have offered a new treatment alternative in terminal heart failure patients with reduced ejection fraction (HFrEF), providing a unique combination of significant pressure and volume unloading together with an increase in CO. The small left ventricular cavity in HFpEF patients challenges left-sided pressure unloading, and new anatomical entry points need to be explored for mechanical pressure and volume unloading. Optimized and pressure/volume-adjusted mechanical circulatory support (MCS) devices for HFrEF patients may conceivably be customized for HFpEF anatomy and hemodynamics. We have developed a long-term MCS device for HFpEF patients with atrial unloading in a pulsed algorithm, leading to a significant reduction of filling pressure, maintenance of pulse pressure, and increase in CO demonstrated in animal testing. In this article, we will discuss HFpEF pathology, hemodynamics, and the principles behind our novel MCS device that may improve symptoms and prognosis in HFpEF patients. Data from mock-loop hemolysis studies, acute, and chronic animal studies will be presented.

Polymorphism of CYP3A4 isoenzyme gene in patients with chronic rheumatic heart disease

AIM: This study aimed to identify the associations of CYP3A4 isoenzyme gene polymorphism with the parameters of echocardiography (EchoCG), spirometry, and endothelial function of patients with chronic rheumatic heart disease (CRHD). MATERIALS AND METHODS: A total of 128 patients with CRHD (15.6% men and 84.4% women) were examined. A392A, A392G, and G392G polymorphic markers were genotyped through polymerase chain reaction (PCR) with an SNP-EXPRESS electrophoretic scheme (NPF Litekh, Russia) to detect results after DNA was isolated from leukocytes in venous blood. EchoCG was implemented on an Affinity 50 apparatus (Philips, the Netherlands), endothelial function was assessed with an AngioScan01 apparatus (AngioScan-Electronics, Russia), and respiratory function was examined using a SpiroLab II spirometer (MIR Medical, Italy). RESULTS: The distance in a 6 min walk test did not show any significant differences among the groups: A392A 327.47 6.71 m, A392G 303.63 26.19 m, G392G 338.87 20.12 m (p=0.505). The area of the mitral opening was as follows: A392A 1.74 (1.67; 1.81) cm2, A392G 1.68 (1.45; 1.92) cm2, and G392G 1.65 (1.67; 1.81) cm2 (p = 0.214). As for the EchoCG parameters, the group of G392G homozygotes had the lowest linear dimensions of the left ventricle (the end diastolic dimension 4.83 (4.72; 4.95) cm, the end systolic dimension 2.97 (2.79; 3.14) cm, the right ventricle (2.45 [2.32; 2.58] cm), of the right atrium (4.09 [3.56; 4.62] cm), and the criteria of left ventricular hypertrophy (thickness of the interventricular septum 0.88 [0.81; 0.95] cm, and the posterior wall 0.88 (0.81; 0.95 cm). No statistically significant differences were found in the occlusion index amplitude among the groups, that is, single nucleotide replacements of CYP3A4 had no influence on the system of low-resistance arteries. Conversely, the values of the phase shift between channels (reflecting the condition of large arteries) significantly differed. The G392G polymorphism showed the worst parameters, and minimal changes were observed in the A392A group. Contour analysis demonstrated the highest augmentation index values in the G392G group, reflecting the maximal stiffness of vessels. The CYP3A4 polymorphism had no effect on the parameters of respiratory function in the studied cohort of patients. Spirometry revealed that the obstructive and restrictive parameters were not significant although homozygotes demonstrated the highest forced vital capacity of the lungs (76.5% [71.1% and 82.0%]) and forced expiratory volume for 1 s (84.6% [79.0% and 90.3%]). The maximal parameter of the vital capacity of the lungs in homozygotes for A392A (85.6% [82.3% and 88.8%]). CONCLUSION: Patients with CRHD homozygous for G392G had the minimum parameters of hypertrophy and dimensions of the left ventricular cavity. They also had the lowest values for the cavities of the right heart. CYP3A4 polymorphism had no effect on the parameters of respiratory function in the studied patients with CRHD.