Diabetic Cardiomyopathy (DiabCM) develops in patients with Type-2-Diabetes Mellitus (T2D) and is characterized by cardiac dysfunction independent of ischemic heart disease or systemic hypertension. Its underlying mechanisms remain poorly defined with likely genetic and non-genetic mechanisms including epigenetic modifications. Combining T2D-derived polygenic risk scores (PRS) and methylation risk scores (MRS) with key clinical characteristics may aid risk stratification for myocardial dysfunction among patients with T2D. We analyzed 173 deeply phenotyped participants from the CARDIATEAM discovery study, grouping them by the severity of myocardial dysfunction determined by echocardiography. Both PRS and MRS show significantly different distribution between severity groups (p-value = 0.02 and 1.29e-05, respectively) with significant odds ratios (ORs) at ≥ 80th and ≥ 90th percentiles: PRS (2.23 [95

Accurate quantification of left ventricular ejection fraction (LVEF ) is crucial for assessing cardiac function, and for diagnosing and managing cardiovascular diseases.. Traditional methods for estimating LVEF, such as manual delineation of the endocardial border, using Simpson’s biplane method, are often time-consuming, and subject to observer variability. We present an end-to-end deep learning pipeline integrating cardiac phase detection and left ventricular segmentation for automated LVEF estimation. Evaluated on 100 GE ultrasound acquisitions from a multi-center dataset with cardiologist-reported values as reference, the proposed method achieved an R2 of 0.65, indicating moderate correlation with ground truth on unseen clinical data.

HomeCirculation: Heart FailureVol. 17, No. 3Blood Speckle Imaging in Critical Care: A New Tool in Mechanical Circulatory Support Management No AccessCase ReportRequest AccessFull TextAboutView Full TextView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialNo AccessCase ReportRequest AccessFull TextBlood Speckle Imaging in Critical Care: A New Tool in Mechanical Circulatory Support Management Wouter L'Hoyes, Thomas Rosseel, Bart Jacobs, Charlotte Van Edom, Guido Tavazzi, Jens-Uwe Voigt, Susanna Price, Dieter Frans Dauwe and Christophe Vandenbriele Wouter L'HoyesWouter L'Hoyes https://orcid.org/0000-0002-5612-127X Department of Cardiovascular Diseases (W.L., T.R., C.V.E., J.-U.V., C.V.), University Hospitals Leuven, Belgium. Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium (W.L.). , Thomas RosseelThomas Rosseel https://orcid.org/0000-0002-9688-3033 Department of Cardiovascular Diseases (W.L., T.R., C.V.E., J.-U.V., C.V.), University Hospitals Leuven, Belgium. , Bart JacobsBart Jacobs https://orcid.org/0000-0002-1218-157X Department of Intensive Care Medicine (B.J., D.D.), University Hospitals Leuven, Belgium. , Charlotte Van EdomCharlotte Van Edom https://orcid.org/0000-0003-2830-624X Department of Cardiovascular Diseases (W.L., T.R., C.V.E., J.-U.V., C.V.), University Hospitals Leuven, Belgium. , Guido TavazziGuido Tavazzi https://orcid.org/0000-0002-9560-5138 Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy (G.T.). , Jens-Uwe VoigtJens-Uwe Voigt https://orcid.org/0000-0002-0575-1888 Department of Cardiovascular Diseases (W.L., T.R., C.V.E., J.-U.V., C.V.), University Hospitals Leuven, Belgium. , Susanna PriceSusanna Price https://orcid.org/0000-0002-6425-3360 Adult Intensive Care, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (S.P., C.V.). , Dieter Frans DauweDieter Frans Dauwe https://orcid.org/0000-0002-9771-2543 Department of Intensive Care Medicine (B.J., D.D.), University Hospitals Leuven, Belgium. and Christophe VandenbrieleChristophe Vandenbriele Correspondence to: Christophe Vandenbriele, MD, PhD, Royal Brompton and Harefield, Guy's & St. Thomas' NHS Foundation Trust, Adult Intensive Care Unit, Hill End Rd, Harefield, Uxbridge UB9 6JH, United Kingdom. Email E-mail Address: [email protected] https://orcid.org/0000-0001-5151-6400 Department of Cardiovascular Diseases (W.L., T.R., C.V.E., J.-U.V., C.V.), University Hospitals Leuven, Belgium. Adult Intensive Care, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom (S.P., C.V.). Originally published8 Feb 2024https://doi.org/10.1161/CIRCHEARTFAILURE.123.010697Circulation: Heart Failure. 2024;17FootnotesFor Sources of Funding and Disclosures, see page 289.Supplemental Material is available at https://www.ahajournals.org/doi/suppl/10.1161/CIRCHEARTFAILURE.123.010697.Correspondence to: Christophe Vandenbriele, MD, PhD, Royal Brompton and Harefield, Guy's & St. Thomas' NHS Foundation Trust, Adult Intensive Care Unit, Hill End Rd, Harefield, Uxbridge UB9 6JH, United Kingdom. Email christophe.vandenbriele@gmail.comREFERENCES1. Balthazar T, Vandenbriele C, Verbrugge FH, Den Uil C, Engstrom A, Janssens S, Rex S, Meyns B, Van Mieghem N, Price S, et al. Managing patients with short-term mechanical circulatory support: JACC review topic of the week.J Am Coll Cardiol. 2021; 77:1243–1256. doi: 10.1016/j.jacc.2020.12.054CrossrefMedlineGoogle Scholar2. de Waal K, Crendal E, Boyle A. Left ventricular vortex formation in preterm infants assessed by blood speckle imaging.Echocardiogr. 2019; 36:1364–1371. doi: 10.1111/echo.14391CrossrefMedlineGoogle Scholar3. Baldetti L, Beneduce A, Romagnolo D, Frias A, Gramegna M, Sacchi S, Calvo F, Pazzanese V, Cappelletti A, Ajello S, et al. Impella malrotation within the left ventricle is associated with adverse in-hospital outcomes in cardiogenic shock.J Am Coll Cardiol Intv. 2023; 16:739–741. doi: 10.1016/j.jcin.2023.01.020CrossrefGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails March 2024Vol 17, Issue 3 Advertisement Article InformationMetrics © 2024 American Heart Association, Inc.https://doi.org/10.1161/CIRCHEARTFAILURE.123.010697PMID: 38328968 Originally publishedFebruary 8, 2024 Keywordsblood speckle imagingextracorporeal membrane oxygenationImpellamechanical circulatory supportpositionPDF download Advertisement SubjectsCardiopulmonary Resuscitation and Emergency Cardiac CareEchocardiography

Pulmonary vein stenosis (PVS) and pulmonary vein occlusion (PVO) represent rare complications after lung transplantation (LTx), with limited therapeutic options and a high risk of graft loss. We present 2 cases of successful endovascular transatrial stenting following double LTx. A 60-year-old woman with chronic obstructive pulmonary disease who underwent double lobar LTx was diagnosed at postoperative day 72 with a high-grade PVS on the left side. A 22-year-old woman with idiopathic pulmonary arterial hypertension who underwent double LTx was diagnosed 9 days later with PVO of the left upper lobe vein. To avoid surgical reintervention, endovascular transatrial dilatation and stenting were performed successfully in both cases. Transatrial endovascular stenting of PVS or PVO after LTx seems an effective and safe treatment option that should be considered for these life-threatening complications and executed with care.

An 81-year-old man had a witnessed in-hospital cardiac arrest. He had been hospitalized on the gastroenterology ward for 3 weeks, recovering from a partial hepatectomy with bile duct resection and hepaticojejunostomy for a cholangiocarcinoma. His medical history also included well-controlled arterial hypertension and hypercholesterolemia. Bystander CPR was started immediately at the ward, followed by advanced cardiac life support (ACLS) at the arrival of the crash team. Pulseless electrical activity (PEA) was observed; the patient was intubated, and 1 mg of epinephrine was administered while CPR was continued. Return of spontaneous circulation was achieved after 2 minutes of ACLS. During transferal to ICU, however, PEA recurred, and ACLS was restarted and continued at arrival on the ICU. After 12 minutes of CPR and administration of 3 mg of epinephrine, return of spontaneous circulation was sustained. At subsequent clinical evaluation chest expansion and lung auscultation were symmetric. The peripheral saturation was 83% with Fio2 of 100%. Mean arterial pressure was 50 mm Hg, and there was a sinus tachycardia of 140 beats per minute. Arterial blood gas analysis confirmed severe hypoxemia and revealed severe lactate acidosis (maximum lactate, 18 mM). Hemoglobin was 7.4 g/dL, compared with 8.2 g/dL 20 hours earlier. Because the patient remained hypotensive despite fluid resuscitation, pharmacologic support with norepinephrine (maximum dose, 0.6 μg/kg/min) was initiated. Point-of-care ultrasound scan of the abdomen was negative for free fluid. Postresuscitation ECG, however, showed pronounced ST-segment elevation in the inferior leads (Fig 1) and, subsequently, a transesophageal echocardiography (TEE) was performed (Video 1). Question: Based on the patients’ clinical presentation and the ultrasound findings, what is the most likely diagnosis?A.Acute coronary syndromeB.Pericardial tamponadeC.Left ventricular outflow tract obstructionD.Aortic dissection Answer: Left ventricular outflow tract obstruction TEE revealed a systolic anterior motion (SAM) of the anterior mitral leaflet (AML) and subvalvular apparatus, resulting in left ventricular outflow tract (LVOT) obstruction (LVOTO) and eccentric mitral regurgitation. Furthermore, a hyperdynamic left ventricle with a small cavity was seen, which suggests underlying hypovolemia as a possible explanation for SAM. A small pericardial effusion surrounding the inferior right and left ventricular wall was noticed, but there was no atrial or ventricular collapse. The context and location suggest that this is a consequence of CPR, rather than the cause of the collapse. The right ventricle was mildly hypokinetic; however, it was not dilated, and there were no signs of right ventricle pressure overload (ie, no D-shaping, no bulging of the right atrial septum), which would be expected if pulmonary embolism, another possible cause of postoperative cardiac arrest, was the cause of the patient’s PEA and collapse. Right ventricle hypokinesia is observed in roughly 50% of patients in the postresuscitation period, independent of the underlying disease1Ramjee V. Grossestreuer A.V. Yao Y. et al.Right ventricular dysfunction after resuscitation predicts poor outcomes in cardiac arrest patients independent of left ventricular function.Resuscitation. 2015; 96: 186-191Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar (Video 2). Despite findings of inferior ST-segment elevation on the ECG, no regional wall motion abnormalities were noted on the initial TEE. Furthermore, cardiac arrest due to acute coronary syndrome mostly presents with ventricular tachycardia or ventricular fibrillation, rather than PEA, in the absence of mechanical complications. These observations make an acute coronary event unlikely. In this case, ST elevation that indicated myocardial ischemia can be explained by low flow due to LVOTO as a consequence of hypovolemia in combination with elevated myocardial oxygen use (and maybe coronary spasm) after administration of epinephrine. A second ECG confirmed spontaneous resolution of the ST elevation in the inferior leads. Shortly after bedside ultrasound scanning was performed, severe hematemesis developed, which confirmed the suspicion that hypovolemia tipped this patient into SAM with LVOTO, which led to his cardiac arrest. Urgent gastroscopy could not identify the source of bleeding, but the presence of fresh blood in the duodenum suggested a bleeding at the hepaticojejunostomy. Considering the hemodynamic instability and ongoing bleeding, the patient was transferred urgently to the catheterization laboratory. Angiography confirmed active bleeding at the coeliac trunk, for which a successful coiling procedure was performed, followed by hemodynamic stabilization. Despite successful coiling and maximum supportive care, the patient died 2 days later due to multiorgan failure. SAM is defined as displacement of the AML towards the LVOT during systole, which can result in mitral regurgitation and LVOTO. Although typically observed in hypertrophic cardiomyopathy, it is uncommon in a structurally normal heart. The prevalence of SAM in patients without preexisting cardiac disease is not well-studied but is thought to be <1%.2Pearson A.C. Pasierski T.J. Orsinelli D.A. Gray P. Huschart K. Systolic anterior motion of the mitral chordae tendineae: prevalence and clinical and Doppler-echocardiographic features.Am Heart J. 1996; 131: 748-753Crossref PubMed Scopus (11) Google Scholar In these patients, SAM is more likely to occur when the heart is subjected to permissive physiologic conditions that provoke SAM: reduced preload, increased inotropic state, and decreased afterload.3Raut M. Maheshwari A. Swain B. Awareness of “systolic anterior motion” in different conditions.Clin Med Insights Cardiol. 2018; 12 (1179546817751921)Crossref Scopus (11) Google Scholar All these conditions are present in hypovolemic shock and during septic shock in instances when LVOTO might be an underestimated phenomenon.4Chauvet J.L. El-Dash S. Delastre O. et al.Early dynamic left intraventricular obstruction is associated with hypovolemia and high mortality in septic shock patients.Crit Care. 2015; 19: 262Crossref Scopus (33) Google Scholar The mechanism of SAM in a patient who is hypovolemic is explained by the small and hyperdynamic left ventricle generating high flow velocities in the LVOT, therefore creating a Venturi effect that pulls the mitral valve leaflet toward the septum, obstructing the LVOT.5Luckie M. Khattar R.S. Systolic anterior motion of the mitral valve: beyond hypertrophic cardiomyopathy.Heart. 2008; 94: 1383-1385Crossref PubMed Scopus (42) Google Scholar This can be detected easily by echocardiography. An elongated AML and hypertrophic appearance of the basal septum are predisposing anatomic factors,6Henein M. Arvidsson S. Pilebro B. Backman C. Mörner S. Lindqvist P. Long mitral valve leaflets determine left ventricular outflow tract obstruction during exercise in hypertrophic cardiomyopathy.Int J Cardiol. 2016; 212: 47-53Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar both of which were present in this patient. The hemodynamic consequences of SAM with mitral regurgitation and LVOTO include elevated pulmonary capillary wedge pressures and a prolongation of systolic ejection phase with reduced stroke volume. The clinical presentation ranges from symptoms like dyspnea (because of pulmonary congestion) to severe hemodynamic collapse due to LVOTO.7Abbas H. Senthil Kumaran S. Zain M.A. Ahmad A. Ali Z. Transient systolic anterior motion of the anterior mitral valve leaflet in a critical care patient with a structurally normal heart.Cureus. 2019; 11e3963Google Scholar Echocardiography enables early diagnosis of SAM and therefore is essential to guide resuscitative efforts. Doppler imaging easily can also localize and quantify the severity of LVOTO. Because LVOTO is associated with increased mortality rates,8Bulkley B.H. Fortuin N.J. Systolic anterior motion of the mitral valve without asymmetric septal hypertrophy.Chest. 1976; 69: 694-696Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar early identification is crucial in a critically ill patient. Because the most commonly used vasopressors in the ICU also have inotropic effects, it is crucial to correct the intravascular volume deficit as much as possible to avoid increased contractility in a volume-depleted and small left ventricle. Vasopressor agents with selective alpha agonist properties or vasopressin are preferred because this will not enhance cardiac contractility as much, therefore relieving LVOTO. Inotropic agents should be avoided preferably. 1.Point-of-care echocardiography can provide valuable diagnostic information to differentiate between different types of shock.2.The visualization of a small, hyperdynamic left ventricle with SAM of the AML and turbulent flow in the LVOT should raise suspicion for LVOTO.3.Contribution of LVOTO to shock can be underestimated easily in conditions in which hypovolemia, enhanced cardiac contractility, and vasoplegia come together.4.Norepinephrine can increase SAM by its inotropic properties. Financial/nonfinancial disclosures: None declared. Other contributions: CHEST worked with the authors to ensure that the Journal policies on patient consent to report information were met. Additional information: To analyze this case with the videos, see the online version of this article. https://journal.chestnet.org/cms/asset/5b4becc2-2cea-435d-b187-0d7ed677caff/mmc1.mp4Loading ... Download .mp4 (11.08 MB) Help with .mp4 files Video 1Trailer video with all acquired cardiac viewshttps://journal.chestnet.org/cms/asset/7afe9929-79fb-4b4e-a58b-c49a64b9a060/mmc2.mp4Loading ... Download .mp4 (40.61 MB) Help with .mp4 files Video 2Narration video

We read the article Critical care ultrasonography in acute respiratory failure [1] by Vignon et al. with great interest.We agree that echocardiography plays an important role in the evaluation of patients with acute respiratory failure.We do not, however, agree with the statement that massive mitral regurgitation causes a reversal in pulmonary vein diastolic inflow or "D wave" as implied in Figure 2