Cardiovascular Medicine

Cardiac anatomy is the cornerstone of cardiovascular medicine, yet it remains one of the most reliably challenging subjects for health sciences students at every level of training. The human heart-a three-dimensional, dynamically moving structure whose chambers, valves, vessels, and conduction pathways are folded into a compact muscular mass-is consistently taught through two-dimensional diagrams and static cross-sections that fundamentally cannot represent what students need to understand. The result is a predictable and well-documented pattern of misconceptions: inverted spatial relationships, confused valve anatomy, misidentified coronary territories, and an inability to translate two-dimensional imaging findings into three-dimensional anatomical understanding. This review identifies the ten most common areas of cardiac anatomy misunderstanding among students, examines why conventional teaching approaches fail to resolve them, presents the evidence for 3D illustration and animation as a transformative educational intervention, and provides practical guidance for students seeking to close their own conceptual gaps. The goal is a learning framework that moves students from memorised labels to genuine spatial understanding of the heart.

Inferior vena cava (IVC) point of care ultrasound (POCUS) is essential for hemodynamic evaluation, with
the subcostal view (SCV) being the gold standard. However, in situations where this view is inaccessible, the
transhepatic view (THV) is a viable alternative. This study evaluates the concordance between these two views in
ventilated and non-ventilated patients, categorizing the IVC as small, intermediate, or large. Methods: This prospective
observational study included 99 patients; healthy volunteers, ventilated patients, and non-ventilated patients. We
measured end-expiratory IVC diameter, classified as small (<10 mm), intermediate (10–20 mm) or large (>20 mm), via
SVC and THV. We then assessed agreement by categorical concordance, using Bland–Altman (mean bias ± 95%
limits) and Pearson’s correlation (r). Results: The overall concordance between both views was 83.8% (83/99; 95%
CI: 76.4–90%). By IVC diameter category, concordance was 93.8% (15/16; 95% CI: 69.8–99.8) for small, 84% (42/50;
95% CI: 70–90 %) for intermediate, and 82% (27/33; 95% CI: 77–95%) for large. Concordance was unaffected by
ventilation status (p = 0.83), but patients with Body Mass Index (BMI) ≥ 30 had lower concordance than those with BMI
< 30 (73.9% vs. 89.5%; p = 0.086). The Bland–Altman analysis showed a mean bias of +0.22 mm with 95% limits of
agreement from –6.99 to +7.43 mm. Pearson’s correlation coefficient for the 99 paired measurements was r = 0.86 (p
< 0.001), overall, and when stratified by category was r = 0.81 (small), r = 0.78 (intermediate) and r = 0.74 (large) (all p
< 0.001).The sensitivity and specificity of THV for identifying “responders” (CI > 42%) were 28% and 93%, respectively.
Conclusion: The THV is a reliable alternative for categorical evaluation of the IVC, particularly when the SCV is
inaccessible. This method supports rapid and accurate clinical decision, especially for dichotomous POCUS decisions
but should be used cautiously in patients with elevated BMI.

For patients with asymptomatic severe aortic stenosis and normal left ventricular function, current practice guidelines empirically recommend serial evaluations every 6 to 12 months. The benefit of this clinical monitoring is unknown. To determine the association of guideline adherence with clinical outcomes in patients with asymptomatic severe aortic stenosis. This retrospective cohort study involved 300 patients with asymptomatic severe aortic stenosis who were seen in the ambulatory Minneapolis Heart Institute at Abbott Northwestern Hospital. Rates of survival and adverse clinical events, including myocardial infarction, stroke, and heart failure hospitalization, were compared between patients who adhered to serial evaluation guidance and those who did not. Medical records were reviewed from July 25, 2007, to December 6, 2012. Data analysis took place from February 4, 2017, to July 10, 2017. All-cause mortality, heart failure hospitalization, and major adverse clinical events dur...

Introduction: With a similar set of symptoms, distinguishing acute myocarditis and acute coronary syndrome remains a challenge. The rise of established scoring system, such as the Salzburg Myocarditis (SAMY) and Diagnosis of Acute Myocarditis in Emergency (DAME) scoring, aids in the swift diagnosis of myocarditis. This systematic review aims to compare diagnostic accuracy and practical applicability of SAMY and DAME in adults with chest pain. Methods: A systematic review was performed in PubMed, Scopus, and Cochrane databases until 25 October 2025 in accordance with PRISMA 2020 guidelines. Eligible studies included studies involving adult patients comparing SAMY/DAME scores against reference standards. Outcomes included sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). QUADAS-2 tool was used to assess study quality. Results: Two studies were included in the study. The SAMY score demonstrated a sensitivity of 90.3% and specificity of 93.1%, which is increased with a higher cut off. The DAME score, derived from 104 patients, reported an AUC of 0.958, sensitivity of 100%, and specificity of 85.1% with 7 as a cutoff rule-out score. DAME is MRI-independent and utilizes basic laboratory parameters, useful in lowresource settings. Discussion: Both the SAMY and DAME scores demonstrate solid diagnostic performance for myocarditis. The SAMY score (>4 or >7) offers flexibility using easily accessible clinical and laboratory data taken, appropriate for environments with limited resources. On the other hand, the DAME score (>7) that offers high sensitivity and specificity is suitable for well-equipped settings as it utilizes cardiac biomarkers and advanced diagnostic tools like echocardiography. However, both scoring systems have drawbacks. DAME's multicenter variability may induce bias whereas SAMY's single-center design restricts generalizability. Conclusion: Both DAME and SAMY scoring systems provide important data for myocarditis diagnosis. As both methods have disadvantages, combining both scores, according to the resources at hand, can improve diagnostic precision instead of using either score alone.

Background: Ischemic cardiomyopathy (ICM), the most prevalent cause of heart failure globally, remains a significant contributor to cardiovascular morbidity and mortality. Despite advances in medical and interventional therapies, outcomes for patients with ICM remain suboptimal, underscoring the need for accurate diagnostic tools and effective risk stratification. Cardiac magnetic resonance imaging (CMR) has emerged as a powerful, non-invasive modality that provides detailed anatomical, functional, and tissue-level insights essential for managing this complex condition. Methods: A literature search was performed using PubMed, Embase, and the Cochrane Library to identify relevant studies published between January 2005 and January 2026. Search terms included combinations of "cardiac magnetic resonance," "ischemic cardiomyopathy," "late gadolinium enhancement," "stress perfusion CMR," "myocardial viability," "prognosis," and "revascularization." Randomized controlled trials, cohort studies, systematic reviews, metaanalyses, and major society guidelines evaluating CMR in adult patients with suspected or established ischemic cardiomyopathy were included. Discussion: This review explores the comprehensive role of CMR in the diagnosis, differentiation, and prognostication of ICM. It highlights CMR's role in quantifying ventricular function and detecting myocardial ischemia using routine cine and perfusion sequences, while also emphasizing the emerging role of CMR speckle tracking-referred to as feature tracking (CMR-FT)-in the detection of ischemia and the assessment of myocardial viability. The review further evaluates the role of CMR in distinguishing ischemic from non-ischemic cardiomyopathies through advanced tissue characterization techniques, including parametric mapping and late gadolinium enhancement (LGE). Additionally, CMR plays an important role in guiding revascularization decisions and predicting clinical outcomes through assessment of myocardial viability and scar characteristics. It can also identify high-risk prognostic markers, including extensive fibrosis, microvascular obstruction (MVO), and intramyocardial hemorrhage (IMH). Conclusion: Although certain limitations remain, such as accessibility and patient compatibility, CMR continues to represent the standard for non-invasive cardiac imaging in ICM, providing clinicians with critical information across all stages of patient care, however, the expanding applications of CMR must be interpreted within evolving evidence and guideline recommendations rather than generalized superiority claims.

Ischemic heart disease continues to rank as the leading cause of death and disability worldwide and it remains the most prevalent underlying cause of cardiomyopathy and heart failure. In a pooled analysis of 13 major multicenter heart failure trials, ischemic cardiomyopathy (ICM) was responsible for nearly 70% of all heart failure cases. 2 Clinically, ICM is defined by impaired left ventricular (LV) systolic function in the setting of significant coronary artery disease. 2 Despite significant progress in pharmacotherapy, devicebased treatments, and revascularization techniques, ICM still imposes a heavy global health burden. Mortality rates hover around 16% at one year and can climb to nearly 40% by five years in both the U.S. and Europe. These figures underscore the urgent need for early, accurate diagnosis,

Aims: To critically review the available transcatheter aortic valve implantation techniques and their results, as well as propose recommendations for their use and development. Methods and results: A committee of experts including European Association of Cardio-Thoracic Surgery and European Society of Cardiology representatives met to reach a consensus based on the analysis of the available data obtained with transcatheter aortic valve implantation and their own experience. The evidence suggests that this technique is feasible and provides haemodynamic and clinical improvement for up to 2 years in patients with severe symptomatic aortic stenosis at high risk or with contraindications for surgery. Questions remain mainly concerning safety and long-term durability, which have to be assessed. Surgeons and cardiologists working as a team should select

Despite a decreasing incidence rate of acute myocardial infarction (MI) per person-years of follow-up, cardiovascular disease remains a major health and economic burden to society, accounting for the greatest proportion of deaths in both men and women above the age of 65 years [1, 2]. Over recent decades, research into the causes and mechanisms driving the development of cardiovascular disease has rapidly evolved from focusing purely on blood pressure or lipid management, to treating the inflammatory processes closely associated with it. In everyday real life, this translates into ever more targeted treatment strategies that can be adapted to each individual's cardiovascular history and risk.

Despite a decreasing incidence rate of acute myocardial infarction (MI) per person-years of follow-up, cardiovascular disease remains a major health and economic burden to society, accounting for the greatest proportion of deaths in both men and women above the age of 65 years [1, 2]. Over recent decades, research into the causes and mechanisms driving the development of cardiovascular disease has rapidly evolved from focusing purely on blood pressure or lipid management, to treating the inflammatory processes closely associated with it. In everyday real life, this translates into ever more targeted treatment strategies that can be adapted to each individual's cardiovascular history and risk.

Over recent decades, research into the causes and mechanisms driving the development of cardiovascular disease has rapidly evolved. In everyday real life, this translates into ever more targeted treatment strategies that can be adapted to each individual’s cardiovascular history and risk.

C-reactive protein measured by high sensitivity assays (hsCRP) is an established biomarker of systemic inflammation and a cut-off at 2 mg/L has been widely studied and proposed to identify patients at residual inflammatory risk (RIR). It remains unclear how many patients remain at residual inflammatory risk (RIR) at 12 months after acute coronary syndromes (ACS) in a contemporary real-world cohort and if RIR is associated with cardiovascular outcome. Patients included in the SPUM-ACS cohort (NCT01000701) with a primary diagnosis of ACS referred for coronary angiography between 2009 and 2012 and available hsCRP measurements at baseline and at 1 year follow-up. High RIR was defined as hsCRP ≥2mg/L. Patients were divided into four groups: persistently high RIR, increased RIR (first low-, then high hsCRP), attenuated RIR (first high-, then low hsCRP), or persistently low RIR. Adjudicated major adverse cardiac and cerebrovascular events (MACCE) at 365 days were defined as the composite o...

Right ventricular myocardial work (RVMW) is a novel method for non-invasive assessment of right ventricular (RV) function utilizing RV pressure-strain loops. This study aimed to explore the relationship between RVMW and invasive indices of right heart catheterization (RHC) in a cohort of patients with heart failure with reduced left ventricular ejection fraction (HFrEF), and to compare values of RVMW with those of a group of patients without cardiovascular disease.

Right ventricular myocardial work (RVMW) is a novel method for non-invasive assessment of right ventricular (RV) function utilizing RV pressure-strain loops. This study aimed to explore the relationship between RVMW and invasive indices of right heart catheterization (RHC) in a cohort of patients with heart failure with reduced left ventricular ejection fraction (HFrEF), and to compare values of RVMW with those of a group of patients without cardiovascular disease.

AIMS Right ventricular myocardial work (RVMW) is a novel method for non-invasive assessment of right ventricular (RV) function utilizing RV pressure-strain loops. This study aimed to explore the relationship between RVMW and invasive indices of right heart catheterization (RHC) in a cohort of patients with heart failure with reduced left ventricular ejection fraction (HFrEF), and to compare values of RVMW with those of a group of patients without cardiovascular disease. METHODS AND RESULTS Non-invasive analysis of RVMW was performed in 22 HFrEF patients [median age 63 (59-67) years] who underwent echocardiography and invasive RHC within 48 h. Conventional RV functional measurements, RV global constructive work (RVGCW), RV global work index (RVGWI), RV global wasted work (RVGWW), and RV global work efficiency (RVGWE) were analysed and compared with invasively measured stroke volume and stroke volume index. Non-invasive analysis of RVMW was also performed in 22 patients without cardio...

Background--Improving cardiovascular health (CVH) of all Americans by 2020 is a strategic goal of the American Heart Association. Understanding the sources of variation and identifying contextual factors associated with poor CVH may suggest important avenues for prevention. Methods and Results--Cross-sectional data from the Behavioral Risk Factor Surveillance System for the year 2011 were linked to state-level coronary heart disease and stroke mortality data from the National Vital Statistics System and to state-level measures of median household income, income inequality, taxes on soda drinks and cigarettes, and food and physical activity environments from various administrative sources. Poor CVH was defined according to the American Heart Association definition using 7 selfreported CVH metrics (current smoking, physical inactivity, obesity, poor diet, hypertension, diabetes, and high cholesterol). Linked micromap plots and multilevel logistic models were used to examine state variation in poor CVH and to investigate the contributions of individual-and state-level factors to this variation. We found significant state-level variation in the prevalence of poor CVH (median odds ratio 1.32, P<0.001). Higher rates of poor CVH and cardiovascular disease mortality were clustered in the southern states. Minority and low socioeconomic groups were strongly associated with poor CVH and explained 51% of the statelevel variation in poor CVH; state-level factors explained an additional 28%. State-level median household income (odds ratio 0.89; 95% CI 0.84-0.94), taxes on soda drinks (odds ratio 0.94; 95% CI 0.89-0.99), farmers markets (odds ratio 0.91; 95% CI 0.85-0.98), and convenience stores (odds ratio 1.09; 95% CI 1.01-1.17) were predictive of poor CVH even after accounting for individual-level factors. Conclusions--There is significant state-level variation in poor CVH that is partly explained by individual-and state-level factors. Additional longitudinal research is warranted to examine the influence of state-level policies and food and physical activity environments on poor CVH.

Background Although the influence of pacing on left ventricular function is well documented, the effect of right ventricular (RV) pacing, particularly concerning lead location (septal vs. apical), on RV function remains underexplored. Furthermore, there is a lack of literature regarding right atrial (RA) remodelling and functional changes following pacemaker implantation. Purpose To assess the effect of a dual-chamber pacemaker on RA and RV structure and function, and their correlation with the site of RV lead positioning using 4D echocardiography. Methods This prospective study evaluated 22 patients undergoing permanent dual-chamber pacemaker implantation. Comprehensive clinical and transthoracic echocardiographic assessments were performed at three time points: pre-implantation, pre-discharge, and at the 3-month follow-up. RV function was quantified using tricuspid annular plane systolic excursion, myocardial performance index, global longitudinal strain, and 3D RV ejection fraction. RA function was assessed for reservoir, conduit, and contractile phases using strain analysis. All echocardiographic measurements were conducted by a single echocardiographer utilizing the 4D Vivid S70N system. Device programming parameters were recorded postoperatively. Results Although conventional parameters remained within the normal range, functionally, a decline in RA reservoir and conduit strain (p = 0.01 and p = 0.02, respectively) and RV GLS (p < 0.001) was observed. TR severity also worsened in nearly 40% of patients compared to baseline (p < 0.001). All patients had a pacing burden greater than 80%. Conclusion RA and RV structural and functional changes begin within 3 months, irrespective of lead site, although non-septal sites exhibited a greater impairment.

Background--The electrocardiographic interatrial block (IAB) has been associated with atrial fibrillation (AF). We aimed to test whether IAB can improve risk prediction of AF for the individual person. Methods and Results--Digital ECGs of 152 759 primary care patients aged 50 to 90 years were collected from 2001 to 2011. We identified individuals with P-wave ≥120 ms and the presence of none, 1, 2, or 3 biphasic P-waves in inferior leads. Data on comorbidity, medication, and outcomes were obtained from nationwide registries. We observed a dose-response relationship between the number of biphasic P-waves in inferior leads and the hazard of AF during follow-up. Discrimination of the 10-year outcome of AF, measured by time-dependent area under the curve, was increased by 1.09% (95% confidence interval 0.43-1.74%) for individuals with cardiovascular disease at baseline (CVD) and 1.01% (95% confidence interval 0.40-1.62%) for individuals without CVD, when IAB was added to a conventional risk model for AF. The highest effect of IAB on the absolute risk of AF was observed in individuals aged 60 to 70 years with CVD. In this subgroup, the 10-year risk of AF was 50% in those with advanced IAB compared with 10% in those with a normal P-wave. In general, individuals with advanced IAB and no CVD had a higher risk of AF than patients with CVD and no IAB. Conclusions--IAB improves risk prediction of AF when added to a conventional risk model. Clinicians may consider monitoring patients with IAB more closely for the occurrence of AF, especially for high-risk subgroups.

Syncope is a common symptom in emergency department visits and, despite extensive evaluation, still remains unexplained in a significant number of cases. Our study compared the clinical characteristics of patients with syncope of unexplained aetiology (SUA) with those of patients with other causes of syncope after the application of a standardised work-up. Recurrence and death rates were also evaluated at one year. We found that patients with SUA shared most of the clinical and paraclinical characteristics of patients with neurally mediated syncope. During followup, recurrences occurred essentially in the SUA group. These findings support the concept that patients with SUA suffer from some form of neurally mediated syncope.

Imaging of myocardial perfusion with SPECT, SPECT/CT and PET/CT is widely used for the detection of flow-limiting epicardial lesions and risk stratification of patients with suspected or known CAD. While regional reductions in radiotracer uptake during stress as compared to rest identify flow-limiting effects of the most advanced focal epicardial lesions, the haemodynamic significance of less severe obstructive CAD lesions in multivessel disease or the presence of subclinical and nonobstructive CAD may be missed. The concurrent ability of PET/CT to determine regional myocardial blood flow (MBF) in ml/g/min at rest and during pharmacologically induced hyperaemic flows allows the calculation of the myocardial flow reserve (MFR). Adding the hyperaemic MBF and MFR to the conventional visual analysis of myocardial perfusion (1.) signifies reductions in coronary vasodilator capacity, as functional precursor of the CAD process, and determines its response to preventive medical intervention, (2.) provides important prognostic information in subclinical -and clinically manifest CAD, as well as in cardiomyopathy, (3.) improves the identification and characterisation of the extent and severity of CAD burden; and (4.) contributes to denote the flow-limiting effect of single lesions in multivessel CAD. The diagnostic scope of PET/CT, however, extends beyond myocardial flow to the identification of hibernating stunning myocardium in ischaemic cardiomyopathy, cardiac sarcoid involvement, and inflammatory coronary plaque burden. It is anticipated that with the advent of PET/MRI

Among patients with acute coronary syndromes (ACS), patients with diabetes, elderly patients and women represent groups at high risk for adverse outcomes. Higher risk patients sustain a high proportion of the mortality and morbidity that accompanies ACS, yet also potentially derive greater absolute benefit from effective management strategies and interventions. This review focuses on information regarding the increased risk, as well as select aspects of management of ACS, for patients with diabetes, the elderly, and women. Special attention is given to aspects of prognosis or management that may differ from general patients with ACS.

Background: Patients with left main coronary artery (LMCA) stenosis are considered to be vulnerable population that requires reliable assessment of functional significance of lesions observed on coronary angiography. The aim of this study was to determine the prognostic value of noninvasively measured coronary flow reserve (CFR) in patients with angiographically assessed intermediate LMCA stenosis during long-term follow up. Methods: Ninety eight patients, 60.2+9.1 years of age, 83 (84.7%) patients male, having LMCA stenosis assessed by coronary angiography to be ≤50% (diameter stenosis) and without significant left anterior descending artery (LAD) stenosis, were enrolled in this prospective study. Single vessel disease was present in 45 (45.9%) patients. Transthoracic Doppler echocardiography was used to obtain CFR values. All measurements were performed for the medial segment of LAD in baseline conditions, and after the hyperemic stimuli that was induced with adenosine (at infusion rate 140 mcg/kg/min). CFR values were calculated as the ratio between hyperemic maximal flow velocity and resting (baseline) flow velocity. Participants, who were referred to coronary artery by-pass based on CFR ≤ 2, were excluded from further analysis. Patients were followed for the mean period of 14.7 +9.9 months for the occurrence of composite end point including cardiovascular death, myocardial infarction, hospitalization due to unstable angina and clinically guided revascularization. Results: Mean CFR value was 2.3+0.5. Twenty eight patients had CFR ≤2 (28.6%), while 70 patients had CFR .2 (71.4%). Mean CFR value of 1.9+0.5 for patients having events was significantly lower, compared to those who were free of events where mean CFR value was 2.4+0.5 (p=0.027). Patients with lower CFR values (CFR≤2) had a statistically significant higher event rate (7 pts, 25%) compared to those whit CFR . 2 (5 pts, 7%), (p,0.05) during follow-up. By Kaplan-Meier analysis and log rank test, it was shown that patients having CFR.2 had a significantly higher survival rate (P ,0.001). Value of the coronary flow reserve (CFR) ≤2 was associated with a significant risk increase of experiencing events of the composite end point (P=0.017). Conclusion: CFR measured by transthoracic Doppler echocardiography provides reliable and precise, yet non-invasive tool for the assessment of functional severity of LMCA disease that carries significant prognostic information in long-term follow-up.

tion (PCI) may lead to poor outcomes in patients with bifurcation lesions. However, the mechanism of side-branch complications after PCI for bifurcations lesions remains unclear. Purpose: We investigated the impact of lesion morphologies and plaque characteristics in coronary bifurcation lesions on the occurrence of side-branch complications. Methods: We investigated 63 patients with 68 native coronary bifurcation lesions without baseline side-branch stenosis undergoing single new-generation drugeluting stent implantation (29 bioresorbable polymer sirolimus-eluting stent (BP-SES) and 39 BP-everolimus-eluting stents (BP-EES)). All lesions underwent preand post-intervention optical coherence tomography (OCT). Side-branch complication was defined as side-branch stenosis (>90%) during PCI. Lesions plaque characteristics were assessed at five regions in relation to side-branch: proximal side-branch side; distal side-branch side; bifurcation site; proximal side-branch opposite side; and distal side-branch opposite side. OCT-derived longitudinal plaque distribution and morphologies, and quantitative variables related to bifurcation angles were assessed. Results: Side-branch complications were observed in 31 lesions (45.6%). Lesions with side-branch complications had higher frequency of lipid-rich plaque (48.4% vs. 21.6%, p=0.04) at bifurcation site, and lipid-rich plaque (51.6% vs. 21.6%, p=0.02) at distal side-branch opposite side, smaller carina-tip angle (50.8±22.5°vs. 78.9±25.5°, p<0.001), and shorter branching-point to carinatip length (0.90±0.26mm vs. 1.44±0.67mm, p<0.001) than those without. Optimal cutoff value of carina-tip angle and branching-point to carina-tip length for side-branch complications was 55.7°(area under the curve 0.81, p<0.001) and 1.24mm (0.79, p<0.001). Of 4 pre-PCI OCT features including lipid-rich plaque at bifurcation site, calcification at distal opposite side, carina-tip angle ≤55.7°, and branching-point to carina-tip length ≤1.24mm, 3 or 4 feature positive lesions had higher prevalence of side-branch complications than 2 or less feature positive lesions (94.4% vs. 28.0%, p<0.001). Post-PCI OCT findings showed that 54.9% of lesions with side-branch complications were related with carina-shift and 38.8% with tissue protrusion. Stent types did not influence our results. Conclusion: Longitudinal plaque distribution and morphologies as well as bifurcation angles detected by OCT may influence the occurrence of side-branch complications after BP-DESs.

Cationic bolaamphiphiles or bolaforms have gained significant attention due to their unique self-assembly behavior and potential applications in biomedical science. In this study, we have synthesized two novel cationic bolaamphiphiles, C 12-(2-(4-carbamoylpiperazin-1-yl)pyridin-1-ium chloride) 2 [C 12 (CPPC) 2 ], and C 10-(2-(4-formylpiperazin-1-yl)pyridin-1-ium chloride) 2 (C 10 (FPPC) 2) featuring urea and amide linkers with C-12 and C-10 spacers that may modulate their self-assembly properties. Their interfacial properties and aggregation behavior in aqueous solution were systematically investigated using various techniques, which revealed the formation of micellar, vesicular, and elongated assemblies by the bolaforms. Calorimetric studies further demonstrated thermodynamically favorable and entropy-driven aggregate formation in water, highlighting their potential for supramolecular and nanostructured material applications. We have also demonstrated potential antifungal activities of the studied bolaforms.

Background: Speckle Tracking Echocardiography (STE) is based on tracing of pixels groups in grayness scale for quantitative measurement of myocardium strain and myocardium strain rate. Recent data suggest that evaluation of STE could be a tool for myocardial function assessment similarly to MRI. Aim: To assess predictive value of STE for evaluation of infarct size in patients with anterior STEMI Methods: We enrolled 40 patients with the first anterior wall STEMI (mean age 59+10 years, 30 males). All patients were treated with primary PCI and time from the symptom onset to reperfusion was 294 + 195 min. LVEF assessed in 3D echocardiography was 47+9%. On day of discharge STE was performed to determine average global value of peak longitudinal strain (GLS) of 16 myocardial segments. Separately, average value of peak longitudinal strain for 9 segments supplied by left anterior descending artery-LAD (AGLS) was assessed. Infarct size was assessed 3 months after STEMI by MRI using late gadolinium enhancement (LGE), and a large infarct was defined as at least 20% LV myocardium covered by the scar. Results: According to MRI results we defined 2 groups: 23 patients with large infarct (≥ 20%, group A) and 17 patients with small infarct (,20%, group B) . There were no differences between both groups in demographics and cardiovascular risk factors. There was significant correlation between GLS and a degree of myocardium injury assessed by MRI (r = 0,62, p = 0,001). The correlation was higher for AGLS (r = 0,68, p = 0,001). With ROC curve the cutoff point for GLS was calculated (212,3 ), which defined large infarct with 82 % sensitivity and 87 % specificity (AUC = 0,84). For segments supplied by LAD the cutoff value for prediction of large infarct was -11,5 (sensitivity 91%, specificity 73%, AUC = 0,85). Conclusion: Speckle Tracking Echocardiography seems to be a very promising tool for prediction of infarct size in patients with anterior STEMI.

Purpose: Ultra-fast cardiac imaging (frame rate (FR) ~500Hz for a 908 sector) can be achieved by transmitting a plane wave (PW) instead of a focused beam. This increased temporal resolution is at the expense of spatial resolution, reducing 2D image quality. However, for functional imaging, temporal resolution gain might outbalance reduced spatial resolution. We aimed to, at an initial stage of development, test the feasibility of PW imaging for myocardial motion estimation in normals. Methods: The septum was imaged in 10 healthy volunteers from the apex by PW and Colour Doppler Myocardial Imaging (CDMI), both with 2.5 MHz transducers. A PW transmit combined with 4 parallel receive beams was implemented on an Epsilon Ultra DCI5000, using B-mode imaging at FR of 212Hz. CDMI data were obtained with a GE Vivid E9. A similar FR was achieved by adjusting the opening angle. Midseptal velocity profiles were extracted from both datasets. The Sum of Absolute Differences was used to obtain the velocity trace from the RF data from the PW system and a commercial software package (GE EchoPac) was used to extract it from the CDMI data. The peak systolic (S') and early (E')/late (A') diastolic velocities were extracted from the PW and CDMI traces. Results: Peak velocity values were comparable between the two modalities: CDMI S' 5.4 + 0.8, PW S' 5.7 + 1.9, CDMI E' 28.5 + 2.3, PW E' 27.6 + 2.2, CDMI A' 25.11 + 1.5 PW A' 24.4 + 1.6, all cm/s, P.0.05. Figure shows positive correlations between PW and CDMI values. Conclusions: Our results demonstrate the feasibility of PW in functional cardiac imaging. The available hardware allowed for a 4x increase in acquisition rate which could be increased with multiple beamformers. PW imaging provides improved temporal resolution in myocardial velocity/deformation imaging.

Obstructive sleep apnea (OSA) is one of the most common and serious sleep-related breathing disorders with a high prevalence among patients with cardiovascular (CV) diseases. Despite its widespread presence, OSA remains severely undiagnosed and untreated. CV mortality and morbidity are significantly increased in the presence of OSA as it is associated with an increased risk of resistant hypertension, heart failure, arrhythmias, and coronary artery disease. Evaluation and treatment of OSA should focus on recognizing patients at risk of developing OSA. The use of screening questionnaires should be routine, but a formal polysomnography sleep study is fundamental in establishing and classifying OSA. Recognition of OSA patients will allow for the institution of appropriate therapy that should alleviate OSA-related symptoms with the intent of decreasing adverse CV risk. In this review, we focus on the impact OSA has on CV disease and evaluate contemporary OSA treatments. Our goal is to heighten awareness among CV practitioners.

Intervendor differences of 2D/3D strain measurements are well known issues that significantly limit their adoption in clinical routine. Whether a similar discordance affects also the quantitation of left ventricular (LV) geometry and function and the LV normative ranges for different 3D echo softwares has not been investigated. Methods: Full-volume LV 3D data sets (35+6 vps) have been acquired in 235 healthy volunteers (44+14 years, range 18-76 years, 104 men) using a GE Vivid E9 scanner. Exclusion criteria were athletic training, pregnancy, body mass index . 30 kg/m2, and poor apical acoustic window. An experienced researcher analyzed all LV data sets using a vendor-specific software (EchoPac BT12, GE Healthcare, N). Three months later, the same researcher repeated the analysis with a vendor-independent DICOM-based software (4D LV Analysis 3.1, TomTec, D), being blinded from previous measurements. Results: Despite the differences in LV parameters obtained with the two softwares were statistically significant (Table ), Bland-Altman analysis shows a clinically irrelevant bias and reasonable limits of agreement for LV volumes and EF. LV mass measurements by EchoPac were slightly larger than those by TomTec and had relatively wider limits of agreement than LV volumes. Both softwares showed significant and consistent relationships of LV 3D parameters with age, gender and body size in healthy subjects (p,0.0001 for all relationships). Conclusion: Our data shows that converting 3D data sets in DICOM format does not significantly affect the normative values for LV volumes and ejection fraction with respect to those provided by proprietary software. The availability of vendor-independent softwares and respective normative values will encourage the adoption of 3D echocardiography for routine LV quantitation in multi-vendor echo labs.

TAVI is a relatively new interventional procedure designed for management of aortic stenosis in patients with high surgical risk. Performing it on someone with a prosthetic mitral valve is a challenge, made much easier by the new delivery systems and valves. We present one such procedure and try to put some light on the difficulties that await along the way to successful implantation.

s S101 Eur J Echocardiography Abstracts Supplement, December 2006 assessed by measuring mitral annulus velocities with TDI and mitral annulus displacement. These findings suggest that pure diastolic dysfunction is probably rare and that some systolic dysfunction is present in many patients with heart failure and normal ejection fraction. Results:

Background: Autonomic dysfunction (AD) is highly prevalent in hemodialysis (HD) patients and has been implicated in their increased risk of cardiovascular mortality. Objective: To correlate heart rate variability (HRV) during exercise treadmill test (ETT) with the values obtained when measuring functional aerobic impairment (FAI) in HD patients and controls. Methods: Cross-sectional study involving HD patients and a control group. Clinical examination, blood sampling, transthoracic echocardiogram, 24-hour Holter, and ETT were performed. A symptom-limited ramp treadmill protocol with active recovery was employed. Heart rate variability was evaluated in time domain at exercise and recovery periods. Results: Forty-one HD patients and 41 controls concluded the study. HD patients had higher FAI and lower HRV than controls (p &lt; 0.001 for both). A correlation was found between exercise HRV (SDNN) and FAI in both groups. This association was independent of age, sex, smoking, body mass in...

The theory of David Barker on "the fetal origin of adult diseases" is revolutionising the pathophysiology and aetiopathogenesis of adult human diseases such as atherosclerosis. Atherosclerosis and related coronary heart diseases (CHDs) appear to be the result of fetal programming, with the cardiovascular system, and particularly the endothelium component, being the principal target of this process. This suggests that cardiovascular diseases can take place during fetal development. This life period is crucial for developmentally programming body systems (such as the cardiovascular system), their ageing and disease. A sophisticated interplay of exogenous-gestational environmental factors with the fetal genome induces epigenetic changes (microRNA, DNA methylation patterns and histone structure alterations) and expression of altered phenotypes of developing systems. A poor maternal diet rich in cholesterol, diabetes, obesity, smoking and exposure to various environmental pollutants represent the major factors related to an increased risk and progression of atherosclerosis in postnatal life. The fetal cardiovascular system is susceptible to these factors, and developmental programming events cause endothelial dysfunction, small coronary arteries, stiffer vascular tree, fewer cardiomyocytes, coagulopathies and atherogenic blood lipid profiles in the fetus. Consequently, preventive interventions are recommended for both parents who want to have children, for counteracting the onset of atherosclerosis and CHDs in new generations.

We present the case of a 54-year-old woman with severe symptomatic stenosis of an exceedingly rare type of bicuspid aortic valve (BAV) with two raphes. Preoperative coronary angiography showed an intraseptal right aortic sinus-connected left main coronary artery (LMCA) and a left anterior descending (LAD) artery arising from the intraseptal segment of the LMCA and coursing inside the interventricular septum. The patient underwent successful replacement of his valve and proximal ascending aorta. This case highlights the importance of accurate recognition of this unique LMCA-LAD course prior to aortic valve replacement. The "reverse S" coronary angiographic sign observed in the right anterior oblique view might be useful in this regard.

Background and objectives: Children with congenital heart diseases (CHD) undergoing surgical correction are at high risk for serious post‑operative morbidity and mortality. This study was conducted to figure out the association of inotropes score (IS) and vasoactive inotropes score (VIS) with clinical outcomes after congenital heart surgery.
Materials and methods: This retrospective observational study included 477 patients (April–December 2017) in a pediatric cardiac ICU (PCICU) of a tertiary cardiac hospital. Demographic, operative, and post‑operative variables were documented, including doses of inotropic and vasoactive medications during the first 48 hours after PCICU admission. Maximum IS and VIS within the first 48 hours were recorded. Linear and multivariate regression analyses were used to determine associations between IS/VIS and pre‑, intra‑, and postoperative variables as well as clinical outcomes.
Results: Among the 477 patients, 5.4% were neonates, 14.67% infants, and 80.08% children. The ROC curve identified cut‑off values for high IS (7.2; sensitivity 58%, specificity 94%) and high VIS (17.5; sensitivity 86%, specificity 92%). High VIS (≥17.5) was significantly associated with younger age, higher cardiac complexity, longer CPB and cross‑clamp times, and postoperative open sternum (p < 0.001). Higher VIS levels correlated with greater incidence of re‑intubation, prolonged ventilation, longer ICU stay, higher AKI incidence, and mortality (p < 0.05). High IS was also associated with lower body weight at surgery, greater complexity, longer CPB and cross‑clamp times, need for re‑operation, re‑intubation, prolonged ventilation and ICU stay, and mortality (p < 0.05). Multiple regression showed longer CPB time, open sternum, and longer cross‑clamp time were independent risk factors for high IS and VIS. Both high IS and VIS were predictors of re‑intubation; VIS was an independent predictor of prolonged mechanical ventilation and mortality (p < 0.05).
Conclusions: Patients with high IS and VIS were strongly associated with younger surgical age, complex cardiac lesions, prolonged CPB and cross‑clamp times, and experienced prolonged ventilator support, extended ICU stay, increased morbidity, and higher mortality.

The efficacy of amlodipine, a calcium channel blocker, in treating systemic hypertension is well established but the most efficacious brand of this drug is still uncertain. The cost of different brands of amlodipine is tremendously different which may affect decision-making in hypertension treatment. The purpose of this study was to compare the efficacy and safety of different brands of amlodipine (Amlodipine, Amlopress, and Norvasc) in the treatment of hypertension in adult patients. Methods: This was a double-blind, randomized, three-sequence crossover study. Ambulatory patients with hypertension who had the inclusion criteria were enrolled. Patients were randomized and entered into three groups to receive either brand of amlodipine in a crossover method. After every four weeks of treatment completed, the other brand of drug was prescribed. The total period of the study was 12 weeks for all three drugs including four weeks for each brand. Results: A total of 20 patients entered to the study, 15 completed the 12-week treatment schedule. The absolute reductions in seated and supine systolic blood pressure (SBP) and diastolic blood pressure (DBP) were similar with all three brands during the 4 weeks of treatment. Headache, malaise and weakness were the most common reported adverse effects (AE) with all three drugs. Generic amlodipine had the most AE as compared with other brands. These AE were mild and did not require withdrawal of the drug. There is no statistical difference in lowering blood pressure by three different brands of amlodipine thus everyone which has the lowest price can be the first choice. jpc.tums.ac.ir

Objective: To systematically summarize and synthesize the evidence from 20 key studies examining the therapeutic effects of Tai Chi and Qigong on cardiovascular disease (CVD) and its major risk factors, using artificial intelligence (Grok) as an assistive tool for literature analysis, while maintaining methodological consistency with prior reviews on other conditions.

Introduction Mineralocorticoid receptor antagonists (MRAs) reduce mortality and morbidity in patients with heart failure and reduced ejection fraction (HFrEF), but are largely underused. We evaluated the frequency, motives, predictors and outcomes of MRA discontinuation in a realworld heart failure population. This was a single-centre, retrospective cohort study where medical record-based data were collected on patients with HFrEF between 2010 and 2018. In the final analysis, 572 patients were included that comprised the continued MRA group (n=275) and the discontinued MRA group (n=297). Patients that discontinued MRA were older, had a higher comorbidity index and a lower index estimated glomerular filtration rate (eGFR). Predictors of MRA discontinuations were increased S-potassium, lower eGFR, lower systolic blood pressure, higher frequency of comorbidities and a higher left ventricular ejection fraction. The most common reason for MRA discontinuation was renal dysfunction (n=97, 33%) with 59% of these having an eGFR <30 mL/ min/1.73m 2 , and elevated S-potassium (n=71, 24%) with 32% of these having an S-potassium >5.5 mmol/L. Discontinuation of MRA increased the adjusted risk of allcause mortality (HR 1.48; 95% CI 1.07 to 2.05; p=0.019). Conclusions Half of all patients with HFrEF initiated on MRA discontinued the treatment. A substantial number of patients discontinued MRA without meeting the guidelinerecommended levels of eGFR and S-potassium where mild to moderate hyperkalaemia seems to be the most decisive predictor. Further, MRA discontinuation was associated with increased adjusted risk of all-cause mortality. ⇒ We suggest that the risk of inadequate means of follow-up restrains optimal use of MRAs, especially in patients with moderately impaired renal function and/or mild hyperkalaemia. Our findings provide explanations to the gap between guideline-directed use of MRAs and real-world practice.

Genitopatellar syndrome (GPS) is a rare autosomal dominant disorder caused by de novo pathogenic variants in the KAT6B gene. It is characterized by genital abnormalities, patellar hypoplasia/agenesis, flexion contractures of the hips and knees, corpus callosum agenesis with microcephaly, and hydronephrosis and/or multiple renal cysts. More than half of patients with GPS have congenital heart defects, mostly atrial and/or ventricular septal defects, patent foramen ovale, and patent ductus arteriosus. We report a case of a Japanese neonate with a de novo heterozygous c.3769_3772delTCTA pathogenic variant in the KAT6B gene who presented with a cardiac intramural cavity of the ventricular septum at birth. The cavity unexpectedly disappeared at 1 month of age, but trabecular septal thinning and flash remained. The features of the cavity were not consistent with those of congenital ventricular diverticulum or aneurysm, and its identity and prognosis are still unclear. Because patients wit...