Artificial Intelligence-Based Echocardiography in Pulmonary Arterial Hypertension.

Background: Echocardiography is central when assessing pulmonary hypertension (PH), but manual interpretation can be time-consuming and prone to error.

Research Question: Is a fully automated deep learning (DL) workflow in echocardiography reliable when assessing PH?

Study Design And Methods: The study had two parts: the first determined the bias and precision of DL reads using Us2.ai software version 1.

Cardiac CT fractal analysis of LV noncompaction and common cardiomyopathies.

Background: Left ventricular noncompaction (LVNC), or hypertrabeculation, is a myocardial condition that remains challenging to diagnose and differentiate from other cardiomyopathies. This study evaluated the ability of cardiac CT to differentiate between LVNC, hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), and controls using fractal analysis of LV trabeculae.

Methods: Subjects with LVNC, HCM, DCM, as well as controls, who underwent coronary CT angiography were included.

Febrile neutropenia in the Middle East and North Africa Region: trends, management, and outcomes (2000-2024)-A systematic review.

Febrile neutropenia (FN) is a serious complication of chemotherapy, especially in hematologic malignancies, and carries significant risk of morbidity and mortality risks. Infections, often originating from endogenous flora, are common, with gram-positive and gram-negative bacteria being the predominant pathogens. This systematic review, registered in PROSPERO (ID: CRD420241008055) examines FN incidence, characteristics, infections, and treatment outcomes in the Middle East and North Africa.

2 Hypermethylation Is a Risk Factor for Stage B Heart Failure and Hospitalizations in the Project Baseline Health Study.

The heart is a metabolically active organ with high energy demands that depend on mitochondrial oxidative phosphorylation, however as the heart begins to fail there is metabolic inflexibility and changes in mitochondrial function. Epigenetic changes such as DNA methylation can modify the transcription of genes essential for normal mitochondrial function, however this has not been studied in Stage B or pre-heart failure (HF). In 752 participants from the Project Baseline Health Study, we tested differences in DNA methylation in mitochondrial-related genes for association with Stage B HF compared to Stage A (at-risk for HF).

Challenges and opportunities in assessing right ventricular structure and function: a Roadmap for standardization, clinical implementation and research.

Given its crucial role in determining patient symptoms and outcomes in various cardiopulmonary diseases, the thorough and accurate assessment of right ventricular function is essential for both diagnosis and ongoing patient monitoring. In the era of precision medicine, a more detailed characterization of patients with cardiopulmonary diseases is needed, especially with the emergence of novel pharmacological and device-based therapies, such as transcatheter tricuspid valve intervention, gene therapy in patients with cardiomyopathy and anti-obesity interventions for patients with heart failure. Precise and reproducible quantification of right ventricular morphology and function are crucial for risk stratification, the selection of different therapies for the appropriate patients and the evaluation of treatment outcomes.

PWV to GLS Ratio in the General Population: Reference Values, Correlates, and Predictive Value of a Noninvasive Ventricular-Arterial Index.

Purpose: Noninvasive imaging markers combining ventricular and arterial properties may help predict cardiac disease. We conducted a general population study to determine reference values, clinical correlates, and the predictive value of the ratio of the carotid-femoral pulse wave velocity (cfPWV) to the left ventricular global longitudinal strain (GLS).

Methods: We measured cfPWV by applanation tonometry and 4-chamber GLS by echocardiography in 1026 individuals (mean age 50.

Altered maturation and activation state of circulating monocytes is associated with their enhanced recruitment in pulmonary arterial hypertension.

Background: It is well-established that patients with pulmonary arterial hypertension (PAH) exhibit increased recruitment of circulating monocytes to their pulmonary arteries. However, it remains unclear whether these monocytes have intrinsic abnormalities that contribute to their recruitment and to PAH pathogenesis. This study aimed to characterize the gene expression profiles of circulating classical, intermediate, and non-classical monocytes and assess their maturation trajectory in patients with idiopathic (I) PAH compared to control subjects.

Comparison of the prognostic value of right atrial echocardiographic parameters in pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) guidelines advocate measures of area for right atrial (RA) dimensions, while echocardiographic guidelines recommend RA volume. We compared the prognostic value of RA echocardiographic parameters to predict transplant-free survival in 332 adult patients with PAH. RA area correlated strongly with volume (r = 0.

Reference equations for peak oxygen uptake for treadmill cardiopulmonary exercise tests based on the NHANES lean body mass equations, a FRIEND registry study.

Aims: Cardiorespiratory fitness (CRF), measured by peak oxygen uptake (VO2peak), is a strong predictor of mortality. Despite its widespread clinical use, current reference equations for VO2peak show distorted calibration in obese individuals. Using data from the Fitness Registry and the Importance of Exercise National Database (FRIEND), we sought to develop novel reference equations for VO2peak better calibrated for overweight/obese individuals - in both males and females, by considering body composition metrics.

Abnormal Exercise Electrocardiography With Normal Stress Echocardiography Is Associated With Subclinical Coronary Atherosclerosis.

Background: Patients with abnormal (positive) exercise electrocardiography, but normal stress echocardiography (+ECG/-Echo), have an increased risk of adverse cardiovascular events compared with patients with a normal (negative) ECG and a normal stress Echo (-ECG/-Echo). However, it is unclear if +ECG/-Echo discordance is associated with a greater burden of subclinical coronary atherosclerosis.

Methods: Project Baseline Health Study participants who underwent a stress Echo and coronary artery calcium (CAC) scan were stratified by stress Echo result: -ECG/-Echo or +ECG/-Echo.

A generalized equation for predicting peak oxygen consumption during treadmill exercise testing: mitigating the bias from total body mass scaling.

Background: Indexing peak oxygen uptake (VOpeak) to total body mass can underestimate cardiorespiratory fitness (CRF) in women, older adults, and individuals with obesity. The primary objective of this multicenter study was to derive and validate a body size-independent scaling metric for VOpeak. This metric was termed exercise body mass (EBM).

The Acquisition of Cardiovascular Adaptation to Aerobic Exercise: When Does It Begin and How Does It Evolve Depending on Intrinsic and Extrinsic Factors?

The acquisition and evolution of cardiovascular (CV) adaptation to physical activity or exercise training are critical in enhancing cardiorespiratory fitness and reducing CV disease (CVD) risk. CV adaptations to exercise occur through structural, functional, and molecular changes that enhance cardiac efficiency. These adaptations, such as increased stroke volume, improved blood pressure regulation, and enhanced endothelial function, collectively reduce CVD morbidity and mortality.

The Association of Echocardiographically Measured Donor Left Ventricular Mass and 1-Year Outcomes After Heart Transplantation.

Background: Donor-recipient heart size matching is crucial in heart transplantation; however, the often-used predicted heart mass (PHM) ratio may be inaccurate in the setting of obesity.

Objectives: In this study, the authors sought to investigate the association between echocardiographically measured donor left ventricular mass (LVM) for heart size matching and the risk of the primary 1-year composite outcome of death or retransplantation.

Methods: The Donor Heart Study was a prospective, multicenter, observational cohort study that collected echocardiograms from brain-dead donors.

Tricuspid annular plane systolic excursion in pulmonary hypertension-Moving beyond the sector plane.

Tricuspid annular plane systolic excursion (TAPSE) is usually measured with M-mode using sector line, however, this may not align with the anatomical shortening of the right ventricular (RV). In this study, we compared the different methods to measure TAPSE using three different reference lines (sector line, anatomical line, and apico-annular line). We included 148 patients diagnosed with pulmonary arterial hypertension (PAH) who underwent TTE and right heart catheterization within 2 weeks of each other.

Pathophysiology of the right ventricle and its pulmonary vascular interaction.

The right ventricle and its stress response is perhaps the most important arbiter of survival in patients with pulmonary hypertension of many causes. The physiology of the cardiopulmonary unit and definition of right heart failure proposed in the 2018 World Symposium on Pulmonary Hypertension have proven useful constructs in subsequent years. Here, we review updated knowledge of basic mechanisms that drive right ventricular function in health and disease, and which may be useful for therapeutic intervention in the future.

Factors associated with lower quarter performance-based balance and strength tests: a cross-sectional analysis from the project baseline health study.

Objectives: Physical performance tests are predictive of mortality and may screen for certain health conditions (e.g., sarcopenia); however, their diagnostic and/or prognostic value has primarily been studied in age-limited or disease-specific cohorts.

Novel Reference Equations for Pulmonary Artery Size and Pulsatility Using Echocardiography and Their Diagnostic Value in Pulmonary Hypertension.

Background: According to the most recent pulmonary hypertension (PH) guidelines, a main pulmonary artery (MPA) diameter > 25 mm on transthoracic echocardiography supports the diagnosis of PH. However, the size of the pulmonary artery (PA) may vary according to body size, age, and cardiac phases.

Research Question: (1) What are the reference limits for PA size on transthoracic echocardiography, considering differences in body size, sex, and age? (2) What is the diagnostic value of the PA size for classifying PH? (3) How does the selection of different reference groups (healthy volunteers vs patients referred for right heart catheterization [RHC]) influence the diagnostic OR (DOR)?

Study Design And Methods: The study included a reference cohort of 248 healthy individuals as control patients, 693 patients with PH proven by RHC, and 156 patients without PH proven by RHC.

Periodic Fasting and Acute Cardiac Events in Patients Evaluated for COVID-19: An Observational Prospective Cohort Study.

Background: Periodic fasting was previously associated with greater longevity and a lower incidence of heart failure (HF) in a pre-pandemic population. In patients with coronavirus disease 2019 (COVID-19), periodic fasting was associated with a lower risk of death or hospitalization. This study evaluated the association between periodic fasting and HF hospitalization and major adverse cardiovascular events (MACEs).