Salutary Effects of Nutritional Ketosis for the Diseased Human Heart.

Purpose Of Review: We provide an overview of cardiac metabolism, ketone physiology and terminology, methods of elevating ketones and their effect on cardiac function and disease. We discuss future research directions and speculate what ketogenic strategies may yield optimal effects on the heart and cardiovascular disease.

Recent Findings: Nutritional ketosis acutely elevates cardiac function (cardiac output, myocardial perfusion, etc.

Atorvastatin and Left Atrial Function During Anthracycline-based Chemotherapy.

Background: Structural and functional abnormalities of the left atrium (LA) predict adverse outcomes such as heart failure and mortality in many patients with heart disease. However, the effect of anthracyclines on LA structural and functional abnormalities remains incompletely characterized. Further, atorvastatin prevented the anthracycline-associated decline in the left ventricular ejection fraction; however, whether atorvastatin protects against anthracycline-associated impairment of LA structure and function is currently unknown.

Genetic architecture of hypertrophic cardiomyopathy in individuals of Chinese and United Kingdom ancestry.

Background: No studies have explored the genetic differences between the Chinese and other ethnic hypertrophic cardiomyopathy (HCM) populations.

Methods: This cross-sectional study included Chinese patients ( = 593) with HCM and controls ( = 491) who underwent whole-exome sequencing. Rare variants in 16 validated HCM genes were assessed and compared with a United Kingdom HCM cohort ( = 1 232) and controls ( = 344 745).

Misclassification of recovery in dilated cardiomyopathy by echocardiography as compared to cardiac MRI.

Accurate assessment of cardiac function is the cornerstone of DCM diagnosis and management. Studies have compared CMR and 2D-TTE but the impact of these measurements on HF classification and assessment of EF improvement has not been explored. We aim to compare left ventricular (LV) ejection fraction (EF) and volumes as measured by cardiovascular magnetic resonance (CMR) and two dimensional (2D) transthoracic echocardiography (TTE) in dilated cardiomyopathy (DCM) patients in the initial EF based classification of heart failure (HF) and subsequent follow-up.

Advanced 4-chamber echocardiography techniques enable clinically matched precise characterization of heart disease progression in mice.

Background: Transthoracic echocardiography remains the primary non-invasive method for assessing cardiac function in clinical practice. However, technical challenges in acquiring accurate apical 4-chamber-long-axis (A4CLAX) views have historically limited mouse studies to left ventricle (LV) assessment using parasternal short-axis (SAX) M-mode imaging.

Methods: To overcome this limitation, we developed an A4CLAX imaging approach for mice and performed a comparative analysis with established echocardiographic methods to assess cardiac function in healthy mouse hearts.

Multi-dynamic deep image prior for cardiac MRI.

Purpose: Cardiovascular magnetic resonance imaging is a powerful diagnostic tool for assessing cardiac structure and function. However, traditional breath-held imaging protocols pose challenges for patients with arrhythmias or limited breath-holding capacity. This work aims to overcome these limitations by developing a reconstruction framework that enables high-quality imaging in free-breathing conditions for various dynamic cardiac MRI protocols.

Long-term prognostic value of native myocardial tissue relaxation parameters (T1, T2, and T1ρ) in patients with precapillary pulmonary hypertension.

Quantitative native cardiovascular magnetic resonance imaging (CMR) techniques such as T1, T2, and T1ρ mapping can provide myocardial tissue characteristics non-invasively. The objective of this study was to evaluate the alterations of T1, T2, and T1ρ in patients with precapillary pulmonary hypertension (PH) and their prognostic value. We prospectively enrolled 35 PH patients and 15 healthy controls between 2014 and 2017.

Cardiac Phenotype Characterization at MRI in ALPK3 Associated Hypertrophic Cardiomyopathy.

Background: Alpha-protein kinase 3 (ALPK3) was recently identified as a candidate gene associated with hypertrophic cardiomyopathy (HCM). However, clinical data regarding carriers of ALPK3 variants are limited.

Objectives: To evaluate the prevalence of heterozygous ALPK3 variants in adult patients with HCM through whole-exome sequencing, and to elucidate the phenotypes of individuals harboring these variants.

Cardiopulmonary responses to acute exogenous ketosis at rest, and during submaximal and maximal exercise.

Nutritional ketosis achieved through various methods in animals and humans has been shown to augment cardiac efficiency and function. However, this response during exercise has not been well characterized. Recreationally active adults (n = 12) completed a double blind, balanced, placebo-controlled, crossover study to examine the effects of bis-octanonyl (R)-1,3-butanediol (BO-BD) ingestion on cardiopulmonary function at rest and during a maximal oxygen consumption (V̇O) treadmill test (Bruce Protocol).

A novel nurse-led, multidisciplinary, and guideline-directed disease intensive management program improves long-term survival of pulmonary hypertension patients.

Background: Although the overall survival of pulmonary hypertension (PH) patients improved in the current era, better management strategy for PH patients still needs further exploration.

Objectives: Here, we proposed a novel nurse-led, multidisciplinary, and guideline-directed disease intensive management program and hypothesized this strategy would improve the overall survival of PH patients.

Methods: Patients were prospectively enrolled and divided into the intensive management group (IDM) and the conventional disease care (CDC) group voluntarily.

Sex differences in pre- and post-surgical left ventricular remodelling and outcomes in primary mitral regurgitation.

Aims: Studies suggest that females have worse post-surgical left ventricular (LV) reverse remodelling and clinical outcomes than males in primary mitral regurgitation (MR). These studies were retrospective, used linear dimensions of the LV, and did not account for MR severity. This study is to determine if there are sex differences with respect to pre- and post-surgical LV remodelling and clinical outcomes.

Effect of obesity on myocardial tissue characteristics in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance-based study.

Background: Obesity is associated with cardiac steatosis in healthy adults and is independently associated with increased left ventricular (LV) mass and could contribute to the progression of heart failure-related composite events in patients with hypertrophic cardiomyopathy (HCM). However, it is unclear whether the increased LV mass is accompanied by increased fibrosis. We aimed to assess the impact of increased body mass index (BMI) on myocardial tissue characteristics in patients with HCM.

Thrombotic Thrombocytopenic Purpura (TTP) Survivors Exhibit Impaired Stress Perfusion on Cardiac MRI.

Stress images are on the left and rest images are on the right. The top row is a TTP subject and the bottom row is a control subject. The color maps show myocardial blood flow (MBF) in ml/g/min with brighter colors indicating higher perfusion.

Subclinical myocardial work impairment in non-diabetic overweight and obese individuals: Impact of cardiometabolic traits.

Background: Early detection of cardiac impairment in overweight and obesity is essential for early preventive strategies against heart failure. Myocardial work is a novel echocardiographic parameter that incorporates left ventricular afterload into global longitudinal strain analysis. This study aimed to: 1) assess subclinical alterations of myocardial work among non-diabetic overweight and obese individuals with normal left ventricular ejection fraction (LVEF); 2) investigate the impact of cardiometabolic traits on these alterations; and 3) determine the correlation between myocardial work and myocardial tissue characteristics.

Accelerated real-time cine and flow under in-magnet staged exercise.

Background: Cardiovascular magnetic resonance (CMR) imaging is a well-established imaging tool for diagnosing and managing cardiac conditions. The integration of exercise stress with CMR (ExCMR) can enhance its diagnostic capacity. Despite recent advances in CMR technology, quantitative ExCMR during exercise remains technically challenging due to motion artifacts and limited spatial and temporal resolution.

Feasibility of Noncontrast 3D MR Angiography on a Commercial Wide-Bore 0.55-T System: Comparison with 1.5-T MR Angiography.

Purpose To evaluate a noncontrast electrocardiographically triggered, navigator-gated, three-dimensional, balanced steady-state free precession MR angiography (MRA) research sequence on a wide-bore 0.55-T commercial low-field-strength system, by comparing image quality and aortic dimension measurements against images obtained at 1.5 T.

Prognostic value of the right ventricular to left ventricular volume ratio on cardiac magnetic resonance imaging in predicting adverse outcomes for adults with pulmonary hypertension.

Background: Right ventricular (RV) performance impacts clinical outcomes across pulmonary hypertension (PH), yet noninvasive tools for early detection and risk stratification are limited. Cardiac MRI (CMR) derived RV to left ventricular (LV) volume ratio (RV/LV ratio) provides a relative assessment of RV size by normalizing chamber size to the LV. However, its prognostic utility remains underexplored.

A ketogenic-promoting beverage acutely elevates cardiac function and myocardial blood flow compared to placebo in adults: A cardiac MRI investigation.

Increasing evidence suggests cardiac function improves in healthy and failing hearts alongside circulating ketones (1-4 mM). This study characterized cardiac function and blood flow responses to a ketogenic beverage compared to a volume/calorie matched placebo with repeated imaging over 120 min. This was a two-group, placebo-controlled, acute cardiac imaging study.

Feasibility of strain-encoded magnetic resonance at 0.55T.

Background: Low-field (<1.0T) wide-bore cardiovascular magnetic resonance (CMR) has the potential to improve patient accessibility; however intrinsically reduced signal-to-noise ratio may affect techniques such as strain-encoded magnetic resonance (SENC), a method to quantify regional strain. We sought to characterize the performance of SENC on a low-field system in a phantom, healthy subjects, and a porcine model of myocardial infarction (MI).

Atorvastatin and Myocardial Extracellular Volume Expansion During Anthracycline-Based Chemotherapy.

Background: In the STOP-CA (Statins to Prevent the Cardiotoxicity From Anthracyclines) trial, atorvastatin preserved the left ventricular ejection fraction among patients with lymphoma treated with anthracyclines. The protective mechanisms are currently unclear.

Objectives: The aim of this study was to test the effect of atorvastatin on the anthracycline-associated increase in myocardial extracellular volume (ECV) using cardiac magnetic resonance imaging (MRI).

Prognostic Value of Myocardial T1 Mapping for Predicting Adverse Events in Hypertrophic Cardiomyopathy.

Background: In patients with hypertrophic cardiomyopathy, the prognostic value of myocardial T1 and extracellular volume fraction for adverse cardiovascular events has not been well defined.

Methods: A total of 663 consecutive participants with hypertrophic cardiomyopathy who underwent 3T cardiovascular magnetic resonance were recruited. The follow-up end points included heart failure (HF)-related death, HF hospitalization, and sudden cardiac death or aborted sudden cardiac death.

Test-retest Assessment of Biventricular Myocardial Oxidative Metabolism and Perfusion in Pulmonary Hypertension Patients Using C-acetate PET Imaging: A Pilot Study.

Purpose: C-acetate PET is used to measure biventricular oxygen myocardial consumption rate (MVO) and myocardial blood flow (MBF) changes associated with right ventricular (RV) remodelling. We studied PET reproducibility and repeatability for such RV assessments.

Procedures: 10 pulmonary hypertension (PH) patients underwent C-acetate PET.

Predictive Value of Left Atrial Strain for Thrombotic Events in Hypertrophic Cardiomyopathy without Atrial Fibrillation.

Purpose To assess the predictive value of left atrial (LA) fast long-axis strain derived from cardiac MRI for thrombotic events (TEs) in individuals with hypertrophic cardiomyopathy (HCM). Materials and Methods This secondary analysis of an ongoing prospective trial (Chinese Clinical Trial Registry: ChiCTR1900024094) included consecutive participants with HCM without atrial fibrillation (AF) who underwent cardiac MRI from January 2012 to December 2020. The LA fast long-axis strain was obtained by semiautomatically tracking the distance between the atrioventricular junction and the midposterior LA wall.