In patients with dyssynchronous heart failure (DHF), cardiac conduction abnormalities cause the regional distribution of myocardial work to be non-homogeneous. Cardiac resynchronization therapy (CRT) using an implantable, programmed biventricular pacemaker/defibrillator, can improve the synchrony of contraction between the right and left ventricles in DHF, resulting in reduced morbidity and mortality and increased quality of life. Since regional work depends on wall stress, which cannot be measured in patients, we used computational methods to investigate regional work distributions and their changes after CRT. We used three-dimensional multi-scale patient-specific computational models parameterized by anatomic, functional, hemodynamic, and electrophysiological measurements in eight patients with heart failure and left bundle branch block (LBBB) who received CRT. To increase clinical translatability, we also explored whether streamlined computational methods provide accurate estimates of regional myocardial work. We found that CRT increased global myocardial work efficiency with significant improvements in non-responders. Reverse ventricular remodeling after CRT was greatest in patients with the highest heterogeneity of regional work at baseline, however the efficacy of CRT was not related to the decrease in overall work heterogeneity or to the reduction in late-activated regions of high myocardial work. Rather, decreases in early-activated regions of myocardium performing negative myocardial work following CRT best explained patient variations in reverse remodeling. These findings were also observed when regional myocardial work was estimated using ventricular pressure as a surrogate for myocardial stress and changes in endocardial surface area as a surrogate for strain. These new findings suggest that CRT promotes reverse ventricular remodeling in human dyssynchronous heart failure by increasing regional myocardial work in early-activated regions of the ventricles, where dyssynchrony is specifically associated with hypoperfusion, late systolic stretch, and altered metabolic activity and that measurement of these changes can be performed using streamlined approaches.
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http://dx.doi.org/10.1371/journal.pcbi.1012150 | DOI Listing |
G Ital Cardiol (Rome)
January 2025
U.O. Radiologia Cardio-Toraco Vascolare, Oncoematologica, d'Urgenza e dell'Età Pediatrica, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna.
We report the case of a 78-year-old patient with acute ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI) of the right coronary artery, subsequently found to have a large subepicardial mass. The patient underwent a non-invasive multimodal diagnostic work-up including cardiac computed tomography and cardiac magnetic resonance imaging, which led to the diagnosis of subepicardial hematoma following coronary perforation during primary PCI. Due to clinical stability and absence of active bleeding sources, the patient was managed conservatively with gradual absorption of the mass and favorable prognostic outcome.
View Article and Find Full Text PDFInt J Cardiol Congenit Heart Dis
March 2024
Service of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Since the late 1980s, the standard approach for treating D-transposition of the great arteries has been the arterial switch operation (ASO), replacing the Mustard/Senning procedure. Although ASO has shown impressive long-term survival rates, recent case series have revealed late complications such as neoaortic dilation and coronary artery stenosis. New findings emphasize the need for comprehensive evaluation of coronary risk and a deeper understanding of the mechanisms leading to coronary artery stenosis and myocardial ischemia over the long term.
View Article and Find Full Text PDFInt J Cardiol Congenit Heart Dis
December 2024
Division of Structural and Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium.
Background: The Mustard and Senning operations for dextro-transposition of the great arteries (D-TGA) establish a biventricular physiology with a subaortic right ventricle (sRV). While prolonged QRS has been associated with worse prognosis in these patients, current echocardiographic tools fall short in adequately assessing the (mal)performance and function decline of the sRV during follow-up. The present study is the first to characterize Myocardial Work (MW) indices of the sRV in D-TGA patients after Mustard/Senning repair.
View Article and Find Full Text PDFCureus
November 2024
Interventional Radiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, GBR.
Pulmonary embolism (PE) is the third most frequent cause of acute cardiovascular presentation after myocardial infarction and stroke. The treatment approach for PE consists of hemodynamic and respiratory support, anticoagulation, reperfusion treatment, and vena cava filters. Reperfusion treatment consists of systemic thrombolysis (recombinant tissue-type plasminogen activator, streptokinase, and urokinase); percutaneous catheter-directed therapy (CDT); and surgical embolectomy.
View Article and Find Full Text PDFCureus
November 2024
Interventional Cardiology Department, Lady Reading Hospital, Peshawar, PAK.
Background: Primary percutaneous coronary intervention (PCI) is crucial in managing acute ST-segment elevation myocardial infarction (STEMI), emphasizing the importance of optimal myocardial reperfusion.
Objective: The goal of this research was to determine how loading doses of rosuvastatin and atorvastatin affected the flow rate of thrombolysis in myocardial infarction (TIMI) immediately post-perfusion thrombolysis in patients undergoing primary PCI.
Methodology: This prospective, comparative study was carried out over a one-year period (January 2023 to December 2023) in Pakistan.
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