The components of metabolic syndrome (MS) are risk factors for developing both cardiovascular disease (CVD) and non-alcoholic fatty liver disease (NAFLD). Strain (SI) and strain‑rate imaging (SRI) are able to recognize early changes in cardiac function. Vibration-controlled transient elastography (VCTE) and controlled attenuation parameter (CAP) detect and quantify liver fibrosis and steatosis. We aimed to assess whether there is any correlation between liver fibrosis and steatosis and left ventricular (LV) dysfunction in MS patients.A total of 150 adults with MS were registered in the study. They were compared with a control group of 150 age- and sex-matched adults without MS. After the classic echocardiographic assessment of LV function, two-dimensional speckle echocardiography (2D-STE) was used to evaluate LV peak systolic strain (S) and peak systolic strain rate (SR), while liver steatosis and fibrosis were evaluated by VCTE and CAP.LV diastolic dysfunction was significantly more frequent among the patients with MS. We found significant differences between the two groups regarding the presence of subtle LV systolic dysfunction, detected by reduced values of S and SR. The risk for LV diastolic dysfunction was 3.6 times higher in MS with severe steatosis and 8 times higher in patients with severe fibrosis, P<0.0001. The risk for LV systolic dysfunction was double in MS with severe steatosis and 1.7 times higher in MS with severe fibrosis, P<0.0001.In MS patients with normal LV ejection fraction, conventional echocardiography parameters identified diastolic LV dysfunction, while SI and SRI identified subtle impairment of systolic LV dysfunction. The presence of hepatic steatosis and fibrosis increases significantly the risk for cardiac dysfunction in MS patients (P<0.0001).
Hypoglycemic medications are widely used in managing diabetes mellitus, with emerging evidence suggesting their role in cardiac reverse remodeling. This systematic review aims to quantitatively synthesize data regarding the impact of these medications on left ventricular end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD), and to evaluate the clinical relevance of these changes in promoting favorable cardiac outcomes. We conducted a comprehensive search across PubMed, Scopus, and the Web of Science up to 22 April 2024, selecting studies based on inclusion criteria that focused on the impact of hypoglycemic medications on LVEDD and LVESD in patients with diabetes. Studies were selected through a rigorous process, adhering to PRISMA guidelines, and involving various designs including randomized controlled trials and observational studies. The main outcomes were changes in LVEDD and LVESD measured by validated cardiac imaging techniques. A total of ten studies met the inclusion criteria, involving a total of 1180 patients. Treatment durations ranged from 3 to 24 months. Significant improvements in cardiac dimensions were noted with some medications. For instance, Liraglutide treatment over three months significantly improved LVEF from 47.2% to 57.2% and reduced LVEDD and LVESD from 46.5 mm to 45.2 mm and 35.2 mm to 32.7 mm, respectively. In contrast, other medications like Sitagliptin showed minimal impact over 24 months. On average, hypoglycemic medications reduced LVEDD from 58.2 mm to 55.0 mm and LVESD from 48.3 mm to 44.3 mm, with a mean improvement in LVEF from 38.9% to 43.8%. Hypoglycemic medications contribute variably to cardiac reverse remodeling. Medications such as Liraglutide and Dapagliflozin demonstrate significant potential in improving cardiac dimensions and function, indicating their utility beyond glycemic control. This review highlights the need for tailored treatment approaches to maximize cardiac outcomes in patients with diabetes, suggesting a broader therapeutic role for these agents.
The constitutive elements of the metabolic syndrome (MetS) are linked with both non-alcoholic fatty liver disease (NAFLD) and cardiovascular disease. Controlled attenuation parameter (CAP), and vibration controlled transient elastography (VCTE), are able to detect and quantify NAFLD, while conventional and two-dimensional speckle tracking echocardiography (2D-STE) is capable to identify subclinical changes in cardiac function. We wanted to evaluate whether there is any correspondence between left ventricular (LV) diastolic dysfunction and different degrees of liver steatosis and fibrosis in MetS subjects with NAFLD.
Anemia is frequently observed in heart failure (HF) patients. The aim of this prospective study was to assess if it is an independent predictor of outcome or a marker of a worse clinical condition in these patients. The study included 134 heart failure patients aged over 18 years. The patients were divided into two groups, according to the presence or absence of anemia at hospital admission. Anemia was defined as a hemoglobin concentration of less than 12 g/dl for women and less than 13 g/dl for men. The endpoints were: length of hospitalization, all cause-death during hospitalization, and all-cause death and HF rehospitalizations at 1 year. Anemia occurred in 33% of HF patients. The HF patients with anemia were significantly older, had more often ischemic etiology of heart failure and atrial fibrillation, chronic kidney disease and 3 or more comorbidities. The length of hospitalization was similar between the two groups. Deaths during hospitalization occurred in 13% of anemic and in 3% of the nonanemic patients (P=0.04). During the 1- year follow-up, 45% of the anemic vs. 28% of the nonanemic patients were rehospitalized due to aggravated HF (P=0.04), and 14% of the anemic vs 20% of the nonanemic patients died (P=0.38). Anemia was strongly predictive for in-hospital and 1- year all-cause deaths in univariate analysis, but not in multivariate analysis. Anemia seems more a marker of a worse clinical condition, rather than an independent risk factor in HF.
Abstract Aims The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) European Endocarditis (EURO-ENDO) registry aims to study the care and outcomes of patients diagnosed with infective endocarditis (IE) and compare findings with recommendations from the 2015 ESC Clinical Practice Guidelines for the management of IE and data from the 2001 Euro Heart Survey. Methods and results Patients (n = 3116) aged over 18 years with a diagnosis of IE based on the ESC 2015 IE diagnostic criteria were prospectively identified between 1 January 2016 and 31 March 2018. Individual patient data were collected across 156 centres and 40 countries. The primary endpoint is all-cause mortality in hospital and at 1 year. Secondary endpoints are 1-year morbidity (all-cause hospitalization, any cardiac surgery, and IE relapse), the clinical, epidemiological, microbiological, and therapeutic characteristics of patients, the number and timing of non-invasive imaging techniques, and adherence to recommendations as stated in the 2015 ESC Clinical Practice Guidelines for the management of IE. Conclusion EURO-ENDO is an international registry of care and outcomes of patients hospitalized with IE which will provide insights into the contemporary profile and management of patients with this challenging disease.
Background: As more long-term cancer survivors facing with the heart side effect after anthracycline treatment, it is urgent to explore the optimal monitoring method.Our aim was to investigate the value of Tei index combined with serum high-sensitivity troponin T (hs-cTnT) for monitoring cardiac toxicity induced by anthracycline chemotherapy on patients with diffuse large B-cell lymphoma (DL-BCL).Methods: We conducted a retrospective analysis of 56 consecutive patients who were newly diagnosed as DLBCL and treated with doxorubincin-containing chemotherapy.Echocardiographic pulse wave Doppler Tei index (PW-Tei index) as well as tissue Doppler Tei index (TDI-Tei index), serum hs-cTnT levels, and left ventricular ejection fraction (LVEF) obtained by radionuclide assessment were measured before they received any anthracycline, after 2-4 chemotherapy cycle (100-200mg/m 2 ) as well as 6-8 chemotherapy cycle (300-400mg/m 2 ).Cardiotoxicity was defined as an asymptomatic reduction of LVEF ≥10% or<50% detected by radionuclide.Results: Following anthracycline-based chemotherapy, 31 (55.36%)patients developed cardiotoxicity during the investigation.Two (3.57%) patients' cardiac function impaired notably presented from normal LVEF to abnormal.According to nuclear medicine, the average LVEF decreased (66.39±6.13% vs. 62.25±7.34% vs. 62.46±7.54%,p=0.001), with diastolic index peak filling rates (PFR) deteriorated significantly (3.518±0.647%SV/secvs. 3.253±0.663%SV/secvs. 3.135±0.609%SV/sec,p=0.001).Meanwhile, PW Tei-index, an echocardiographic parameter combined systolic and diastolic cardiac functions, increased obviously (0.347±0.115 vs. 0.459±0.161vs. 0.424±0.139,p<0.001), correlated with systolic injury (p<0.001) and diactolic damage (p<0.001)evaluated by radionuclide.Moreover, serum hs-cTnT levels significantly increased following chemotherapy (0.006±0.006ng/ml vs 0.012±0.007ng/mlvs 0.020±0.013ng/ml,P<0.001).The sensitivity, specificity and AUC of early diagnosis of anthracycline-induced cardiotoxicity with elevated serum hs-cTnT levels after 2-4 cycle and increased left ventricular PW-Tei index after 6-8cycle treatment were 75%, 85%, 0.736 and 92%, 50%, 0.675 respectively (P<0.05).Conclusions: Our results may help physicians using the easily obtainable echocardiographic PW-Tei index combined with serum hs-cTnT for an early detection of cardiac toxicity on patients whether in the community hospitals or the high-volume teaching hospitals.
The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE).Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated.Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.
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