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Re: Targeting NOS as a therapeutic approach for heart failure

Bonsu KO, Kadirvelu A, Reidpath DD

Pharmacol Ther, 2014 Sep;143(3):350.
PMID: 24769330 DOI: 10.1016/j.pharmthera.2014.04.003
Matched MeSH terms: Heart Failure/drug therapy*
Biologic valved conduits in infants

Corno AF

Ann Thorac Surg, 2014 May;97(5):1853.
PMID: 24792290 DOI: 10.1016/j.athoracsur.2013.12.010
Matched MeSH terms: Heart Defects, Congenital/surgery*
Fulltext Infiltrative cardiac lymphoma with tricuspid valve involvement in a young man

Abdullah HN, Nowalid WK

World J Cardiol, 2014 Feb 26;6(2):77-80.
PMID: 24575174 DOI: 10.4330/wjc.v6.i2.77

Cardiac metastases are among the topics with limited systematic reviews. Theoretically, the heart can be infiltrated by any malignancy with the ability to spread to distant structures. Thus far, no specific tumors are known to have a predilection for the heart, but some do metastasize more often than others, for example, melanoma and primary mediastinal tumors. We report a case of cardiac metastasis from a diffuse large B cell lymphoma in a young man. The peculiarity of this case is that besides the involvement of right ventricle and atrium, the tricuspid valve was also infiltrated. Valvular metastasis is rarely reported in the medical literature.

Matched MeSH terms: Heart Neoplasms; Heart Ventricles
Robust aortic valve non-opening detection for different cardiac conditions

Ooi HL, Ng SC, Lim E, Salamonsen RF, Avolio AP, Lovell NH

Artif Organs, 2014 Mar;38(3):E57-67.
PMID: 24422872 DOI: 10.1111/aor.12220

In recent years, extensive studies have been conducted in the area of pumping state detection for implantable rotary blood pumps. However, limited studies have focused on automatically identifying the aortic valve non-opening (ANO) state despite its importance in the development of control algorithms aiming for myocardial recovery. In the present study, we investigated the performance of 14 ANO indices derived from the pump speed waveform using four different types of classifiers, including linear discriminant analysis, logistic regression, back propagation neural network, and k-nearest neighbors (KNN). Experimental measurements from four greyhounds, which take into consideration the variations in cardiac contractility, systemic vascular resistance, and total blood volume were used. By having only two indices, (i) the root mean square value, and (ii) the standard deviation, we were able to achieve an accuracy of 92.8% with the KNN classifier. Further increase of the number of indices to five for the KNN classifier increases the overall accuracy to 94.6%.

Matched MeSH terms: Heart-Assist Devices*
Automated classification of patients with coronary artery disease using grayscale features from left ventricle echocardiographic images

Acharya UR, Sree SV, Muthu Rama Krishnan M, Krishnananda N, Ranjan S, Umesh P, et al.

Comput Methods Programs Biomed, 2013 Dec;112(3):624-32.
PMID: 23958645 DOI: 10.1016/j.cmpb.2013.07.012

Coronary Artery Disease (CAD), caused by the buildup of plaque on the inside of the coronary arteries, has a high mortality rate. To efficiently detect this condition from echocardiography images, with lesser inter-observer variability and visual interpretation errors, computer based data mining techniques may be exploited. We have developed and presented one such technique in this paper for the classification of normal and CAD affected cases. A multitude of grayscale features (fractal dimension, entropies based on the higher order spectra, features based on image texture and local binary patterns, and wavelet based features) were extracted from echocardiography images belonging to a huge database of 400 normal cases and 400 CAD patients. Only the features that had good discriminating capability were selected using t-test. Several combinations of the resultant significant features were used to evaluate many supervised classifiers to find the combination that presents a good accuracy. We observed that the Gaussian Mixture Model (GMM) classifier trained with a feature subset made up of nine significant features presented the highest accuracy, sensitivity, specificity, and positive predictive value of 100%. We have also developed a novel, highly discriminative HeartIndex, which is a single number that is calculated from the combination of the features, in order to objectively classify the images from either of the two classes. Such an index allows for an easier implementation of the technique for automated CAD detection in the computers in hospitals and clinics.

Matched MeSH terms: Heart Ventricles/ultrasonography*
Fulltext Perinatal management of cardiac tumors: a case series

Amelia A, Mohd Nizam MB

Med J Malaysia, 2013 Aug;68(4):374-5.
PMID: 24145275 MyJurnal

Primary cardiac tumours in the foetuses and neonates are uncommon. Foetuses with cardiac tumour have risk for heart failure and hydrops fetalis. Therefore, an early decision for delivery should be made in the evidence of foetal compromise. Early neonatal care varies on tumour size, type, location and obstructive features. Antenatal detection of foetal cardiac tumours ensures better prenatal and postnatal management. We describe our 5- year experience in managing 5 cases of primary cardiac tumours from 1st January 2006 to 31st December 2010.

Matched MeSH terms: Heart Neoplasms*
Linear and nonlinear analysis of normal and CAD-affected heart rate signals

Acharya UR, Faust O, Sree V, Swapna G, Martis RJ, Kadri NA, et al.

Comput Methods Programs Biomed, 2014;113(1):55-68.
PMID: 24119391 DOI: 10.1016/j.cmpb.2013.08.017

Coronary artery disease (CAD) is one of the dangerous cardiac disease, often may lead to sudden cardiac death. It is difficult to diagnose CAD by manual inspection of electrocardiogram (ECG) signals. To automate this detection task, in this study, we extracted the heart rate (HR) from the ECG signals and used them as base signal for further analysis. We then analyzed the HR signals of both normal and CAD subjects using (i) time domain, (ii) frequency domain and (iii) nonlinear techniques. The following are the nonlinear methods that were used in this work: Poincare plots, Recurrence Quantification Analysis (RQA) parameters, Shannon entropy, Approximate Entropy (ApEn), Sample Entropy (SampEn), Higher Order Spectra (HOS) methods, Detrended Fluctuation Analysis (DFA), Empirical Mode Decomposition (EMD), Cumulants, and Correlation Dimension. As a result of the analysis, we present unique recurrence, Poincare and HOS plots for normal and CAD subjects. We have also observed significant variations in the range of these features with respect to normal and CAD classes, and have presented the same in this paper. We found that the RQA parameters were higher for CAD subjects indicating more rhythm. Since the activity of CAD subjects is less, similar signal patterns repeat more frequently compared to the normal subjects. The entropy based parameters, ApEn and SampEn, are lower for CAD subjects indicating lower entropy (less activity due to impairment) for CAD. Almost all HOS parameters showed higher values for the CAD group, indicating the presence of higher frequency content in the CAD signals. Thus, our study provides a deep insight into how such nonlinear features could be exploited to effectively and reliably detect the presence of CAD.

Matched MeSH terms: Heart Rate*
Fulltext Brain metastasis of atrial myxoma: Case report

Badrisyah I, Saiful R, Rahmat H, Naik VR, Tan YC

Med J Malaysia, 2012 Dec;67(6):613-5.
PMID: 23770956 MyJurnal

Metastasis of an atrial myxoma to the brain is extremely rare. Thus far there are only 17 cases reported, including our present case. Most of the brain metastases manifest only in 3 to 6 decades, after an average time frame of one to two years after surgical removal of parental tumour. We present a case of brain metastases of atrial myxoma in a teenager of the youngest age among all reported cases, unusually as early as 15 years old. The progress of the metastatic process had been insidious for three years after heart surgery, The imaging demonstrated a rather sizeable tumour by the time when the patient is symptomatic. The location of the metastatic tumour is anyhow superficial to the cortical surface, enabling complete surgical excision of the tumour easily achievable with favourable outcome.

Matched MeSH terms: Heart Neoplasms*
The nonlinear elastic and viscoelastic passive properties of left ventricular papillary muscle of a guinea pig heart

Hassan MA, Hamdi M, Noma A

J Mech Behav Biomed Mater, 2012 Jan;5(1):99-109.
PMID: 22100084 DOI: 10.1016/j.jmbbm.2011.08.011

The mechanical behavior of the heart muscle tissues is the central problem in finite element simulation of the heart contraction, excitation propagation and development of an artificial heart. Nonlinear elastic and viscoelastic passive material properties of the left ventricular papillary muscle of a guinea pig heart were determined based on in-vitro precise uniaxial and relaxation tests. The nonlinear elastic behavior was modeled by a hypoelastic model and different hyperelastic strain energy functions such as Ogden and Mooney-Rivlin. Nonlinear least square fitting and constrained optimization were conducted under MATLAB and MSC.MARC in order to obtain the model material parameters. The experimental tensile data was used to get the nonlinear elastic mechanical behavior of the heart muscle. However, stress relaxation data was used to determine the relaxation behavior as well as viscosity of the tissues. Viscohyperelastic behavior was constructed by a multiplicative decomposition of a standard Ogden strain energy function, W, for instantaneous deformation and a relaxation function, R(t), in a Prony series form. The study reveals that hypoelastic and hyperelastic (Ogden) models fit the tissue mechanical behaviors well and can be safely used for heart mechanics simulation. Since the characteristic relaxation time (900 s) of heart muscle tissues is very large compared with the actual time of heart beating cycle (800 ms), the effect of viscosity can be reasonably ignored. The amount and type of experimental data has a strong effect on the Ogden parameters. The in vitro passive mechanical properties are good initial values to start running the biosimulation codes for heart mechanics. However, an optimization algorithm is developed, based on clinical intact heart measurements, to estimate and re-correct the material parameters in order to get the in vivo mechanical properties, needed for very accurate bio-simulation and for the development of new materials for the artificial heart.

Matched MeSH terms: Heart Ventricles*
Fulltext Surgical management of recurrent postinfarction ventricular septal defect

Eng JB

Med J Malaysia, 2007 Aug;62(3):261-2.
PMID: 18246924 MyJurnal

A 57 year old man presented with postinfarction ventricular septal infarct (VSD) a week after myocardial infarction and thrombolytic therapy. Coronary angiography confirmed double vessel disease. He underwent surgical repair of the VSD and coronary artery bypass grafting. Two days postoperatively, he deteriorated due to recurrence of VSD. Reoperation was carried out with satisfactory results. The surgical management is described with a review of the relevant literature.

Matched MeSH terms: Heart Septal Defects, Ventricular/surgery*
Transcatheter closure of defects within the oval fossa using the Amplatzer Septal Occluder

Latiff HA, Alwi M, Samion H, Kandhavel G

Cardiol Young, 2002 May;12(3):224-8.
PMID: 12365167

This study reviewed the short-term outcome of transcatheter closure of the defects within the oval fossa using an Amplatzer Septal Occluder. From January 1997 to December 2000, 210 patients with defects within the oval fossa underwent successful transcatheter closure. We reviewed a total of 190 patients with left-to-right shunts, assessing the patients for possible complications and the presence of residual shunts using transthoracic echocardiogram at 24 h, 1 month, 3 months and one year. Their median age was 10 years, with a range from 2 to 64 years, and their median weight was 23.9 kg, with a range from 8.9 to 79 kg. In 5 patients, a patent arterial duct was closed, and in 2 pulmonary balloon valvoplasty performed, at the same sitting. The median size of the Amplatzer device used was 20 mm, with a range from 9 to 36 mm. The median times for the procedure and fluoroscopy were 95 min, with a range from 30 to 210 min, and 18.4 min, with a range from 5 to 144 min, respectively. Mean follow-up was 20.8 +/- 12.4 months. Complete occlusion was obtained in 168 of 190 (88%) patients at 24 h, 128 of 133 (96.2%) at 3 months, and 103 of 104 (99%) at one year. Complications occurred in 4 (2.1%) patients. In one, the device became detached, in the second the device embolized into the right ventricular outflow tract, the lower end of the device straddled in the third, and the final patient had significant bleeding from the site of venupuncture. There were no major complications noted on follow-up. We conclude that transcatheter closure of defects within the oval fossa using the Amplatzer Septal Occluder is safe and effective. Long-term follow-up is required, nonetheless, before it is recommended as a standard procedure.

Matched MeSH terms: Heart Septal Defects/radiography; Heart Septal Defects/surgery*; Heart Septal Defects/ultrasonography; Heart Septum/radiography; Heart Septum/surgery*; Heart Septum/ultrasonography
Isolated atrial amyloidosis: a clinicopathologic study indicating increased prevalence in chronic heart disease

Looi LM

Hum Pathol, 1993 Jun;24(6):602-7.
PMID: 8505038

Congo red screening of 211 consecutive cardiac biopsy specimens obtained during cardiac surgery from 167 patients revealed 26 (16%) instances of isolated atrial amyloidosis (IAA). The ages of IAA-positive patients ranged from 25 to 52 years (mean age, 39 years). Twenty-three (88%) IAA-positive biopsy specimens were from patients with chronic rheumatic heart disease (CRHD) while three (12%) were from patients with an atrial septal defect (ASD). The prevalence of IAA in the CRHD patients was 23%, appreciably higher than that in the ASD patients (15%) and in other patients with atrial biopsies. The prevalence of IAA in both CRHD and ASD patients was significantly higher (P < .001) than in controls. Controls consisted of 247 healthy adults who were autopsied after traumatic deaths, with an age range of 18 to 89 years (mean age, 38 years). Only seven (3%) control subjects were IAA positive; all were over 40 years of age. Isolated atrial amyloidosis deposits were permanganate resistant and immunohistochemically positive for human amyloid P (AP) protein and negative for human amyloid-associated (AA) protein and immunoglobulin light chains. They were observed as fine congophilic and birefringent deposits in intramyocardial vessel walls, along the myocardial sarcolemma, and in the subendocardium. There was associated myocyte hypertrophy but no atrophy. Electron microscopy demonstrated typical nonbranching amyloid fibrils. It is postulated that stretching of the atria in chronic heart disease results in a raised prevalence of IAA. Recent reports that IAA contains atrial natriuretic peptide, a polypeptide hormone product of atrial myocytes, supports this view.

Matched MeSH terms: Heart Diseases/etiology; Heart Diseases/epidemiology*; Heart Diseases/pathology; Heart Valve Diseases/complications*; Rheumatic Heart Disease/complications*
Fulltext Diagnosing Perioperative Cardiovascular Risks in Noncardiac Surgery Patients

Li P, Lei Y, Li Q, Lakshmipriya T, Gopinath SCB, Gong X

J Anal Methods Chem, 2019;2019:6097375.
PMID: 31534814 DOI: 10.1155/2019/6097375

Every year, over 200 million adults are undergoing noncardiac surgery. These noncardiac surgery patients may face the risk of cardiac mortality and morbidity during the perioperative and recovery periods. Around ten million patients who underwent noncardiac surgery experience cardiac complications within the first 30 days of the postoperative period; the complications are myocardial infarction, cardiac death, and cardiac arrest. This cardiovascular risk is mostly faced by the patients having cerebrovascular or cardiac disease and the patients with the age greater than 50 years. Monitoring and treating cardiac diseases with a suitable biomarker during the perioperative period is necessary for the early recovery of noncardiac surgery patients. This review discussed the risk factors and the key guidelines to avoid the cardiovascular risks during the perioperative period of noncardiac surgery patients. In addition, the biomarkers and identification strategies for cardiac diseases are discussed.

Matched MeSH terms: Heart Arrest; Heart Diseases
Fulltext Iron deficiency in heart failure patients with reduced ejection fraction and the correlation with left ventricular ejection fraction

Kok Leng Tan, Seng Loong Ng, Soon Eu Chong1, W Yus Haniff W Isa, Hady, Jun Jie Tan, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(1):131-136.
MyJurnal

Introduction: Iron deficiency (ID) has recently been identified as a threat to patients with heart failure with reduced ejection fraction (HFrEF). This study was conducted to determine the occurrence of ID among HFrEF patients in a Malaysian tertiary hospital and its correlation between left ventricular ejection fraction (LVEF). Methods: Stable patients with LVEF less than 45% were included. Demographic data, LVEF (Simpsons) and cardiac functional status were studied, along with full blood count and iron profile. Results: 81 patients with a mean LVEF of 33.6% were recruited. 43.2% of them were NYHA class II patients, followed by 38.3% class III, 13.6% class I and 4.9% class IV patients. About 2/5 of the study population were anaemic, and of those, 48.5% were iron deficient. Majority of these anaemic patients (87.5%) had an absolute iron deficiency. Pearson’s statistical analysis showed positive correlation between ejection fraction and serum ferritin (r=0.624, p< 0.001), serum iron (r= 0.302, p

Matched MeSH terms: Heart; Heart Failure
The effect of beta-blockers on a course of chronic heart failure in patients with a low triiodothyronine syndrome

Pyvovar SM, Rudyk IS, Kopytsya MP, Lozyk TV, Galchinskaya VI, Chenchik TO

Wiad Lek, 2020;73(7):1402-1409.
PMID: 32759428

OBJECTIVE: The aim: The aim is to study the effect of β-ABs in patients with LT3 S on the course of HF.
PATIENTS AND METHODS: Materials and methods: 354 patients with HF on a background of post-infarction cardiosclerosis were included in the 2-yeared follow-up study. LT3 S was diagnosed at 89 (25.1%) patients. The levels of thyroid-stimulating hormone, free T3f and T4f, and reversible T3 were determined. The echocardioscopy was performed.
RESULTS: Results: Patients with HF in combination with LT3 S have a heavier functional class by NYHA, greater dilatation of the left heart cavities, less myocardial contractility, a higher frequency of atrial fibrillation and re-hospitalization. The use of β-ABs in patients with HF without LT3 S leads to a likely decrease in hospitalization frequency, while in patients with LT3 S it has an opposite effect. The frequency of rehospitalization increases with an excess of β-ABs dose > 5 mg (equivalent to bisoprolol). At these patients a decrease in serum T3 level and negative dynamics of parameters of intracardiac hemodynamics are observed.
CONCLUSION: Conclusions: The use of β-ABs in patients with LT3 S leads to an increase in re-hospitalization at a dose over 5.0 mg (equivalent to bisoprolol). In these patients there is a decrease in serum T3, an increase in T4 level; and the ejection fraction decrease; and heart cavities size increase.

Matched MeSH terms: Heart Failure*
A review of heart valve disease research in Malaysia

Khoo PLZ, Poon JS, Tan GJS, Yahya A, Chan KMJ

Med J Malaysia, 2020 11;75(6):722-730.
PMID: 33219184

INTRODUCTION: Heart valve disease comprises a cluster of conditions affecting the aortic, mitral, pulmonary and tricuspid valves. This paper reviews all the research on heart valve disease in Malaysia published between the years 2000- 2016.
METHODS: The methodology was based on the search process described in the paper, "Bibliography of clinical research in Malaysia: methods and brief results". The search databases included PubMed, Scopus and several Malaysian journals such as MyJurnal and UKM Journal Repository, by using the following keywords: (heart valve disease OR infective endocarditis OR rheumatic heart disease) and (Malaysia).
RESULTS: In all 94 papers were identified of which 39 papers were selected and reviewed on the basis of their relevance. The local studies contributed to the knowledge and understanding of the epidemiology, aetiology, pathophysiology, clinical presentations, investigations, treatment, and outcomes of heart valve disease in the country.
DISCUSSION: The clinical relevance of the studies performed in the country is discussed along with recommendations for future research.

Matched MeSH terms: Heart Valve Diseases; Rheumatic Heart Disease
Tolerability with special reference to cough, of captopril in patients with congestive cardiac failure

Quek DKL, Alfred E, Ong SBL

Family Physician, 1991;3:34-38.

Cough associated with angiotensin converting-enzyme (ACE) inhibitor therapy has been reported in Western communities, where its incidence is disputed. We, therefore, reviewed our patients who were treated with captopril primarily for congestive cardiac failure. 19 of 61 patients (31.1%) receiving an ACE inhibitor had volunteered cough as an important adverse effect, compared with only one of 59 patients who recieved other treatment. In 3 patients, the cough was intolerably severe to require discontinuation of treatment. Another 7 patients were withdrawn from ACE inhibitor treatment because of other adverse effects including deteriorating renal function, insomnia, dizzy spells, ageusia and proteinuria, and skin rash. We suggest that although ACE inhibitors are very beneficial in improving the clinical status of congestive heart failure, intolerable adverse effects are not uncommon and might mandate withdrawal in a sizeable minority (16.4%).

Matched MeSH terms: Heart; Heart Failure
Quantitative and qualitative comparison of low- and high-cost 3D-printed heart models

Lau I, Wong YH, Yeong CH, Abdul Aziz YF, Md Sari NA, Hashim SA, et al.

Quant Imaging Med Surg, 2019 Jan;9(1):107-114.
PMID: 30788252 DOI: 10.21037/qims.2019.01.02

Current visualization techniques of complex congenital heart disease (CHD) are unable to provide comprehensive visualization of the anomalous cardiac anatomy as the medical datasets can essentially only be viewed from a flat, two-dimensional (2D) screen. Three-dimensional (3D) printing has therefore been used to replicate patient-specific hearts in 3D views based on medical imaging datasets. This technique has been shown to have a positive impact on the preoperative planning of corrective surgery, patient-doctor communication, and the learning experience of medical students. However, 3D printing is often costly, and this impedes the routine application of this technology in clinical practice. This technical note aims to investigate whether reducing 3D printing costs can have any impact on the clinical value of the 3D-printed heart models. Low-cost and a high-cost 3D-printed models based on a selected case of CHD were generated with materials of differing cost. Quantitative assessment of dimensional accuracy of the cardiac anatomy and pathology was compared between the 3D-printed models and the original cardiac computed tomography (CT) images with excellent correlation (r=0.99). Qualitative evaluation of model usefulness showed no difference between the two models in medical applications.

Matched MeSH terms: Heart; Heart Defects, Congenital
Conservative Treatment for Right Ventricular Free Wall Rupture in a Patient with Acute Myocardial Infarction

Firdaus MAM, Rahim NSA, Rusdi N, Idris NS, Mohd Said MR, Abidin IZ

Case Rep Cardiol, 2020;2020:8836627.
PMID: 32774930 DOI: 10.1155/2020/8836627

Ventricular wall rupture possesses a high mortality rate in patients with acute myocardial infarction. We presented a case of a ninety-year-old gentleman who presented with acute inferolateral myocardial infarction in cardiogenic shock and right ventricular free wall rupture. He was treated conservatively and survived.

Matched MeSH terms: Heart Rupture; Heart Ventricles
Fulltext Cardiorespiratory Fitness in Youth: An Important Marker of Health: A Scientific Statement From the American Heart Association

Raghuveer G, Hartz J, Lubans DR, Takken T, Wiltz JL, Mietus-Snyder M, et al.

Circulation, 2020 08 18;142(7):e101-e118.
PMID: 32686505 DOI: 10.1161/CIR.0000000000000866

Cardiorespiratory fitness (CRF) refers to the capacity of the circulatory and respiratory systems to supply oxygen to skeletal muscle mitochondria for energy production needed during physical activity. CRF is an important marker of physical and mental health and academic achievement in youth. However, only 40% of US youth are currently believed to have healthy CRF. In this statement, we review the physiological principles that determine CRF, the tools that are available to assess CRF, the modifiable and nonmodifiable factors influencing CRF, the association of CRF with markers of health in otherwise healthy youth, and the temporal trends in CRF both in the United States and internationally. Development of a cost-effective CRF measurement process that could readily be incorporated into office visits and in field settings to screen all youth periodically could help identify those at increased risk.

Matched MeSH terms: American Heart Association*

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