Heart failure is a prevalent cardiovascular condition with significant health implications, necessitating effective diagnostic strategies for timely intervention. This study explores the potential of continuous monitoring of non-invasive signals, specifically integrating photoplethysmogram (PPG) and electrocardiogram (ECG), for enhancing early detection and diagnosis of heart failure. Leveraging a dataset from the MIMIC-III database, encompassing 682 heart failure patients and 954 controls, our approach focuses on continuous, non-invasive monitoring. Key features, including the QRS interval, RR interval, augmentation index, heart rate, systolic pressure, diastolic pressure, and peak-to-peak amplitude, were carefully selected for their clinical relevance and ability to capture cardiovascular dynamics. This feature selection not only highlighted important physiological indicators but also helped reduce computational complexity and the risk of overfitting in machine learning models. The use of these features in training machine learning algorithms led to a model with impressive accuracy (98%), sensitivity (97.60%), specificity (96.90%), and precision (97.20%). Our integrated approach, combining PPG and ECG signals, demonstrates superior performance compared to single-signal strategies, emphasizing its potential in early and precise heart failure diagnosis. The study also highlights the importance of continuous monitoring with wearable technology, suggesting a significant stride forward in non-invasive cardiovascular health assessment. The proposed approach holds promise for implementation in hardware systems to enable continuous monitoring, aiding in early detection and prevention of critical health conditions.

UNASSIGNED: Cardiovascular disease is the leading cause of death in Cushingžs syndrome (CS). Primary bilateral macro-nodular adrenal hyperplasia (PBMAH), is a rare cause of CS that is clinically distinct from the other common types of CS, but cardiac characteristics have been poorly studied.
UNASSIGNED: The clinical data, steroid hormones and echocardiographic variables of 17 patients with PBMAH were collected. Twenty-one CS patients with cortisol-producing adenoma (CPA) were collected as controls. The similarities and differences of clinical and cardiac features between the two groups were compared.
UNASSIGNED: Kardiovaskularne bolesti su vodeći uzrok smrti kod Kušingovog sindroma (CS). Primarna bilateralna makro-nodularna hiperplazija nadbubrežne žlezde (PBMA ) je redak uzrok CS koji se klinički razlikuje od drugih uobičajenih tipova CS, ali kardijalne karakteristike su slabo proučavane.
UNASSIGNED: Prikupljeni su klinički podaci, steroidni hormoni i ehokardiografske varijable 17 pacijenata sa PBMA. Dvadeset i jedan pacijent sa CS sa adenomom koji proizvodi kortizol (CPA) je sakupljen kao kontrola. Upoređene su sličnosti i razlike kliničkih i kardijalnih karakteristika između dve grupe.
UNASSIGNED: U grupi PBMA udeo žena je bio manji (35,30 prema 100,00%), starosna dob je bila starija (55,76±2,42 godine prema 39,57±2,72 godine), a tok bolesti je bio duži 13,00 (5,00, 50) godine u odnosu na 1,58 (1,00, 5,00) godina. Procenat pacijenata sa PBMA sa hipertenzijom bio je veći nego kod pacijenata sa CPA (100,00% naspram 61,90%). Kortizol u plazmi i 24-časovni kortizol bez mokraće (24-časovni UFC) bili su niži kod pacijenata sa PBMA nego kod pacijenata sa CPA jutarnji kortizol 19,50 (15,35, 24,48) mg/dL naspram 28,30 (22,88, 29,89) mg/dL, 04h/dL, 04h/dL. 156,58) naspram 506,23 (292,53, 712,18) mg. Grupa PBMA imala je duži prečnik desne komore (24,06±1,23 mm naspram 20,48±0,83 mm), prečnik leve pretkomore (39,41±1,15 mm naspram 32,86±0,76 mm) i veću stopu dijastolne funkcije od 53% (s 76 ± 0,8%). CPA grupa. Univarijantna regresiona analiza je pokazala da kombinacija hipertenzije i trajanja hipertenzije ima značajne efekte na prečnik leve pretkomore (b=6,383, P=0,001; b = 0,276, P<0,001, respektivno) i E/A odnos (b=-0,496, P < 0,001, b=0,022, P<0,001, respektivno). Multivarijantna regresiona analiza je pokazala da nivo kortikosterona ima značajan uticaj na sistolni krvni pritisak (b=6,712, P=0,025).
UNASSIGNED: U poređenju sa CPA, ventrikularna dijastolna disfunkcija je česta kod pacijenata sa PBMA pod relativno nižim nivoom kortizola. PBMA je imao visok nivo kortikosterona koji može igrati ulogu u razvoju hipertenzije i daljih srčanih promena.

BACKGROUND: New-onset atrial fibrillation (NeAF) is common after cavotricuspid isthmus-dependent counterclockwise atrial flutter (CCW-AFL) ablation. This study aimed to investigate a simple predictive model of NeAF after CCW-AFL ablation.
METHODS: From January 2013, to December 2017, consecutive patients receiving CCW-AFL ablation were enrolled from 3 centres. Clinical, echocardiographic, and electrocardiographic data were collected and followed. Patients from 2 centres and another centre were assigned into the derivation and validation cohorts, respectively. In the derivation cohort, logistic regression was performed to evaluate the ability of parameters to discriminate those with and without NeAF. A score system was developed and then validated.
RESULTS: Two hundred seventy-one patients (mean 59.7 ± 13.6 age; 205 male) were analyzed. During follow-up (73.0 ± 6.5 months), 107 patients (39.5%) had NeAF; 190 and 81 patients were detected in the derivation and validation cohorts, respectively. Hypertension, age ≥ 70 years, left atrial diameter ≥ 42 mm, P-wave duration ≥ 120 ms and the negative component of flutter wave in lead II ≥ 120 ms were selected as the final parameters. A weighted score was used to develop the HAD-AF score ranging from 0 to 9. In the derivation cohort, area under the receiver operating characteristic curve (AUC) was 0.938 (95% confidence interval [CI], 0.902-0.974), superior to those of currently used CHA2DS2-VASC (0.679, 95% CI, 0.600-0.757) and HATCH scores (0.651, 95% CI, 0.571-0.730) (P < 0.001). Performance maintained in the validation cohort.
CONCLUSIONS: Six years after CCW-AFL ablation, 39.5% of patients developed NeAF. HAD-AF score can reliably identify patients likely to develop NeAF after CCW-AFL ablation.

OBJECTIVE: This study aims to assess the feasibility and effectiveness of color doppler flow imaging (CDFI) technology and the Slow Flow HD imaging technique in identifying fetal pulmonary veins (PVs) in the first trimester (11-13 + 6 weeks), and further explore the factors affecting fetal pulmonary vein identification in early pregnancy.
METHODS: Echocardiography and scanning of PVs were performed in 240 normal singleton fetuses in early pregnancy by using CDFI and slow flow HD techniques, to compare the ability of two methods to identify the PVs. Slow Flow HD technology was used to further investigate the difference of PVs identification at different gestational ages [group I (11-11 + 6 weeks), group II (12-12 + 6 weeks), group III (13-13 + 6 weeks)] and with different maternal body mass indices (BMI) (≥ 25 and < 25). In 31 cases of 240 fetuses, transvaginal ultrasonography was added due to maternal habitus or significant retroversion of the uterus, and the difference in PVs identification between transabdominal and transvaginal examination was analyzed.
RESULTS: Successful PVs identification rates via CDFI and Slow Flow HD were 32.0% and 88.3%, respectively (p < 0.05). The identification rate of at least one and two pulmonary veins in Slow Flow HD was 88.3% and 76.2%, and all four pulmonary veins in 11.6% (p < 0.05). The identification rate of group I, II and III were 76.4%, 88.9% and 96.0%, respectively. The identification rate was 45.1% in the transabdominal ultrasound group and 83.8% in the transvaginal ultrasound group. The identification rate was 62.5% in the BMI ≥ 25 group and 94.7% in the BMI < 25 group (p < 0.05).
CONCLUSIONS: Slow Flow HD can detect PVs in early pregnancy more often than using CDFI. Slow Flow HD is a feasible and effective imaging technique for evaluating PVs in early pregnancy.

In this report, we present a case of left-right sinus fusion in a Ruptured sinus of Valsalva aneurysm (RSVA) that perforated into the myocardium, giving rise to myocardial dissection. The existence of an anomalous bicuspid aortic valve (BAV) is contemplated as a potential etiological element in this context. Employing multimodal imaging modalities, encompassing transthoracic echocardiography and computed tomography (CT), facilitated the visualization of a dissecting hematoma situated within the myocardium subsequent to the RSVA. Following this, our patient underwent an Cabrol surgical intervention, received patch repair, and underwent mitral valve annuloplasty, during which a three-year period transpired without the occurrence of any deleterious cardiac events. In summary, this report establishes the cornerstone for the surgical intervention of RSVA, shedding light on the efficacious handling of RSVA-associated myocardial dissection. It posits that the presence of a BAV may serve as a predisposing factor to RSVA rupture, potentially elevating the susceptibility to myocardial dissection. The utilization of diverse multimodal imaging methodologies played an indispensable role in the detection of a hematoma within the myocardial tissue subsequent to the RSVA rupture. The uneventful three-year postoperative follow-up of the patient underscores the efficacy of the undertaken interventions.

The purpose of this study was to explore echocardiographic parameters of the left ventricle (LV) in relation to the outcomes of omphalocele neonates with pulmonary hypertension (PH).
This retrospective study was conducted among omphalocele patients with PH born from 2019 to 2020. Patients in this study did not have additional severe malformations or chromosomal aberrations. Patients who died under palliative care were excluded. The echocardiographic parameters of LV were obtained within 24 h after birth. Clinical and outcomes data were recorded, echocardiograms evaluated for left ventricular internal dimension in end-diastole (LVIDd), end-diastolic volume (EDV), stroke volume (SV) and cardiac output index (CI), among others.
There were 18 omphalocele newborns with PH, of whom 14 survived and 4 died. Both groups were comparable in the baseline characteristics. Non-survival was associated with a smaller LV [LVIDd (12.2 mm versus15.7 mm, p < 0.05), EDV (3.5 ml versus 6.8 ml, p < 0.05)] and with worse systolic function [SV (2.3 ml versus 4.2 ml, p < 0.05), and CI (1.7 L/min/m2 versus 2.9 L/min/m2, p < 0.01)].
In the cohort of omphalocele patients with PH, lower LVIDd, EDV, SV and CI were associated with mortality.
Level III.

OBJECTIVE: To summarize echocardiographic characteristics of the anatomy and hemodynamic and clinical outcomes in fetuses with isolated pulmonary stenosis (PS) or pulmonary atresia with intact ventricular septum (PA/IVS).
METHODS: This was a single-center retrospective study of fetuses with isolated PS or PA/IVS. Echocardiographic variables and clinical outcomes after delivery were evaluated and compared.
RESULTS: Between 2016 and 2021, 115 livebirths with isolated PS or PA/IVS were included. Proportion of fetuses with mild, moderate and critical PS and PA/IVS was 41.7 %, 18.3 %, 26.1 % and 13.9 %. Fetuses with more severe PS had worse anatomic and hemodynamic profiles. Specifically, the cardiothoracic ratio, pulmonary valve (PV) velocity, degree and velocity of tricuspid regurgitation increased as PS severity increased; and the pulmonary artery/aorta ratio, right ventricle/left ventricle long-axis (TV/MV) ratio, tricuspid valve/mitral valve annulus (TV/MV) ratio, and tricuspid valve inflow duration/cardiac cycle ratio decreased as PS severity increased (P <0.001 for all). PV velocity ≥2 m/s predicted PV pressure ≥40 mm Hg after delivery, with an AUC of 0.81; TV/MV ratio combined with RV/LV ratio predicted clinical outcomes, with an AUC of 0.88. Live births with more severe PS had higher mortality rate (mild 0 vs. moderate 0 vs. critical 11 % vs. PA-IVS 36 %) and lower rate of developing bi-ventricles (mild 100 % vs. moderate 95 % vs. critical 89 % vs. PA-IVS 36 %).
CONCLUSIONS: Findings of this study help better understand the anatomy and hemodynamic and clinical outcomes in fetuses with isolated PS or PA/IVS, which could have implications for prenatal counseling and prediction of fetal outcome.

UNASSIGNED: Cardiovascular disease is the leading cause of morbidity and mortality globally. Echocardiography is a commonly used method for assessing the condition of patients with cardiovascular disease. However, little is known about the population characteristics of patients who are recommended for echocardiographic examinations.
UNASSIGNED: The National Ambulatory Medical Care Survey was a cross-sectional survey previously undertaken in the USA. In this study, publicly accessible data from the National Ambulatory Medical Care Survey database (for 2007-2016 and 2018-2019; data for 2017 was not published) were utilized to create a nomogram based on significant risk predictors. The study was performed in accordance with the relevant guidelines and regulations stipulated in the National Ambulatory Medical Care Survey database. Patients were randomly assigned to one of two groups: training cohort or validation cohort. The latter was used to assess the reliability of the prediction nomogram. Decision curve analysis was performed to evaluate the net benefit. Propensity score matching analysis was used to evaluate the relevance of echocardiography to clinical decision-making.
UNASSIGNED: A total of 217,178 outpatients were enrolled. Multivariable logistic regression analysis demonstrated that hypertension, hyperlipidemia, coronary artery disease/ischemic heart disease/history of myocardial infarction, congestive heart failure, major reason for visit, metropolitan statistical area, cerebrovascular disease/history of stroke or transient ischemic attack, previously assessed, insurance, referred, diagnosis, and reason for visit were all predictors of echocardiogram prescription in outpatients. The reliability of the predictive nomogram was confirmed in the validation cohort. After propensity score matching, there was a significant difference in new cardiovascular agent prescriptions between the echocardiogram and no echocardiogram groups (P < 0.01).
UNASSIGNED: In this cohort study, a nomogram based on the characteristics of outpatients was developed to predict the possibility of prescribing echocardiography. The echocardiogram group was more likely to be prescribed new cardiovascular agents. These findings may contribute to providing information about the gap between actual utilizations and guidelines and the actual outpatient practice, as well as meeting the needs of outpatients.

BACKGROUND: Takayasu arteritis (TAK) is a chronic inflammatory arteritis. It most often affects non-specific large vessel progressively, such as the aorta and its branches. The diagnosis in TAK is typically delayed. Isolated pulmonary artery involvement in Takayasu arteritis is uncommon. Owing to its rarity, the diagnosis is challenging and requires an integrated approach comprising clinical and imaging findings. In order to facilitate early diagnosis of TAK for clinicians, wider use of non-invasive imaging is impacting this.
METHODS: In this report, we present the imaging characteristics of a rare isolated pulmonary artery involvement in Takayasu arteritis. Pulmonary computed tomography angiography revealed only limited thick walls of both proximal pulmonary artery and stenosis of pulmonary artery lumen, and the other large blood vessels were not involved. The patient undergone pulmonary endarterectomy and pulmonary angioplasty. Then, approximately one month afterward, she passed away due to heart failure.
CONCLUSIONS: Imaging examination is the main basis for diagnosing this disease. This impression might improve disease awareness among doctors and progress in diagnosis.

UNASSIGNED: Primary pericardial synovial sarcoma is an extremely rare malignant tumor, and affected patients have a poor prognosis. Only a few cases have been reported in the literature.
UNASSIGNED: A 34-year-old man was admitted to our hospital with chest tightness and a cough. An echocardiogram revealed a heterogeneous mass with a large pericardial effusion. Further computed tomography (CT) of the chest and cardiac magnetic resonance imaging (CMRI) demonstrated an irregular pericardial mass abutting the left atrium and left ventricle and invading the mediastinal structures. Pathology results showed that the tumor was a monophasic synovial sarcoma. The patient underwent chemotherapy and survived for 17 months.
UNASSIGNED: Many cardiac tumors are clinically asymptomatic or nonspecific, and they are frequently detected or diagnosed at an advanced stage of the disease. Multimodal cardiac imaging facilitates the detection and assessment of cardiac tumors. In particular, CMRI is considered as a superior imaging tool, because it provides high tissue contrast and can detect invasion of the myocardium. We describe the clinical details and multimodal imaging features of a rare primary pericardial synovial sarcoma, hoping to provide guidance for the diagnosis of similar cases in the future.