View clinical trials related to Ventricular Remodeling.
Filter by:STEMI is a serious type of coronary heart disease, which is a major cause of disability and death. Morphologically the key feature of remodeling is myocyte hypertrophy, myocyte loss from necrosis or apoptosis, as well as interstitial cell growth especially fibroblast proliferation leading to myocardial fibrosis . Elevated serum LDL-cholesterol concentrations play a proatherogenic role by stimulating inflammation and oxidative processes. Statins have been documented to retard fibrosis and ventricular hypertrophy by the cessation of myofibroblast activity. Clinical studies have proven that statins not only regulate lipids but also improve myocardial fibrosis, regulate cell proliferation and apoptosis, regulate ventricular remodeling, and protect the myocardium
The American Heart Association announces that exercise training should be considered for all stable cardiac patients (Class I, Level A). Therefore, exercise is an important issue for cardiac patients. It has also been reported that high-intensity interval training (HIIT) brings benefits on reversal of cardiac remodeling and long-term survival for HF patients. This study explores high-intensity interval training (HIIT) effects on long-term survivals in heart failure (HF) patients, diagnosed according to the Framingham criteria. This retrospective cohort study is going to analyze HF patients diagnosed between January 1, 2009 and May 31, 2022 in a tertiary care hospital. All HF patients underwent the multidisciplinary disease management program (MDP) in the hospital were initially surveyed. Participants were further categorized into HF with reduced ejection fraction (HFrEF) (left ventricle ejection fraction [LVEF]<40%), HF with mildly reduced EF (HFmrEF) (LVEF>=40% and LVEF< 50%), and HF with preserved EF (HFpEF) ( LVEF>=50%) based on the initial 2-D echocardiography. Participants will be further divided into HIIT+MDP or MDP only in each group based on patient preference. Age, sex, body height, body weight, disease duration, etiology for HF, co-morbidities, and medication were documented during follow-up (F/U). B-type natriuretic peptide, natriuretic peptide (BNP), cardiopulmonary exercise test (CPET) for peak oxygen consumption (VO2peak) and 2-D echocardiography for LV geometry were repeatedly assessed during follow-up. The end-point is the death of the patients or the date of May 31, 2022. All mortality causes and overall survival rates will be determined at the end of F/U. HIIT effects on long-term survival (Kaplan-Meier survival curve) for patients with different heart failure phenotypes will be estimated by log rank test. Continuous variables between different groups were analyzed by student t-test, while continuous variables before and after HIIT within groups were assessed by paired t-test. Other non-continuous variables such as sex, and co-morbidities were compared by chi-square test.
A prospective, randomized, controlled study will be conducted at Clinical Cardioglogy department, Ain Shams University Hospitals, assessing the efficacy and tolerability of SGLT2 inhibitors (dapagliflozin) addition on the clinical outcome and cardiac remodeling markers of post myocardial infarction (MI) diabetic patients
The study intends to investigate the alteration of regional myocardial work in patients with acute anterior myocardial infarction underwent primary percutaneous coronary intervention (PCI), and compare the distribution of regional myocardial work in patients with/without early remodeling at acute phase and 3-month follow-up.
This study investigates damage of the right cardiac chamber in adult patients with a congenital heart defect involving the pulmonary valve (the heart valve between the right cardiac chamber and the lungs). The investigators want to investigate if novel, less invasive techniques are feasible to assess damage of this right cardiac chamber, to improve follow-up and timing of intervention (valve replacement) in this group of patients.
This study aim to investigate the predictive value of CMR parameters: infarct size (IS), intramyocardial hemorrhage, microvascular obstruction, area at risk and CMR derived strain parameters with the Major Adverse Cardiovascular Events (MACEs) and myocardial remodeling afterinfarction.
ST-segment elevation myocardial infarction (STEMI) is one of the most important causes of death and disability around the world. The main goal in the management of acute myocardial infarction (AMI) is early restoration of coronary artery flow in order to preserve viable myocardium. Primary percutaneous coronary intervention (PCI) has proven to be superior to other reperfusion strategies in terms of mortality reduction and preservation of left ventricular (LV) function. Despite improvements in the treatment of MI, 30% of patients show LV remodeling post-MI. Over time, remodeling adversely affects cardiac function and can lead to significant morbidity and mortality. Early risk stratification is essential to identify patients who will benefit from close follow-up and intense medical therapy. The most widely investigated functional left ventricular (LV) characteristic to predict patient outcome after STEMI is LV ejection fraction (LVEF). Several structural LV characteristics have also shown to be important predictors of cardiovascular adverse events and death, including LV end diastolic volume (LVEDV), end systolic volume (LVESV) and mass (LVM). Cardiovascular magnetic resonance (CMR) imaging is the current reference standard for assessing ventricular volumes and mass. Adverse remodeling results from an inability of the heart to maintain geometry post MI in the context of large infarcts and increased wall stresses. The compensatory hypertrophic response of the remote non-infarcted myocardium (end diastolic wall thickness (EDWT) and end systolic wall thickness (ESWT)) might also play an important role in the remodeling after myocardial infarction but this needs to be investigated. Infarct size -as a crucial endpoint for adverse remodeling- is influenced by several factors: - the size of the area at risk (AAR) (myocardium supplied by the culprit vessel); residual flow to the ischemic territory (e.g., collateral flow); myocardial metabolic demand; and the duration of coronary occlusion. Assessment of the size and distribution of the infarction area after revascularization therapy can facilitate prompt and appropriate clinical intervention. Biomarkers such as troponin and creatine kinase are mainly used for AMI identification but lack myocardial specificity and may overestimate the (IS). Left ventricle ejection fraction (LVEF) fails to detect minimal and early pathological changes. The myocardial damage following STEMI can be assessed accurately by delayed gadolinium enhancement imaging using CMR imaging. In the acute phase of a STEMI, the extracellular space is increased in the infarct region due to a combination of necrosis, hemorrhage, and edema. The extent of hyper enhancement in the acute phase has been related to the outcome in patients with STEMI. However, later on the necrotic tissue is replaced by fibrotic scar tissue also with increased extracellular space. This process leads to ongoing 'infarct shrinkage' after the first week until the infarction reaches its final size after ∼30 days. - - Measurement of hyper enhancement in the acute phase of an infarction might therefore overestimate the necrotic infarct size, whereas 'final extent of hyper enhancement' is more precisely related to the amount of necrotic tissue. In STEMI patients the prognostic importance and predictors of the final infarct size are not fully elucidated. Myocardial strain is a quantitative index based on measuring myocardial deformation during a cardiac cycle. Major tools for detecting changes in myocardial strain include CMR tagging, CMR feature tracking (FT-CMR) and speckle tracking echocardiography (STE). Previous studies have shown an advantage of strain in sensitively and accurately diagnosing and assessing IS compared to traditional functional indexes. However, the degree to which strain analysis can reflect the infarction areas quantified by CMR, adverse LV remodeling as well as the diagnostic accuracy of this analysis is still under dispute. In the past 3 years in particular, newly developed three-dimensional (3D) STE has overcome the inherent shortcomings of two-dimensional (2D) STE.
Background: Sacubitril/valsartan, a novel therapy in the treatment of heart failure with reduced ejection fraction (HFrEF), has recently proved efficacy in improving exercise tolerance and cardiac performance. Cardiopulmonary exercise test (CPET) provides functional prognostic parameters for patient with HFrEF (i.e. peakVO2 and ventilation/CO2 production [VE/VCO2] slope) and it is a well-recognized, valuable, accurate tool for risk stratification. Aim of the study and methods: The aim of the study is to prospectively enroll a cohort of 100 HFrEF outpatients eligible for sacubitril/valsartan and perform serial CPET, laboratory and echocardiographic assessments before and during the gradual titration of the treatment, in order to evaluate its effects on cardiopulmonary function and left ventricular remodeling. The procedures will be repeated along the follow-up at 1, 2 and 3 months after the enrollment (titration period) and at 6 months after the reach of the maximum tolerated dose.
This prospective study evaluates the mechanisms of benefit of sacubitril/valsartan in a population of outpatients with heart failure with reduced ejection fraction, to investigate the relationship between the effects on left ventricular ejection fraction and volumes and noninvasively hemodynamic echo-derived parameters, as cardiac output and left ventricular filling pressure.
Right ventricular (RV) physiological remodeling in response to prolonged strength exercise remains poorly studied. This prospective, non-randomized, single-center study, proposes to follow 24 healthy sedentary volunteers who will benefit from a high-intensity pure resistance training program over a 6-month period. The volunteers, aged between 18 and 40 years old and male, will be recruited and evaluated at the University Hospital center of Caen Normandy. Cardiac remodeling in response to physical exercise will be analyzed by trans-thoracic echocardiography repeated during the follow-up. The physical impact of the training program will be assessed by a treadmill exercise test predicting maximal oxygen consumption (VO2max) before and after completing the training, and an isokinetic muscular test repeated every 3 months. Participants rest/activity cycles will be monitor before and after 3 months of training. The aim of the study is to demonstrate the existence of a physiologic RV remodeling in response to pure high-load resistance chronic exercise. The results will help to improve the understanding of the physiological RV response expected in strength athletes.