Comparison of a Deep Learning Algorithm vs. Humans for Vertebral Heart Scale Measurements in Cats and Dogs Shows a High Degree of Agreement Among Readers

Heart disease is a leading cause of death among cats and dogs. Vertebral heart scale (VHS) is one tool to quantify radiographic cardiac enlargement and to predict the occurrence of congestive heart failure. The aim of this study was to evaluate the performance of artificial intelligence (AI) performing VHS measurements when compared with two board-certified specialists. Ground truth consisted of the average of constituent VHS measurements performed by board-certified specialists. Thirty canine and 30 feline thoracic lateral radiographs were evaluated by each operator, using two different methods for determination of the cardiac short axis on dogs' radiographs: the original approach published by Buchanan and the modified approach proposed by the EPIC trial authors, and only Buchanan's method for cats' radiographs. Overall, the VHS calculated by the AI, radiologist, and cardiologist had a high degree of agreement in both canine and feline patients (intraclass correlation coefficient (ICC) = 0.998). In canine patients, when comparing methods used to calculate VHS by specialists, there was also a high degree of agreement (ICC = 0.999). When evaluating specifically the results of the AI VHS vs. the two specialists' readings, the agreement was excellent for both canine (ICC = 0.998) and feline radiographs (ICC = 0.998). Performance of AI trained to locate VHS reference points agreed with manual calculation by specialists in both cats and dogs. Such a computer-aided technique might be an important asset for veterinarians in general practice to limit interobserver variability and obtain more comparable VHS reading over time.

Case Report: Hypothyroidism Misdiagnosed as Fulminant Myocarditis in a Child

Background: Hypothyroidism can lead to bradycardia, reduced cardiac output, cardiac enlargement, and abnormal electrocardiogram. However, hemodynamic instability and malignant arrhythmias due to hypothyroidism is rarely reported in children.Patient Findings: We report the case of a child with third-degree atrioventricular block, cardiogenic shock, and Adams Stokes Syndrome, who was initially misdiagnosed with fulminant myocarditis and was later found to have hypothyroidism during treatment.Summary: The child's condition did not improve after the administration of gamma globulin, methylprednisolone, and isoproterenol. Even after the placement of temporary pacemakers, the therapeutic effect was still not ideal. Upon reviewing the medical history, the child's condition improved rapidly after levothyroxine supplementation.Conclusions: Hypothyroidism is a common disease, but secondary severe cardiovascular lesions are particularly rare in children. Therefore, the delay in diagnosis can lead to serious cardiovascular manifestations. When pediatric patients develop severe AVB and bradycardia, hypothyroidism should be considered as a possible cause.

Heterozygous desmin gene (DES) mutation contributes to familial dilated cardiomyopathy

Familial dilated cardiomyopathy (FDCM) is characterized by high genetic heterogeneity and an increased risk of heart failure or sudden cardiac death in adults. We report the case of a 62-year-old man with a 2-month history of shortness of breath during activity, without paroxysmal nocturnal dyspnea. The patient underwent a series of examinations including transthoracic echocardiography, coronary arteriography, transesophageal echocardiography, and myocardial perfusion imaging. After excluding secondary cardiac enlargement, he was diagnosed with dilated cardiomyopathy (DCM). His sister had also been diagnosed with DCM several years before. Genetic sequencing analysis revealed that the patient, his sister, and his son all had the same mutation in the desmin gene ( DES) (chr2-220785662, c.1010C>T). Genetic testing confirmed a heterozygous DES mutation contributing to FDCM. In this case, the etiology of the patient’s whole-heart enlargement was determined as FDCM with DES gene mutation. This is the first report to describe DES c.1010C>T as a cause of FDCM.

Similarities and Differences of CT Features between COVID-19 Pneumonia and Heart Failure

Aims: During the COVID-19 epidemic, chest computed tomography (CT) has been highly recommended for screening of patients with suspected COVID-19 because of an unclear contact history, overlapping clinical features, and an overwhelmed health system. However, there has not been a full comparison of CT for diagnosis of heart failure or COVID-19 pneumonia.Methods: Patients with heart failure (n = 23) or COVID-19 pneumonia (n = 23) and one patient with both diseaseswere retrospectively enrolled. Clinical information and chest CT images were obtained and analyzed.Results: There was no difference in ground-glass opacity, consolidation, crazy paving pattern, the lobes affected,and septal thickening between heart failure and COVID-19 pneumonia. However, a less rounded morphology (4% vs.70%, P = 0.00092), more peribronchovascular thickening (70% vs. 35%, P = 0.018) and fissural thickening (43% vs. 4%, P = 0.002), and less peripheral distribution (30% vs. 87%, P = 0.00085) were found in the heart failure group than in the COVID-19 group. Importantly, there were also more patients with upper pulmonary vein enlargement (61% vs. 4%, P = 0.00087), subpleural effusion (50% vs. 0%, P = 0.00058), and cardiac enlargement (61% vs. 4%, P = 0.00075) in the heart failure group than in the COVID-19 group. Besides, more fibrous lesions were found in the COVID-19group, although there was no statistical difference (22% vs. 4%, P = 0.080).Conclusions: Although there is some overlap of CT features between heart failure and COVID-19, CT is still a useful tool for differentiating COVID-19 pneumonia.

Visceral Adipose Tissue Promotes Pressure-Induced Heart Failure Associated with Circulating Fatty Acids

Visceral adipose tissue (VAT) is the main source of circulating fatty acids (FAs) that provides the energy substrate for the heart. Till now, studies have not shown a clear association between individual circulating FAs and heart failure (HF). In this study, we aimed to investigate the changes in circulating FAs in HF mice and their association with VAT by removing epididymal white adipose tissue (eWAT). Here, we found that the serum levels of four fatty acids, namely arachidic acid, behenic acid, lignoceric acid, and docosapentaenoic acid, were significantly decreased in pressure-induced HF mice via transverse aortic constriction (TAC) surgery accompanied with cardiac enlargement and fibrosis. Most importantly, removal of eWAT in mice led to a significant decrease in the levels of the above-mentioned fatty acids without any significant difference between the HF and sham groups. Accordingly, cardiac enlargement and fibrosis were significantly alleviated. We concluded that VAT excision alleviated TAC-induced cardiac failure by decreasing serum arachidic acid, behenic acid, lignoceric acid, and docosapentaenoic acid levels.

Pacemaker generator replacement as a key to the puzzle of dyspnoea in a community dwelling centenarian

A 104-year-old woman presented with dyspnoea. Workup revealed normal troponins, elevated D-dimer at 2285 with subsequent chest CT angiogram negative for pulmonary embolism. NT-pro BNP elevated to 5208 pg/mL. Chest X-ray revealed mild cardiac enlargement with bilateral pleural effusions. ECG revealed accelerated junctional rhythm. The initial plan was to obtain transthoracic echocardiogram and start diuresis for presumed heart failure. Given her specific cardiac history, pacemaker interrogation was ordered which revealed her pacemaker mode changed from DDDR to VVI. She underwent pacemaker battery exchange with complete resolution in her symptoms and ability to return to prior functional status. Overall, dyspnoea in centenarians could be multifactorial. Pacemaker elective replacement mode secondary to end of life battery can present as non-specific cardio respiratory symptoms. As the pacemaker population ages to the survival beyond the battery life, pacemaker aetiology behind heart failure symptoms needs to be highly considered by medical providers.

Visceral Adipose Tissue Promotes Pressure-Induced Heart Failure Associated with Circulating Fatty Acids

Visceral adipose tissue (VAT) is the main source of circulating fatty acids (FAs) that provides the energy substrate for the heart. Till now, studies have not shown a clear association between individual circulating FAs and heart failure (HF). In this study, we aimed to investigate the changes in circulating FAs in HF mice and their association with VAT by removing epididymal white adipose tissue (eWAT). Here, we found that the serum levels of four fatty acids, namely arachidic acid, behenic acid, lignoceric acid, and docosapentaenoic acid, were significantly decreased in pressure-induced HF mice via transverse aortic constriction (TAC) surgery accompanied with cardiac enlargement and fibrosis. Most importantly, removal of eWAT in mice led to a significant decrease in the levels of the above-mentioned fatty acids without any significant difference between the HF and sham groups. Accordingly, cardiac enlargement and fibrosis were significantly alleviated. We concluded that VAT excision alleviated TAC-induced cardiac failure by decreasing serum arachidic acid, behenic acid, lignoceric acid, and docosapentaenoic acid levels.

Atrial septal defect closure in a midget toy poodle

Background: Atrial septal defect (ASD) is a rare congenital cardiac disease, and there have been no reports about the treatment of ASD in midget breed dogs.Case Description: A 7-month-old female toy poodle weighing 1.4 kg presented with cardiac enlargement. Echocardiography revealed a secundum-type ASD, right ventricular and atrial enlargement, and pulmonary hypertension. Blood flow through the ASD exhibited left-to-right shunting. The dog underwent ASD closure through a hybrid approach, in conjunction with catheter techniques and thoracotomy. Ten months after treatment, cardiac enlargement and pulmonary hypertension were improved.Conclusion: Even in midget dog breeds, ASD can be corrected through a hybrid approach. Keywords: Canine, Cardiology, Catheter, Congestive heart failure, Small breed.

The Mechanism of High-Output Cardiac Hypertrophy Arising From Potassium Channel Gain-of-Function in Cantú Syndrome

Dramatic cardiomegaly arising from gain-of-function (GoF) mutations in the ATP-sensitive potassium (KATP) channels genes, ABCC9 and KCNJ8, is a characteristic feature of Cantú syndrome (CS). How potassium channel over-activity results in cardiac hypertrophy, as well as the long-term consequences of cardiovascular remodeling in CS, is unknown. Using genome-edited mouse models of CS, we therefore sought to dissect the pathophysiological mechanisms linking KATP channel GoF to cardiac remodeling. We demonstrate that chronic reduction of systemic vascular resistance in CS is accompanied by elevated renin–angiotensin signaling, which drives cardiac enlargement and blood volume expansion. Cardiac enlargement in CS results in elevation of basal cardiac output, which is preserved in aging. However, the cardiac remodeling includes altered gene expression patterns that are associated with pathological hypertrophy and are accompanied by decreased exercise tolerance, suggestive of reduced cardiac reserve. Our results identify a high-output cardiac hypertrophy phenotype in CS which is etiologically and mechanistically distinct from other myocardial hypertrophies, and which exhibits key features of high-output heart failure (HOHF). We propose that CS is a genetically-defined HOHF disorder and that decreased vascular smooth muscle excitability is a novel mechanism for HOHF pathogenesis.