The triglyceride-glucose (TyG) index has been identified as a reliable alternative biomarker of insulin resistance (IR). Recently, a considerable number of studies have provided robust statistical evidence suggesting that the TyG index is associated with the development and prognosis of cardiovascular disease (CVD). Nevertheless, the application of the TyG index as a marker of CVD has not systemically been evaluated, and even less information exists regarding the underlying mechanisms associated with CVD. To this end, in this review, we summarize the history of the use of the TyG index as a surrogate marker for IR. We aimed to highlight the application value of the TyG index for a variety of CVD types and to explore the potential limitations of using this index as a predictor for cardiovascular events to improve its application value for CVD and provide more extensive and precise supporting evidence. 

/pdf/triglyceride-glucose-index-as-a-marker-in-cardiovascular-2cl6h0cm.pdf

Triglyceride-glucose index as a marker in cardiovascular diseases: landscape and limitations

### Learning objectives

The current era has seen major advances in myocardial imaging. We are now able to assess cardiac anatomy, function, tissue composition and disease activity across a wide range of disease states. Recently, there has been major interest in imaging myocardial fibrosis, predominantly with cardiovascular magnetic resonance (CMR). Fibrosis represents a common response to injury in most cardiomyopathies, but the distribution and pattern of fibrosis differ between pathologies, underscoring its potential role as a diagnostic marker. Furthermore, fibrosis is closely associated with impaired left ventricular function, as well as cardiac arrhythmias; as such, fibrosis imaging also provides powerful prognostic information.

In this review, we discuss the pathophysiology of myocardial fibrosis, review the applications of CMR in the non-invasive detection of myocardial fibrosis and provide an overview of common pathologies in which fibrosis imaging may be of clinical utility.

Our understanding of myocardial function and disease is largely focused on cardiomyocytes. However, the majority of cardiac cells in the adult mammalian heart are non-myocytes. Cardiac fibroblasts are one such cell type that play a crucial role in myocardial disease and healing. These cells are responsible for the production and deposition of extracellular matrix proteins—type 1 collagen being the prototype—which serve as a scaffold for other cellular components and are integral to the structural integrity and function of the myocardium. Fibroblasts respond to cytokines and neurohormal factors, differentiating into activated fibroblasts and smooth muscle-like myofibroblasts that are critical in the healing response of diseased or injured myocardium. These cells exert their effects on the extracellular matrix via regulation of matrix metalloproteinases and fibronectin. Although the primary response to myocardial injury—wound healing, reparative scar formation and …

https://heart.bmj.com/content/heartjnl/early/2019/10/24/heartjnl-2019-315560.full.pdf

Myocardial fibrosis: why image, how to image and clinical implications.

Background The relative contribution of amyloid and fibrosis to extracellular volume expansion in cardiac amyloidosis (CA) has never been defined. Methods and Results We included all patients diagn...

https://www.ahajournals.org/doi/pdf/10.1161/JAHA.120.020358

Amyloid Deposits and Fibrosis on Left Ventricular Endomyocardial Biopsy Correlate With Extracellular Volume in Cardiac Amyloidosis.

Cardiac MRI plays an important role in the evaluation of cardiovascular diseases (CVDs), including ischemic heart disease, cardiomyopathy, valvular disease, congenital disease, pericardial disease, and masses. Large multicenter trials have shown the positive impact of MRI-based management on outcomes in several CVDs. These results have made MRI an indispensable technique in the evaluation of these diseases, and cardiac MRI has an important role in multisociety guidelines. MRI is the reference standard for quantification of ventricular volumes and function. Flow imaging enables accurate quantification of flow and velocities through valves, shunts, and surgical conduits or baffles. Late gadolinium enhancement and parametric mapping techniques enable tissue characterization and yield prognostic information. In the past decade, cardiac MRI technology has seen rapid advances in both hardware and sequences. Multiple novel sequences, such as parametric mapping and four-dimensional flow, are increasingly being incorporated into routine clinical practice. Acceleration strategies have matured, allowing faster acquisition of cardiac MRI sequences in patients with arrhythmia and poor breath holding. Challenges of cardiac MRI at high-field-strength magnets and in patients with indwelling cardiac devices or severe renal dysfunction have been mitigated. Artificial intelligence techniques are decreasing the complexity of MRI acquisition and postprocessing. This article reviews the current state of the art and emerging techniques in cardiac MRI.

Cardiac MRI: State of the Art.

Progress in precision medicine is limited by insufficient knowledge of transcriptomic or proteomic features in involved tissues that define pathobiological differences between patients. Here, myectomy tissue from patients with obstructive hypertrophic cardiomyopathy and heart failure is analyzed using RNA-Seq, and the results are used to develop individualized protein-protein interaction networks. From this approach, hypertrophic cardiomyopathy is distinguished from dilated cardiomyopathy based on the protein-protein interaction network pattern. Within the hypertrophic cardiomyopathy cohort, the patient-specific networks are variable in complexity, and enriched for 30 endophenotypes. The cardiac Janus kinase 2-Signal Transducer and Activator of Transcription 3-collagen 4A2 (JAK2-STAT3-COL4A2) expression profile informed by the networks was able to discriminate two hypertrophic cardiomyopathy patients with extreme fibrosis phenotypes. Patient-specific network features also associate with other important hypertrophic cardiomyopathy clinical phenotypes. These proof-of-concept findings introduce personalized protein-protein interaction networks (reticulotypes) for characterizing patient-specific pathobiology, thereby offering a direct strategy for advancing precision medicine.

/pdf/individualized-interactomes-for-network-based-precision-xksqsaye5g.pdf

Individualized interactomes for network-based precision medicine in hypertrophic cardiomyopathy with implications for other clinical pathophenotypes.

Diffuse myocardial fibrosis measured by extracellular volume associates with incident ventricular arrhythmia in implantable cardioverter defibrillator recipients more than focal fibrosis

Hemochromatosis debut after liver transplant: a rare case of cardiogenic shock

See Article by Nordin et al 

> Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease.1 
> 
> —Sir William Osler

Many ostensibly diffuse disease processes of the heart affect the myocardium variably, where involvement and severity vary by left ventricular location. Such diffuse disease processes that exhibit spatially heterogeneous involvement may include genetic disease (eg, hypertrophic cardiomyopathy), infiltrative disease (eg, amyloidosis), combined infiltrative and genetic disease (Fabry disease [FD]), valvular heart disease (aortic stenosis), and any of the disease processes that promote myocardial fibrosis and remodeling (eg, hypertension). Surprisingly, detailed phenotyping reveals that the severity of myocardial involvement often varies spatially in these diseases that affect the myocardium globally.

Historically, left ventricular hypertrophy manifested by increased myocardial thickness provides a simple, readily detectable parameter to demonstrate variable myocardial involvement. Hypertrophic cardiomyopathy with asymmetrical hypertrophy provides perhaps the best-known exemplar. In this scenario, despite a genetic disease affecting the genotype of each myocardial cell, …

Constancy of Spatial Variation in Diffuse Myocardial Disease: Implications for Diagnosing Disease.

Aorto - rv fistula and severe aortic regurgitation due to prolapse of right coronary cusp in membranous ventricular septal defect

Rare cause of intracardiac mass: epstein bar virus related cardiac lymphoma.

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