bluuebunny/crossref_metadata_2025 huggingface dataset:
Myocardial work and aortic strain in hypertensive patients: a speckle tracking echocardiographic study
Authors: Capotosto L , Placanica G , Mangieri E , Tanzilli G , Iannucci G , Placanica A , Miraldi F , Vitarelli A
Published: January 2025

Purpose

The aim of the present study was to investigate whether systemic arterial hypertension is associated with abnormal left ventricular (LV) function assessed by myocardial work determined by speckle tracking echocardiography and how such changes are related to left ventricular hypertrophy (LVH) and aortic strain.

Methods

We examined 102 hypertensive (mean age, 65±16 years, 53% male) and 102 sex- and age-matched healthy controls (mean age, 66±14 years, 52% male). The following three-dimensional echocardiographic parameters were evaluated: LV end-diastolic volume, LV end-systolic volume, LV stroke volume, LV ejection fraction (LVEF), LV end-diastolic mass, and LV end-diastolic mass index (LVMI). Hypertensive patients were divided into two groups: patients without LVH (group-A) and patients with LVH (group-B, LVMI>115g/m2 men, LVMI>95g/m2 women). All of them had preserved LV ejection fraction. Global LV longitudinal strain (GLS) was calculated by two-dimensional speckle tracking echocardiography. The following indices of MW were assessed: global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). Corrected circumferential ascending aorta strain (AAo-S) was calculated by two-dimensional speckle tracking echocardiography as global aortic strain /pulse pressure. Data analysis was performed offline (GE EchoPAC v.R6).

Results

In group-A GWI and GCW were increased compared to controls (p=0.04). In group-B GWI and GCW were decreased compared to controls (p=0.01). GWW was increased in group-A(p=0.01) and group-B(p<0.001). GWE was decreased in group-A(p=0.004) and group-B(p<0.001). There was a positive correlation between GWE and AAo-S(r=0.53,p=0.02). GWE was independently associated with GLS(β=0.28,p=0.012), LV mass(β=0.33,p=0.01) and AAo-S(β=0.36,p=<0.01) in the whole hypertensive population. At ROC (receiver operating characteristic) analysis, optimal cutoff values of GWI, GLS, AAo-S, GWE and combination of GWE and AAo-S discriminating LV hypertrophy were 0.7413, 0.7685, 0.8167, 0.8538 and 0.9016, respectively.

Conclusions

In systemic hypertension, aortic strain assessment improved the ability of myocardial work variables to differentiate patients with LVH, patients without LVH, and control subjects. The decrease in GWE and AAo-S occurred even in the absence of LV hypertrophy.
Elevated left atrial stiffness index is a poor prognostic factor in heart failure with preserved ejection fraction undergoing transcatheter aortic valve replacement
Authors: Yamaguchi N , Takahashi T , Nishio S , Zheng R , Saijo Y , Kadota M , Kawabata Y , Ise T , Yamaguchi K , Yagi S , Yamada H , Wakatsuki T , Sata M
Published: January 2025

Background

Patients with severe aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR) present with a high prevalence of heart failure with preserved ejection fraction (HFpEF). An elevated left atrial stiffness index (LASI) has recently been recognized as a potential prognostic factor for worsened outcomes in HFpEF patients.

Purpose

This study investigates whether the LASI is a prognostic factor for outcomes following TAVR in HFpEF patients.

Methods

In this single-center retrospective study, patients with severe aortic valve stenosis who underwent TAVR at our center from February 2020 to May 2023 and had left ventricular ejection fraction >40% were included (Figure 1). The LASI was defined as the ratio of E/e’ to the left atrial reservoir strain from transthoracic echocardiography performed before and one week after TAVR. The primary endpoint was a composite outcome of all-cause mortality and cardiovascular events during the follow-up period.

Results

We analyzed 178 patients with a median age of 84 years, of whom 69% were female. During a median follow-up period of 549 days, 34 cases (19%) experienced the composite outcome. Multivariate Cox proportional hazards analysis using preoperative indices showed that LASI was independently associated with the occurrence of outcomes (HR 1.84 [95% CI; 1.15-2.95, P = 0.011] per 1.0 increase). A sub-analysis excluding cases had left bundle branch block postoperatively revealed a significant association between postoperative LASI and outcomes (HR 3.62 [95% CI; 2.01-6.51, P = <0.001] per 1.0 increase), particularly pronounced in patients with preoperative grade 2 left ventricular diastolic dysfunction (HR 4.38 [95%CI; 2.07-9.26, P=<0.001] per 1.0 increase) (Figure 2).

Conclusion

There is potential for LASI as a prognostic factor for outcomes following TAVR in HFpEF patients.
Detection of ischemia in kidney transplant candidates: is pharmacological stress echocardiography essential?
Authors: Velez Salas A , Ruben Cano Carrizabal R C C , Carlos Casanova Rodriguez C C R , Daniel Rodriguez Alcudia D R A , Ana Lareo Vicente A L V , Rosalia Cadenas Chamorro R C C , Elena De La Cruz Berlanga E C B , Victor Martinez Dosantos V M D , Arturo Martin-Penato A M M , Maria Cruz Aguilera Martinez M A M , Diego Iglesias Del Valle D I V , Belen Paredes Gonzalez B P G , Angel Garcia Garcia A G G
Published: January 2025

Introduction and Objectives

The increase in the average age of candidates for kidney transplantation (KT) implies a higher number of comorbidities and cardiovascular risk (CVR). Pharmacological stress echocardiography (SE) is frequently preferred over exercise to assess pre-surgical CVR in these patients. However, this preference is based on the assumption that they have poorer functional capacity, which is not sufficiently supported by scientific evidence.

The objective of this study is to determine the cardiovascular risk profile of kidney transplant candidates and the utility of exercise echocardiography (EE) for risk stratification and predicting complications arising from the transplant.

Methods

Retrospective analysis of patients referred to Cardiology for pre-KT evaluation following our local protocol, between January 2021 and December 2023. EE was preferably performed if the patient had adequate ambulation capacity, using a treadmill with the Bruce protocol to maximum capacity, setting the target heart rate at 85% of the theoretical maximum heart rate (TMHR, 220-age). Functional capacity was measured in exercise time (ET) and metabolic equivalents (METs). SE was performed with dobutamine or dipyridamole.

Results

Forty-six patients with advanced renal failure were included, 63% on renal replacement therapy (RRT), with a mean age of 66± 11 years and 76.1% male. In 70% of the patients, EE was initially performed, with 13 studies (34%) being inconclusive due to TMHR criteria, of which 8 subsequently required SE (17% of the total). The mean exercise time was 6.11± 2.9 minutes. The mean functional capacity was 6.8 ± 2.3 METs, slightly lower than predicted for sex and age (7.5 METs), but this difference was not significant (p=0.23).

Among the SEs (30%), one study was performed with dipyridamole, and the rest with dobutamine, with complications such as non-sustained ventricular arrhythmias and arterial hypotension recorded in 2 SEs. Only one study was positive for inducible ischemia, for which a coronary angiography was performed without significant lesions. A total of 11 patients (24%) received KT, with no cardiovascular complications recorded during the perioperative period.

Conclusions

Patients with advanced renal failure or on RRT who are candidates for KT, despite their high CVR, have a low incidence of inducible ischemia and acceptable functional capacity. EE is a test that allows for cardiovascular risk assessment prior to the intervention in most patients, with fewer complications than SE.

Baseline characteristics
Value of combined cardiopulmonary exercise testing with stress echocardiography in the management of late effects cardio-oncology patients.
Authors: Donovan K , Alkhateeb A , Bruce D , Malcolmson J , Grandage V , Windsor R , Walker M , Bhattacharyya S , Lloyd G , Ghosh A , Savvatis K
Published: January 2025

Introduction

Advancements in cancer treatments are resulting in improved prognosis for patients. However, these therapies may cause cardiotoxicity, including left ventricular systolic dysfunction which may manifest years later. Echocardiographic monitoring frequency for cancer survivors, timing and role of initiation of cardioprotective medication to manage asymptomatic mild systolic dysfunction in this cohort is poorly understood.

Aims

To assess role of combined cardiopulmonary exercise test stress echo (CPET-SE) in providing additional benefit in monitoring patients at risk of cardiotoxicity.

Methods

Retrospective analysis of patients in the late effects clinic who were at higher risk of cardiotoxicity due to treatment received. Patients were referred for CPET-SE due to borderline reduced LVEF (<55%) with absence of heart failure symptoms.

Results

A total of 57 patients (mean age 32 years, 82% male, 70% receiving anthracycline treatment) were assessed between January 2019 and September 2022.

Forty-nine (86%) patients performed a maximal exercise test, with all patients reporting fatigue as the reason to stop. 86% of patients showed appropriate contractile reserve with mean increase in LVEF of 9±6%. Mean resting and peak LVEF was 50 and 59% respectively (mean difference 9±5%). Only four patients saw no improvement in peak LVEF (3 of whom experienced a decrease with mean drop of -2%). There was improvement of longitudinal function: average resting and peak GLS were -14 and -17% respectively, with mean improvement of -3±2.1%. Average lateral S’ was 7.4 cm/s at rest and 12.5cm/s at peak exercise, mean increase was 5.1± 2.5cm/s.

Despite improvement in cardiac function, all patients had reduced peak VO2 on CPET: average VO2 peak 26.8 ml/kg/min (69% target or moderately reduced). Mean peak O2 pulse was 11.5 ml/beat. VE/VCO2 was 25.5 suggesting there was no respiratory limitation, supported by normal spirometry, breathing reserve and oxygen saturations in all patients. Markers of contractile reserve and peak VO2/O2 pulse were significantly correlated (Figure 1): peak O2 pulse and peak EF r = 0.4 (P=0.004); between delta S’ and VO2 peak r = 0.3 (P=0.047), albeit relatively weak, indicating likely influence of non-cardiac causes on reduced peak VO2 / O2 pulse. Limitation in most patients was thought to be secondary to deconditioning.

Conclusion

Our data indicate that cancer survivors may demonstrate significant exercise limitation which remains underdiagnosed, and that non-cardiac factors likely contribute. CPET-SE differentiates cardiac dysfunction from other causes of exercise limitation and guide management focusing on rehabilitation programmes or early initiation of cardioprotective medication in patients with impaired contractile reserve.
Evaluation of novel cardiovascular risk calculators in patients with rheumatoid arthritis
Authors: Gonzalez-Gonzalez V , Guajardo-Jauregui N , Cardenas-De La Garza J A , Arvizu-Rivera R I , Galarza-Delgado D A , Azpiri-Lopez J R , Colunga-Pedraza I J , Elizondo-Benitez M F , Polina-Lugo R L , Gonzalez-Melendez A , Guajardo-Aldaco A L , Mendoza-Venegas D J
Published: January 2025

Background

Patients with rheumatoid arthritis (RA) have a higher cardiovascular risk (CVR) compared to the general population contributing to a decreased life expectancy. Systematic and periodic assessment of CVR is recommended in all patients with RA. The newly developed PREVENTTM calculator was designed to estimate the absolute risk of cardiovascular disease and provides an estimate of atherosclerotic cardiovascular disease and heart failure.

Purpose

This study aimed to evaluate the sensitivity and specificity of the new PREVENTTM algorithm to identify CP in RA patients without prior CVD and to compare these results with other CVR algorithms.

Methods

We performed a cross-sectional study that included patients with RA aged 40 to 79 who fulfilled the 2010 ACR/EULAR Classification Criteria for RA. Patients with previous CVD, pregnancy, or overlap syndrome were excluded. A B-mode carotid ultrasound was performed on all patients. The presence of CP was defined as diffuse carotid intima-media thickness (cIMT) ³1.2 mm or focal thickness ³0.5 mm. The CVR was evaluated using Globorisk, HEARTS, QRISK3, ERS-RA, SCORE2, and PREVENTTM algorithms. The result was multiplied by 1.5 in algorithms where RA is not included as a variable, according to EULAR 2015/2016 recommendations. ROC curve analysis was performed to evaluate the different CVR algorithms' performance to identify CP. Youden index was calculated to select the optimum cutoff point and posteriorly calculate sensitivity, specificity, and predictive values. A p-value of £0.05 was considered statistically significant. Statistical analysis was performed with SPSS version 29.0 (IBM Corp, Armonk, NY, USA).

Results

A total of 261 patients with RA were included, mostly women (n=244, 93.5%), with a mean age of 56±9.3 years, and a median disease duration of 7.7 (3.0-14.7) years. Dyslipidemia was the most prevalent CVR factor (n=104, 39.8%). The prevalence of CP was 38.0%. According to the ROC curves, the Globorisk, HEARTS, and QRISK3 algorithms showed a higher area under the curve (AUC) than the other algorithms. The HEARTS and QRISK3 algorithms showed the highest positive likelihood ratios, showing rates of 1.87 and 1.84, respectively, to identify RA patients with CP (Figure 1).

Conclusion

Our study showed that Globorisk, HEARTS, and QRISK3 calculators presented the best diagnostic accuracy to detect CP in patients with RA. The novel CVR calculator PREVENTTM did not show better performance than older calculators in our population. Imaging studies evaluating coronary artery calcium and CP may offer better alternatives in high-risk populations like patients with RA.
Imapct of radiation and trastuzumab therapy on echocardiographic parameters in her2 positive breast cancer patients- eight years follow-up
Authors: Krstic I , Deljanin Ilic M , Simonovic D
Published: January 2025

Background

Trastuzumab has benefits in treatment of HER2 positive breast cancer. However its also carries the risk of cardiotoxicity and in addition of prior radiotherapy, the risk is higher.

Purpose

To assess the imapct of radiation and trastuzumab therapy on echocardiographic parameters at the end of completing treatment period, as well as during follow up period of eight years in HER2 positive breast cancer patients(pts).

Methods

At the beginning, the study included a group of 96 HER2 positive breast cancer patients(mean age, 59.57±9.6 years). During 8 years follow up after last cycle of trastuzumab, 6 pts died and connection was lost with 68 pts. Eight-year follow-up was conducted on 22 pts. All pts uderwent trastuzumab therapy and 11 pts had radiation before trastuzumab. In all pts echocardiography study was performed before and after trastuzumab and 8 years after the last cycle of trastuzumab.

Results

In all 22 pts after trastuzumab therapy ejection fraction(EF) decreased(from64.63±7.047% to 63.28±4.74%, p= 0.238 ), while left atrium (LA) (from 33.54±5.00 mm to 34.09±3.86 mm, p=0.384) and left ventricular mass (LVM) (from162.43±46.40 g to 172.36±48.04 g, p=0.434) increased but not significantly. After 8 year follow up period value of EF was lower by 4,91%, LVM was higer by 11,71% and dimension of right ventricle (RV) was significantly higer by 26,74% (p<0,004) in the subgroup of pts with radiation therapy and trastuzumab(N=11) then in subgroup of pts with only trastuzumab therapy.

Conclusions

The results of the study showed decrease of LVEF and increase of LVM and LA after trastuzumab therapy. During 8 years follow up, pts with radiation and trastuzumab had greater reduction of EF and increase of LVM and RV than those with trastuzumab therapy without radiation.
Noninvasive left atrial stiffness is associated with atrial fibrillation recurrence after catheter ablation
Authors: Chirumamilla S S K , Cifci G , Wen S , Pislaru S V , Pellikka P A , Kane G C , Asirvatham S J , Pislaru C
Published: January 2025

Background

Catheter ablation for atrial fibrillation (AF) improves quality of life and lowers cardiovascular adverse events. However, AF recurrence rates remain high - thus the need for better or improved predictors of AF recurrence. The role of left atrial (LA) stiffness remains unclear, as prior findings were controversial.

Purpose

To explore the relationship between a noninvasive LA stiffness index (LAstiffn) and AF recurrence after catheter ablation.

Methods

We analyzed a prospectively recruited cohort of patients who underwent catheter ablation for AF, were in sinus rhythm at 3 months post-ablation, had no significant (< moderate) valvular disease, and had LA volumes and LA diastolic function prospectively measured. LAStiffn was calculated as (E/e’)/LA emptying fraction (LAEF) ratio (abnormal defined as >15/45≈0.3). Outcome endpoint was the first documented AF/atrial flutter episode, lasting >30s, beyond 3 months post ablation (end of blanking period).

Results

A total of 589 patients were studied (mean age 60±10 years; 75% men; 50% with persistent AF; Table 1). At 3 months post-ablation, mean LAVI(Left atrial volume index) was 36±10 mL/m2 and LAstiffn 0.32±0.22. LAstiffn tended to be higher in older patients, in females, and patients with persistent AF and comorbidities (hypertension, congestive heart failure, coronary artery disease, CHA2DS2-VASc score ≥2, etc). At multivariable regression analysis, LAstiffn correlated with LV size and mass, degree of mitral/tricuspid regurgitation, and right ventricular systolic pressure. At 1 year, 3 years, and 8 years follow up, AF recurred in 118, 191, and 347 patients, respectively. At univariate Cox proportional hazards regression analysis, LAstiffn index >0.3 was significantly associated with AF recurrence at 1 year (log-rank P=.0005), 3 years (P=.0002), and 8 years follow up (P<.0001; Figure). In multivariate analysis including all clinical and laboratory factors with P<.10 in univariate analysis, LAstiffn >0.3 remained an independent factor for AF recurrence only at 3-years (adjusted HR 1.40 [1.03-1.91], P=.03) and 8 years follow up (adjusted HR 1.65 [1.29-2.13], P<.0001) after adjustment for age, sex, type of AF (persistent/paroxysmal), LA volume index (LAVi), obstructive sleep apnea, and prior pacemaker/ICD implantation (best independent factors); P=.14 at 1 year follow up. In ROC analysis, LAstiffn (AUC 0.61, P=.001) performed slightly better than LA deformation LAEF (AUC 0.59, P=.002) or E/e’ (AUC 0.58, P=.03), though with modest sensitivity/specificity (58%/62%).

Conclusions

LAstiffn may reflect LA myopathy that is likely due to the cumulative effects of comorbidities, diastolic dysfunction, and intrinsic LA tissue remodeling. LA stiffening may be a substrate facilitating redevelopment of AF, thus patients with increased LAstiffn may need more frequent monitoring to prevent/treat AF recurrence earlier.
Mitral annulus calcification-derived cardiac computed tomography: a marker for cardiovascular prognosis after aortic valve replacement
Authors: Cozac D A , Motta R , Savo M T , De Amicis M , Pergola V
Published: January 2025

Introduction

Calcific aortic stenosis (AS) is the most common valvular heart disease in developed countries, with incidence rising due to an aging population. Although transthoracic and transesophageal echocardiography are the primary imagistic tools for patients with AS, cardiac computed tomography (CCT) is essential in the pre-procedural planning of aortic valve replacement (AVR), crucially informing management strategies. Furthermore, CCT provides detailed imaging of cardiovascular calcification, such as mitral annular calcification (MAC) presence and extension for these patients. However, the implications of CCT-derived MAC for patient outcomes, particularly regarding major adverse cardiovascular events (MACE) remain unclear.

Purpose

This study aimed to determine if the presence and extent of CCT-derived MAC affect all-cause, non-cardiovascular mortality, and MACE in patients undergoing AVR.

Methods

Several clinical cardiovascular risk factors were collected retrospectively and CCT scans of 313 patients with AS were assessed semi-quantitatively. CCT was conducted in spiral acquisition mode with retrospectively electrocardiogram-gated reconstruction and a contrast agent was injected. This study categorizes MAC severity using Guerrero et al.'s recently validated CCT-derived MAC score. Patients were followed for 60 months post-AVR to evaluate MACE (composite of cardiovascular mortality, major arrhythmias, heart failure, and stroke), all-cause, and non-cardiovascular-related deaths. Cox univariate models were used to study the role of MAC as a predictor of the aforementioned outcomes.

Results

The population's median age was 81 years (78-84) and most of them were females (60.3%). Arterial hypertension was present in 85.9% of the patients, 30.6% presented diabetes mellitus, 12.1% presented chronic kidney disease, and 36% had previous myocardial revascularization. The median left ventricular ejection fraction was 58% (55-63), the mean index aortic valve area was 0.4 cm2/m2 (0.3-0.5) and most of them presented a tricuspid aortic valve (94.8%). The median STS risk score of mortality was 4.14 % (2.85-6.29), while the EuroScore II was 2.83 (1.70-4.77) points. In univariate Cox models, the lowest and intermediate MAC severity categories did not show any significant associations with MACE, all-cause, and non-cardiovascular mortality (all p values >0.05). However, the MAC score for the highest category (3 vs. 0 points) was significantly associated with MACE (HR 2.32, 95% CI [1.13-4.77], p=0.02), all-cause (HR 2.37, 95% CI [1.36-4.16], p< 0.0.001), and non-cardiovascular mortality (HR 2.09, 95% CI [1.05-4.16], p=0.03).

Conclusion

In the present study, severe MAC was identified as an independent predictor of cardiovascular outcomes in patients with AS undergoing AVR. These results could be translated into a more practical, largely available, clinical tool to ensure closer monitoring of this population
Left atrial function is a predictor of 90-day readmissions in patients with a first hospitalization for heart failure
Authors: Islas F , Poveda V , Davila C , Carrion I , Gil-Abizanda S , De Agustin J A , Olmos C
Published: January 2025

Aim

Heart failure (HF) readmissions are frequent and have important prognostic consequences.

LACE index is a tool that estimates the risk of rehospitalization in different clinical scenarios, and has shown moderate discriminatory performance in HF.

Our aim was to analyze the association of different clinical and echocardiographic parameters with the risk of 90-day readmissions and to address the performance of the LACE index in our cohort of patients with a first HF hospitalization.

Methods

Prospective cohort of patients with a first HF hospitalization in a tertiary care center between 2020 and 2022. Clinical, analytical and echocardiographic variables were collected at the time of admission. The primary outcome was 90-day readmissions for HF.

Results

The mean age of our cohort (n=178) was 73.4 (13) years and 69 (39%) were female. Mean LVEF was 43.8% (15).

The prevalence of comorbidities was high: arterial hypertension 71%, diabetes 39%, obesity 29%, atrial fibrillation 25%, and chronic kidney disease 15%.

Mean LACE index was 10 (2.8), which corresponds to a high risk of readmission.

The incidence of 90-day readmission was 14%. Variables significantly associated with readmission were female sex, history of AF, right ventricular-arterial coupling index, left atrial stiffness, creatinine clearance, and systolic arterial pressure at discharge (Figure 1).

A multivariable logistic regression analysis showed that atrial stiffness (OR 1.71; p=0.042) and creatinine clearance (OR 0.95; p=0.066) were the only two independent predictors of readmissions. A model comprising these 2 variables had an area under the ROC curve of 0.758 (95% CI: 0.65-0.84), and was statistically superior to LACE index (AUC 0.55; 95% CI: 0.48-0.63); p<0.005 (Figure 2).

Conclusions

In a cohort of patients with a first hospitalization for HF and high burden of comorbidities, a simple model which takes into account renal function and left atrial function showed good diagnostic yield for predicting 90-day readmissions.

Logistic regression analysis

ROC curves
Echocardiographic estimation of cardiovascular energy transfer in patients with heart failure: an explorative study
Authors: Yttervoll I , Ostvik A , Aadahl P , Mo R , Leangen Grenne B , Kirkeby-Garstad I
Published: January 2025

Background

Heart failure (HF) is a complex and debilitating condition. The pathophysiology of HF is related to the dynamic interplay governing the energy transfer from the heart to the vascular bed. This energy transfer can be estimated by calculating the heart's external power, measured in watts, which is the product of flow and pressure divided by time. Although power measurements can potentially improve hemodynamic assessment in patients with heart failure, clinical estimation of cardiovascular energy transfer is rarely used due to cumbersome analyses and dependence on invasive measurements. We propose a novel method based on echocardiography and continuous non-invasive blood pressure measurement to estimate cardiovascular energy transfer.

Aim

To test whether non-invasive estimates of cardiovascular energy transfer can differentiate between HF patients with reduced and preserved left ventricular ejection fraction (LVEF).

Methods

We included patients hospitalized with decompensated HF not optimally treated in the study. All patients underwent an echocardiographic examination using a GE HealthCare Vivid E95 scanner. We used the biplane Simpson method to calculate LVEF and the pulsed wave Doppler velocity spectrum in the left ventricular outflow tract to estimate flow. Continuous non-invasive blood pressure measurements were obtained using a Finapres finger cuff device calibrated with the brachial blood pressure. We developed an application for tracing the velocity spectrum, synchronizing flow and pressure curves, and calculating the power curves as the product of continuous synchronized flow and pressure curves. The patients were categorized into two groups based on whether LVEF was < 40% or ≥ 40%.

Results

We observed that cardiovascular energy transfer, estimated as external power, differed between patients with LVEF <40% vs. ≥40%. The study cohort comprised twenty-eight patients (25% women), averaging 76 years (SD 11). Eighteen patients had LVEF <40%, with a mean LVEF of 27% (SD = 9%), mean velocity time index (VTI) 11.7 cm (SD = 2.94), and) and mean systolic blood pressure 116 mmHg (SD = 19). Ten patients had LVEF ≥40%, with a mean LVEF of 47% (SD = 6 %), VTI 16.5 cm (SD = 5.50), and mean systolic blood pressure 143 mmHg (SD = 20). External power was significantly different between patients with LVEF <40% vs. ≥40%, 0.81 W (SD = 0.21 W) vs. 1.43 W (SD = 0.41 W), respectively, p<0.0001 (Fig. 1). We observed a modest but significant correlation between LVEF and power (R = 0.28, P-value < 0.005).

Conclusion

Cardiovascular energy transfer, estimated non-invasively as external power, was significantly lower in acutely decompensated heart failure patients with LVEF <40% compared to those with LVEF ≥ 40%. More extensive studies should explore the possible value of estimating cardiovascular energy transfer in stratification and therapeutic decisions in patients with HF.
Prognostic value of TAPSE/RVSP ratio in patients with acute heart failure: a prospective observational cohort study
Authors: Kosmidis D , Samara K , Theodoridou P , Sotiroglou E , Pastirmatzi E , Vatitsis D , Liosi E , Gouliaros N , Stefanidis C , Chatzieleftheriou C
Published: January 2025

Background/Introduction

The tricuspid annular plane systolic excursion (TAPSE)/right ventricular systolic pressure (RVSP) ratio, derived from echocardiography, has been proposed as a valid, non-invasive surrogate of the right ventricle-pulmonary artery coupling in heart failure (HF), demonstrating strong prognostic utilities in stable patients with chronic HF and preserved or reduced ejection fraction (EF). However, there are scarce data in patients with acute HF.

Purpose

The aim of the current study was to investigate the prognostic role of the TAPSE/RVSP ratio in adult patients hospitalised for acute HF in our Cardiology department.

Methods

This was a prospective observational cohort study of consecutive adult individuals who experienced an acute de novo HF event or had acute decompensated HF between August 2023 and June 2024. An independent investigator conducted a comprehensive transthoracic echocardiogram within the first 24 hours since admission and each patient was classified as having HF with reduced, mildly reduced or preserved EF according to the ESC guidelines. Moreover, the TAPSE/RVSP ratio was calculated according to the EACVI guidelines. All-cause mortality or HF re-hospitalisation was defined as the primary composite outcome and each patient was followed until the 20th of June or until the composite outcome occurred. TAPSE/RVSP ratio was divided in tertiles (≤0.30, 0.31-0.40, >0.40). Kaplan-Meier curves as well as univariate and multivariable cox regression analyses were used for data analysis and presentation.

Results

In total, 143 patients with acute HF (mean age 82 years, 58% female) were included in the study. Of those, 36% were diagnosed as having acute de novo HF. Half of total patients were classified as HF with preserved EF. Mean right ventricular diameter was 40 ± 8 mm and mean TAPSE was 15.4 ± 3.7 mm. During a median follow-up of 123 days, the composite outcome occurred in 36% of patients (n=52). By Kaplan-Meier analysis, individuals in the lowest tertile (TASPE/RVSP ratio ≤0.30) showed the lowest freedom from the composite outcome (Figure 1; p <0.0001, log-rank test). In multivariable regression analysis, TAPSE/RVSP ratio ≤0.30 was associated with a 14-fold risk of all-cause mortality or HF re-hospitalisation (Figure 2; adjusted hazard ratio: 14.7; 95% CI: 2.5, 85.3; p=0.002).

Conclusions

In patients hospitalised for acute HF, a statistically significant association between the TAPSE/RVSP ratio and the composite outcome was found. Those patients with TAPSE/RVSP ratio ≤0.30 had a 14-fold risk of all-cause mortality or HF re-hospitalisation.

Kaplan-Meier curves

Multivariable Cox regression analysis
Heart failure with preserved global longitudinal strain: a distinct phenotype in patients with preserved ejection fraction: data from a real-world registry
Authors: Kim G , Kim K , Gwak S , Lee H , Cho I , Hong G , Ha J , Shim C
Published: January 2025

Background

Heart failure with preserved ejection fraction (HFpEF) is a clinical syndrome caused by various pathophysiologic mechanisms, and has recently received increasing attention. Many research results show that the longitudinal left ventricular (LV) function is deteriorated, however, in the real world, we often encounter patients with preserved LV global longitudinal strain (GLS). This study sought to determine the prevalence, characteristics, and outcome of patients with preserved LV GLS in a real-world registry of HFpEF.

Method

The registry data included 1,798 patients with HFpEF (72.2 ± 11.6 years, 55.2% female) who met the inclusion criteria of previous randomized controlled trials (New York Heart Association class II or higher symptoms, LVEF > 40%, and NT-proBNP > 300 pg/mL) at a single tertiary hospital between 2014 and 2021. LV GLS analysis was performed using vendor-independent 2D speckle-tracking imaging software. Patients with LV GLS ≤ -18% were defined as heart failure with preserved GLS. The primary outcome was a composite of heart failure admissions and cardiovascular death.

Results

In this population, 757 (42.1%) patients had preserved LV GLS. The patients with preserved GLS were tended to be younger (71.7 ± 11.5 vs. 72.7 ± 11.6 years, p=0.073) and more female predominance (60.6 vs. 51.3%, p<0.001), and wider pulse pressure (61.0 ± 17.4 vs. 54.8 ± 18.1 mmHg, p<0.001) compared with those with reduced GLS. The average NT-pro BNP of the preserved GLS group was 2242.4 ± 4391.8 pg/ml and the average LV GLS was -20.1±1.6%, which were significantly lower than each value of the reduced GLS group. In terms of echocardiographic characteristics, the patients with preserved GLS had higher LV ejection fraction (68.8 ± 5.8 vs. 62.5 ± 8.6%, p<0.001) and stroke volume (78.1 ± 21.4 vs. 61.9 ± 19.3, p<0.001). During 21.3 months (interquartile range 6.6-39.7 months) follow-up, the group with preserved GLS had a better primary outcome than the group with reduced GLS (log-rank p < 0.001) (Figure)

Conclusion

Heart failure with preserved GLS is common among patients with HFpEF in real-world data. This phenotype is more common in females, is associated with higher stroke volume and arterial stiffness, and ultimately shows a favorable outcome.

Figure. Clinical outcomes of HFpGLS
Favorable impact of FFRCT on myocardial revascularization outcomes: results from an observational real-world registry
Authors: Lammens J , Motoc A , Tanaka K , Belsack D , Vandeloo B , Lochy S , Schoors D , De Potter T , Michiels V , Tsugu T , Van Dalem A , Magne J , De Mey J , Cosyns B , Argacha J F
Published: January 2025

Background

Based on excellent clinical outcomes data, coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) is endorsed by ESC guidelines for diagnosing obstructive coronary artery disease (OCAD) (1). The impact of FFRCT use on cardiovascular outcomes after revascularization is not well known.

Purpose

To assess the impact of FFRCT use on the post-procedural myocardial injury and long-term clinical outcomes of patients with OCAD undergoing myocardial revascularization.

Methods

Patients with suspected OCAD on CCTA (at least one stenosis of >50% in any vessel) were included from a 2013-2021 tertiary hospital registry. Propensity score adjusted Cox- regression and logistic regression analysis, respectively were used to assess the impact of FFRCT on the outcomes of patients with OCAD undergoing percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Post-revascularization myocardial injury (PMI) was defined as cardiac troponin (hs -cTnT) > 5 times the 99th percentile URL for PCI and hs- cTnT > 10 times the 99th percentile URL for CABG. Major adverse cardiovascular events (MACE) were defined as a composite endpoint of all – cause mortality, hospitalization for acute myocardial infarction, stroke, hospitalization for heart failure and repeated revascularization.

Results

Among 7541 patients, 1601 had suspected CCTA - derived OCAD. 559 patients were revascularized: 386(69.05%) by PCI, 166(29.7%) by CABG. FFRCT was performed in 252(45.1%) patients. During a follow-up of 4.4±2.2 years, 137(24.5%) patients experienced MACE. Survival analysis indicated significant differences in MACE and all-cause mortality–rates between FFRCT use and no FFRCT use (log- rank p = 0.033 and 0.004). A non–significant trend towards reduced MACE risk by using FFRCT (HR 0.736, 95% CI 0.513-1.055, P=0.095) and a significant reduction in all-cause mortality (HR 0.476, 95% CI 0.230–0.985, P=0.046) were observed. In the CABG group, FFRCT was associated with lower PMI incidence (5.3% vs. 15.6%, p=0.044). Multivariable analysis revealed no significant association between FFRCT use and PMI.

Conclusion

Using an observational design, this study demonstrates for the first time that FFRCT is able to reduce post- myocardial revascularization MACE. Contrary to previous studies on invasive FFR, this observed FFRCT - related MACE reduction was mainly driven by the reduction in all-cause mortality. No clear reduction of PMI was observed suggesting that the potential adjunctive value of FFRCT was not simply related to some technical improvements in the planning of PCI or CABG procedures. Even if derived from a large real-world registry, these promising observations will need to be confirmed by randomized studies.

Survival analysis

Forest Plot - multivariables analysis
Echocardiographic predictors of right ventricular involvement in cardiac sarcoidosis
Authors: Okafor J , Azzu A , Ahmed R , Wechalekar K , Wells A , Baksi A J , Sharma R , Kouranos V , Khattar R S
Published: January 2025

Background

Right ventricular (RV) involvement in cardiac sarcoidosis (CS) is associated with adverse cardiovascular outcomes. Echocardiography is recommended in the screening of sarcoidosis patients for cardiac involvement. Abnormal imaging should prompt onward performance of cardiac magnetic resonance (CMR) and 18fluorodeoxy glucose positron emission tomography (FDG-PET). Suspicion of RV involvement in the screening phase could prompt more expedient advanced imaging.

Purpose

This study aimed to determine how well RV-focused echocardiographic parameters could predict RV involvement of CS. We defined RV involvement by the presence of RV impairment (RVEF <50%) and/or RV late gadolinium enhancement (LGE) on CMR and/or RV FDG-uptake on FDG-PET.

Methods

Consecutive patients referred for evaluation of suspected CS were prospectively recruited. All those with evidence of extracardiac sarcoidosis were included. Detailed 2D and 3D echocardiography with RV strain, CMR and FDG-PET was performed in all patients within 3 months. CS was diagnosed in line with the 2014 Heart Rhythm Society criteria. RV/pulmonary artery (PA) coupling was defined as the tricuspid annular plane systolic excursion (TAPSE):pulmonary artery systolic pressure (PASP) ratio. RV 4-chamber strain included the RV free wall and septal longitudinal strain components.

Results

Among the 198 sarcoidosis patients enrolled, 97 (49%) were diagnosed with CS. The prevalence of pulmonary hypertension was 3%. RV involvement was present in 26 (13%) among which 14 had RV free wall or septal LGE, 17 had CMR RVEF <50% and 10 had RV FDG uptake. Six patients had both LGE and FDG uptake while 8 patients had both LGE and RVEF <50%.

Compared to those without, patients with RV impairment had lower RV fractional area change (38% [IQR 28-46] vs 43% [39-48], p=0.005), RV free wall strain (-17.7 ± 4.2% vs -22.5 ± 5.5%, p<0.001), RV 4-chamber strain (-13.9 ± 3.4% vs -18.5 ± 4.5%, p<0.001), 3DE RVEF (44 ± 7.4% vs 50 ± 7.5%, p=0.019) and greater RV basal diameter (3.99 ± 0.60cm vs 3.63 ± 0.58cm, p=0.004). There was no significant difference in TAPSE (p=0.091), PASP (p=0.811), RV/PA coupling (p=0.271) and tissue doppler RV S’ (p=0.203) values between the two groups.

RV 4-chamber strain (AUC: 0.797) had the best ability to predict RV involvement followed by RV free wall strain (AUC: 0.757) and 3DE RVEF (AUC: 0.730). The optimal cut-off for RV 4-chamber strain to predict RV involvement was -15.3% which had 74% sensitivity and 77% specificity.

Conclusion

In a prospective cohort, RV strain is a useful indicator of RV involvement among suspected CS patients and should be performed routinely in all screening studies of sarcoidosis patients.
Inflammation clashing onto myocardial susceptibility: a tale of two rare diseases—a case report
Authors: Lima Maria Rita , Certo Pereira Joana , Maltês Sérgio , Freitas Pedro , Rocha Bruno M L
Published: January 2025

Background

Sarcoidosis is a rare inflammatory disease characterized by the presence of myocardial non-caseating granulomas. Heart failure, conduction abnormalities, and/or life-threatening arrhythmias are the main manifestations of cardiac sarcoidosis (CS). Cardiac magnetic resonance plays a major role in the diagnostic suspicion of cardiac involvement in sarcoidosis. However, late gadolinium enhancement (LGE) patterns are non-specific, and one should consider alternative or additional aetiologies for myocardial disease.

Case summary

We report the case of a 40-year-old male with a past medical history remarkable for pulmonary and cutaneous sarcoidosis, presenting with asymptomatic premature ventricular contractions and severe left ventricular (LV) dilation and moderately reduced systolic function. Computed tomography angiography excluded coronary artery disease. Cardiac magnetic resonance revealed myocardial oedema in the anterior, anterolateral, and inferolateral walls and the presence of septal intra-mural and anterior, inferior, and lateral sub-epicardial ‘ring-like’ LGE. He had elevated inflammatory plasma biomarkers. N-terminal pro-brain natriuretic peptide was 110 pg/mL, and high-sensitivity troponin T was 20 ng/dL. Positron emission tomography computed tomography scan showed increased myocardial uptake consistent with inflammatory disease. Endomyocardial biopsy was normal. Thus, a presumptive diagnosis of isolated CS was made, and immunosuppression therapy was initiated, with full LV function recovery. Given the ‘ring-like’ LGE pattern, we recommended genetic testing, which identified a deletion in the dystrophin gene, classified as likely pathogenic.

Discussion

This case highlights the contemporary diagnostic pathway for primary cardiomyopathies, emphasizing the increased likelihood of genetically influenced myocardial vulnerability to continuous harm when coupled with an acquired precipitant of myocardial damage. We describe a case of CS likely superimposed on a genetic myocardial substrate.
Prediction of tricuspid regurgitation regression after mitral valve transcatheter edge-to-edge repair using three-dimensional transoesophageal echocardiography
Authors: Takeuchi Makoto , Utsunomiya Hiroto , Tohgi Kiyotaka , Hamada Ayano , Hyodo Yohei , Tsuchiya Akane , Mogami Atsuo , Takemoto Hajime , Izumi Kanako , Takahari Kosuke , Ueda Yusuke , Itakura Kiho , Ikenaga Hiroki , Nakano Yukiko
Published: January 2025

Aims

We aimed to identify three-dimensional echocardiographic predictors of tricuspid regurgitation (TR) regression in patients with functional TR of moderate or greater severity undergoing mitral valve transcatheter edge-to-edge repair to optimize patient selection and improve clinical outcomes.

Methods and results

This retrospective study analysed 61 patients (mean age 81.3 ± 7.6 years; 55.7% males) who underwent mitral valve transcatheter edge-to-edge repair. Two-dimensional transthoracic echocardiography was performed pre- and 1-month post-procedurally, while three-dimensional transoesophageal echocardiography was performed pre-procedurally. We collected data on clinical variables, medications, and detailed echocardiographic measurements to evaluate procedural outcomes. Tricuspid regurgitation severity was semiquantitatively assessed and categorized. At the 1-month follow-up, TR severity had regressed in 43% of patients. A lower prevalence of atrial fibrillation, smaller left atrial volume index, and smaller right atrial area were significantly associated with TR regression. Multivariate analysis revealed the tricuspid valve annulus perimeter, area, and area change as significant predictors of post-procedure TR regression; tricuspid valve annulus perimeter was the strongest predictor among the three indicators [area under the receiver operating characteristic curve, 0.84 (95% confidence interval: 0.75–0.94), P < 0.001]. Receiver operating characteristic curve analysis indicated that tricuspid valve annulus perimeter cut-off of ≤13.75 cm was the best predictor of post-procedure TR regression. Additionally, tricuspid valve annulus area ≤13.55 cm² and annulus area change ≥17.5% were predictors of post-procedure TR regression.

Conclusion

In patients with relatively severe mitral regurgitation with a non-dilated tricuspid annulus and significant change in tricuspid valve annulus area, mitral valve transcatheter edge-to-edge repair may lead to TR regression.
Types of social group participation and long-term cognitive preservation in older ages
Authors: Hsieh Min Jia , Yang Tien Yu Owen , Li Tzu Yi , Chiao Chi , Ting Te Tien , Chiu Yen Ling , Chuang Yi Fang
Published: January 2025

Background and Objectives

Participating in social groups predicts better cognitive preservation in older adults in the short term (<5 years). Long-term evidence with direct comparison between specific types of social groups is needed.

Research Design and Methods

In the Taiwan Longitudinal Study of Aging (n=4,009, mean age 64 years), 1479 individuals reported participation in at least one of the four common types of social groups at baseline in 2003, including socializing, volunteering, religious, and networking groups. Cognitive function was measured by a modified Short Portable Mental Status Questionnaire (SPMSQ) at year 0 (baseline), 4, 8, and 12. Linear mixed-effects models were used to estimate relative cognitive preservation (in %) compared to individuals who did not participate in social groups at baseline or compared to individuals who participated in different social groups at baseline.

Results

We found volunteering group participation was associated with most consistent cognitive preservation at year 4 (35%, 95% CI: +10% to +60%), 8 (+64%, +44% to +84%), and 12 (+57%, +24% to +89%) compared to the individuals who did not participate in social groups, and at year 12 compared to participants of other social groups (+65%, +16% to +114%).

Discussion and Implications

Our findings support a long-term prediction of better cognitive preservation among volunteering group participants.
Caregivers’ Perspectives on Discussions of Medical Treatment Preferences for People Living with Dementia Are Associated with Their Dementia Health Literacy and the Caregiving Relationship
Authors: Zhang Yuchen , Sereika Susan , Seaman Jennifer , Pettigrew Corinne , Albert Marilyn , Lingler Jennifer
Published: January 2025

Background and Objectives

People living with dementia experience progressive functional decline and increased dependence on caregivers. This study examined the influence of caregivers’ dementia health literacy on perceptions of medical care preferences and advanced care planning (ACP) in people living with dementia.

Research Design and Methods

This analysis used data from a cross-sectional survey, “Care Planning for Individuals with Dementia”, administered nationwide by Alzheimer’s Disease Centers. We conducted binary, ordinal, and multinomial logistic regression.

Results

On average, surveyed caregivers (n=431) were 78.3 years, had 16 years of education, and were mainly white (88.5%). Most lived with (76.8%) and were the designated healthcare proxy (95.1%), with high dementia knowledge scores (mean=8.4/10). As caregivers’ dementia knowledge scores increased, they were 1.27 times more likely (p=0.02) to endorse comfort care. Caregivers with greater knowledge about severe dementia were less likely to need further treatment preference-related discussions (knowing a lot: OR=0.17, p<0.001; knowing some things: OR=0.37, p=0.006). Caregivers live apart from patients were 2.71 times more likely to know about such discussions (p<0.001). Caregivers of people in earlier stages endorsed greater needs for further conversations with clinicians (no impairment & MCI: OR=7.38, p=0.002; mild impairment: OR=5.32, p=0.005) and their care recipients (no impairment & MCI: OR=5.24, p=0.02).

Discussion and Implications

These findings highlight the role of dementia-specific education in ACP discussions among people living with dementia, caregivers, and healthcare clinicians. These findings are important since evidence suggests that ACP may promote quality of life, reduce iatrogenic harm, minimize healthcare overutilization, and alleviate care-related burdens.