bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of preprocedural LA strain on outcome in severe MS
Authors: Yoon S , Kim D Y , Cho I S , Son J W , Choi K U , Kim I C , Seo J W , Shim C Y , Ha J W , Kim H S , Hong G R
Published: January 2025

Background

In patients with mitral stenosis (MS), left atrial (LA) remodeling is crucial for predicting outcomes in severe cases. In this study, we aimed to investigate whether LA longitudinal strain, a parameter of LA remodeling, is associated with adverse outcomes following mitral valve (MV) intervention in patients with severe MS.

Methods

We included patients with severe MS who underwent percutaneous mitral valvuloplasty (PMV) or MV replacement (MVR) from the long-term registry of Multicenter mitrAl STEnosis with Rheumatic etiology (MASTER) except for previous valvular surgery / intervention or coronary artery bypass surgery, at least moderate other valvular dysfunction, abnormal heart rate (<50 or >100 beats per minute). LA longitudinal strain for each patient was measured on pre-interventional echocardiography, and decreased LA strain was defined as the lower cut-off value on receriver operating characteristics analysis. The primary outcome was defined as all-cause mortality.

Results

Among 505 patients over a mean follow-up of 6.8 ± 4.9 years after MV intervention, 27 (5.3%) patients had experienced primary outcomes. Patients with decreased LA strain were older (61.1 ± 11.6 vs. 58.2 ±12.1 years, p=0.007), had more atrial fibrillation (97.6 vs. 79.5%, p<0.001), underwent more MVR (89.4 vs. 82.8%, p=0.038), had higher mean diastolic pressure gradient (MDPG) and right ventricular systolic pressure, had lower left ventricular ejection fraction, and larger LA. Patients with decreased LA strain (< 12.2%) revealed a poorer outcome than those with preserved LA strain (log-rank p<0.001) (Figure 1).

Conclusions

Decreased LA strain on pre-interventional echocardiography was associated with an increased risk of all-cause death after MV intervention. Further prospective studies would be warranted to establish the risk stratification of MV intervention in patients with severe MS.

Figure 1. Kaplan-Meier analysis for primary outcomes according to the cut-off value of LA longitudinal strain in patients with severe MS.
Bioprosthetic valve function in carcinoid heart disease
Authors: Douglas S , Yuan M , Gue Y , Hodson J , Rooney S , Ashoub A , Muir A , Shah T , Dobson R , Steeds R P
Published: January 2025

Background

Carcinoid heart disease (CHD) is a complication of neuroendocrine tumours (NETs) with significant cardiovascular morbidity and mortality. It causes fibrotic damage to predominantly the right-sided valves with subsequent tricuspid valve (TV) and/or pulmonary valve (PV) regurgitation leading to right ventricular (RV) dilatation and dysfunction. The definitive treatment is valve replacement commonly using bioprosthetic valves. Case studies have suggested that bioprosthetic valve degeneration may occur due to ongoing carcinoid plaque deposition, but serial data is lacking.

Purpose

To assess the trajectory of prosthetic valve function on serial transthoracic echocardiography (TTE) in patients with CHD and determine the effect on long-term outcomes.

Methods

A retrospective multicentre observational cohort study including 81 patients who had valve replacement for CHD between 2005-2022. TTE data assessing prosthetic valve function (peak velocity, mean gradient, para/transvalvular regurgitation) and any associations with outcome were identified.

Results

Eighty-one patients (64±8 years, 56% male) were followed up for a median of 24 months (IQR: 8-48), during which there were 52 deaths, an estimated median survival of 32 months and 1-, 3- and 5-year survival rates of 69%, 48% and 38%, respectively.

The post-operative TTE was carried out at a median of 10 days (IQR: 7-47) after surgery. Of the 71 patients with available post-operative TTEs, 48 had >1 TTE.

No significant trends were seen in TV parameters over time. PV peak velocity and mean gradient increased significantly over time (p=<0.001).

Increasing TV peak velocities were significantly associated with shorter survival (p=0.008) and those with increases of >5% per year had 5-year survival of 0% compared to 70% in those with decreasing by <5% per year.

Increasing PV mean gradients were associated with longer survival (p=0.014), with 5-year survival 35%, 55%, and 91% for patients with increases of <0, 0-2 and ≥2 mmHg per year, respectively. This may reflect RV remodelling and improved RV function.

There were 5 cases of prosthetic valve dysfunction, with only 1 needing re-intervention with transcatheter valve-in-valve procedure.

A cause of death was available for 39 patients, 46% were due to NET causes and 31% due to cardiac causes.

Conclusions

Our data suggests that bioprosthetic valve degeneration in CHD is uncommon. TV function did not change over time and PV velocities although increased with time did not lead to significant valve dysfunction.

The main cause of death was due to advancing NET disease. This raises the question as to whether transcatheter replacement may be a viable alternative in patients with CHD, who are facing a median survival of less than 3 years.
Assessing handheld echocardiography: can it reliably detect HVD and LVSD compared to comprehensive echo?
Authors: Laskar N , Melamed T , Singh H , Joshi A , Bhattacharyya S , Lloyd G
Published: January 2025

Introduction

Hand held echocardiography (HHE) and abbreviated protocols (AP) offer the opportunity to widen accessibility in the community. There remain doubts about the sensitivity of these techniques to detect clinically relevant pathology when compared with standard transthoracic echocardiography (TTE). We therefore compared TTE in patients identified with significant left sided valve disease (VHD) or Left ventricular systolic dysfunction (LVSD) for agreement between the two tests.

Methods

Patients attending a community detection program underwent HHE using an AP on the GE Vscan Extend platform. The AP included parasternal long axis view, four chamber view and three chamber view, with and without colour. Those adjudicated to have anything more than trivial disease underwent full TTE. All adjudications were made by an accredited sonographer. The two tests were examined for agreement .

Results

Of the 518 patients evaluated in the community program, 73 TTE’s were available for comparison with handheld AP studies, which were identified as having potentially significant HVD or LVSD. Among these there were 67 identified with HVD , 39 aortic (26 regurgitation, 13 stenosis or calcified )and 41 mitral (39 regurgitation, 2 stenosis).

Comparing both studies, aortic regurgitation (AR) had the highest kappa values (0.88), and showed high specificity (95%) and sensitivity (93%). The kappa value for MR was 0.37 with high sensitivity (95%) and low specificity (41%). This is primarily due to mild MR seen during initial HHE, which appeared to be trivial or absent at the time of TTE. Conversely, calcified mitral and aortic valves showed the lowest kappa values (0.48 and 0.54) and the lowest sensitivity and specificity (50% and 99%) and 86% and 89%. For HVD, TTE identified 39 studies for MR, 2 for MS or a calcified MV, 30 for AR and 13 for AS or calcified aortic valve (for MR, 6 were moderate/severe, for AR, 4 were moderate/severe and for AS, 2 were moderate/severe.

For those with suspected LVSD on HHE, 4 studies did not show LVSD on TTE. Additionally, 1 case of LVSD was newly identified on comprehensive echocardiography. The kappa for LVSD was 0.74 with a sensitivity of 90% and a specificity of 95%.

2 studies of AR on HHE were not detected on TTE, 20 cases of MR, 7 cases of AS/Calcified AV and 1 for MS/Calcified MV.

Conclusion

These results suggest that abbreviated echo using HHE shows variable reliability. The detection of impaired LV and aortic regurgitation are reliable with other lesions less so. Improved technology and machine learning based detection and analysis are likely to improve the technique.
Mitra-Clip results based on a single centre experience
Authors: Golinska-Grzybala K , Szosarczyk B , Stapor M , Trebacz J , Gackowski A
Published: January 2025

Background/Introduction

The uncertainty, whether TEER may improve clinical outcome was explored in two randomized trial targeting patients with symptomatic heart failure (HF), reduced left ventricular ejection fraction (LVEF) and moderate or severe mitral regurgitation (MR) – the MITRA-FR and COAPT trials. So far the COAPT trial is the only randomised trial that showed lower mortality in TEER group.

Purpose

The objective of this study is to compare the results of single Mitra-Clip centre with COAPT trial, with the focus on baseline population characteristic and 2-years overall and HF related mortality rates.

Methods

This study was designed as a retrospective cohort study that included 108 consecutively enrolled, sympomatic patients with moderate-to-severe and severe SMR and HF who underwent mitral valve repair with the MitraClip device (Abott) in John Paul II Hospital in Krakow, between 2014 and 2021. The exclusion criteria were cardiogenic shock, end-stage right or left heart failure or severe aortic valve disease.

Results

Among all patients 86 (79.6%) had fulfilled all Copat criteria. Initially one or two clips were implanted, and in over 90% of patients only mild and moderate (I or II degree) residual MR was observed in echocardiography at discharge and during follow up. In most most patients we also observed significant improvement in clinical status – before the procedure 86% patients were in NYHA class III and IV, and afterwards only 32% at discharge and 34% during follow-up. Death from any cause in the study population between 2016 and 2021 occurred in 16 % (n=31) and heart failure related death was observed in 10 % (n=16) patients.

Conclusions

Despite some differences between our study and COAPT trial, especially concerning patient selection, left ventricle structure and severity of MR, the overall 2 years mortality in our study was 16% vs. 29% in COAPT trial. This confirms that also some non-COAPT patients as well may contribute from TEER procedure, and beside the patients selection the procedural success significantly contributes to mortality benefit.
The SGLT-2 inhibitor empagliflozin improves myocardial strain,ejection fraction, reduces pro-inflammatory cytokines and H-FABP/troponin in models of anthracyline-induced cardiotoxicity
Authors: Quagliariello V , Paccone A , Palma G , Luciano A , Bruzzese F , Giacobbe I , Izzo F , Barbato M , Arianna R , Giordano V , Di Mauro A , Ferrara G , Berretta M , Maurea N I C O L A
Published: January 2025

Background

Empagliflozin (EMPA), a selective inhibitor of the sodium glucose co-transporter 2, reduced the risk of hospitalization for heart failure and cardiovascular death in type 2 diabetic patients in the EMPA-REG OUTCOME trial. Recent trials evidenced several cardio-renal benefits of EMPA in non-diabetic patients through the involvement of biochemical pathways that are still to be deeply analysed. We aimed to evaluate the effects of EMPA on myocardial strain of non-diabetic mice treated with doxorubicin (DOXO) through the analysis of NLRP3 inflammasome and MyD88-related pathways resulting in anti-apoptotic and anti-fibrotic effects.

Methods

C57Bl/6 mice were untreated (Sham, n = 6) or treated for 10 days with doxorubicin (DOXO, n = 6), EMPA (EMPA, n = 6) or doxorubicin combined to EMPA (DOXO-EMPA, n = 6). DOXO was injected intraperitoneally. Ferroptosis and xanthine oxidase were studied before and after treatments. Cardiac function studies, including EF, FS and radial/longitudinal strain were analysed through transthoracic echocardiography (Vevo 2100). Cardiac fibrosis and apoptosis were histologically studied through Picrosirius red and TUNEL assay, respectively and quantified through pro-collagen-1α1, MMP-9 and Caspase-3 expression. Tissue NLRP3, MyD88 and cytokines were also quantified before and after treatments through ELISA methods.

Results

In preclinical study, EMPA increased EF and FS compared to DOXO groups (p < 0.05), prevented the reduction of radial and longitudinal strain after 10 days of treatment with doxorubicin (RS) 30.3% in EMPA-DOXO vs 15.7% in DOXO mice; LS - 17% in EMPA-DOXO vs - 11.7% in DOXO mice (p < 0.001 for both). Significant reductions in ferroptosis, xanthine oxidase expression, cardiac fibrosis and apoptosis in EMPA associated to DOXO were also seen. A reduced expression of pro-inflammatory cytokines, NLRP3, MyD88 and NF-kB in heart, liver and kidneys was also seen in DOXO-EMPA group compared to DOXO (p < 0.001). Troponin-T, B-type natriuretic peptide (BNP), N-Terminal Pro-BNP (NT-pro-BNP) and H-FABP were strongly reduced by EMPA during anthracycline therapy (p<0.005 for all).

Conclusion

EMPA reduced ferroptosis, fibrosis, apoptosis and inflammation in doxorubicin-treated mice through the involvement of NLRP3 and MyD88-related pathways, resulting in significant improvements in cardiac functions. These findings provides the proof of concept for translational studies designed to reduce adverse cardiovascular outcomes in non-diabetic cancer patients treated with doxorubicin.
Mavacamten reduces left ventricular mechanical dispersion in hypertrophic obstructive cardiomyopathy
Authors: Ozbay B , Venkatesan N , Wong T C , Sade L E
Published: January 2025

Background

Mavacamten, a cardiac myosin inhibitor, reduces actin–myosin cross-bridge formation, has been shown to improve exercise capacity and symptoms in patients with hypertrophic obstructive cardiomyopathy (HOCM). However, its effects on left ventricular (LV) arrhythmogenic substrate remains unknown.

Aim

This study aimed to investigate the effects of mavacamten on LV remodeling and mechanical dispersion (MD).

Method

We consecutively reviewed 32 patients’ echocardiograms before and 2-12 months after mavacamten treatment. Speckle tracking echocardiography was performed, and the MD was calculated as the standard deviation of the time to peak strain of 17 segments. Patients were monitored for life threatening arrythmias (sustained ventricular tachycardia and sudden cardiac arrest).

Results

In 32 patients (mean age 60.5 ± 13.5 years, 11 female) LV outflow tract gradient reduced from 71 (44-125) mmHg to 10 (7-24) mmHg (p<0.001) after mavacamten treatment. We observed significant decrease in LV ejection fraction (66±4% vs 59±5%, p<0.001), LV deformation (global longitudinal strain (GLS); -14.3±3.2% vs -12.5±2.9%, p=0.038) and increase in end-systolic volume index (20±4 ml/m2 vs 26±6 ml/m2, p<0.001). Despite impaired LV contractile function, MD improved significantly (87.1±26.6 ms vs 62.8±14.5 ms, p<0.001). None of the patients experienced life-threatening arrhythmias during the follow-up period (median 8, range 2-21 months), despite the fact that 9% had a history of life-threatening arrhythmias before mavacamten treatment.

Conclusion

Mavacamten appears to improve MD despite decreasing LV contractile function. Further studies are warranted to investigate whether mavacamten is associated with reduced risk of life-threatening arrhythmias in patients with HOCM.
Validity of the left ventricular sphericity index in apical and basal aneurysms
Authors: Tomic S , Veljkovic S , Perunicic A , Djokic O , Radoicic D , Nikolic A , Bojic M
Published: January 2025

Introduction

Left ventricular aneurysm (LVA) correlates with changes in ventricular geometry related to the size and shape of the left ventricle (LV). On echocardiography it presents as global changes in the ventricle with reduced systolic function (ejection fraction - EF). Abnormal remodeling geometry of the ventricle leads to a more spherical shape and the manifestation of the spherity index (SI) as a parameter of abnormal geometric change (SI is the ratio of the short (S) to the long (L) axis of the heart measured from the apical four-chamber view). In healthy individuals and in ischemic dilated cardiomyopathy SI remains constant due to proportional enlargement of S and L.

The aim of this study was to evaluate the value of SI in the presence of apical left ventricular aneurysm (A-LVA) and basal aneurysm (B-LVA) using echocardiography, to determine the parameters that can influence SI, and their significance in daily clinical practice.

Material and Methods

The clinical study included 54 patients with post-infarction LVA (36 men, 18 women). The localization of the LVA was determined by echocardiography. A-LVA was formed near the apex of the LV, while B-LVA was in the basal segments of the LV walls. SI was determined in systole and diastole in the entire population and stratified among patients with A-LVA and B-LVA. LV EF was determined by Simpson's method.

Results

Study included 41 patients with A-LVA and 13 with B-LVA. The average SI value in diastole was 0.55 and in systole 0.47. Patients with A-LVA had an average SI value in diastole of 0.51 and in systole 0.44. Significantly higher SI values were found in the presence of B-LVA, with diastolic SI at 0.65 and systolic SI at 0.57 compared to A-LVA. The reason is that the long axis (L) values of the heart in both diastole and systole are lower in B-LVA compared to A-LVA.

LV EF in patients with A-LVA was 23.95%, and in B-LVA, it was 30.85%, with no significant difference. The difference in absolute values is due to apical aneurysms being larger compared to basal aneurysms, thus more significantly reducing the percentage of functional myocardium.

Conclusion

The results indicate that it is important to differentiate A-LVA and B-LVA by determining SI using echocardiography. SI is higher in B-LVA due to the reduction of the long axis (L). Surgical reconstruction of the left ventricle always addresses the reduction in length (L) compared to the reduction in width (S). Therefore, in surgical reshaping of the LV for B-LVA, it is crucial to maximally preserve the long axis (L) to maintain a more physiological shape.
Early cardiac mechanics abnormalities in patients with mitochondrial diseases
Authors: Lillo R , Meucci M C , Malara S , Primiano G , Servidei S , Lombardo A , Grandinetti M , Massetti M , Lanza G A , Limongelli G , Burzotta F , Graziani F
Published: January 2025

Background

Evidence about early cardiac mechanics abnormalities in patients with mitochondrial diseases (MDs) before overt cardiomyopathy is limited.

Purpose

To investigate whether conventional and advanced echocardiography can unveil signs of early cardiac involvement in MDs.

Methods

In this prospective study, we performed a comparative analysis of conventional and speckle tracking echocardiographic parameters between patients with genetically identified MDs and no overt cardiomyopathy vs controls matched for age, sex and cardiovascular risk factors. The Newcastle mitochondrial disease adult scale (NMDAS) was calculated, using a threshold of >21 as indicator of high disease severity.

Results

We enrolled 24 MDs patients (50% males, mean age 47.2±14.3 years), the most prevalent mutation was the MT-TL1 m.3243A.G (37.5%). In MDs patients all dimensional echocardiographic parameters were similar to controls. Conversely, albeit normal, Tissue Doppler septal systolic (p=0.002) and early diastolic velocities (p=0.016) were significantly lower and E/e’ ratio was higher (p=0.032) in MDs. Moreover, LV-GLS was significantly reduced in MDs as compared to their counterparties (20.2±1.6 vs 22.6±1.5, p<0.001). Similarly, LA reservoir and conduit strain were significantly lower in MDs (31.7±7.0 vs 35.9±6.6, p=0.038; 19.7±5.6 vs 23.1±6.0, p=0.049 respectively), while LA contractile strain was similar between the two groups. Lower values of LV-GLS were observed in patients with NMDAS>21 vs patients with NMDAS≤21 (19.0±1.2 vs 21.0±1.3, p=0.001).

Conclusions

In patients with MDs and no overt cardiomyopathy Tissue Doppler and speckle tracking analysis unveil worse LV systolic and diastolic function indices as compared to controls. Reduced LV-GLS values were found especially in those with worse disease burden.
Unfavorable systemic and coronary hemodynamic profile of left ventricular hypercontractile phenotype in hypertrophic cardiomyopathy
Authors: Wierzbowska-Drabik K , Palinkas E D , D'alfonso M G , Mori F , Del Franco A M , Peteiro Vazquez J , Tesic M , Djordjevic-Dikic A , Re F , Palinkas A , Aguiar Rosa S , Ciampi Q , Pellikka P , Olivotto I , Picano E
Published: January 2025

Background

The left ventricular (LV) hypercontractile phenotype (HP) plays a critical role in hypertrophic cardiomyopathy (HCM) and is usually identified with the left ventricular outflow tract gradient (LVOTG).

Purpose

To assess the systemic and coronary hemodynamic profile associated with HP identified with increased LV elastance (also known as force) at rest in patients with HCM.

Methods

We enrolled 1248 HCM patients (age 50 ± 15 years, 798 males, 64%) with ejection fraction (EF) ≥50%, referred for rest transthoracic echocardiography (TTE) in 14 quality-controlled sites from 7 countries TTE assessment included LVOTG, EF, and LV force (systolic blood pressure + LVOTG/LV end-systolic volume, mmHg/mL). Volumetric echocardiography with Simpson’s method was used to measure EF from end-diastolic volume (EDV) and end-systolic volume (ESV), stroke volume (SV), arterial elastance (AE) and ventricular-arterial coupling (VAC). We also assessed resting peak diastolic coronary flow velocity (D-CFV) in the mid-distal left anterior descending artery in a subset of 275 patients.

Results

EF equaled 68 ± 7%, force = 6.8 ± 5.3 mmHg/ml and LVOTG = 22 ± 28 mmHg. HP was identified as the highest quartile of force (> 7.85 mmHg/ml, mean value= 13.3 ± 7.0). HP showed the lowest SV (46 ± 18 ml) and EDV (61 ± 20 ml), with the highest AE (3.19 ± 1.35 mmHg/ml) and VAC (3.46 ± 1.59) compared to other quartiles (p<0.001) ( see Picture) . D-CFV was not higher in patients with HP (n = 65) compared to those (n = 210) without HP (41± 11 vs 38 ± 14 cm/s, p=ns, but higher in comparison to joint first and second Force quartile (n=122) vs 37 ±14 p =0.0472). Table displays the demografic, clinical and TTE parameters related to HP (Table). In multivariate logistic analysis 4 independent predictors of HP were identified: SBP >130 mmHg with OR 2.5, female sex with OR 5.4, LV EF >70% with OR 6.1 and LVOTG >30 mmHg with the highest OR = 6.3. Conclusion: HCM patients with HP exhibit a distinctive systemic hemodynamic and coronary physiology profile, characterized by low SV, high VAC, and supranormal baseline D-CFV compared to non-HP patients. These findings suggest reduced cardiovascular efficiency and increased myocardial oxygen demand, possibly detrimental over time.
Aorto-mitral angle: an emerging indicator for successful alcohol septal ablation in hypertrophic obstructive cardiomyopathy - a pilot study
Authors: Sosdean R , Pascalau L , Mircea M , Pescariu S A , Voinescu O , Lazar M A , Sturza A , Ionac A , Luca C T , Mornos C
Published: January 2025

Background

Approximately 10-20% of patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA) exhibit a suboptimal response, despite accurate targeting of the septal artery. This suboptimal response may be due to structural and functional factors related to the mitral valve and left ventricular (LV) dimensions. Currently, there is a lack of specific parameters or cutoffs to predict ASA success. The aorto-mitral angle is crucial for predicting systolic anterior motion (SAM) in mitral valve repair surgery, but its relationship with ASA outcomes remains underexplored.

Purpose

This study aims to investigate the relationship between aorto-mitral angle values and the success of alcohol septal ablation, and to assess the impact of this parameter on ASA outcomes.

Methods

The study retrospectively included 23 HOCM patients who underwent ASA in our clinic, with data collected from thorough evaluations conducted before and at least six months after the procedure. The left ventricular outflow tract pressure gradient (LVOT PG) and other standard parameters were measured using transthoracic echocardiography. The aorto-mitral angle was assessed through three-dimensional data acquisition during transoesophageal echocardiography, analyzed offline using specific software (zoom 3D of the mitral valve, MVQ).

Results

Nineteen patients experienced successful ASA, defined as a >50% reduction in LVOT PG compared to baseline, while four patients had suboptimal results. There were no significant differences in baseline LV dimensions, LVOT PG, age, or comorbidities between the groups. The aorto-mitral angle was significantly higher in patients with successful ASA (138.21 ± 7.6 versus 115 ± 9.2 degrees, p<0.001). This angle correlated with the percentage decrease in LVOT PG (R = 0.59, p = 0.02), though the correlation with the absolute decrease was not statistically significant (R = 0.38, p = 0.06). After further validation, the aorto-mitral angle may be useful for predicting ASA success (logistic regression odds ratio 1.37, 95% confidence interval (1.01, 1.86), p = 0.04). Additionally, significant differences were found between redundant anterior mitral leaflet (AML) length, anterior displacement of the coaptation point, and ASA success in this cohort (p = 0.04 for both).

Conclusion

The aorto-mitral angle appears to play a role in the obstruction mechanism of HOCM and could serve as a valuable predictor for ASA success. These findings may prompt further investigation and potential inclusion of this parameter in a prediction model alongside other mitral valve and LV size parameters.
Influence of ROI width in evaluation of regional and global longitudinal strain in patients with hypertrophic cardiomyopathy
Authors: Matsutani H , Izumi C , Amano M , Sakai Y , Kuwano K , Shimada M , Kamioka M , Miyake M
Published: January 2025

Background

Longitudinal strain (LS) is useful in evaluating global and regional left ventricular function in patients with hypertrophic cardiomyopathy (HCM), but it is not fully investigated the influence of the ROI width on LS value in patients showing localized or asymmetrical hypertrophy.

Purpose

The purpose of this study is to evaluate regional and global LS in patients with HCM showing localized or asymmetrical hypertrophy, compared with hypertensive patients with diffuse and symmetrical hypertrophy as control, and to clarify the influence of ROI width on LS value.

Methods

We retrospectively investigated LS in patients with apical hypertrophy (APH), asymmetrical septal hypertrophy (ASH) and hypertension (control group). LS in hypertrophic region (APH: apical 6 segments, ASH: basal and mid septal 4 segments) and global LS (GLS) were compared with control group. LS was measured with uniform ROI width by default (D method) and after manual adjustment of ROI width as covering the whole thickness in the hypertrophic region (A method) (Figure).

Results

LS in hypertrophic region was decreased in patients with APH and ASH compared with control group. LS was decreased in A method than D method in patients with APH (Table).

Conclusions

We should consider the setting of ROI width in evaluating regional myocardial systolic function by LS in patients with HCM showing localized or asymmetrical hypertrophy.

Figure
Sarcomere gene mutations leading to lower myocardial work values in hypertrophic cardiomyopathy
Authors: Takacs H , Racz G , Nagy V , Boda K , Vidacs D , Csanyi B , Hategan L , Borbas J , Kormanyos A , Polestyuk B , Schvartz N , Szili-Torok T , Sepp R
Published: January 2025

Background

Sarcomere gene mutations is hypertrophic cardiomyopathy (HCM) can have prognostic value and role in risk assessment, according to numerous studies. In our previous investigations, we confirmed that echocardiographic parameters of left ventricular (LV) myocardial work (MW) derived from the non-invasive pressure-strain curve were reduced in patients with HCM, especially in the case of clinical features with advanced disease. The aim of our present work was to investigate the MW parameters in genotyped HCM patients.

Patients and Methods

We examined 75 genotyped HCM patients [48 men (64%), age 51±12 years], who underwent standard and 2D-speckle tracking echocardiography. The patients were divided into sarcomere mutation positive (P/LP+, n=32) and mutation negative (P/LP-, n=43) groups based on carrying a pathogenic/probably pathogenic (P/LP) sarcomere gene variant. Later we extended our examination to patients with variants of unknown significance (VUS).

Results

There was no significant difference between the demographic (age, gender, BMI, BSA) and laboratory (troponin T, NTproBNP) parameters of the P/LP+ and P/ LP- groups. Also, no significant difference was found in most echocardiographic parameters (LAV, LAVI, LVmax, EF, SV, SV index, TAPSE) between the two groups, except that the proportion of obstructive patients was higher in the P/LP group (p=0.026) and the resting (p= 0.004) and provoked (p=0.0082) LVOT gradients were higher. Despite of no difference in the GLS value in the two groups (p=0.850), the P/LP+ group had lower global work index [GWI: p=0.0035), global constructive work (GCW: p=0.0006), and global wasted work (GWW: p=0.0098), while global work efficiency (GWE: p=0.485) did not differ. The differences remained even when patients carrying variants of unknown significance (VUS+) were examined in a separate group (GWI: p=0.013; GCW: p=0.001; GWW: p=0.005).

These results indicate that the pathological gene mutation underlying HCM, leads to lower myocardial work values, even with a similar morphological or functional appearance. The latter observation further confirms the possible role of MW parameters in the prognosis of HCM.
a comparative study to evaluate radiation exposure in patent ductus arteriosus device closure by conventional method and echocardiography guided method- an experience from eastern India
Authors: Ghosh S , Majumdar I S H I T A
Published: January 2025

Background

PDA constitutes 5-10% of all congenital heart defects, with a prevalence of symptomatic PDA being 0.5/1000 live births. Percutaneous PDA device closure has the advantage of early discharge and less anesthesia - related complications. However, during the procedure, the operators and patients are exposed to radiation. Use of transthoracic echocardiogram (TTE) for imaging during trans-catheter PDA closure reduces the dose of radiation, complications related to femoral arterial access and procedural time. In our institution we planned to compare the radiation exposure and procedural time of PDA device closure by transthoracic echocardiography with the use of minimal fluoroscopy(case) compared to conventional method(control) in pediatric patients.

Purpose

i)To compare the radiation exposure and procedural time of PDA device closure by transthoracic echocardiography with the use of minimal fluoroscopy(case) to conventional technique(control) in a tertiary care hospital.

ii) To compare the complications between the two groups.

Methods

This was a single-centre prospective randomized case control study. Children between 6 months -12 years with an indication for percutaneous PDA device closure were selected after concsent. A six month post-operative follow up was planned. 106 patients were included in the study from July 2018 to January 2020. The first patient was selected through lottery who underwent the procedure under echocardiographic guidance with minimal fluoroscopy use and thereby every alternate patient was selected as case (n=51). 51 patients underwent closure following the conventional method(control). Each group were selected with comparable age group and other characteristics. 4 patients in the case arm had to undergo aortogram, so excluded from the study.

Results

Patients were equally distributed in both groups. There was statistically significant difference in the procedural time, fluoroscopy time and radiation dose in terms of total kerma, dose area product and dose area product/kg among the two groups, all of them were lower in the echocardiography group compared to fluoroscopy group.The least fluoroscopy time, radiation exposure and procedural time in the echocardiography group were 43 seconds, 1mGy, 20minutes respectively.

Conclusion

In both the groups the patient characteristics, defect size and device used was comparable. The fluoroscopy group had a single case of groin hematoma, managed conservatively. Fluoroscopy time, procedural time and amount of radiation exposure in TTE guided group was significantly less than the control group. In echocardiography group, no contrast was used and all the possible arterial access related complications were easily prevented. Above results show that it is safe and feasible to perform PDA device closure with TTE-guided percutaneous PDA occlusion as compared to conventional method with minimal fluoroscopy exposure.
Marantic endocarditis in patients with malignant disease and stroke: a prospective, observational study.
Authors: Frydas A , Zach V , Schoels M N , Rakhimov K , Schmidt W U H , Kemna C P , Pfaefflin F , Doehner W , Dreger H , Morris D A , Schneider-Reigbert M
Published: January 2025

Background

Non-bacterial thrombotic "marantic" endocarditis (NBTE) is characterized by sterile platelet–fibrin vegetations on normal cardiac valves in patients with malignant disease. Common complications of the disease include cerebrovascular or systemic thromboembolism. Systematic prospective data on this disease is missing. We sought to prospectively investigate prevalence and outcome of marantic endocarditis in patients with active malignancy who present with stroke.

Methods

At our tertiary university center, we prospectively included all patients from 12/2023 to 06/2024 who were admitted with stroke and had active malignant disease. All patients received transthoracic and, if indicated and tolerated, transesophageal echocardiography. Comprehensive interdisciplinary work-up of neurology, infectious diseases, hematology/oncology, and cardiology was performed.

Results

For this preliminary analysis, a total of 8 patients were included. The median age was 62 years, 6 were female. The underlying malignant diseases included carcinoma of the ovaries in two patients, and melanoma, lung carcinoma, breast carcinoma, oropharynx carcinoma, pancreatic carcinoma, carcinoma of the esophagogastric junction, acute myeloid leukemia, and carcinoma of the thyroid gland in one patient each. Three patients (37.5%) had NBTE: one involving the mitral valve, one involving the aortic valve, and one involving both the mitral and aortic valves. At the time of stroke, one of these patients was receiving anticoagulation therapy with apixaban, one with prophylactic doses of enoxaparin. Two of the patients with NBTE were switched to anticoagulation with low-molecular-weight heparin (LMWH) after the diagnosis of NBTE and one of them continued the anticoagulation therapy with apixaban. One patient was switched to rivaroxaban after the resolution of the lesions and showed a re-occurrence in the follow-up visit.

Conclusion

NBTE is common in patients who have active malignant disease and present with stroke which therefore must be included in the list of likely differential diagnoses. Consistent with previously published case reports, we observed another case where NBTE lesions resolved under LMWH therapy and originated and even reoccurred under NOAK therapy.
Low probability of pulmonary hypertension: a novel tricuspid regurgitation velocity threshold
Authors: Sciarrone P , Giannoni A , Santi G , Savonitto G , Chubuchny V , Airo' E , Bauleo C , Monti S , Formichi B , Gentile F , Lund L , Passino C , Emdin M , Manouras A , Stolfo D
Published: January 2025

Background

The diagnosis of pulmonary hypertension (PH) relies on measuring pulmonary artery pressures at right heart catheterization (RHC). Echocardiographic tricuspid regurgitation velocity (TRV) is a screening tool to define PH probability. While latest guidelines reduced RHC threshold for PH diagnosis, TRV thresholds were not. We aimed to update TRV thresholds for PH probability according to the novel RHC criteria.

Methods

Patients undergoing RHC for suspected PH were prospectively enrolled. A retrospective cohort was used for external validation. All patients underwent echocardiography and RHC within 6-hours under stable conditions.

Results

In the derivation cohort (n=400), 85% of patients had PH at RHC. However, only 68% had intermediate or high PH probability with the conventional 280 cm/s TRV threshold (76% sensitivity, 24% false-negative rate). The optimal threshold for low probability was 250 cm/s, with higher sensitivity (90%, 10% false-negative rate). In the validation cohort (n=1,348), 76% of patients had PH. In this cohort, the proposed 250 cm/s low probability threshold was confirmed to hold high sensitivity (97%, 3% false-negative rate).

Conclusions

This large multicenter derivation-validation study supports lowering the TRV threshold from ≤280 to ≤250 cm/s to decrease false-negative rate and missing referral to RHC in patients with suspected PH.

Graphical abstract
Transcatheter treatment of severe mitral regurgitation in high surgical risk patients: analysis of clinical and echocardiographic data from a referral center
Authors: Pinheiro Junior J A , Galuban A C F , Pires C R T , Koroishi J H Y , Holanda L M , Guimaraes L F C , Abizaid A A C , Siqueira D A A
Published: January 2025

Introduction

Mitral regurgitation (MR) is the most common valvular heart disease, affecting 2-3% of the population, with a prevalence of around 10% in individuals over 75 years old. It is a frequent cause of decompensation in patients with heart failure (HF), associated with unfavorable clinical outcomes, including increased morbidity and mortality. Transcatheter mitral valve repair using an edge-to-edge mitral valve leaflet repair technique has become a therapeutic option for patients with severe MR who are considered high surgical risk. Transesophageal echocardiography (TEE) is crucial for determining eligibility, guiding the procedure, monitoring potential complications, and assessing the final result.

Objectives

To analyze data related to etiology (primary, secondary, and mixed), number of clips used, average age, severity of MR, and the final procedure outcome.

Methods

We conducted a descriptive analysis of a series of 43 cases of high surgical risk severe mitral regurgitation from 2019 to 2024 at a referral hospital in São Paulo, indicated for transcatheter treatment by a "heart team". We described the prevalence of etiologies, average age, pre-procedure MR severity, and final echocardiographic outcome. Continuous variables were described as mean and standard deviation.

Results

We analyzed 43 cases of transcatheter mitral valve implantation from 2019 to 2024. One patient died on the first day post-procedure. Of the total cases, 42% had primary MR, 38% secondary MR, and 20% mixed etiology. The average age of the patients was 79.8 years and the number of implanted clips was 1.62 ± 0.72, considering all the cases. A decrease in the average number of clips implanted is observed When analyzed separately by year: in 2019, na average of 2.3±1, and in 2023/2024, 1.8±0.7. All procedures were performed in a catheterization or hybrid room, guided by TEE with the addition of three-dimensional technology. Using a grading scale for MR from mild (1+) to severe (4+), evaluated by TEE, the average after clip implantation was 1.27 ± 0.59. Regarding the mean gradient, the average post-procedure was 3 ± 1.2 mmHg.

Conclusion

The use of the transcatheter mitral valve implantation, following anatomical criteria for mitral valve selection, proved to be an effective and safe therapeutic option for reducing MR in high-risk patients. TEE is an essential tool in patient eligibility, guiding the procedure, evaluating the final result, and identifying potential complications.
The patient's perspective on transesophageal echocardiography - a prospective observational study.
Authors: Sokour A , Spinka F , Schulz M , Dreger H , Morris D A , Schneider-Reigbert M
Published: January 2025

Background

Transesophageal echocardiography (TEE) is a common methodology regularly performed in every echocardiography laboratory. Naturally, the procedure requires inserting the probe into the patient’s esophagus, which can cause worries about the examination. We sought to prospectively investigate how patients feel who are referred for TEE.

Methods

From January until Juli 2024, consecutive patients with indication for TEE were included at our tertiary center for this prospective observational study. Critically ill patients were not included. A questionnaire investigating anxiety and previous TEE experiences was performed before the examination.

Results

A total of 101 patients (54% male) with a mean age of 66 years (range 26-86) were included in this preliminary analysis. Most common indication for TEE was to exclude intracardiac thrombi before ablation therapy (32%) or cardioversion (18%), evaluation of valvular heart disease (32%), search for source of embolism (9%), and suspicion for endocarditis (6%).

Sixty-three patients (62%) had had previous TEE examinations, 83% under sedation. Good past experiences were reported by 71% of those who had been sedated, compared to 64% who had received TEE without sedation. Forty-two patients expressed worries before the procedure, mainly about gagging (n=12), sore throat (n=6), sedation effects (n=7), and death or respiratory arrest (n=5).

Conclusion

In echocardiography, TEE is a common, quick, and low-risk procedure which adds incremental information in numerous diseases. With our data we discovered that patients who are referred for TEE express a diverse range of worries before the examination. Satisfaction with previous examinations was moderate, both in those who had and who had not received sedation. This needs to be addressed by thorough consultation before the procedure, and a calm and professional atmosphere in the examination room.
Impact of obesity when associated with gestational diabetes on fetus heart
Authors: Zairi I , El Bardi M , Msaad H , Echaieb W , Bouzidi H , Mzoughi K , Kraiem S
Published: January 2025

Background

Obesity increases the metabolic effect of diabetes, which has a teratogenic impact on the fetus, including the heart. The aim of this study was to investigate the impact of obesity, when associated with gestational diabetes mellitus (GDM), on fetus’s heart systolic function using conventional fetal echocardiography and speckle-tracking technique.

Methods

This was a prospective mono-centric study. Standard fetal echocardiography and speckle-tracking technique were performed in 43 fetuses of mothers with GDM. Two groups were later compared: fetuses of non-obese women with GDM(G1)(n=25) and those of obese women with GDM(G2)(n=18).

Results

There was no significant difference between the two groups regarding mitral and tricuspid annular plane systolic excursion MAPSE(p=0,757) and TAPSE(p=0,554) or left ventricular ejection fraction(p=0,138). On the other hand, fetuses of women with GDM had a lower left ventricle global longitudinal strain (LV-GLS) (p=0,014; G1:-20,03 ± 0,94%, G2: -19,42 ± 1,08% )

Conclusion

Our study suggests that the association of obesity and GDM may increase fetus’s systolic function impairment demonstrated by using speckle-tracking technique.
Left ventricular global longitudinal strain (LV-GLS) by speckle-tracking echocardiography (STE) predicts appropriate defibrillator therapy in patients with dilated cardiomyopathy (DCM)
Authors: Omran H , Rudolph T , Lucas P , Reil J , Ivannikova M , Sommer P , Friedrichs K , Rudolph V
Published: January 2025

Background

Patients with dilatied cardiomyopathy (DCM) have an increased risk for sudden cardiac death (SCD) which may be prevented by an implantable cardioverter-defibrillator (ICD). Current guidelines set the indication to implant an ICD in DCM patients based on a left ventricular ejection fraction (LVEF) of ≤ 35 %. However, this approach has been questioned by recent research in non-ischemic DCM. Left ventricular global longitudinal strain (LV-GLS) as assessed by speckle-tracking-echocardiography (STE), directly measuring myocardial deformation in the longitudinal dimension, is a new method to characterize global LV function. Data is scarce regarding the diagnostic value of LV-GLS in predicting sudden cardiac death (SCD) events.

Purpose

The aim of this study was to assess whether LV-GLS measurements predict the rate of appropriate ICD therapies in DCM patients better than LVEF.

Methods

Patients with DCM who underwent primary prophylactic ICD implantation from 2011-2016 at our hospital, who had baseline echocardiographic data adequate for STE analysis, and a follow-up duration of > 6 months were included. ICD interrogation data were retrieved from hospital electronic records. Patients with secondary preventive ICD indication were excluded.

Results

115 patients were included (26% females, age: 61.3 ± 12.4 years, LVEF 27.9 ± 5.4%, NYHA functional class 2.7 ± 0.5). During a follow-up time of 35.2 ± 12.3 months 30 patients had at least one appropriate ICD therapy (25 patients had anti-tachycardia pacing (ATP), 8 patients had ICD-shocks). Mean LV-GLS in patients with ICD therapy was significantly worse than in those without ICD therapy (-6.4% vs. -7.8%, p=0.018). Multivariate logistic regression analysis showed that LV-GLS (odds ratio 1.31, 95% confidence interval: 1.07-1.60, p= 0.01) but not LVEF (OR 0.97, p= 0.47) was an independent predictors of appropriate ICD therapy. Using ROC analysis, we found a cut-off value of -9,7% for LV-GLS to best predict ICD therapy over follow-up with a sensitivity of 93.3% sensitivity (c-statistic 0.64).

Conclusion

Our findings indicate that LV-GLS is a useful marker to risk stratify patients with DCM, outperforming the current standard LVEF. LV-GLS should be implemented in the standard echocardiographic assessment of patients with cardiomyopathy.
Left atrial stiffness index by three-dimensional speckle tracking echocardiography:association with exercise capacity in hypertension-related heart failure with preserved ejection fraction patients
Authors: Zhang Q , Wang Y , Yin L X
Published: January 2025

Objective

The purpose of this study was to analyze the characteristics of left atrial function and its utility compared with exercise E/e’(Ex-E/e’). To explore the diagnostic value of three dimensional left atrial stiffness index(3D-LASI) in predicting exercise ability in hypertension(HT) and hypertension-related heart failure with preserved ejection fraction (HT-HFpEF) patients.

Methods

The study population consisted of 62 healthy subjects and 163 patients with hypertension (112 patients in the simple HT group and 51 patients in the HT-HFpEF group) from July 1, 2022 to July 31, 2023. Standard two dimensional and three dimensional ultrasonic images were collected and analyzed, especially the 3D left atrial function were evaluated.Treadmill exercise stress test was performed, and hemodynamic parameters were recorded.To evaluate the diagnostic value of 3D-LASI (E/e’/LASr and E/e’/LASr-c) in HT and HT-HFpEF patients’ exercise capacity.

Results

Compared with the healthy subjects, the HT group’s left atrial volume of different phase increased and strain value decreased (p < 0.05). In HT-HFpEF group, the longitudinal strain of reserve phase(LASr),circumferential strain of reserve and contraction phase(LASr-c,LASct-c) furtherd decreased. The E/e’/LASr and E/e’/LASr-c were significantly correlated with METs (r=-0.498, p < 0.001;r=-0.412, p < 0.001) , through multiple regression model analysis, E/e’/LASr and E/e’/LASr-c remained independent predictors of metabolic equivalents(METs) .The E/e’/LASr and E/e’/LASr-c(AUC, 0.845;AUC,0.809) demonstrated great value for identify HT-HFpEF with reduced exercise capacity by receiver operating characteristic curves and E/e’/LASr had similar diagnostic efficacy compared with Ex-E/e’(AUC: 0.845 vs 0.876, p=0.239 dron test)).

Conclusion

The left atrial stiffness in HT-HFpEF patients can be evaluated by 3D speckle tracking technology, including rapid acquisition of different phase parameters.The E/e’/LASr and E/e’/LASr -c as indicators of atrioventricular compliance plays key role in maintaining left atrial function, and E/e’/LASr is an independent predictor of exercise ability and with similar diagnostic value to Ex-E/e’ in HT-HFpEF patients.

correlation analysis heat map

ROC for identify HT-HFpEF