bluuebunny/crossref_metadata_2025 huggingface dataset:
The response of total isovolumic time (t-IVT) to transcatheter aortic valve implantation (TAVI)
Authors: Tsigkriki L , Koulaouzidis G , Lazaridis P , Leptopoulos E , Grammenos O , Tsaousidis A , Tzalamouras V , Siarkos M , Maligkos G , Giannakopoulou P , Mavrogianni A D , Henein M Y , Zarifis I
Published: January 2025

Background

Total isovolumic time (t-IVT), the period of neither filling nor ejection, reflects global cavity dyssynchrony. It is free of geometric assumptions and has been demonstrated to serve as a reliable predictor of early response to various heart failure management strategies, medical and interventional.

Purpose

The aim of this prospective study is to assess the response of t-IVT to transcatheter aortic valve implantation (TAVI) as well as its relation to other echocardiographic parameters of myocardial function.

Methods

This is a single-center prospective study, which included patients with symptomatic, severe aortic stenosis (AS) who underwent TAVI. Echocardiographic myocardial function parameters included LV ejection fraction (EF), Tei-index and t-IVT and were assessed at three occasions; at baseline; within one month of TAVI and 3 months after procedure.

Results

The studied population consisted of 35 consecutive (81.6 ± 5.4 years, 19 males) patients. No deaths or major cardiovascular events were reported during the study period of 3 months after the TAVI. Seven (7) patients had LV EF ≤45%. After TAVI LV EF increased (from 51.7 ± 6.6 to 53.7 ± 5.6%; p=0.008), while Tei-index remained normal (from 0.33 ± 0.09 to 0.39 ± 0.06, p=0.02). Likewise, t-IVT shortened (from 9.1 ± 4.7 to 6.8 ± 4.8 s/min, p=0.005). Neither E/A (0.93 ±0.43 vs.0.94± 0.47, p=0.9) nor E/E’ (18±10.6 vs. 17.2± 8.7, p= 0.6) demonstrated any significant change. Finally, the BNP levels were reduced after TAVI (from 408.9 ± 497.9 to 289.5 ±276.9, p=0.03). An increase in LV EF>10% was observed in 17 patients in whom there was a significantly profound fall in t-IVT compared to the rest (36.3 ±16.2 vs. 24±12.2, p=0.001).

Conclusion

In patients with severe AS, t-IVT is prolonged particularly in those with worse LV EF. The significant recovery of both markers reflect better procedure related systolic and synchronous function recovery.
Discriminative power of dobutamine echocardiography in patients with discordant low gradient aortic stenosis and preserved left ventricular ejection fraction.
Authors: Galli E , Le Ven F , Coisne A , Bernard A , Le Pabic E , Donal E
Published: January 2025

Aims

to explore the value of dobutamine stress-echocardiography (DSE) to identify severe aortic stenosis (AS) in patients with discordant low-gradient AS and preserved left ventricular ejection fraction (LVEF>50%).

Methods

Among 52 patients (age 79±7 years; males 46%, mean aortic gradient: 31±5 mmHg) with low gradient AS stenosis and preserved LVEF prospectively enrolled in the ROTAS trial, 42 underwent both DSE and CT aortic calcium score.

An aortic calcium score > 1200 AU in women and > 2000 AU in men was used as a referral limit to identify severe AS. The Youden method was used to identify the best cut-off rest and stress echocardiography aortic parameters able to predict AS severity.

Results

In the overall population, DSE-parameters such as aortic valve area (AVA), indexed AVA (AVAi), aortic maximal velocity (AVMax), mean aortic gradient (MAG) and projected AVA (AVAproj) were modest predictors of AS severity

Limiting the analysis to patients with stroke volume index < 35 ml/m², a DSE AVMax> 4.5 m/sec was a fair predictor of AS severity (AUC 0.73, Se 60%, Sp 95%, PPV 86%, NPV 81%, accuracy 82%) (Table1).

Conclusions

in patients with discordant low-gradient AS and preserved LVEF, echo-derived parameters have a modest predictive value for the detection of severe AS. A slightly better performance is observed when limiting the analysis to patients with low-flow.
Hemodynamic forces assessment in severe aortic stenosis undergoing transcatheter aortic valve intervention
Authors: Angotti D , Monosilio S , Cimino S , Netti L , Ciuffreda A , Tocci M , Improta R , Di Pietro G , Mancone M , Vizza C D , Maestrini V
Published: January 2025

Background

Estimated hemodynamic forces (HDFs) are a novel and validated marker of cardiac function evaluation computed by standard echocardiography. They have been demonstrated to be altered in many cardiac diseases, such as heart failure. However, their application in valvular disease is still not completely known.

Aim

to analyze left ventricular (LV) HDFs in patients with severe aortic stenosis before and immediately after transcatheter aortic valve implantation to reveal whether cardiac changes occur early after the procedure.

Methods

All the patients with severe aortic stenosis referred to ourutively enrolled. Transthoracic echocardiography (TTE) was performed before and early after the procedure (within five days). Standard TTE parameters for volume dimension and function were collected along with peak and mean aortic gradients and aortic valve area. TTE cine loops in 3-2 and 4 chambers were analyzed offline with a dedicated speckle tracking echocardiography (STE) software to compute global longitudinal strain (GLS) and HDFs using LV endocardial displacement and the estimated mitral and aortic valve areas as input. HDFs were computed during the entire cardiac cycle, in systole and diastole, in their two main directions: apex-to-base (AB) and lateral-septal (LS). The LS over AB ratio was also calculated, representing HDFs’ distribution into the LV. HDFs were normalized with LV volumes and expressed as a percentage of the force of gravity.

Results

31 patients undergoing TAVI were enrolled (mean age 82 years ± 7, 45 % females, Euroscore II 4.2% ± 2.1, 71% history of CAD). Baseline standard and advanced TTE parameters are described in the table. After the procedure, no significant changes in ejection fraction (55±9 vs. 57±10, p=0.105) were observed, while a trend in GLS improvement was observed even without statistical significance (-16.6±9.1 vs -19.1±5.8, p=0.63). HDFs in the entire cycle showed a significant improvement in terms of magnitude, apical-base (p=0.08) and lateral septal (p=0.01), but no significant changes in the LS/AB ratio were observed, even if there was a slight reduction (p=0.670).

A slight improvement in HDFs AB and LS and a reduction in LS/AB ratios were observed in both systole and diastole, even if they were not statistically significant (Table).

Conclusions

Preliminary data suggest that HDFs by TTE, representing advanced LV function evaluation, showed a trend in improvement after acute pressure unloading in TAVI patients. A greater cohort is needed to expand these data.

Figure 1

Table 1
Long-term temporal and seasonal trends of infective endocarditis
Authors: Pereira Mateus C , Gerardo F , Miranda I , Sarmento M , Lima Lopes J , Passos M , Bicho Augusto J
Published: January 2025

Background

Over the past two decades, the epidemiology of infective endocarditis (IE) has changed significantly with the increase of life expectancy, use of cardiac implantable devices, and more invasive procedures. There is an ongoing shift in the incidence of IE, but a temporal/seasonal association with specific pathogens is yet to be investigated.

Aims

In this study, we aimed to assess (1) whether there is a temporal trend / increase in IE incidence in recent years, and (2) if there is a seasonality among specific IE-related pathogens.

Methods

We conducted a single center retrospective study of all consecutive patients in a 6-year period between 2017 and 2022, with a diagnosis of definite infective endocarditis as assessed by the modified Duke criteria. All electronic medical records were reviewed for demographics, blood cultures dates and results, and echocardiographic results were analyzed. The blood cultures collection date was used to define the time of the year for IE. Seasons were defined according to the northern hemisphere as Winter (January to March), Spring (April to June), Summer (July to September) and Autumn (October to December). If blood cultures were negative, the date of the first echocardiography with signs of infective endocarditis was noted.

Results

A total of 103 cases of IE were identified over a 6-year period. Mean age of IE patients was 70±13 years, 31.1% were female (n=32). No significant difference was found over the years. Overall, 76.7% had one isolated pathogen (n=79), 3.9% had 2 different pathogens (n=4), and 19.4% had persistent negative blood cultures (n=20). The most predominant infective agent was Streptococcus species (30.1% of cases, n=31), followed by Staphylococcus species (29.1%, n=30) and Enterococcus species (18.4%, n=19). The most affected valve was native aortic valve (35.9%, n=37), followed by native mitral valve (30.1%, n=31) and biological prosthetic aortic valve (17.5%, n=18). Summer had the fewer cases of IEs (18.4%), while Spring is the season with more IEs (32.0%). Negative blood cultures were more frequent in the Spring (24.2%). In Autumn, the proportion of Staphylococcus IE increases to 36% of all infections in this season. The most frequent pathogen in Winter and Spring is Streptococcus, representing 34.6% and 36.4% of IEs in these seasons.

Conclusion

In our population, there was no significant increase in the incidence of IEs over the years. However, there was a seasonal trend both in frequency and in specific pathogens: Summer had fewer IEs and Spring was the season with the highest frequency; Streptococcus is the most frequent pathogen in both Winter and Spring. These results may not represent the reality nationwide, and further epidemiological studies would be necessary to establish a trend.
prognostic value of biohumoral markers and echocardiography images in infective endocarditis
Authors: Jocic I , Cojocaru N , Stefanescu G L , Tudose L A , Benza V , Rus H , Bobescu E , Covaciu A
Published: January 2025

Introduction

The incidence of infective endocarditis (IE) has risen due to an increasing at-risk population and improved diagnosis through the widespread use of imaging techniques. With the surge in COVID-19 cases during the pandemic, there have been more frequent reports of patients being diagnosed with IE, likely due to factors such as immunosuppressive therapies and the use of central venous or urinary catheters.

Purpose

To analyze the prognostic value of biohumoral markers and valvular impairement assessed by echocardiography.

Methods

We conducted a retrospective observational study involving 29 patients diagnosed with IE who were admitted to our department in 2021. During hospitalization, we monitored and analyzed various biological parameters, including blood count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), serum creatinine and blood cultures. We also interpreted findings from transthoracic and transesophageal echocardiography.

Results

Most patients were presented with signs of inflammatory syndrome: leukocytosis upon admission in 22 patients (75.8%), elevated CRP in 28 patients (96.5%), ESR in 27 patients (93.1%), and procalcitonin in 6 patients (20.6%). Our analysis also included biomarker parameters with prognostic significance in IE: anemia was present in 22 patients (75.8%), while thrombocytopenia was observed in 11 patients (37.9%). Renal impairment was noted in 11 patients (37.9%). Among the pathogens identified Staphylococcus spp. was detected in 11 patients (37.93%), Streptococcus spp. in 5 patients (17.24%), Enterococcus spp. in 2 patients (6.89%), Acinetobacter spp. in 1 patient (3.44%), and Escherichia coli in 1 patient (3.44%). A notable proportion of cases (31.03% - 9 patients) had negative blood cultures, contrasting with findings from other registries. Vegetations were predominantly localized on the aortic valve in 15 patients (51.72%), followed by the mitral valve in 6 patients (20.68%). Less common locations included prosthetic heart valves in 5 patients (17.24%) and the tricuspid valve in 3 patients (10.34%). Among valvular complications, valve abscesses were most frequently observed in 6 patients (20.6%), followed by valve ruptures in 5 patients (17.2%), and valvular pseudoaneurysms in 2 patients (6.8%).

Conclusions

CRP was the most sensitive inflammation marker for assessing infection severity, while the most relevant prognostic biomarkers were hemoglobin, platelet count, and serum creatinine. Diagnosing this condition required complex analyses, as a significant percentage of patients presented with negative blood cultures. Staphylococcus spp. was the most identified microorganism. The most frequent infection sites were the native aortic valve, followed by the native mitral valve. The most common local complications included valve abscesses and valve ruptures.
Prevalence and gender distribution of mitral annular calcification and associated mitral valve dysfunction across age groups: a retrospective analysis
Authors: Khalil A M , Albadarin F , Khalil M E
Published: January 2025

Background

Mitral Annular Calcification (MAC) is a significant predictor of cardiovascular events and mitral valve dysfunctions (MVD), including mitral regurgitation and mitral stenosis. This study investigates the prevalence of MAC and its severity across different age groups and genders, and examines its association with MVD in a single tertiary care center.

Methods

A retrospective analysis was conducted on an echocardiography database of 48,912 consecutive patients. The prevalence of MAC, including both any MAC and moderate to severe MAC was assessed. Patients were categorized into different age groups: <55 years, 55-65 years, 66-75 years, and >75 years. The study also analyzed the prevalence of MVD in these patients and examined gender differences. Chi-square tests were used to evaluate statistical significance in gender and age group differences in association with MVD.

Results

The overall prevalence of any MAC was 12.5% (6,104), while moderate or severe MAC was observed in 2.2% (1,104) of the patients. When stratified by age, the prevalence of any MAC was 3% in patients <55 years, 15.0% in patients 55-65 years, 28.6% in patients 66-75 years, and 40.9% in patients >75 years. The prevalence of moderate or severe MAC followed a similar trend, with 0.2%, 1.9%, 5.5%, and 10.7% in the respective age groups. Gender distribution analysis revealed a significant female predominance among patients with moderate or severe MAC (59.5% vs. 40.5%), p < 0.0001. Patients with moderate or severe mitral annular calcification (MAC) had a more than four-fold increased risk of mitral valve disease (MVD) compared to those with mild MAC (57.9% vs. 13.1%, p < 0.0001).Age group was not a significant factor in MVD prevalence.

Conclusion

The age-related prevalence of mitral annular calcification (MAC), especially in older women, represents a significant clinical concern given its association with increased risk of mitral valve disease (MVD). This highlights the importance of vigilant MAC screening and proactive MVD management in this population. Future research should focus on identifying modifiable risk factors and developing effective screening strategies to mitigate the progression of MAC and its associated valvular complications.
Guideline adherence to echocardiographic monitoring of aortic stenosis
Authors: Donisan T , Balanescu D , Gochanour B R , Scott C G , Pislaru S V , Nkomo V T , Kane G C , Thaden J J
Published: January 2025

Background/Introduction

Close monitoring of aortic stenosis (AS) by follow-up echocardiography is recommended by all Cardiology and Imaging Societies’ guidelines. Whether these guidelines are strictly followed is unknown.

Purpose

We aimed to describe our institution’s practice patterns for echocardiographic monitoring in patients with aortic sclerosis (AScl) and AS of any severity.

Methods

Adult patients residing in our institution’s county with an echocardiographic diagnosis of AScl or AS between 01/2005-01/2022 were identified and classified into 4 groups: AScl, mild AS, moderate AS, or severe AS, at each echocardiogram during the study timeframe. Kaplan Meier analyses were used to evaluate the composite outcome, the occurrence of follow-up echocardiogram or death. Patients were censored at the time of aortic valve replacement/repair, heart transplant, or last clinical follow-up. Guideline follow-up was considered appropriate when the primary outcome occurred by 5 years (AScl/mild AS), 2 years (moderate AS), and 1 year (severe AS).

Results

A total of 23,726 echocardiograms from 9,578 unique patients were included. At index echocardiogram, median patient age was 74 years (IQR 65-82) and 4,806 (50.2%) were women. AScl was observed in 7,358 (76.8%) cases, mild AS in 1,442 (15.1%) cases, moderate AS in 479 (5%), and severe AS in 301 (3.1%) cases. Rates of composite outcome achievement by the end of the guideline-recommended interval were 81%, 90%, 80%, and 72% in AScl, mild, moderate, and severe AS, respectively. Rates for men were 83%, 92%, 82%, and 75% in these groups, while rates for women were 78%, 88%, 78%, and 68%, respectively (Figure 1). Follow-up rates were similar before and after 2012 (when transcatheter aortic valve replacement was approved for treatment of severe AS in high-risk surgical patients in the USA). Follow-up rates were higher in patients managed by cardiovascular providers compared to non-cardiovascular providers (Figure 2).

Conclusion

Depending on disease severity, between one fourth and one tenth of patients remained alive and unfollowed at the end of their guideline-recommended surveillance interval. There is significant variability in echocardiogram monitoring based on sex and referring provider specialty.

Figure 1

Figure 2
Exploring the heart's shape: the sphericity index in myocarditis patients and its prognostic significance
Authors: Ayduk Govdeli E , Yavuz M L , Dursun M , Karaca Ozer P
Published: January 2025

Objectives

Myocarditis, a leading cause of non-ischemic dilated cardiomyopathy, has increased in prevalence during the COVID-19 pandemic1. Although imaging is vital for diagnosing myocarditis, its prognostic value is not well understood2,3. The sphericity index, which assesses the roundness of the left ventricle, may help in both diagnosis and prognosis of various diseases4–6. This study examines the prognostic significance of the sphericity index in myocarditis patients.

Methods

We analyzed clinical and imaging data from 30 myocarditis patients diagnosed using the Revised Lake Louise criteria and a control group of 20 age- and gender-matched individuals. The primary outcomes were all-cause mortality, sudden cardiac death, heart failure hospitalization, and ventricular arrhythmia. We compared CMR and TTE parameters, including the CMR-derived sphericity index, between groups and used regression analysis to identify factors influencing outcomes.

Results

The mean age was 39.28 ± 15.2 years, with 72% of patients being male. LVEF values from TTE and CMR were significantly lower in the primary outcome group, while the sphericity index was significantly higher (0.51 ± 0.1 vs 0. 3 ± 0.1 and 0.39 ± 0.1, p-value 0.001). The sphericity index showed good intra- and interobserver reliability (ICC 0.95 and 0.88, respectively) and sphericity index >0.4 predicted primary outcomes with 88.89% sensitivity and 71.43% specificity (AUC 0.825, p<0.001). Regression analysis identified the sphericity index as a significant prognostic factor (OR 6.987, p=0.012).

Conclusion

The CMR-derived sphericity index is a straightforward imaging parameter that plays a crucial role in predicting the prognosis of myocarditis.

Measurement of sphericity index

Comparison of sphericity index
Clonal hematopoiesis of indeterminate potential and clinical characteristics in hypertrophic cardiomyopathy
Authors: Kim S , Moon I , Kong M , Park H , Choi H , Seo J , Seo H , Cho Y , Lee N
Published: January 2025

Background

Hypertrophic cardiomyopathy (HCM) is a genetic disorder that is commonly diagnosed at a young age, often in individuals in their 20s. However, with increasing life expectancy and advancements in diagnostic techniques, the incidence of HCM being diagnosed in older individuals is rising. Clonal Hematopoiesis of Indeterminate Potential (CHIP) is a common age-related condition resulting from the expansion of hematopoietic stem cells due to mutations.

Purpose

In this study, we analyzed the correlation between HCM and CHIP and their clinical characteristics.

Methods

A study was conducted on 66 HCM patients recruited from a tertiary hospital in Korea, from November 2021 to January 2024. The patients' demographic data, echocardiographic parameters and HCMP patterns were collected. The HCM patterns were analyzed based on Helmy's classification, and Pattern 4 was classified as Pure apical. Furthermore, the genomic DNA related to HCM in those patients was extracted and sequenced. Analysis for Clonal Hematopoiesis of Indeterminate Potential (CHIP) mutation was also conducted.

Results

CHIP mutation analysis was performed on 66 patients, and mutation was detected in 31 of them. The most common variant was DNMT3A(33%), followed by TET2 and ASXL. Compared to CHIP (-) patients, CHIP (+) patients were significantly older on average (60.31±10.3 vs 67.1±9.3, P-value=0.07) and had a significantly higher average age at diagnosis(55.49±12.1 vs 61.06±10.1, P-value=0.049). Additionally, they had a significantly lower BMI(26.1±3.2 vs 24.5±3.0, p value=0.037) and higher prior stroke(5.7% vs 25.8%, P-value=0.037). In echocardiographic findings, the deceleration time(DT) was significantly shorter(223.7±59.8 vs 193.9±44.4, P-value=0.027) in CHIP (+) patients. Although a higher proportion of CHIP (+) patients had the Pure apical type compared to CHIP (-) patients, this difference was not statistically significant (34.3% vs 54.8%, P-value 0.093). Based on genomic DNA analysis, patients were divided into those with Pathogenic/Likely Pathogenic (P/LP) variants and those without. Among P/LP(-) patients, groups were further divided based on the presence or absence of CHIP mutation. Analyzing age and age at diagnosis among these three groups revealed no significant differences.

Conclusions

CHIP mutations exhibit a prevalence of approximately 10% in individuals over the age of 70. In our pilot study, CHIP (+) was found in 31 out of 66 patients (47%), which is a higher proportion than in the general population. The CHIP (+) group was, on average, older and had an older age at diagnosis. They also had a higher incidence of stroke, shorter Deceleration Time, and lower BMI. While the analysis of HCM patterns showed that the Pure apical type was more common in the CHIP (+) group, this difference was not statistically significant.

Characteristics of HCM patients
The cardiac myosin inhibitor mavacamten reduces even extreme left ventricular outflow gradient in obstructive hypertrophic cardiomyopathy already after one week of treatment
Authors: Nagy V , Racz G , Takacs H , Polestyuk B , Schvartz N , Borbas J , Kormanyos A , Vidacs L D , Szili-Torok T , Sepp R
Published: January 2025

Introduction

Mavacamten is a selective, allosteric and reversible cardiac myosin inhibitor indicated for the treatment of symptomatic (NYHA II-III class) adult patients with obstructive [≥ 50 mmHg resting or provokable left ventricular outflow tract (LVOT) peak gradient] hypertrophic cardiomyopathy (HOCM).

Patients and Methods

Ten patients with HOCM [5 men (50%), mean age: 57±11 years) were treated with mavacamten. In 9 patients the resting or provoked gradient was >100 Hgmm. In addition to recording the main demographic, clinical parameters, complete standard and 2D-speckle tracking echocardiographic examination was performed in the patients after 1 week (1W) and 16 weeks (16W) of treatment.

Results

After 1W from initiation of mavacamten therapy, the resting peak LVOT gradient decreased by an average of -38 mmHg, from 113±36 mmHg to 75±36 mmHg (p=0.0028); which decreased further at 16W (mean difference -89 Hgmm, p=0.0002). The LVOT gradient provoked by the Valsalva maneuver decreased by -49 mmHg at 1W, from 150±43 mmHg to 107±50 mmHg (p=0.001), which further decreased at 16W (mean difference -107 Hgmm, p=0,0001). As the LVOT gradient decreased, patients' NTpBNP levels decreased at 1W by -690 pg/ml (p=0,0244), from 1270 (IQR: 636-2247) pg/ml to 756 (IQR: 377-1343) pg/ml, which further decreased at 16W (mean difference: -1103 pg/ml; p=0,0078). The ejection fraction and global longitudinal strain remained unchanged at 1W (EF: +0,7 %; p=0,6537; GLS: +0,5%; p=0.4303) and at 16W (EF: -2%; p=0.4499; GLS: 0%; p=0.9885). As the gradient decreased, the global work index and global constitutive work decreased at 1W (GWI: 2026±365 vs. 1675±382 mmHg%; p=0.0009; GCW: 2618±395 vs. 2091±468 mmHg%; p=0.0062) and at 16W (mean difference, GWI: : -406mmHg%; p=0,0062; GCW: -572 mmHg%; p=0,0018). Left atrial volume values showed a favorable regression trend at 1W (LAV: 137±30 vs. 124±25 ml; p=0.1513; LAVI: 71±13 vs. 64±12 ml/m2; p=0.1528) which became significant at 16W (mean difference, LAV: -35 ml; p=0,01; LAVI: -17 ml/m2, p=0,0092).

Conclusion

The direct myosin inhibitor mavacamten effectively reduces even extreme (>100 Hgmm) LVOTO gradients and has a beneficial effect on other structural and functional cardiac parameters. It has an effect even in the short term.
Right heart morphology and function in patients with severe aortic stenosis and cardiac amyloidosis
Authors: Pollak M , Wrede-Wihl K , Soekmen S , Huscher D , Hahn K , Knebel F , Messroghli D , Mattig I
Published: January 2025

Background

Additional cardiac amyloidosis (CA) in severe aortic stenosis (AS) is prevalent in around 8% of AS patients and leads to increased morbidity and mortality. Since both conditions cause comparable symptoms and echocardiographic characteristics of the left ventricle, such as apical sparing and left ventricular wall thickening, diagnosis of CA is challenging in clinical practice.

Purpose

The present substudy of the SAVER trial aims to compare right heart morphology and function in AS patients with and without additional CA.

Methods

From 2020 to 2023, AS patients planned for surgical (SAVR) or transcatheter aortic valve replacement (TAVR) with complete echocardiography of the right heart were enrolled in the SAVER study. Transthoracic echocardiography was performed during AS evaluation prior to SAVR or TAVR and, in case of suspected CA, patients underwent further diagnostics including bone scan or MRI. In the present subanalysis, we compared right heart morphology and function of AS patients with and without additional CA as confirmed by bone scan or MRI.

Results

A total of 28 AS patients were analyzed, including 13 patients with additional CA. The median age was 81±6 years, 75% of patients were male, and 96% were treated with TAVR. Left ventricular wall thickness was comparable between AS patients with and without CA. Regarding right heart morphology and function, AS patients with CA presented a tendency to larger right atrial and ventricular dimension (right atrial area: AS with CA 22 [12-32] mm² vs. AS 17 [8-26] mm²; right ventricular diameter basal: AS with CA 42 [32-52] mm vs. AS 38 [29-47] mm) and a reduced right ventricular function measured by right ventricular fractional area change (AS with CA 37±10% vs. AS 46±11%), right ventricular global (AS with CA -15±6% vs. AS -22±6%) and free wall strain (AS with CA -18±7% vs. AS -19±5%). Right ventricular wall thickness was comparable between both groups and reached 5±1mm. Further echocardiographic parameters are listed in Table 1.

Conclusion

AS patients with additional CA presented a tendency towards reduced right ventricular function and a more dilated right heart compared to AS patients without CA. These parameters may help to differentiate between both conditions in clinical practice.
Prognosis and clinical features according to types of hypertrophic cardiomyopathy
Authors: Kim S , Moon I , Kong M , Park H , Choi H , Seo H , Seo J , Cho Y , Lee N
Published: January 2025

Introduction

Hypertrophic cardiomyopathy (HCMP) is a condition characterized by hypertrophy of the myocardium, which can be classified into types based on the location of the hypertrophy. Among these, the most common type is the group with septal hypertrophy. However, prognosis and clinical features according to the type are not well known.

Method

This study was conducted on 137 patients with HCMP from March 2016 to August 2023. Their echocardiographic findings and demographic features were retrospectively collected, and Single photon emission computed tomography(SPECT) and clinical outcomes were also analyzed. The types of HCMP were classified based on Helmy's classification: basal septal hypertrophy alone (Type I), hypertrophy of the septum and adjacent segments sparing the apex (Type II), apical hypertrophy with hypertrophy of other segments (Type III), and apical hypertrophy alone (Type IV). Additionally, the clinical outcomes, including mortality and cardiovascular hospitalization rates, were analyzed by dividing them into Type I and other types (II~IV).

Results

The prevalence of type I, II, III, and IV was 23.3% (n = 32), 0% (n = 0), 30.6% (n = 42) and 46% (n = 63). The patients were divided into two groups as septal HCMP (Group I) and non septal HCMP (Group II), with more patients in Group II (n=105, 76.6%) than in Group I (n=35, 23.3%). Mean age, systolic blood pressure, heart rate and body mass index were similar between two groups. In the subgroup analysis of echocardiographic parameter, left ventricular mass (LVM) and relative wall thickness (RWT) were significantly lower in Type IV compared to the other types. In contrast, there was no significant difference between Type I and Type III. In the strain analysis, the global strain values of Type III were significantly lower. (Type I vs. Type III vs. Type IV; -14.7 ± 3.7 vs. -11.1 ± 3.0 vs. -14.2 ± 4.0; p<0.01). Analysis of LV perfusion scores using SPECT showed that cardiac perfusion during stress compared to rest was significantly more impaired in Type III than Type I (p=0.03). In terms of clinical outcomes, mortality was higher in the order of Type I, III, and IV. However, there was no significant difference between Type I and Type III compared to Type IV. Regarding hospitalization, there were no significant differences between the types.

Conclusion

Patients with non-septal type HCMP accounted for a significant proportion of all HCMP cases. Non-septal types showed differences in echocardiographic parameters and perfusion compared to the septal type. Although the septal type is known to have a worse prognosis, this study did not find a significant difference in hospitalization rates. Further research is warranted.
Impact of global longitudinal strain on long-term survival and transplant-free survival in fontan patients
Authors: Roesner A , Diab S G , Friedberg M K , Lui G K
Published: January 2025

Background

Patients with single-ventricle physiology undergoing Fontan operations face a high risk of morbidity and mortality. Classic-pattern dyssynchrony (CPD) and protein-losing enteropathy (PLE) have been established as significant predictors of adverse outcomes in these patients. However, the role of global longitudinal strain (GLS) as an independent predictor of outcomes is less clear, particularly when patients with CPD and PLE are excluded from analyses.

Purpose

This study aims to evaluate the predictive value of GLS for mortality and transplantation in Fontan patients, in addition to CPD and PLE. Furthermore, we intended to enhance the understanding of GLS as a potential tool for risk stratification and management in this high-risk population, thereby improving their long-term, transplant-free survival.

Methods

A retrospective cohort study was conducted involving 132 Fontan operated patients. Echocardiographic data, including GLS, were collected and analyzed using speckle tracking derived strain analysis. The primary endpoint was transplant-free survival.

Results

In this retrospective cohort study of 132 Fontan patients, we identified 15 patients with classic-pattern dyssynchrony (CPD), and 29 with protein-losing enteropathy (PLE). among all other patients we identified 37 with moderately reduced global longitudinal strain (GLS <-8% ≥-16%), 18 with highly reduced GLS (≥-8%) and 33 individuals with GLS <-16%.

Multivariate Cox regression analysis demonstrated that moderately reduced GLS indicated increased risk at a hazard ratio (HR) of 5.8, with a 95% confidence interval (CI) of 1.27 to 26.5 and a p-value of 0.023, for predicting mortality or transplantation highly reduced GLS had an HR of 10.3 (95% CI: 2.18 -48.6 p=0.003). This predictive power was comparable to CPD, which had an HR of 11.5 (95% CI: 2.39 -55.6, p=0.002) and PLE, with an HR of 14.9 (95% CI: 3.32-66.4, p<0.001).

Conclusion

Low GLS is a powerful independent predictor of long-term Tx free survival in Fontan patients, in addition to CPD and PLE. These findings underscore the importance of incorporating GLS assessment in the routine follow-up of Fontan patients to identify high-risk individuals who may benefit from early treatment. Further research is warranted to explore the underlying mechanisms and potential therapeutic strategies to improve outcomes in this vulnerable population.

Figure 1: Survival Function for PLE (Protein losing enteropati), CPD (Classic pattern dyssynchrony) and Low and moderately reduced GLS (Global longitudinal strain) compared to the General Fontan Group (all Fontan patients without any of these risk factors).

Figure 2: Overview over Death/Tx in dependency of Age, and the different risk factors like PLE (Protein losing enteropati), CPD (Classic pattern dyssynchrony) and Longitudinal Strain. Survivors are circles, patients who died or were transplanted are marked as triangles.

Figure 1

Figure 2
Descriptive analysis of portal vein flow variations in patients with tetralogy of Fallot
Authors: Lozano-Edo S , Calvo-Asensio M , Buendia-Fuentes F , Rodriguez-Serrano M , Osa-Saez A , Martinez-Dolz L , Rueda-Soriano J , Aguero J
Published: January 2025

Background and purpose

Patients with repaired Tetralogy of Fallot (TOF) develop significant pulmonary regurgitation (PR) as a main sequel in the adulthood, leading to right ventricular (RV) dilatation and dysfunction.

Our objective was to evaluate in adult patients with repaired TOF, the differences in portal venous flow pulsatility (PVFP) compared to controls without structural heart disease, and the relationship between PVFP with the severity of PR and tricuspid regurgitation (TR), as well as parameters of right chamber remodeling and inferior vena cava (IVC) dilation.

Methods

Single center, observational study. Sixty-seven patients with repaired TOF (prosthetic pulmonary valve: n=27) were included. TOF patients were compared with a control group (n=74). PVFP was assessed using maximum (Vmax) and minimum (Vmin) Doppler velocities in portal vein flow: (Vmax-Vmin)/Vmax.

Results

There were no differences in age and sex between the two groups. A higher PVFP was observed in the group of patients with TOF compared to the control group (0.4 vs 0.22, p < 0.001; Figure 1A). Pulmonary valve intervention in adulthood was non-significantly associated with an increase in PVFP (intervention vs no intervention 0.46 vs 0.37, p=0.1, Figure 1B).

Regarding PR severity, we observed that the 33 patients with severe PR showed a trend to higher PVFP values in relation to patients with moderate PI (n=5); 0.37 vs 0.26, p=0.06 (Figure 1C). No relationship was observed between PVFP and the severity of TR: absence of TR (n=9) 0.36, mild TR (n=49) 0.41, moderate TR (n=7) 0.45, severe TR (n=2) 0.43, p=0.84 (Figure 1D).

In patients with TOF, PVFP was not correlated with right atrial area (R=0.02), RV end-diastolic area (R=0.23), RV strain (R=0.36), or with IVC dimensions (R=-0.1).

Conclusions

In this descriptive study, we identified an altered pattern of portal venous flow in patients with repaired TOF compared to subjects without structural heart disease. This increase in PVFP did not show an evident association with right valvular heart disease associated with TOF, nor with other markers of volume overload, suggesting the influence of multiple determining factors and a potential incremental value over standard measurements in these patients.
The efficacy of party balloon inflation maneuver to detect masked patent foramen ovale
Authors: Horita R , Kasai Y , Otake R , Shitan H , Hachinohe D , Fujita T
Published: January 2025

Background

The efficacy of transcatheter closure for patent foramen ovale (PFO) , which is considered a cause of cerebral infarction, has been reported. PFO often becomes apparent only during the Valsalva maneuver, making its diagnosis sometimes challenging. As a method to overcome inadequate Valsalva maneuvers, cases using the party balloon inflation maneuver have been reported. However, there are no verified reports on its actual effectiveness in daily clinical practice.

Purpose

To investigate the efficacy of party balloon inflation maneuver for revealing " masked " PFO.

Methods

We conducted a retrospective study to evaluate the efficacy of party balloon inflation maneuver during microbubble test transthoracic echocardiography in our hospital cases, which were diagnosed with embolic stroke of undetermined source and underwent the microbubble test with party balloon maneuver inflation between June 2023 and June 2024.

Results

A total of 74 patients（age 67 ± 15 years, 41 female) underwent microbubble test with party balloon inflation maneuver and were included. The average Rope score was 3.4 ± 1.9 because of high average age of patients.

The party balloon inflation maneuver increased the grade of right to left shunt in 12 cases, leading to a diagnosis of a large right-to-left shunt.

Moreover, the diagnosis rate of PFO and presence of the Eustachian valve with party balloon inflation maneuver were significantly higher than the conventional Valsalva maneuver with abdominal compression (diagnosis rate: 83.3 % vs 32.2 % ; p < 0.01 , Eustachian valve: 50.0 % vs 16.1 % ; p < 0.01) , but the rate of atrial septum aneurism was equivalent (17.7 % vs 25.0 % ; p = 0.69).

Conclusions

The party balloon inflation maneuver is an effective and excellent method to reveal " masked " PFO in dairy clinical practice.
Complications in transesophageal echocardiography: a prospective observational study.
Authors: Spinka F , Sokour S , Dreger H , Morris D A , Schneider-Reigbert M
Published: January 2025

Background

Transesophageal echocardiography (TEE) is a routine examination that serves to answer various clinical questions. Due to the nature of the procedure, mechanical complications of the probe as well as complications due to administered sedation are rare but possible. Previous investigations have particularly focused on complications in long-lasting intraoperative TEE and TEE in critically ill patients in the intensive care setting. Little data exists on complications of TEE in non-critically ill patients.

Methods

From January until Juli 2024, consecutive patients with indication for TEE were included at our tertiary university center for this prospective observational study. Critically ill patients were not included. The patients were divided into a high-risk cohort (received oral anticoagulation on the day of the procedure, known esophageal varices) and a low-riskcohort (all other patients). A questionnaire investigating complications was performed via telephone interview 1-4 weeks after 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%).Mean time of examination was 5 minutes and 49 seconds. Sixty-four patients (63%) were in the low-risk cohort, thirty-two patients (32%) were in the high-risk cohort. No major complications occurred. A total of 25% of patients reported slight discomfort of the throat lasting for 1-2 days. A total of 11% reported bloody tinged sputum and/or coughing for 1-2 days. Two patients consulted their general practitioner due to these symptoms.

Conclusion

No serious complication occurred in this prospective investigation. However, discomfort of the throat for a few days after examination was frequent and even resulted in further medical consultations at the general practitioner. This needs to be addressed in the pre-examination consultation.
Left atrial and ventricular deformation coupling in mitral regurgitation
Authors: Verbeke J , Kamoen V , De Buyzere M , Claessens T , Timmermans F
Published: January 2025

Aims

This study aimed to evaluate left atrial (LA) and left ventricular (LV) deformation coupling in patients with degenerative (DMR) and functional mitral regurgitation (FMR). For this purpose, we analyzed the effect of MR on the relationship between LA and LV global longitudinal strain (GLS) independent of LA and LV geometry.

Methods and Results

The investigation was conducted in two patient cohorts. Cohort A included 60 patients with severe MR (30 with DMR and 30 with FMR), compared to 30 healthy controls. Cohort B comprised 60 patients (30 with mild MR and 30 with severe MR) matched for LA and LV volumes and ejection fraction. Using speckle tracking-based strain imaging, simultaneous LA and LV deformation was assessed. LA GLS was more impaired than LV GLS in severe MR, with increased area and decreased slope of the LA-LV strain-strain loop, but these findings were no longer present when correcting for LA and LV volumes and ejection fraction.

Conclusion

Our findings indicate that the LV-LA deformation coupling in MR is mainly driven by chamber dimensions and (the forces driving the) displacement of the mitral annular plane, rather than the regurgitant volume load itself. Despite the presence of severe MR, the relationship between LA and LV strain is maintained, emphasizing the need for interpreting LA GLS in the context of both LV GLS and the geometrical properties of the chambers.

Graphical abstract
Reverse structural and functional left atrial remodeling after successful catheter ablation for paroxysmal atrial fibrillation.
Authors: Uzieblo-Zyczkowska B , Kiliszek Marek M K , Potapowicz Krysztofiak Magdalena M P K , Maciorowska Malgorzata M M , Krzyzanowski Krystian K K , Krzesinski Pawel P K
Published: January 2025

Background

Catheter ablation is considered the most effective method for restoring sinus rhythm in patients with atrial fibrillation (AF). However, data on the reverse structural and functional remodeling of the left atrium (LA) after a successful procedure are still inconclusive, especially in patients with sinus rhythm during catheter ablation. The aim of the present study was to investigate echocardiographic parameters indicating the presence of reverse LA remodeling, following a successful procedure and long-term follow-up of sinus rhythm maintenance.

Methods

Of the 106 patients who had undergone successful catheter ablation (between January 2021 and May 2023) for paroxysmal AF (with sinus rhythm on echocardiography during ablation), 49 patients were included in the study up to now. The absence of AF recurrence was assessed during a follow-up consisting of outpatient visits/televisits and 7-day Holter monitoring (at 6 and 12 months after ablation). All patients underwent conventional and 2D speckle tracking echocardiography on the day of ablation and after the long-term of follow-up period of maintanance of sinus rhythm.

Results

A total of 48 patients were included in the study. The mean age of the study population was 60±11 years, of which 62.5% were male. The follow-up period was 17 ± 4month. A significant increase in LA reservoir strain (LASr) (median 23 vs. 25%, p<0.001) and e’ average (median 7.5 vs. 8.5 cm/s, p=0.02) was noted from baseline to follow-up. LA stiffness index (defined as E/e’average/LASr ratio) (median 0.33 vs. 0.28, p=0.001), LA area (median 23.8 vs. 22.1cm2, p=0.003) and LA volume index (median 35.9 vs. 32.9ml/m2, p<0.001) showed significant reduction over the same time period. In addition, left ventricular (LV) end-diastolic diameter, indexed LV mass index and right atrial area, decreased significantly (51 vs. 49 mm, p<0.001; 123 vs. 109g/m2, p<0.001, 17.2 vs. 15.5cm2, p=0.02, respectively). Left ventricular function parameters, such as LV ejection fraction or global LV longitudinal strain, remained unchanged.

Conclusions

During the long-term follow-up period after restoration and maintenance of sinus rhythm following catheter ablation for AF, both structural and functional echocardiographic parameters of the LA improved. Our preliminary results also suggest the possibility of reverse structural LV and RA remodeling after successful AF treatment.
Exploring the inter-vendor variability of GLS: a myocardial deformation analysis on a cohort of healthy volunteers.
Authors: Ciaramella P , Ciuffreda A , Monosilio S , Netti L , Paladino V , Rubino G , Angotti D , Galea N , Marchitelli L , Cimino S , Vizza D C , Maestrini V
Published: January 2025

Background

Global longitudinal strain (GLS) by Speckle-tracking Echocardiography (STE) has emerged as the most sensitive marker of myocardial function with a prognostic value in many cardiac diseases. GLS could also be calculated by cardiac magnetic resonance (CMR) which is the gold standard method for LV morph functional evaluation, applying the feature-tracking (FT) technique. However, there are still difficulties related to the lack of interchangeability between STE and FT techniques and the inter-vendor variability of myocardial deformation parameters.

Aim

To assess the variability of transmural GLS measurements using different analysis software packages from three different specific vendors (Echo 1-2-3) and to compare the variability of endocardial GLS measurements using an independent vendor software between cine-loops obtained by three different echo machines and CMR.

Methods

We enrolled 50 healthy volunteers (age 29 ± 3 years, males 60%, BSA 1.7±0.2 m2) without cardiovascular risk factors. All the subjects were in sinus rhythm (HR 69 ± 12 bpm) and had a good acoustic window. Each volunteer underwent an echocardiographic study on three different echo machines on the same day (Echo 1, Echo 2, Echo3). Over the course of a week, 11 patients also underwent a CRM without contrast administration. The images were acquired on each echo machine by an expert operator. All transmural GLS measurements were performed by a single observer using the dedicated post-processing software package of the respective vendor that were based on a semi-automatic method with possible manual adjustments by the operator. The same operator analyzed the cine-loops obtained from the three echo machines and CMR with an independent software which performed the analysis of STE/FT parameters with a semi-automatic method. The following parameters were obtained: left ventricular (LV) Circumferential Global Strain (GCS), GLS, EF, end-diastolic volume (EDV) and end-systolic volume (ESV).

Results

Comparing the parameters obtained by the three specific software vendors of the echo machines, there were no statistically significant differences in transmural GLS values (p=0.313); (Picture 1). Comparing the parameters obtained by an independent software vendor, there were no statistically significant differences between the endocardial GLS, GCS and EF computed by the software (respectively p=0.290, p=0.655 and p=0.51; (Table 1).

Conclusions

In clinical practice, transmural GLS do not differ using specific vendor software of different echo machines on a cohort of healthy volunteers. At the same time, endocardial GLS, GCS and EF values calculated by an independent multivendor software using echo cine-loops of three different echo machines do not differ between them and from CMR-FT obtained GLS and GCS values.

Picture 1 Table 1