bluuebunny/crossref_metadata_2025 huggingface dataset:
Limited impact of COVID-19 recovery packages on near-term CO2 emissions pathways
Authors: Gaucher Yann , Tanaka Katsumasa , Ciais Philippe , Boucher Olivier
Published: October 2022

Part of the economic recovery plans implemented by governments following COVID-19 is directed towards the energy transition. To understand the potential effects of these post-COVID green recovery packages on reductions of global greenhouse gas emissions until 2030, we investigated three different approaches. First, we analyzed simulation results of Integrated Assessment Models (IAMs) to infer the change in CO2 intensity of GDP that could result from post-COVID low-carbon investment plans. Second, we investigated the scenarios the International Energy Agency (IEA) provided based on a bottom-up energy system model. Combining the two approaches, we found that green recovery packages implemented and planned globally can lead to an emissions reduction of merely 1%–6% from the 2030 baseline levels at most. Third, we looked into the results of the Adaptative Regional Input-Output model, which simulates the dynamic effects of economic crisis and fiscal stimuli through supply chains following labor shortage. The third approach shows that the increase of activity driven by fiscal stimuli leads to a rebound of CO2 emissions even if they do not target carbon-intensive sectors. We conclude that green recovery packages targeting low-carbon technologies have a limited impact on near-term CO2 emissions and that demand-side incentives, as well as other policy efforts to disincentivize the use of fossil fuels, are also crucial for scaling up climate mitigation.
Analysis on the impact of recycled ceramic waste, fiber format, and manufacturing techniques on polymer composite properties
Authors: Sakthi Balan G , Prakash B , Aravind Raj S , Karthik S , Mohan Kumar V
Published: October 2022

Dumping of construction waste is a growing issue in current situation and recycling and reusing are the suitable solutions for solving it. This effort aims to recycle and reuse of ceramic construction waste. This work examines the effects of inclusion of waste tile powder, change in the glass fiber form which was used as a reinforcement, and method of manufacturing method the polymer composite on the properties of the composite. Normal glass-reinforced polymer composites have good tensile, flexural, and toughness properties. The three forms of glass fibers used for the study includes, chopped fiber mat, glass fiber mesh, and woven glass fiber. Fillers are added to improve hardness and tribology related attributes. Composite fabrication was carried out by conventional hand layup, room temperature compression molding, and hot compression molding process. The goal is to harden the composite without reducing the tensile strength of the composite. ASTM D3039, ASTM D2240, and ASTM D570–98 procedures were adapted for measuring tensile, hardness and water intake properties respectively. Characterization was done through SEM image analysis. A result of 160.21 MPa tensile strength, Shore D hardness value of 96.7, and water absorption of 0.71 percent after 24 h of testing was recorded. Adding waste tile powder to the polymer composite increases its hardness and reduces surface defects without affecting tensile properties. Fiber form and manufacturing method also affect the output to some extent. The effect of water absorption on the hardness property of the composite was checked and found to be negligible which makes it durable and reliable to be used in moist environments. This composite can be used in automotive parts, moist environment, window and door frames, and in electrical panels.
Influence of process variables on wear testing of aluminium-silicon/multi-walled carbon nanotubes nanocomposites
Authors: T Shivaramu H , U Vignesh Nayak , K S Umashankar
Published: October 2022

Design of experiments and analysis of variance techniques have been used in the current study to examine the wear behavior of aluminum-silicon/multi-walled carbon nanotubes nanocomposite. Variables that are considered for the assessment of wear included multi-walled carbon nanotubes concentration, applied load, operating speed, distance traversed, and temperature. Results have shown that the 0.5 wt.% multi-walled carbon nanotubes reinforced aluminum-silicon alloy had the highest wear resistance. Systematic examination of variables showed that the applied load is the dominating factor that influenced the wear behavior. The improved wear resistance of the nanocomposite was found due to the reinforcement of the multi-walled carbon nanotube.
The Effects of the COVID-19 Pandemic on Patients Experiencing Family Violence Presenting to an Australian Health Service
Authors: Collins Melinda , Crowe Marianne , Cleak Helen , Kallianis Voula , Braddy Lisa
Published: October 2022

The Social Work Department of a large Australian health service has led an organisation-wide risk identification reporting system providing oversight of family violence cases. The availability of this data offered a unique opportunity for robust evidence collection of the victim survivor experience, and the clinical response, over an eight-month period during the COVID-19 pandemic in 2020. The audit of family violence notifications and clinical notes (n = 283) identified 36 per cent of cases were impacted by pandemic-related factors. Psychological (69 per cent) and physical abuse (64 per cent) were the most identified forms of family violence. Multiple pandemic-related stressors were evident, including financial stress (38 per cent), housing instability (27 per cent) and unemployment (22 per cent). Telehealth was seen as both an opportunity for further control by perpetrators as well as a strategy to stay connected with at risk and isolated patients. Two focus groups with clinical staff (n = 16) described evidence of an increased shared sense of responsibility amongst multidisciplinary colleagues towards family violence presentations during COVID-19. The findings contribute to emerging knowledge about risks and barriers impacting victim survivors during disasters, such as pandemics, and offer strategies for improving practice. Findings highlight the important role of social workers in data collection and analysis to inform their practice.
Anterior dorsal attention network tau drives visual attention deficits in posterior cortical atrophy
Authors: Katsumi Yuta , Putcha Deepti , Eckbo Ryan , Wong Bonnie , Quimby Megan , McGinnis Scott , Touroutoglou Alexandra , Dickerson Bradford C
Published: October 2022

Posterior cortical atrophy (PCA), usually an atypical clinical syndrome of Alzheimer’s disease, has well-characterized patterns of cortical atrophy and tau deposition that are distinct from typical amnestic presentations of Alzheimer’s disease. However, the mechanisms underlying the cortical spread of tau in PCA remain unclear. Here, in a sample of 17 biomarker-confirmed (A+/T+/N+) individuals with PCA, we sought to identify functional networks with heightened vulnerability to tau pathology by examining the cortical distribution of elevated tau as measured by 18F-flortaucipir (FTP) PET. We then assessed the relationship between network-specific FTP uptake and visuospatial cognitive task performance. As predicted, we found consistent and prominent localization of tau pathology in the dorsal attention network and visual network of the cerebral cortex. Elevated FTP uptake within the dorsal attention network (particularly the ratio of FTP uptake between the anterior and posterior nodes) was associated with poorer visuospatial attention in PCA; associations were also identified in other functional networks, although to a weaker degree. Furthermore, using functional MRI data collected from each patient at wakeful rest, we found that a greater anterior-to-posterior ratio in FTP uptake was associated with stronger intrinsic functional connectivity between anterior and posterior nodes of the dorsal attention network. Taken together, we conclude that our cross-sectional marker of anterior-to-posterior FTP ratio could indicate tau propagation from posterior to anterior dorsal attention network nodes, and that this anterior progression occurs in relation to intrinsic functional connectivity within this network critical for visuospatial attention. Our findings help to clarify the spatiotemporal pattern of tau propagation in relation to visuospatial cognitive decline and highlight the key role of the dorsal attention network in the disease progression of PCA.
COVID-19 community pantries as community health engagement: the case of Maginhawa community pantry in the Philippines
Authors: Abesamis Luis Emmanuel A , Suarez Charles Anthony P , Rivera Mary Louise B , Montevirgen Natasha Denise S , Cleofas Jerome V
Published: October 2022

The COVID-19 pandemic has exacerbated and surfaced long-standing inadequacies in the country’s health and social systems. In response to the Philippine government’s inefficient and ineffective COVID-19 response and their dismissal of the calls for accountability, Filipinos at the barangay level organized community pantries to respond to the needs of the community. Using WHO’s Framework for Community Health Engagement, this study positions community pantries as a unique health phenomenon during the COVID-19 pandemic within the Philippine context. This study explores the ways that the Maginhawa Community Pantry—the critical case study—addresses both emergent and pre-existing health needs among Filipinos during the COVID-19 pandemic. By examining community pantries from the perspective of the Maginhawa Community Pantry organizer, this paper elucidates how community pantries engage in diverse initiatives that: (1) mobilize the community for health, (2) improve access to healthcare, (3) ensure community collaboration and (4) call for collective action for systemic issues. The findings of this paper highlight the capacity and potential of community pantries as a health response beyond the COVID-19 pandemic and address gaps in the Philippine healthcare system.
Case series of mobile structures detected vividly by using superb microvascular imaging
Authors: Demura Yutaka , Amano Masashi , Yanagi Yoshiki , Mizumoto Ayaka , Jo Yoshito , Izumi Chisato
Published: October 2022

Background

Superb microvascular imaging (SMI) is a new imaging technique that can reveal low-velocity blood flow without use of a contrast agent. SMI is based on an original algorithm and effectively removes tissue motion artifacts (clutter motion) from the background, thereby preserving visibility of low-velocity blood flow. SMI is expected to be useful for the evaluation of heart diseases, as well as blood vessels.

Case summary

Here, we report three cases in which a mobile structure in the heart or a blood vessel was detected easily by strong enhancement on SMI. In the heart, the entire mass was strongly enhanced by colour-SMI and had the appearance of ‘a fire ball’. In the abdominal aorta and carotid artery, SMI captured a strongly enhanced echo image of a mass and revealed hyperechoic mobile plaque. It was hard to detect with the conventional echocardiography.

Discussion

It is important to detect mobile intravascular and intracardiac structures as they are risk factors of thrombosis. Echo images are often strongly affected by the skill of the examiner, the patient's body habitus, and the presence of intestinal gas; thus, it is often difficult to detect a small mass with conventional echocardiography. With the use of SMI, even small mobile structures can be displayed at high intensity in comparison with the surrounding blood flow. Therefore, the non-invasive SMI was useful for the detection of mobile intravascular and intracardiac structures. Our findings of the current report may lead to new developments in SMI for imaging in the cardiac region.
Efficacy of simulation-based training on transoesophageal echocardiography learning in a multicentre randomised controlled trial: SIMULATOR study
Authors: Pezel T , Dreyfus J , Mouhat B , Thebaut C , Audureau E , Bernard A , Lavie Badie Y , Bohbot Y , Fard D , Biere L , Le Ven F , Fauvel C , Donal E , Mansencal N , Coisne A
Published: October 2022

Background

Evidence on the impact of simulation-based training in transesophageal echocardiography (TEE) is scarce.

Purpose

We aimed to assess the efficacy of simulation-based versus traditional teaching on TEE knowledge and skills for cardiology residents.

Methods

Between November 2020 and November 2021, all consecutive cardiology residents inexperienced from TEE were randomised (1:1, n=324) through 42 French University Centers into two groups with or without simulation support (either a simulation group or a traditional group). The coprimary outcomes were the scores in the final theoretical and practical tests 3 months after the training. TEE duration and the feelings of residents were also assessed. An economic analysis was also performed.

Results

While the theoretical and practical test scores were similar between the two groups before the training (respectively P=0.80 and P=0.51), the residents in the simulation group displayed higher theoretical test and practical test scores after the training than those in the traditional group (respectively 47.2±15.6% vs. 38.3±19.8%, P<0.0001 and 74.5±17.7% vs. 59.0±25.1%, P<0.0001). Subgroups analyses showed that the efficacy of the simulation training was even greater when performed at the beginning of residency (P<0.0001). After the training, the duration to perform a complete TEE was significantly lower in the simulation group than in the traditional group (respectively 8.3±1.4 min vs. 9.4±1.2 min, P<0.0001). Finally, residents' feelings were better in the simulation group than in the traditional group across all components (P<0.0001). Compared to the traditional group, the average additional cost per resident of the simulation program was respectively €1,785, €942 or €662 for 20, 40 and 60 residents.

Conclusion

Simulation-based teaching on TEE showed a significant improvement in knowledge, skills, and feelings of cardiology residents as well as a reduction in the duration to complete the examination.

Funding Acknowledgement

Type of funding sources: None.
Incremental value of left atrial strain to predict atrial fibrillation recurrence after cryoballoon ablation
Authors: Motoc A , Luchian M L , Scheirlynck E , Roosens B , Chameleva H , Galloo X , Von Kemp B , Ramak R , Sieira J , De Asmundis C , Chierchia G B , Magne J , Weytjens C , Droogmans S , Cosyns B
Published: October 2022

Background

Cryoballoon ablation (CBA) has emerged a one of the safest and efficient therapeutic options for atrial fibrillation (AF) [1]. However, AF recurrence rate after CBA remains as high as 25–30%, leading to increased rates of complications and repeated procedures [2]. Left atrial (LA) structural remodeling, defined as LA dilation has been proposed as a predictor of AF recurrence after CBA [2]. However, LA mechanical dysfunction might appear even before the LA enlargement and might be a more sensitive prognostic indicator of AF recurrence [3–5]. The early recognition of LA dysfunction might play a key role in identifying patients at higher risk of AF recurrence after CBA, even in patients without a dilated LA.

Purpose

The purpose of this study was to evaluate the additional value of LA function, assessed using speckle tracking echocardiography to predict AF recurrence after CBA.

Methods

Consecutive patients with paroxysmal/persistent AF undergoing CBA were prospectively included. Echocardiography was performed before CBA, according to standard recommendations. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period.

Results

One hundred seventy two patients (62.2±12.2 years, 61% male) were included in the analysis. During the follow-up period of 11.7±1.6 months, 50 (29%) patients had AF recurrence. In the overall study population, peak atrial longitudinal strain (PALS) ≤17% had the highest incremental predictive value for AF recurrence (HR=9.45, 95% CI: 3.17–28.13, chi-square to improve 37% increase, p<0.001) (Figure 1). In patients with non-dilated LA (119 (69.1%) patients), AF recurrence occurred in 24 (20.2%) patients. In this category of patients, PALS ≤17% remained an independent predictor of AF recurrence (HR=5.39, 95% CI: 1.66–17.52, p=0.005).

Conclusions

This study showed that LA function assessed by PALS provided an additional predictive value for AF recurrence after CBA, over LA enlargement. In patients with non-dilated LA, PALS remained an independent predictor of AF recurrence. These findings emphasize the added value of LA strain, suggesting that it should be implemented in the systematic evaluation of the AF patients before CBA.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Universitair Ziekenhuis Brussel - Wetenschappelijk Fonds Willy Geps of the UZ Brussel
Right ventricular longitudinal contractility mismatch: a novel diagnostic marker of right ventricular arrhythmogenic cardiomyopathy
Authors: Bocchino P P , Frea S , Angelini F , Gravinese C , Gallone G , Clivio A , Toso E , Giustetto C , De Ferrari G M
Published: October 2022

Background

The structural alterations of arrhythmogenic right ventricular (RV) cardiomyopathy (ARVC) mainly involve the RV outflow tract (RVOT), but RVOT systolic function has been poorly investigated.

Purpose

We aimed to evaluate the Doppler Velocity Ratio (DVR) as a novel echocardiographic parameter for ARVC diagnosis.

Methods

30 consecutive ARVC adult patients, 45 asymptomatic healthy volunteers and 45 consecutive patients with RV dysfunction due to ARVC mimics were prospectively enrolled between May 2019 and December 2021 and received complete transthoracic echocardiography examinations. The DVR was calculated as the ratio of RV free wall systolic velocity to RVOT systolic velocity at Doppler tissue imaging. The main study outcomes were to compare the DVR among ARVC patients, healthy controls, and mimics and to assess its diagnostic value in ARVC.

Results

120 patients were included. Mean age was 55±17 years; 46 (38.3%) patients were female. The DVR was significantly higher in ARVC subjects (1.59±0.41) compared to both healthy controls (1.16±0.14, P<0.001) and mimics (1.17±0.23, P<0.001), but similar between healthy controls and mimics (P=1.000). The DVR cut-off value with the highest accuracy for ARVC diagnosis was 1.33 (sensitivity=80.0%, specificity=86.7%). The area under the curve of DVR alone was significantly superior to that of the major echocardiographic 2010 Task Force Criteria (0.833 vs 0.672 respectively, P=0.034). The net reclassification improvement for DVR alone against the major echocardiographic 2010 Task Force Criteria was 32.2% (P=0.023).

Conclusions

The DVR is a simple novel echocardiographic parameter with high accuracy for ARVC diagnosis.

Funding Acknowledgement

Type of funding sources: None.
Pathophysiological mechanisms and prognostic implications of right atrial reservoir strain in patients with heart failure
Authors: Stassen J , Galloo X , Hirasawa K , Van Der Bijl P , Marsan N A , Bax J J B
Published: October 2022

Background

Renal and hepatic dysfunction complicate the treatment course of patients with heart failure and negatively affect outcomes. Because the right atrium functions as a reservoir between the right ventricle and the venous circulation, a reduced right atrial compliance may enhance venous congestion, thereby promoting worsening renal function and hepatic congestion.

Purpose

To evaluate the association between RA reservoir strain (RS) and end-organ dysfunction (renal dysfunction and hepatic congestion), as well as survival in patients with advanced HF.

Methods

RARS was evaluated with speckle-tracking echocardiography in patients with advanced HF (i.e. left ventricular ejection fraction <35% and persistent symptoms of HF despite optimal medical therapy). Linear regression analysis was used to investigate the association between RARS and renal function (i.e. estimated glomerular filtration rate [eGFR]) and hepatic congestion (i.e. gamma-glutamyl transferase [GGT]). Patients were followed-up for all-cause mortality.

Results

A total of 917 patients (mean age 65±11 years, 76% male) were included. Age, male sex, atrial fibrillation, larger left atrial and right ventricular dimensions and right ventricular systolic dysfunction were all associated with lower RARS values. On multivariable analysis (adjusting for age, sex, hypertension, diabetes mellitus, dyslipidemia, body mass index, ischemic etiology, atrial fibrillation, QRS duration, left ventricular end-diastolic volume, left ventricular ejection fraction, left atrial volume index, RV basal diameter and tricuspid annular plane systolic excursion), RARS was independently associated with eGFR (β 0.076; 95% CI 0.012 to 0.367; p=0.037) and GGT (β −0.122; 95% CI −1.800 to −0.034; p=0.038). On multivariable Cox regression analysis, adjusting for baseline clinical and echocardiographic variables, RARS was independently associated with all-cause mortality (HR 0.984; 95% CI 0.972 to 0.996; p=0.008) (Figure 1 and Table).

Conclusion

Reduced RARS is independently associated with renal dysfunction and hepatic congestion. In addition, RARS is independently associated with mortality. Consequently, RARS may be useful for the risk-stratification of patients with HF.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
Clinical significance of myocardial work parameters after acute myocardial infarction
Authors: Coisne A , Fourdinier V , Lemesle G , Delsart P , Aghezzaf S , Lamblin N , Schurtz G , Verdier B , Ninni S , Seunes C , Coppin A , Donal E , Scotti A , Bauters C , Montaigne D
Published: October 2022

Background

To date, there is little data regarding the clinical significance of myocardial work (MW) parameters after a stable period following acute myocardial infarction (AMI).

Purpose

To investigate the additional prognostic value of MW parameters following AMI.

Methods

Between 2018 and 2020, 244 patients admitted in cardiac intensive care unit of a university hospital for AMI were included. One-month following AMI, a comprehensive transthoracic echocardiography (TTE) was performed to assess parameters of myocardial function. Patients were then followed for major events (ME): cardiovascular death, heart failure and unplanned coronary revascularisation.

Results

At 1 month, half of the population was symptomatic (NYHA≥II), and medical therapy was almost optimized (ACEi/ARB in 95.5%, beta-blockers in 96.3%, DAPT in 94.7% and statins in 97.1%). After a median follow-up of 681 [IQR 538–840] days, ME occurred in 26 patients (10.7%). Patients presenting ME were older (65.5±14.2 vs. 58.1±12.1 years, P=0.005) with higher prevalence of hypertension (65.4 vs. 36.2%, P=0.004), more impaired LV function as assessed by left ventricular ejection fraction (LVEF) (P=0.07), global longitudinal strain (GLS) (P=0.03) or MW parameters (P=0.01 for global work efficiency (GWE)), and greater LV and LA dilations (P=0.06 for LVEDVi and P=0.03 for LAVi). After adjustment, GWE was the only TTE parameter independently associated with long-term occurrence of ME (P=0.02). A GWE value <91% was selected to identify patients at higher ME risk (HR 95% CI) = 2.94 (1.36–6.35), P=0.0041) (Figure 1 & 2).

Conclusion

Lower GWE at 1 month after AMI is independently associated with higher ME rates. A GWE <91% can improve the post-AMI patient risk stratification.

Funding Acknowledgement

Type of funding sources: None.
Left bundle branch pacing is superior in preserving ventricular mechanical synchrony and cardiac function than right ventricular pacing: a two-center experience
Authors: Mao Y K , Yang Y , Duchenne J , Garweg C , Sheng X , Zhang J F , Yang Y , Wang M , Yang Y , Voros G A B O R , Fu G S , Voigt J U
Published: October 2022

Background

Left bundle branch pacing (LBBP) has emerged as a novel pacing modality. Although it has been proved to maintain electrical synchrony better than right ventricular pacing (RVP), little is known about the impact on mechanical synchrony. This study investigates if LBBP preserves mechanical synchrony and cardiac function better compared to conventional (CRVP) and leadless (LRVP) RVP.

Methods

Sixty-five patients with pacing indication for bradycardia were prospectively enrolled: Twenty-two were treated with LBBP, 23 with CRVP and 20 with LRVP. All patients underwent echocardiography before and after implantation and at one-year follow-up. Left ventricular (LV) volumes, ejection fraction (EF) and global longitudinal strain (GLS) were measured. Regional septal (SW) and lateral wall work (LW) was calculated as the average from the respective basal and mid-ventricular segments in the apical four-chamber and three-chamber view. The lateral-septal work difference (LSWD) was used as a measure of mechanical dyssynchrony.

Results

At baseline, the QRS duration and LSWD were similar in all three groups. During follow-up, the QRS duration increased least in LBBP compared to CRVP and LRVP (+28.1±18.3ms vs +58.2±31.4 and 47.1±26.1ms, both P<0.01). SW was markedly decreased in CRVP and LRVP while LW work remained unchanged, resulting in a large LSWD compared to LBBP (1308.4±732.9 mmHg*% and 1451.3±606.1 mmHg*% vs. 286.0±479.9mmHg*%, both P<0.001). During one year follow-up, LVEF and LV GLS decreased more in CRVP compared to LBBP (both P<0.05).

Conclusion

LBBP causes less LV dyssynchrony than CRVP and LRVP as it preserves a more physiologic conduction pattern. With this, LBBP appears to preserve LV function better than CRVP. CRVP and LRVP did not differ in mechanical dyssynchrony or LV remodelling.

Funding Acknowledgement

Type of funding sources: None.
Impact of post-transplant diabetes on left ventricular function following heart transplantation
Authors: Borgenvik S , Jumatate R , Giesdal G , Werther Evaldsson A , Braun O , Smith G , Radegran G , Meurling C , Ingvarsson A
Published: October 2022

Background

Orthotopic heart transplantation (OHT) is an end-stage treatment option for heart failure (HF). Although post-transplant diabetes (PTDM) is a well-described complication following immunosuppressive treatment, the impact on LV function post-OHT has not been evaluated. The purpose of this study was to analyse the influence of PTDM on LV function in OHT patients using conventional and speckle tracking echocardiography. Furthermore, we aimed to compare echocardiographic LV function parameters to HbA1c levels in OHT recipients with or without PTDM.

Methods

The study included 104 (n=77 male, mean age 51±15 years) consecutive OHT patients (PTDM n=36) examined at their routine 3-year follow-up. Blood pressure, heart rate, and HbA1c levels were recorded in conjunction with the echocardiographic examination.

Results

Participants with PTDM demonstrated impaired LV function measured by global longitudinal strain (p=0.002). Patients with PTDM also revealed increased septum diameter (p=0.008), and a lower diastolic EA-ratio (p=0.04) compared to the non-PTDM patients. A weak correlation between high HbA1c levels and poor LVGLS was detected (r=0.30, p<0.05). No correlation was found when comparing echocardiographic parameters to blood pressure and heart rate.

Conclusion

A subtle LV dysfunction, including remodelling of the heart (i.e., increased wall thickness), reduced longitudinal contractile function, and altered diastolic function, was present in OHT patients with PTDM. Our findings suggest that sub-clinical myocardial dysfunction is present in OHT patients with PTDM and may progress to clinical LV dysfunction and HF. Hence, analysing secondary cardiac effects of PTDM in OHT patients may have a therapeutic and prognostic value and could potentially influence long-term patient survival.

Funding Acknowledgement

Type of funding sources: None.
New echocardiographic approaches to differentiate cardiac amyloidosis and Fabry disease: the right heart and mitral valve thickness
Authors: Mattig I , Steudel T , Romero Dorta E , Barzen G , Frumkin D , Laule N , Al-Daas M , Spethmann S , Stangl K , Knebel F , Canaan-Kuehl S , Hahn K , Brand A
Published: October 2022

Background

Infiltrative cardiomyopathies such as cardiac amyloidosis (CA) and Fabry disease (FD) are associated with high cardiovascular morbidity and mortality. Diagnosis is often challenging as CA and FD may present similar cardiac phenotypes on standard echocardiographic imaging, especially in early stages of disease.

Purpose

Our study focuses on right ventricular (RV) two-dimensional speckle tracking imaging and mitral valve thickness as diagnostic strategies to discriminate CA from FD. Here, we report preliminary data of our study registry of CA and FD patients.

Methods

We retrospectively screened patients with diagnosed CA or with genetically confirmed FD from our study registry. Global and free wall RV strain and mitral leaflet thickening in both groups were analysed using 2D speckle tracking echocardiography and linear measurements from a parastenal long axis view, respectively (Vivid E9 or E95, GE Vingmed, Horton, Norway, M5S 1.5–4.5MHz transducer). The diagnostic accuracy for discriminating CA and FD in both groups was evaluated using receiver operating characteristic (ROC) curve analysis.

Results

A total of 33 FD and 27 CA patients, including 17 patients with wild-type transthyretin-related (ATTR) CA, 8 patients with hereditary ATTR CA, one patient with light chain CA, and one patient with AA CA, were included. RV function was significantly reduced in CA compared to FD patients as measured by global longitudinal RV strain (−13.6±5.1 in CA vs. −18.4±3.9 in FD, p<0.001) and free wall longitudinal RV strain (−17.5±5.7 in CA vs. −21.3±4.4 in FD, p=0.005). Significantly lower longitudinal RV strain was observed in the basal to mid ventricular region in CA compared to FD patients, while RV apical strain was not significantly different between the two groups. RV global longitudinal strain had the highest diagnostic accuracy of strain analyses (area under the curve [AUC] 0.79, 95% confidence interval [CI] 0.66–0.93) to discriminate CA from FD. Additional measurement of the mitral valve in mid diastole in the parasternal long axis view revealed a significantly thickened leaflet in CA patients (4.6±1.2 mm in CA vs. 2.9±1.0 mm in FD, p<0.001) corresponding to an AUC of 0.84 (95% CI 0.72–0.96) in ROC analysis.

Conclusion

Global longitudinal RV strain was significantly reduced in CA patients while the mitral valve leaflets were significantly thickened compared to FD patients. Therefore, both parameters may be useful to discriminate CA from FD in the echocardiographic workup of patients with unclear left ventricular wall thickening.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Alnylam Pharmaceuticals (Cambridge, MA, USA)
The prognostic value of the ratio of early transmitral filling velocity to early diastolic strain rate in a large general population cohort
Authors: Lassen M H , Skaarup K G , Johansen N D , Qasim A N , Jensen G B , Schnohr P , Moegelvang R , Biering-Soerensen T
Published: October 2022

Background

The ratio of early transmitral filling velocity (E) to early diastolic strain rate (e'sr) (E/e'sr) has recently been proposed as a novel non-invasive measure of early LV filling pressure. Using two-dimensional speckle tracking derived e'sr instead of Doppler-derived e' circumvents several of the limitations known to the Doppler-based method including angle-dependency and the high susceptibility to sampling location. The prognostic value of E/e'sr in relation to cardiovascular morbidity and mortality has previously been demonstrated in a range of specific patient populations including patients with type 2 diabetes, heart failure, atrial fibrillation, and a smaller general population study.

Purpose

To investigate the prognostic value of E/e'sr in relation to major adverse cardiovascular events (MACE) in a large low-risk general population.

Methods

A total of 3,782 participants were included in the present study. All participants had a comprehensive echocardiographic examination performed and analyzed. Two-dimensional speckle tracking analysis was performed to determine e'sr. Additionally, participants answered a questionnaire and underwent a general health examination. The outcome was MACE defined as a composite of incident heart failure, acute myocardial infarction, and cardiovascular death. Cox proportional hazards regression models were used to assess the relationship between E/e'sr and MACE.

Results

The mean age of the study population was 56±17 years and 57.2% were female. Mean E/e'sr was 63.4±19.6cm, mean E/e' was 7.6±2.8, and mean left ventricular ejection fraction was 56.8±5.9%. During follow-up (median: 3.5 years, IQR: 2.6, 4.3) a total of 133 (3.5%) met the composite outcome. Increasing E/e'sr was significantly associated with MACE in a univariable model (Figure 1) with a Harrel's C-statistic of 0.73. Increasing E/e'sr remained significantly associated with MACE in a multivariable model adjusted for age, sex, smoking status, hypercholesterolemia, hemoglobin, diabetes, history of ischemic heart disease, hypertension, heart rate, LVEF <50%, systolic blood pressure, and left atrial volume index (HR=1.09 [95% CI: 1.03; 1.16], p=0.002, per 10cm increase). A total of 824 participants had an E/e' in the indeterminate zone (E/e' between 9 and 14). In this subgroup, E/e'sr remained significantly associated with MACE (HR=1.14 [95% CI: 1.01; 1.29], p=0.038, per 10cm increase). This was also the case in all participants with a E/e <14 (n=3,649) (HR=1.12 [95% CI: 1.02; 1.23], p=0.018, per 10cm increase).

Conclusion

In this large general population sample, E/e'sr provides independent prognostic information in relation to MACE. This was even the case in participants with normal E/e'.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Gentofte University Hospital
A 2D-speckle tracking analysis in patients undergoing trastuzumab in non-metastatic breast cancer
Authors: Springhetti P , Bergamini C , Niro L , Ferri L , Trento L , Minnucci I , Tafciu E , Maffeis C , Benfari G , Rossi A , Fiorio E , Ribichini F
Published: October 2022

Background

Trastuzumab (TZ) is widely used for his key role in HER2 positive breast cancer. However, the most concerning cardiovascular complication is cardiotoxicity. Many studies have highlighted the importance of screening for subclinical myocardial dysfunction using left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). However, there are only few studies investigating a possible atrial damage.

Purpose

Aim of this study is to analyze the modification of GLS and peak atrial systolic longitudinal strain (PALS) in patients undergoing therapy with TZ in a follow-up period of 12 months. The eventual fluctuation of left atrial function under chemotherapy was evaluated and the correlation between subclinical atrial disfunction and early left ventricular impairment was investigated.

Methods

105 women affected by breast cancer treated with TZ were enrolled. Each patient underwent a complete echocardiography at baseline and every 3 months. 37 patients (35%) were excluded from the left atrial function analysis while LV function evaluation was performed in 83 patients (21%). Exclusion criteria were poor quality imaging and lack of a complete follow up with consequent missing data. 2D-Speckle tracking analysis was performed at baseline and at each examination using Tomtec software in order to analyze both atrial and left ventricular function. Subclinical LV disfunction was defined as a GLS reduction of ≥15% compared to the baseline value. Left atrial impairment was arbitrary defined as a PALS reduction of ≥25% compared to the initial value. Finally, trends of GLS and PALS during 12 months-follow up periods were analyzed. Additionally, we explored if diabetes and renal impairment were associated with more prevalent atrial subclinical disfunction as demonstrated in previous studies.

Results

A total of 49% patients developed subclinical LV dysfunction. Similarly, 48% patients showed a left atrial impairment. Interestingly a significant (p=0.0001) reduction in GLS was observed during the follow-up, particularly in the first six months of treatment. PALS showed a similar trend with a significant decrease during the whole 12 months-follow up (p=0.0001) and mostly in the first 6 months.

6 patients presented a diagnosis of diabetes at baseline, and presented lower PALS compared to the non-diabetic counterpart (37.6±9.9% vs 48.7±12.2%, p=0.03).

2 patients presented a significant renal impairment (eGFR ≤30 ml/min). Similarly, these patients presented a lower PALS at baseline (32±7 and 48±7; p=0.05).

Conclusions

In patients treated with Trastuzumab development of left atrial impairment is frequent and PALS modifications follow a similar pattern to GLS variations during the treatment, suggesting a possible cardiotoxic effect of such therapy on both atrial and left ventricular myocardium and physiology.

Funding Acknowledgement

Type of funding sources: None.
Combined left and right atrial stiffness index as an independent predictor of rehospitalization in dilated cardiomyopathy
Authors: Vijiiac A E , Scarlatescu A , Cojocaru C , Verinceanu V , Petre I , Onciul S , Dorobantu M , Vatasescu R
Published: October 2022

Background

Left atrial stiffness index (LASI) derived from speckle-tracking echocardiography (STE) is a marker of pressure transfer to the pulmonary circulation and a predictor of symptoms in patients with heart failure (HF). However, the role of the right atrial stiffness index (RASI) in the setting of left-sided HF is incompletely understood.

Purpose

We sought to evaluate the left, right and combined bi-atrial stiffness index (BASI) in a cohort of patients with dilated cardiomyopathy (DCM) and to assess their prognostic role.

Methods

We prospectively enrolled 60 consecutive patients with DCM in sinus rhythm, who underwent transthoracic echocardiography. As previously described, LASI was defined as the ratio between early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e') and left atrial reservoir strain derived from STE. RASI was defined as the ratio between early diastolic tricuspid flow velocity/lateral tricuspid annulus myocardial velocity (Et/e't) and right atrial reservoir strain. BASI was defined as the sum of LASI and RASI. Patients were followed for 19±9 months for an endpoint of HF decompensation requiring hospitalization.

Results

29 patients reached the endpoint. Patients with rehospitalization had higher LASI (2.50±2.15 vs. 1.23±1.61, p=0.01), higher RASI (0.76±0.77 vs. 0.36±0.41, p=0.02) and higher BASI (3.25±2.65 vs. 1.59±1.71, p=0.006). In univariate Cox regression, all three stiffness indices were predictors of adverse outcome: HR=2.63 [95% CI, 1.22–5.66], p=0.014 for LASI, HR=2.86 [95% CI, 1.26–6.48], p=0.012 for RASI, HR=3.49 [95% CI, 1.49–8.20], p=0.004 for BASI. A multivariable model was constructed using well-established event predictors in DCM. After adjustment for age, left ventricular ejection fraction and indexed maximal left atrial volume, BASI was the only stiffness index that remained an independent predictor of rehospitalization for HF: HR=2.76 [95% CI, 1.08–7.03], p=0.03. In ROC analysis, a BASI greater than 1.25 had a 75.9% sensitivity and 64.5% specificity for event prediction (AUC=0.716, p=0.004).

Conclusion

Stiffness of both atria is significantly greater in patients with DCM who get hospitalized for HF decompensation. Combining the left and right atrial stiffness indices provides a better prognostic stratification than left or right atrial stiffness alone, since BASI was the only stiffness index that remained an independent predictor of rehospitalization after adjustment for confounders.

Funding Acknowledgement

Type of funding sources: None.
Assessment of atrial conduction times in patients with frequent premature venticular complex
Authors: Kahraman E , Keles N , Parsova K , Bastopcu M , Karatas M
Published: October 2022

Background

Premature ventricular complex (PVC) is common in general population. The atrial conduction time (ACT) represents the interval between electrocardiographic P wave and atrial mechanical contraction, and the prolongation of ACT called atrial electromechanical delay (EMD). In the present study, we investigated atrial conduction parameters through echocardiography in patients with frequent PVC.

Methods

The study involved 54 patients with PVC and 54 healthy volunteers as a control group. A comprehensive echocardiographic examination was done. The time difference between the onset of the p wave and septal Am wave was the PA septal, the time difference between the onset of the p wave and the lateral Am wave was the PA lateral, and the time difference between the onset of the p wave and the tricuspid annulus Am wave was the PA tricuspid. The interatrial EMD was the time difference between the PA lateral and the PA tricuspid, the left atrial (LA) intraatrial delay was the time difference between the PA lateral and the PA septal and the right atrial (RA) intraatrial delay was the time difference between the PA septal and the PA tricuspid.

Results

LA anterior-posterior dimension and LA maximum volume were significantly larger in the patient group. Left intraatrial EMD, right intraatrial EMD, and interatrial EMD were significantly longer in the patient group. PA lateral, PA septal, PA tricuspid durations were significantly prolonged in the patient group.

Conclusions

Atrial conduction times were prolonged in patients with frequent PVC.

Funding Acknowledgement

Type of funding sources: None.
Speckle tracking-derived left atrial strain rate – undervalued and useful predictor of adverse events
Authors: Kupczynska K , Miskowiec D , Michalski B W , Wejner-Mik P , Lipiec P , Kasprzak J D
Published: October 2022

Background

Strain rate reflects the rate of change of the distance between two points of the myocardium occurring in the cardiac cycle. It is a time-dependent parameter requiring higher temporal resolution than standard strain assessment. Because of this limitation, speckle tracking-derived left atrial (LA) strain rate analysis is of less interest in the literature.

Purpose

To analyze the prognostic value of LA strain rate during 2-years follow-up in patients with atrial fibrillation (AF).

Methods

The prospective study involved 80 patients with nonvalvular AF scheduled for elective electrical cardioversion (mean age 63.5±13 years, 60% male). All patients underwent echo before cardioversion and 24 hours after conversion to sinus rhythm. We analyzed standard echocardiographic parameters. Using the speckle-tracking method, we assessed LA strain rate during ventricular systole LA-SSR, in the early stage of ventricular diastole LA-ESR, and during atrial active pump phase LA-ASR. The last one is possible to measure only in the sinus rhythm. The analysis included 4-chamber and 2-chamber views. The clinical endpoint was predefined as AF recurrence.

Results

Median time of the current AF episode was 2.1 (IQR 0.5–5) months. Standard echo measurements revealed a median left ventricular ejection fraction of 55% (IQR 46–58) and the median of LA volume indexed to body surface area 42 ml/m2 (IQR 33–51). The successful cardioversion rate was 90%. During follow-up, we noticed AF recurrence in 49 (68%) patients. The median time-to-event was 2 (IQR 1 to 6.9) months. Receiver operating characteristic curve analysis revealed that LA-SSR <−0.73 s–1 (AUC=0.745; p=0.0004) and LA-ESR >−1 s–1 (AUC=0.703; p=0.0015) assessed during AF as well as LA-ESR >−0.88 s–1 (AUC=0.644; p=0.04) and LA-ASR >−1 s–1 (AUC=0.837; p<0.0001) measured in sinus rhythm were the optimal cut-off values for predicting AF recurrence. The figure presents Kaplan-Meier survival analysis for AF recurrence.

Conclusions

Speckle tracking-derived LA strain rate predicts the recurrence of AF after successful electrical cardioversion.

Funding Acknowledgement

Type of funding sources: None.
Predictors of shear wave propagation speed assessed by shear wave elastography
Authors: Bezy S , Cvijic M , Petrescu A , Werner A E , Orlowska M , Duchenne J , D'hooge J , Voigt J U
Published: October 2022

Background

Cardiac shear wave elastography (SWE) is a novel ultrasound-based method that assesses the propagation speed of shear waves travelling in the myocardium induced by e.g. mitral valve closure (MVC). The propagation speed of these waves is related to the stiffness of the myocardium. The capability of SWE to evaluate myocardial stiffness has already been demonstrated in several publications. However, which factors beside the intrinsic mechanical properties of the myocardium influence shear wave speed in vivo has not been extensively investigated.

Purpose

The aim of this study was to investigate the influence of clinical parameters as well as echocardiographic indicators of myocardial tissue properties and left ventricular (LV) filling pressures on shear wave propagation speed after MVC.

Methods

219 subjects (59±17 years; 140 males) were included in the study. Of those, 49 were healthy volunteers, 25 were patients with cardiac amyloidosis, 42 with hypertrophic cardiomyopathy, 35 with hypertensive heart disease and 68 with coronary artery disease. Subjects were scanned with an experimental ultrasound scanner using diverging wave imaging to acquire images at a high temporal resolution (average frame rate: 1167±414 Hz). Shear waves after MVC were visualized on M-mode maps along the interventricular septum which were colour coded for tissue acceleration (Figure 1). The propagation speed was calculated by semi-automatically measuring the spatiotemporal slope of the shear wave. Univariate and multivariate linear regression analysis was performed to identify variables associated with shear wave propagation speed.

Results

Univariate regression analysis revealed an association of the following variables with shear wave speed: age, BMI, systolic blood pressure, E wave, average e', E/e', left atrial volume index (LAVI), grade of diastolic dysfunction, isovolumic relaxation time, septal wall thickness, LV wall mass and presence of cardiomyopathy. These variables were added to a multivariate model. Predictors of shear wave speed after MVC were BMI, E wave, average e', LAVI, LV wall mass and presence of cardiomyopathy (R2=0.53) (Table 1).

Conclusions

The results of this study indicate that both myocardial structural properties (reflected by predictors LV wall mass and presence of cardiomyopathy) and LV filling pressures (reflected by predictors E wave, average e' and LAVI) affect shear wave speed. These findings suggest that SWE has the potential to assess structural as well as functional changes to the LV, which should be further explored.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research foundation Flanders - FWO