bluuebunny/crossref_metadata_2025 huggingface dataset:
Spectrum of ascending aortic aneurysms at a peri urban tertiary hospital: an echocardiography-based study
Authors: Meel R , Hasenkam M , Goncalves R , Blair K , Mogaladi S
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Thoracic ascending aortic (TAA) aneurysms are an important cause of clinical disability that require early detection by imaging methods for rapid and effective management. There is a paucity of data from Africa pertaining to TAA aneurysms.

Purpose

To describe the spectrum of TAA aneurysms at a Tertiary hospital in Africa.

Methods

A descriptive retrospective study was conducted based on clinical and echocardiographic imaging data of patients with clinical diagnosis of TAA, from October 2017-October 2022. Advanced strain imaging using speckle tracking echocardiography was performed to determine the circumferential strain (CS) of ascending aorta as a surrogate of compliance. Left ventricular global longitudinal, and basal and apical circumferential strain were also determined.

Results

The study comprised 139 cases of TAA aneurysms (52.5% females) with a mean age of 50±14.8 years, and 45 age and gender matched normal controls. Majority were of African ethnicity (95%). Main etiologies were hypertension (41.7%), human immunodeficiency virus (HIV) (36.6%), connective tissue disease (10.7%), congenital (2.2%) and mixed pathologies in 8.6% of patients. Two thirds of patients (69.7%) presented in heart failure and 10% of patients presented with aortic dissection. Thirty percent of the patients were in New York Heart Association (NYHA) class I, 59.7% were in NYHA II, 8.6 % in NYHA III and 1.4% of patients in NYHA class IV. Echocardiography revealed enlarged aortic dimensions compared to controls (P=0.00000). TAA aneurysms were complicated by severe aortic regurgitation (AR) in half (50.3%) of the patients, 25.8% had moderate AR and 14.3% of patients had mild AR. The left ventricular ejection fraction was reduced at 46.9±12.7% compared to controls (P=0.0000). Aortic CS was markedly reduced compared to controls (4.5±4.0% vs 10.3±4.37%, P=0.000). Left ventricular longitudinal strain (−13.9±3.9% vs −18.1±6.7%,P=0.000001), basal CS (−13.9±5.6% vs −17.9±5.8%, P=0.00008) and apical CS (−18.7±8.5% vs −30.6±3.8%,p = 0.0016) were all significantly reduced compared to controls. Majority (>50%) of the patients were on diuretic and anti-remodeling therapy for heart failure. Surgery was performed in 29.4% of patients. The overall estimated mortality was 7.9 %.

Conclusion

TAA aneurysms associated with hypertension and HIV are common in this population, and are associated with considerable morbidity and mortality. CS of the aneurysmal aorta was significantly reduced translating into stiffer aortas, possibly at risk for further dilation and dissection.
Correlation between novel echocardiographic indices and biomarkers of myocardial injury in patients with NSTEMI
Authors: Karakosta M , Kalesi A E , Ntiloudi D , Kapsokoli C , Boukis D , Barmpagiannis D , Arnas N , Konstantara A , Grigoraki E , Zachos P , Destounis A , Kasinos N , Pisimisis E , Theodosis-Georgilas A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction / Purpose

The extent of myocardial injury is a prognostic factor in patients with myocardial infarction presenting without persistent ST elevation (NSTEMI). The purpose of this study was the assessment of possible correlation between novel echocardiographic indices and biomarkers of myocardial injury in patients with NSTEMI and normal left ventricular ejection fraction (LVEF).

Methods

Patients with NSTEMI (18 to 80 years old) who were examined at the echocardiography laboratory of our general hospital, from May 2021 until August 2022, were enrolled in this study. All patients had no former history of cardiac disease or other significant comorbidities, and they all had LVEF ≥55% and normal wall motion score index. After coronography all of them were diagnosed with significant coronary artery disease. Among the novel echocardiographic indices, global longitudinal strain (GLS), and the parameters of myocardial work, global work index (GWI), global constructive work (GCW), global wasted work (GWW) και global work efficiency (GWE) were examined. The biomarkers were maximum high sensitive troponin I (hsTNI) during hospitalization, creatine phosphokinase (CPK) and its myocardial isoenzyme (CK-MB). Correlation between the variables was examined with Spearman method, and a p value <0.05 was considered statistically significant.

Results

In this study 34 patients with NSTEMI (26 males), of mean age 60.1 years (SD 10.5 years) participated. Median |GLS| was 17.9%, GWI 1957.7mmHg%, GCW 2231.0mmHg%, GWW 141.7mmHg% and GWE 92.2% (Table 1). As for the biomarkers, median maximum hsTNI value was 1718.0ng/l, CPK 172.0U/l and CK-MB 31.0U/l. A negative correlation was shown between hsTNI and GWE (Spearman’s rs =−0.515, p = 0.002), and a positive between hsTNI and GWW (Spearman’s rs =−0.426, p = 0.013). Also, CK-MB values had a negative correlation with |GLS| (Spearman’s rs =−0.411, p = 0.017) and GWE (Spearman’s rs =−0.425, p = 0.014). No correlation was found between CPK and the echocardiographic indices.

Conclusion

Novel echocardiographic indices were correlated with biomarkers of myocardial injury in patients presenting with NSTEMI and normal LVEF.
Determinants of left atrial reservoir strain in a large healthy population
Authors: Nyberg J , Jakobsen E O , Ostvik A , Holte E , Stolen S , Lovstakken L , Grenne B , Dalen H
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Centre for Innovative Ultrasound Solutions Nord-Trøndelag Hospital Trust.

Background

Echocardiographic evaluation of the left atrium (LA) has until recently been done by assessment of LA end-systolic volume (LAESV) or Doppler measurements. While these measurements provide prognostic information, they indirectly measure LA function. LA reservoir strain, however, is a direct measurement of LA function and provides additional prognostic information but is affected by the left ventricle (LV) through movement of the atrioventricular plane.

Purpose

By evaluation of echocardiograms from a large healthy population we aimed to study the associations of LA reservoir strain with age, LA-, and LV volumes, and LV global longitudinal strain (LV GLS).

Methods

Echocardiographic acquisitions and analyses were performed according to current recommendations. All study personnel were experienced and affiliated with a European Association of Cardiovascular Imaging accredited echocardiographic laboratory. The associations of LA reservoir strain as outcome variable with age, LAESV, LV end-diastolic volume (LVEDV) and LV GLS were assessed by multiple linear regression analyses.

Results

In total 1412 subjects (56% females) with mean (SD) age 57 (12) years were included. Mean LVEF was 60.4% in females and 59.6% in males. Totally, 39% of the variance in LA reservoir strain between subjects was explained by age, LAESV, LVEDV and LV GLS (Table 1). All four characteristics were significantly associated with LA reservoir strain (all p<0.001). Age and LV GLS were the two most important characteristics for determining LA reservoir strain, indicating lower LA reservoir strain with higher age and lower absolute LV GLS. Six years of higher age had a similar effect as one percent lower absolute LV GLS. Similarly, 28 mL larger LAESV and 35mL smaller LVEDV corresponded to one percent lower absolute LV GLS.

Conclusion

In this large healthy population, almost 40% of the variance in LA reservoir strain between subjects was explained by age, LV GLS, and the volumes of LA and LV. The most important determinants were age and GLS, contributing equally to a reduction of LA reservoir strain with higher age and lower absolute LV GLS. Correspondingly, the size of LA and LV contributed less to the variability of LA reservoir strain. In conclusion, both age and LV function should be considered when interpreting LA reservoir strain.
Determinants of disproportionate functional mitral regurgitation
Authors: Arao Y , Izumi Y , Kagiyama N , Maekawara S , Kaneko T , Terada M , Higuchi R , Saji M , Takamisawa I , Nanasato M , Isobe M , Morishima I
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Recent studies have suggested that "disproportionate" functional mitral regurgitation (FMR) defined by greater MR than expected from the degree of left ventricular (LV) dilatation may be a good candidate for transcatheter edge-to-edge repair (TEER). Determinants of disproportionate FMR (d-FMR) is unknown. We hypothesized that additional factors such as asymmetric tethering, extreme mitral annular dilatation, and deep indentation, might worsen the severity of FMR regardless of LV volumes and lead to d-FMR.

Purpose

To investigate the impact of the additional factors on the proportionality of FMR.

Methods

We reviewed consecutive FMR patients who underwent TEER and 3D transesophageal echocardiography (3DTEE) in our institute between 2018 and 2022. d-FMR and proportionate FMR (p-FMR) were defined by the effective regurgitant orifice area (EROA)/LV end-diastolic volume (LVEDV) >0.2 and ≤0.2 mm2/mL, respectively.

Results

A total of 110 FMR patients (63 d-FMR and 47 p-FMR, 75±12 years old, 46.3% female) were included. Patients with d-FMR had significantly larger EROA than p-FMR (41 ± 12 vs 33 ± 11 mm2, P<0.001) despite smaller LVEDV index (100 ± 28 vs 138 ± 49 mL/m2, P<0.001), better LV ejection fraction (37 ± 10% vs 27 ± 8%, P<0.001), and lower tenting height (7.6 ±2.9 vs 9.4 ± 2.7 mm, P=0.009). The 3DTEE analysis revealed that patients with d-FMR were more likely to have asymmetric tethering (29% vs 21%), extreme mitral annular dilatation (>700 mm2/m2; 54% vs 30%), and deep indentation (22% vs 4.3%) The presence of such additional factors was independently associated with d-FMR (odds ratio 3.83, P=0.0081) after adjustment by body surface area and LVEDV index. Furthermore, EROA/LVEDV increased as the number of additional factors increased. (Jonckheere-Terpstra test, P<0.001). TEER successfully reduced FMR regardless of the presence of such additional factor (success rate 95% vs. 96%, P>0.99).

Conclusions

The presence of additional factors exacerbates MR independently of LV size and is an important mechanism of d-FMR. TEER is an effective therapy to reduce FMR regardless of these factors.
Predicting revascularization using 15O-H2O PET myocardial perfusion imaging - impact of atrial fibrillation
Authors: Madsen S , Kjaerulff M L G , Ejlersen J A , Nielsen B R R , Jakobsen L , Sorensen J , Tolbod L P , Gormsen L C
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Myocardial perfusion imaging (MPI) by 15O-H2O positron emission tomography (PET) has excellent diagnostic accuracy for detecting significant coronary stenoses and consequently revascularization in patients with angina and no previous coronary artery disease (CAD). However, arrhythmias such as atrial fibrillation (AF) are thought to reduce myocardial perfusion globally and thresholds indicating ischemic CAD are therefore likely lower in patients with AF.

Purpose

To determine the ability of 15O-H2O PET MPI to predict subsequent revascularization in patients with known AF and angina.

Methods

We prospectively included 330 patients with angina and persistent or paroxysmal AF referred for rest/stress 15O-H2O MPI prior to possible angiography and revascularization. 55% of patients had previously documented CAD (181 patients with CAD and 149 with no CAD), and 41% had AF at the time of the MPI (136 patients with AF and 194 with sinus rhythm (SR)). Thus, patients were divided into four groups (SR-noCAD, AF-noCAD, SR-CAD, AF-CAD) to determine the independent impact of AF on myocardial blood flow (MBF). Primary outcome parameters were hyperemic MBF and revascularization within 3 months of the MPI.

Results

As expected, MBF was significantly affected by the presence of both AF and CAD [MBF (ml/g/min): 2.77 +/- 0.93 (SR-noCAD) vs. 2.10 +/- 0.93 (AF-noCAD) vs. 2.22 +/- 0.93 (SR-CAD) vs. 1.80 +/- 0.74 (AF-CAD), ANOVA p<0.001]. In total, 37 patients (50 coronary vessels) were subsequently revascularized. ROC-analysis of vessel specific hyperemic MBF yielded the following optimal MBF cut-offs (ml/g/min) to predict early revascularization: SR-noCAD: 2.03 (AUC 0.95, p<0.001); AF-noCAD: 1.16 (AUC 0.79, p<0.001); SR-CAD: 1.45 (AUC 0.77, p<0.001); AF-CAD: 1.28 (AUC 0.88, p<0.001).

Conclusion

Hyperemic MBF was approximately 20 % lower for patients with AF regardless of known CAD status. Despite this, the overall ability of 15O-H2O MPI to predict subsequent revascularization was high in this single centre setup, although the presence of AF and/or documented CAD at the time of the PET decreases the diagnostic accuracy moderately.
Ebstein valve rotation angle: a novel quantitative index of anatomical severity and higher clinical risk in Ebstein's anomaly
Authors: Cavazza B , Pasqualin G , Bevilacqua F , Caldaroni F , Chessa M , Giamberti A , Saracino A , Lombardi M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The study aimed to identify cardiovascular magnetic resonance (CMR) imaging parameters representative of Ebstein's Anomaly (EA) anatomical and clinical severity.

Materials and Methods

Consecutive CMR of patients with EA referred to our Center, were evaluated retrospectively. Displacement index (DI) was defined as the distance between the septal leaflet hinge point and the atrio-ventricular groove over the body surface area. The Ebstein’s valve rotation angle (EVRA) was quantified by connecting the inferior atrio-ventricular groove and the systolic leaflet closure plane. The Celermajer index was calculated using area (Cel-a) and volumes (Cel-v) as the ratio between the atrialized RV (aRV) plus the right atrium over the sum of the functional RV (fRV) and left chambers. The occurrence of unfavorable outcome was defined as the presence of sustained brady-tachyarrhythmia or New York Heart Association (NYHA) class ≥ II for unoperated patients and the presence of an at least moderate tricuspid regurgitation or a sustained brady-tachyarrhythmia during the post-operative hospital stay for patients undergone surgical correction.

Results

The study included 45 patients (age 28 +/- 15 years, 64% males). DI, Cel-a, Cel-v and EVRA tend to increase with worsening Carpentier classification (p = 0.002, p =0.02, p = 0.01, p < 0.0001 respectively). EVRA was the only parameter that showed to discriminate patients with unfavorable outcome both in the group of operated (68 ± 13.9° vs 43.5 ± 26.8° p = 0.03) and unoperated patients (58 ± 27° vs 30 ± 27°, p = 0.02). Among the other analyzed parameters, aRV indexed end-diastolic volume (68 ± 45 ml/m2 vs 31 ± 22 ml/m2 , p = 0.03) and anatomical RV (192 ± 81 ml/m2 vs 128 ± 32 ml/m2, p = 0.03) were significantly higher in unoperated patients with unfavorable follow-up, while both fRV/ARV axis (0.52 ± 0.14 vs 0.66 ± 0.2, p = 0.04) and volumes (0.67 ± 0.11 vs p 0.87 ± 0.29, p = 0.03) were significantly lower. fRV indexed-end diastolic volume was significantly lower (110 ± 32 ml/m2 vs 145 ± 31 ml/m2 , p = 0.03) in patients with an unfavorable post-operative stay. The EVRA value that showed to best discriminate patients who had an unfavorable follow-up event was 44.5 °, with a sensitivity of 0.57 (0.37–0.76, 95% CI) and a specificity of 0.88 (0.69–0.96, 95% CI).

Conclusions

EVRA is an emerging parameter that may help to provide a quantitative assessment of EA anatomical severity and may be integrated in the risk stratification for clinical follow-up and surgical planning.
Total regurgitant fraction to predict aortic valve surgery in patients with concomitant aortic and mitral regurgitation
Authors: Montes A , Cecconi A , Teis A , Lacalzada-Almeida J , Lopez Melgar B , Caballero P , Hernandez Muniz S , Benavides C , Viliani D , Di Silvestre M , Izquierdo-Gomez M M , Baeza Garzon F , Escabia C , Jimenez Borreguero L J , Alfonso F
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Both aortic regurgitation (AR) and mitral regurgitation (MR) produce left ventricular (LV) volume overload (1). Current prognostic assessment of AR does not include the presence and magnitude of MR. Therefore, in patients with concomitant AR and MR we might be underestimating the future need of valve replacement surgery. Cardiac magnetic resonance (CMR) is a very precise tool to quantify LV volumes together with aortic and mitral regurgitant volumes. Combining data from cine and phase contrast sequences it is possible to obtain a set parameter: total regurgitant fraction (TRF).

Purpose

To describe the prognostic value of TRF in patients with concomitant AR and MR.

Methods

Patients with concomitant AR and MR with CMR studies were retrospectively recruited in three tertiary hospitals. Cases of at least moderate AR and any grade of MR were included in the analysis. Patients with indication of aortic valve surgery (symptoms, severe LV dilatation or reduced LV eyection fraction) in the moment of the CMR were excluded. Aortic regurgitant fraction (ARF) was calculated from the phase constrast data as the ratio of AR volume and LV forward volume. Mitral regurgitant Fraction (MRF) was calculated from the cine sequences as the ratio of the MR volume and the LV stroke volume (LVSV) . TRF was calculated as the ratio of mitral plus aortic regurgitant volumes and the LVSV (MRV+ARV/LVSV)

Results

35 cases were analyzed, with a mean follow up period of 40 months. 9 patients developed indications of aortic valve surgery. TRF had an area under curve (AUC) to predict aortic valve surgery of 0.82, in opposite to aortic regurgitant fraction (ARF) which had an AUC of 0.75 (Figure 1) The optimum cutoff value of TRF and ARF to predict the need of surgery in our series were 38% and 27%, respectively. After 3 years of follow up 53% of patients with TRF > 38% had to be intervened (Figure 2A). In contrast, 32% of patients with ARF >27% had to be intervened (Figure 2B)

Conclusion

MR presence increases volume overload in patients with moderate or severe AR. TRF is a promising parameter to predict the need of aortic valve surgery in this patients
Subclinical dysfunction in left atrial compliance after successful cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation
Authors: Pilichowska E , Sikorska A , Kowalik I , Baran J , Piotrowski R , Krynski T , Kulakowski P , Zaborska B
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): The Medical Centre of Postgraduate Education.

Purpose

It has been suggested that cryoballoon ablation (CB) for paroxysmal atrial fibrillation (PAF) may lead to more extensive left atrial (LA) injury than radiofrequency ablation (RF), however, results are conflicting. The aim of our study was to estimate the LA function after successful CB and RF for PAF using transthoracic echocardiography (TTE).

Methods

90 pts (66% males, mean age 57±10 years) successfully treated (no AF recurrences confirmed in serial 4–7 day ECG Holter monitoring) with RF (51%) or CB (49%) for PAF were prospectively studied. TTE with speckle tracking (STE) and tissue doppler was performed before and 12 months after the procedure in sinus rhythm. The peak longitudinal LA strain (LAS) during the reservoir (r), conduit (cd) and contraction (ct) phases were measured. The global LAS for each LA phase was calculated by averaging the values observed in all LA segments in the 4- and 2-Chamber views. We set the zero strain point as the time from the beginning of the QRS wave. The velocities of the early (e') and late (a') diastolic phases at the mitral annular septal and lateral corners were measured.

Analysis of covariance was applied to compare changes over time with the baseline measurement as covariance and the type of ablation as the factor. The parallelism of the slopes of the covariance was tested.

Results

Parameters of LA function regarding the mode of ablation at 12 months after the procedure are shown in the table.

Significant decrease in LAScd and e’ was observed in the CB subgroup with better preserved baseline values (≥16% and ≥12cm/s respectively).

Conclusion

Worsening of parameters reflecting LA compliance was observed 12 months after successful CB vs RF ablation for PAF. This might suggest subclinical dysfunction of LA after CB procedure. Clinical significance of this finding warrant further long-term observation.
Role of reduced left atrial mechanical function reserve in exercise intolerance progression in hypertensive heart disease
Authors: Przewlocka-Kosmala M , Serafin A , Jasic-Szpak E , Ponikowski P , Kosmala W
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The identification of mechanisms in hypertensive heart disease (HHD) that favor the development of symptomatic heart failure (HF) is essential. Little is known about the role of left atrial (LA) mechanical response to exertion in this context.

Objectives

We sought to investigate the association of LA strain parameters response to exercise with functional capacity and symptomatic HF in a representative group with HHD.

Methods

Echocardiography (including LA strain and strain-derived LA stiffness index assessment) was performed at rest and immediately post exercise test in 61 patients with stage A, 67 patients with stage B and 73 patients with stage C HF.

Results

There was a progressive worsening of exercise capacity from stage A through stage B to stage C, which was accompanied by a gradual impairment of changes from rest to exercise in LA reservoir and contractile strain, whereas LA stiffness reserve remained unchanged until the HF stage C (Table). In multivariable analysis including LA and left ventricular reserve and clinical variables, changes from rest to exercise in LA reservoir strain and mitral annular e’ (both beta 0.16, SE 0.07, p = 0.02) were the only cardiac function parameters independently correlating with exercise capacity. However, LA stiffness reserve and E/e’ were the strongest associations of symptomatic HF stage C (Akaike information criterion 111.6 and 101.1, respectively).

Conclusions

LA reservoir strain and LA stiffness exercise reserves are among the mediators of reduced functional capacity in HHD, however the trajectories of changes of these parameters are not parallel. While LA strain reserve progressively deteriorates across HF stages, a marked impairment in LA stiffness reserve can only be seen in patients with HF symptoms. This suggests a potential role for these parameters in stratifying the risk of progression to overt HF in HHD.
Comparing of Peak Longitudinal strain and Post Systolic Shortening in detecting ischemia at rest in stable coronary artery disease: an angiography verified study
Authors: Arslan M , Ozden O , Ohtaroglu Tokdil K , Barutcu A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary artery disease is a major public health problem. Early diagnosis and treatment of coronary artery disease is crucial. There is a need for a practical, reliable and cost-effective non-invasive imaging tool. We aimed to evaluate the rest ischemia with speckle tracking echocardiography (STE) compare to the two methods in patients who were scheduled coronary angiography according to the stress tests.

Methods

We included fifty patients with stable angina pectoris who were scheduled for conventional coronary angiography after the stress tests in our study. Speckle tracking echocardiography was performed just before coronary angiography. The association of 2 parameters with coronary artery disease was investigated and compared.

Results

Among 50 patients recruited for the study, 38 of them had severe CAD (>50%), whereas 12 patients had non-significant CAD. Post systolic shortening (PSS) was significantly related with CAD (p<0.0001). The relationship of PLS with the area at risk was found to be statistically insignificant but global longitudinal strain (GLS) was significantly lower in patients with severe CAD (p = 0.011).

Conclusion

PSS may detect coronary ischemia in patients with stable coronary artery disease and it is more sensitive and specific in patients with stable CAD. PSS is a very useful, practical and easy applicable non invasive tool for the detection of severe coronary artery disease at rest.
Myocardial edema at CMR imaging end evolution of ventricular function following COVID-19 myocarditis - insights from the CARDIOCOV study
Authors: Mihaila T , Benedek I , Rosca A , Halatiu V B , Rodean I P , Matyas B B , Ion B N , Benedek T
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The CARDIOCOV project - Prototype for personalized assessment of cardiovascular risk and post-Covid myocarditis based on artificial intelligence, advanced medical imaging and cloud computing - financed by UEFISCDI PN-III-P2-2.1-PTE-2021-0450 (Contract Number 108PTE/2022).

Background

Myocarditis following SARS-COV-2 infection has recently become a subject of concern, being detected in a significant number of post-COVID-19 patients who undergo cardiac magnetic resonance(CMR) examination. While the role of CMR in detecting presence of viral myocarditis has been well established, the CMR features associated with significant alteration of ventricular function in post-COVID patients are not clearly identified yet.

Purpose

The aim of the study was to investigate the role of myocardial edema (ME) at CMR for predicting the evolution of ventricular function in patients with COVID myocarditis.

Methods

In total, 55 patients with CMR signs of viral myocarditis following COVID-19 infection (52.72% males, mean age 36.85+/-16.29) were enrolled in the study. The delayed gadolinium enhancement phase-sensitive inversion recovery sequences were used for characterization of the myocardial tissue, and inversion recovery images showing high signal intensity were considered suggestive of edematous changes. Patients were divided into 2 study groups, according to the presence of myocardial edema at the moment of CMR evaluation: group 1 (n=18, 32.72%) - patients without ME, and group 2 (n=37, 67.27%)-patients with ME identified by CMR. In all patients, end-distolic and end-systolic volume indexes (EDVI and ESVI), ejection fraction (EF) and stroke volume (SV) were calculated.

Results

Compared to patients without ME, those with ME present at CMR were older n (42.9+/-14.8 vs. 36.7+/-16.6, p = 0.145) and more frequently males(59.4% vs. 38.8%). At the same time, EF was significantly lower in patients with ME(50.9+/-14.5% in group 2 vs. 58.4+/-10.2% in group 1, p = 0.03). Patients from group 2 also exhibited a more pronounced dilatation of ventricular cavities, as reflected by a significant increase of ventricular volumes and especially of the ESVI(109.8+/-125.9 versus 80.1+/-14.2, p = 0.5 for EDVI, and 65.2+/-109.1 vs. 30.0+/-11.4, p = 0.02 for ESVI). Compared to the group without ME, those with ME presented a significantly lower stroke volume index: 44.2+/-17.3 in group 1 vs. 47.7+/-7.5, p = 0.03 in group 2.

Conclusions

In patients with COVID-19 myocarditis, presence of ME at CMR imaging is associated with a worse evolution of the left ventricular function, as reflected by increased ventricular dilatation and decreased cardiac output in the post-COVID period.
Association of cardiac functional reserve with body weight in heart failure with preserved ejection fraction
Authors: Jasic-Szpak E , Serafin A , Kotwica T , Kosowski W , Kobusiak-Prokopowicz M , Ponikowski P , Przewlocka-Kosmala M , Kosmala W
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Impaired cardiovascular functional reserve is believed to contribute to adverse outcomes in heart failure with preserved ejection fraction (HFpEF). However, overweight and mild to moderate obesity is associated with substantially improved survival compared to normal weight patients, a phenomenon known as the "obesity paradox".

Aim

We sought to investigate the association between LA and LV strain response to exercise and BMI in patient with heart failure with HFpEF.

Methods

A group of 140 subjects (54 ± 12 yrs) with symptomatic HFpEF underwent clinical evaluation and resting and exercise stress echocardiography (including peak atrial longitudinal strain [PALS], peak atrial contractile strain [PACS] and LV global longitudinal strain [GLS] assessment).

Results

Patients were divided into 3 groups according to BMI ( group A: BMI < 25 kg/m2, group B: BMI 25–30 kg/m2, group C: BMI ≥ 30 kg/m2). The subset with normal weight demonstrated greater changes from rest to exercise in GLS compared to overweight and obese patients (Table). No significant differences were shown for other components of cardiac reserve. Significant correlations were found between BMI and GLS and PACS exercise reserve (r=0.15; p<0.05, and r=0.19; p<0.02, respectively).

Conclusions

In patients with HFpEF, among LV and LA functional reserve parameters, GLS is most predisposed to the detrimental effect of weight excess. The profiles of changes in cardiac reserve parameters across the BMI strata do not indicate that better cardiac reserve should be considered as an explanation for the obesity paradox.
Proportionality concept of mitral regurgitation-truly valid?
Authors: Cvijic M , Rauber M , Skofic N , Toplisek J , Berlot B , Bervar M , Ambrozic J
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): University Medical Centre Ljubljana, Slovenia.

Background

The results of studies of transcatheter mitral valve repair introduced a new conceptual framework that categorized mitral regurgitation (MR) into proportionate (propMR) and disproportionate (dispropMR) according to the relationship between effective regurgitant orifice area (EROA) and left ventricular (LV) end-diastolic volume (EDV). However, pathophysiological mechanisms behind these entities have not been well defined.

Purpose

To identify the echocardiographic characteristics which could explain the underlying mechanism of dispropMR.

Methods

We retrospectively included 179 consecutive patients (age: 69±12 years, male: 132 [74%]) with HFrEF and more than mild MR referred to clinically indicated echocardiography. The disproportional cut-off value specific for our group was calculated from the theoretical line of proportionality based on the ratio EROA/EDV, considering the clinical characteristics of the study group. Correspondingly, the cut-off value for disproportionality was 0.126. Potential factors which might affect proportionality scheme were analysed: factors affecting EDV measurements (LV foreshortening) and factors affecting EROA calculation (dynamic variation of MR flow rate (MRFR) and different PISA approaches for EROA calculation: standard single-point PISA method vs. serial PISA method).

Results

In our cohort, 55 (32%) patients had dispropMR. Patients with dispropMR had more frequent LV foreshortened images for EDV calculation than patients with propMR (31 patients (56.4%) vs. 37 patients (32.7%); p = 0.003), resulting in smaller EDV in dispropMR group. DispropMR group had more substantial dynamic variation of regurgitant flow compared to propMR (Figure A), resulting in a more significant overestimation of MRFR in dispropMR than propMR when using instantaneous MRFR from standard single-point PISA (p = 0.001). EROA was consistently overestimated by standard single-point PISA method compared to serial PISA method (Figure B). Consequently, 73% of patients classified as dispropMR had either a foreshortened image or overestimation of EROA measurement.

Conclusion

Our results suggest that higher EROA/EDV ratio in dispropMR could be explained by underestimation of EDV due to LV foreshortening and overestimation of EROA by standard single-point PISA method due to more substantial dynamic variation of regurgitant flow. The data suggest that methodological limitations have an important impact on echocardiographic measurements used in the definition of proportionality. The proportionality concept is questionable and may not support the patients’ selection for treatment strategies.
The time-dependent prognostic value of coronary computed tomography angiography in symptomatic patients
Authors: Maaniitty T , Jukema R , Van Diemen P , Nammas W , Stenstrom I , Maenpaa M , Kujala I , Raijmakers P G , Sprengers R , Planken R N , Klen R , Knaapen P , Saraste A , Knuuti J , Danad I
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): State Research Funding for Turku University Hospital.

Background

Coronary computed tomography angiography (CCTA) is recommended for diagnostic workup of coronary artery disease (CAD) and is known to provide prognostic information. However, it is unknown whether there is time-dependent variation in the prognostic strength of CCTA.

Purpose

To study the time-varying prognostic value of CCTA in patients with suspected CAD.

Methods

From two academic medical centers, we identified symptomatic patients who underwent CCTA for suspected CAD. A composite endpoint of all-cause mortality and myocardial infarction was recorded. The prognostic value of non-obstructive or obstructive (≥50%) CAD was assessed by Cox proportional hazard model. The prognostic power of the model according to the cumulative length of follow-up was evaluated by measuring area under the receiver operating characteristic (ROC) curve (AUC) as a function of follow-up time (time-dependent AUC).

Results

A total of 2662 patients (age 61 ± 10 years, 45% male) were included, with 247 adverse events (9%) during a median follow-up time of 6.9 years (25th–75th percentile 4.9–8.8 years; maximum 13.3 years). Based on CCTA, 804 (30%) patients had no CAD, 963 (36%) had non-obstructive CAD, and 895 (34%) had obstructive CAD. The presence of non-obstructive CAD (adjusted HR 2.24; p = 0.002) or obstructive CAD (adjusted HR 4.42; p<0.001) were independent predictors of adverse outcome. The predictive power of CCTA findings was relatively stable until 10 years of follow-up time, as demonstrated in the Figure showing time-dependent AUC of the adjusted model (solid line) with 95% confidence intervals (dashed lines). A model including only clinical variables is shown for comparison.

Conclusion

Coronary CTA findings retain their prognostic value in at least 10-year follow-up of symptomatic patients evaluated for suspected CAD.
Prognostic value of combined coronary CT angiography and myocardial perfusion imaging in women and men
Authors: Kujala I , Nammas W , Maaniitty T , Stenstrom I , Klen R , Bax J J , Knuuti J , Saraste A
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): State Research Funding for Turku University Hospital.

Background

Combined anatomical and functional imaging enables detection of non-obstructive and obstructive coronary artery disease (CAD) as well as myocardial ischemia, and also provides prognostic information.

Purpose

We evaluated sex differences in disease phenotype and adverse outcomes by using non-invasive combined anatomical and functional imaging in symptomatic patients with suspected CAD.

Methods

We retrospectively evaluated patients undergone coronary computed tomography angiography (CTA) for suspected CAD. According to local routine, patients with suspected obstructive stenosis on CTA were referred to downstream 15O-water positron emission tomography (PET) myocardial perfusion imaging to assess stress myocardial blood flow (MBF; ≤2.3 mL/g/min considered abnormal). A composite adverse endpoint was recorded, including all-cause death, myocardial infarction, and unstable angina pectoris.

Results

A total of 1948 patients (59% women) underwent coronary CTA of whom 657 (34%) patients underwent downstream PET perfusion imaging. During a mean follow-up of 6.8 years, 182 adverse events occurred. Women more often had normal coronary arteries (42% vs. 22%, p<0.001) and less often abnormal stress MBF (9% vs. 28%, p<0.001), as compared with men. The annual adverse event rate was lower in women versus men (1.2% vs. 1.7%, p = 0.02). Both in women and men, coronary calcification, non-obstructive CAD, and abnormal stress MBF were independent predictors of events. Abnormal stress MBF was associated with 5.0 and 5.6-fold adverse event rates in women and men, respectively. There was no statistical interaction between sex and coronary calcification, non-obstructive CAD, or abnormal stress MBF in terms of predicting adverse outcome.

Conclusion

Among patients evaluated for chronic chest pain, women have lower prevalence of ischemic CAD and lower rate of future adverse events. Combined coronary CTA and PET myocardial perfusion imaging predicts outcomes equally in women and men.
Evolution of non-invasive myocardial work parameters after transcatheter aortic valve implantation in patients with severe aortic stenosis
Authors: Quinio L , Galli E , Hubert A , Taconne M , Le Rolle V , Donal E
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Guidelines recommend replacement in patients with severe aortic stenosis (AS) who present with symptoms or left ventricular ejection fraction (LVEF) < 50%, both conditions representing a late stage of the disease. While global longitudinal strain (GLS) is load dependant but interesting for assessing prognosis, myocardial work has emerged. We aim to evaluate acute changes in myocardial work occurring in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods

Patients who underwent TAVI were evaluated before and after by echocardiography. Complete echocardiographies were considered. Myocardial work indices (global work index (GWI), Global constructive work (GCW), Global work efficiency (GWE), Global wasted work (GWW)) were calculated integrating mean transaortic pressure-gradient and brachial-cuff systolic pressure.

Results

125 patients underwent successful TAVI with significant decrease of the transaortic mean gradient (52.5 ± 16.1 to 12.2 ± 5.0, P<.0001). There was no significant change in LVEF post-TAVI. Myocardial work data post-TAVR showed a significant reduction of GWI (1389 ± 537 vs. 2014 ± 714, P<.0001), GCW (1693 ± 543 vs. 2379 ± 761, P<.0001) and GWE (85,0 ± 7,06 vs. 87,1 ± 5,98, P=0,0034). Decrease of GWI and GCW after TAVI was homogeneous among different sub-groups based on their GLS, LVEF of NYHA status before TAVI. We observed a significant association between GWI and GCW before TAVI and a GLS degradation after TAVI.

Conclusion

Myocardial work parameters show promising potential in best understanding the LV-myocardial consequences of AS and its correction. By their ability to discriminate NYHA status and GLS evolution, we can hypothesize on their clinical value.
Regional differences in the level of inflammation between right and left sided coronary arteries: a cardiac CT study of epicardial fat attenuation index
Authors: Blindu E , Benedek I , Rodean I , Halatiu B , Rat N , Tolescu C , Mihaila T , Rosca A , Matyas B B , Szabo E , Gerculy R , Pasaroiu D , Benedek T
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The CARDIOCOV project - Prototype for personalized assessment of cardiovascular risk and post-Covid myocarditis based on artificial intelligence, advanced medical imaging and cloud computing - financed by UEFISCDI PN-III-P2-2.1-PTE-2021-0450 (Contract Number 108PTE/2022).

Background

Pericoronary fat attenuation index is a novel CT-derived marker used to quantify vascular inflammation at the level of coronary vessels. It has prognostic value for major adverse cardiovascular events and provides improvements in cardiac risk assessment beside classical risk factors and coronary artery calcium score. However, the influence of local factors related to coronary circulation in the right versus left coronary bed, on the development of pericoronary inflammation, has not been elucidated so far.

Purpose

The aim of the study was to evaluate the regional differences in the level of inflammation between right and left sided coronary arteries.

Methods

In total, 153 patients (mean age 62 years, male patients 70.5%) who underwent clinically indicated coronary computed tomography angiography (CCTA) were included in the study. All the plaque features classically associated with vulnerability were evaluated for identification of high-risk plaques. Fat attenuation index (FAI) and the corresponding FAI score (which takes into consideration the risk factors and age) were calculated for all cases at the level of the left anterior descending artery (LAD), circumflex artery (Cx) and right coronary artery (RCA).

Results

A total of 459 coronary arteries were included in the analysis and both FAI and FAI score were higher at the level of RCA compared with LAD and Cx. FAI score was 15.23±11.97 at RCA vs 10.55±6.78 at LAD and 11.48±6.5 for Cx, p = 0.02. Also, a significantly higher value of FAI at the level of RCA was noted in comparison with the other two coronary arteries: −76±7.68 HU for RCA compared to −73.04±8.9 HU for LAD and −71.25±7.47 HU for Cx, p<0.0001. This difference was maintained in all the study sub-group analysis: for patients undergoing CT scan after COVID infection (−75.49±7.62 HU for RCA vs -72.89±9.40 HU for Cx and −71.28 ±7.82 HU for LAD, p = 0.01), or patients with high-risk plaques (20.98±16.29 for RCA vs 11.77±7.68 for Cx and 12.83±6.47 for LAD, p = 0.03).

Conclusion

Plaques located in different coronary territories exhibit different vulnerability patterns and different levels of inflammation. RCA seems to have a more pronounced susceptibility to inflammation, right coronary plaques exhibiting higher scores of inflammation in the territories surrounding coronary plaques.
The association between non-lipid metabolomic biomarkers and prognostically important left ventricular phenotypes
Authors: Sanghvi M M , Aung N , Ramirez J , Munroe P B , Petersen S E
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): British Heart Foundation.

Background

Metabolomics is the detailed profiling of an individual’s circulating metabolites including carbohydrates, lipids, amino and fatty acids, and ketone bodies. Of all the -omics technologies, it provides the most proximal molecular fingerprint to clinical phenotypes and, in conjunction with large-scale population scale cohorts, can allow interrogation of alterations in metabolism that may contribute to cardiovascular disease pathogenesis prior to disease onset.

Purpose

Given the well-established role of lipids as an important cardiovascular risk factor, this study examines the association between non-lipid circulating metabolites and prognostically important CMR phenotypes in order to provide insight into biological mechanisms as well as identify potentially novel biomarkers.

Methods

This study used data from the UK Biobank; 31 non-lipid metabolites were measured. Outcome variables were LV end-diastolic volume, LV mass and LV ejection fraction. Metabolite biomarkers were log-transformed and were included in multivariate regression models with additional covariates: age, sex, ethnicity, height, BMI, hypertension, diabetes, hypercholesterolaemia, physical activity, smoking status and fasting time. Correction for multiple testing was performed using the Benjamini-Hochberg method.

Results

After exclusions and outlier removal, there were 10,769 participants included in the analysis. The mean age was 64 years and 52% of participants were female. Significant results are detailed in Table 1. There was evidence for associations between LV mass, end-diastolic volume and ejection fraction and circulating metabolites, in particular amino acids and fatty acids.

Conclusions

In the context of the limitations and biases inherent in observational analyses, this study suggests that non-lipid circulating metabolites may influence prognostically important CMR phenotypes. Further exploration, in particular through Mendelian randomisation which can suggest potentially causal associations, is required which may, in turn, provide further biological mechanistic insights into remodelling, as well as highlight potentially novel biomarkers.
The impact of continuous positive airway pressure therapy on left atrial function assessed by 2D speckle tracking echocardiography in patients with obstructive sleep apnoea
Authors: Tamulenaite E , Kondrataviciene L , Miliauskas S , Ereminiene E
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Obstructive sleep apnoea (OSA) is associated with left atrium (LA) remodelling and dysfunction, developing even before left ventricle (LV) hypertrophy and diastolic dysfunction. Two-dimensional speckle-tracking echocardiography (2D-STE) may help to detect subclinical LA dysfunction before irreversible cardiac changes.

Purpose

To evaluate changes of LA geometry and function after short term continuous positive airway pressure therapy (CPAP) for OSA using 2D-STE.

Methods

47 obese patients aged between 18 to 65 years old were enrolled in the study. Control group (N=13) consisted of healthy subjects who either did not have OSA, or it was mild (apnea/hypopnea index (AHI) 5 – 14/ hour). OSA group (N=34) consisted of subjects with moderate or severe OSA (AHI ≥ 15/ hour). Transthoracic echocardiography and 2D STE analysis performed before and after 3 months of treatment with CPAP, for control group – at a baseline only. Statistical analyses were performed using the SPSS 27.0 software. The value of p<0.05 was considered as statistically significant.

Results

Control group was younger, had more female patients, and prevalence of arterial hypertension was lower compared to OSA group. All patients had preserved LV EF (>50 %) without significant differences between groups. OSA was related to more prevalent LV diastolic dysfunction (p = 0.023) and increased LV myocardial mass when indexed by height (46.11 (8.23) vs 38.96 (5.9) g/m 2.7, p = 0.007). OSA patients had significantly higher LA diameter (43.58 (8.19) vs 36.23 (3.08) mm, p <0.001), while LA volume did not differ even when indexed by height (p>0.05). LA reservoir strain was significantly lower in patients with OSA (26.56 (1.38) vs 31.01 (1.56) %, p<0.001) when compared to control group. After 3 months of CPAP treatment LA diameter, LA volume, LV MMi, LA conduit and contractile strain did not change , but prevalence of LV diastolic dysfunction decreased and LA reservoir strain improved. (Table 1).

Conclusions

Our study showed more prevalent LV diastolic dysfunction, increased LV myocardial mass indexed by height, together with reduced LA reservoir strain in OSA patients with preserved LV ejection fraction. Short term CPAP treatment significantly improved LV diastolic function and LA reservoir strain in OSA patients.