bluuebunny/crossref_metadata_2025 huggingface dataset:
Additive value of simultaneous cardiopulmonary exercise testing to exercise echocardiography in unexplained dyspnea
Authors: De Schutter S , Verelst F , Nasser R , Hens W , De Bliek E , Van De Heyning C M , Meems L M G , Gevaert A B
Published: January 2025

Background

In patients with unexplained dyspnea, exercise echocardiography with diastolic stress testing is recommended to diagnose heart failure with preserved ejection fraction (HFpEF). Combined cardiopulmonary exercise testing (CPET) with echocardiography (CPETecho) adds respiratory gas analysis and is thus able to characterize all physiologic abnormalities limiting exercise capacity including cardiac, pulmonary and peripheral causes.

Purpose

To evaluate the use of CPETecho in patients with unexplained dyspnea compared to exercise echocardiography alone.

Methods

In this retrospective observational study, we evaluated patients with unexplained dyspnea (normal resting echocardiography and normal lung function) who underwent CPETecho at two university hospitals between July 2021 and November 2023. CPETecho was conducted on a semi-supine bicycle ergometer. At rest, submaximal exercise (heart rate ±100 bpm) and peak exercise echocardiography was performed. Respiratory gases, heart rate, and electrocardiogram were recorded continuously. We evaluated limitations to exercise according to cutoffs in published literature, and compared them to diagnoses obtained via exercise echocardiography values alone with CPET values being blinded.

Results

We enrolled 124 patients (63% women, mean age 67 ± 12 years). Peak VO2 was 88 ± 19% of the predicted value. CPETecho identified causes for dyspnea in 101 patients (81%), compared to 121 patients (98%) with exercise echocardiography. However, only in 60 out of the 121 patients (50%) exercise echo could provide a ‘certain and complete’ diagnosis. In 37 patients (31%), the correct diagnosis was missed by exercise echo: peripheral or pulmonary limitations, hyperventilation or V/Q mismatch. Additionally, in 19 patients (15%) exercise echo incorrectly diagnosed chronotropic incompetence, left ventricular (LV) systolic dysfunction, or impaired right ventricular (RV) reserve while actually patients had a submaximal performance. Finally, 4 patients (3%) had both missing and uncertain diagnoses.

In contrast, CPETecho allowed immediate detection of a submaximal test, ensuring that the identified diagnoses can be considered ‘certain’ (101 patients, 81%). Nineteen patients (15%) had an ‘uncertain’ diagnosis due to a submaximal test, 1 patient (1%) had an uncertain diagnosis despite a maximal test performance, and 3 patients had missing data due to poor image quality (2%).

Conclusions

In patients with unexplained dyspnea, CPETecho led to more accurate diagnoses compared to exercise echocardiography alone. Exercise echocardiography alone misclassified several patients, primarily due to its incapacity to identify pulmonary or peripheral limitations, and the inability to detect a submaximal test.
Hemodynamics and prognostic values of exercise stress echocardiography in the perioperative period for patients undergoing transcatheter edge-to-edge repair
Authors: Toki M , Hayashida A , Nakatsukasa T , Kimura A , Morikawa T , Hiraoka A , Aritaka S , Yoshida K
Published: January 2025

Background

Exercise stress echocardiography (ESE) is widely used and recommended by guidelines for assessing the severity and prognostic values of mitral regurgitation (MR). However, the changes observed in ESE after MR improvement through transcatheter edge-to-edge repair (TEER) and the relationship between pre- and post-operative ESE evaluations and prognosis remain unclear.

Purpose

The aim is to investigate the hemodynamic changes observed in ESE before and after TEER using echocardiographic parameters, and to identify factors related to prognosis based on the hemodynamics before and after the procedure.

Methods

The study included 75 out of 250 cases that underwent TEER from January 2019 to August 2023, which were evaluated with ESE before and after the procedure. Cases with significant valvular disease other than mitral valve disease, those who could not achieve adequate exercise load, and cases with MR due to multiple factors were excluded.

Results

A significant correlation was observed between postoperative mean pressure gradient (mPG) and pulmonary arterial systolic pressure (PASP) at peak stress (r=0.40, p<0.001), while no significant correlation was found between changes in stroke volume (SV) and changes in PASP (r=0.25, p=0.03). An increase in SV observed on ESE after TEER was associated with a better prognosis compared to cases without such increase, suggesting it as a potential predictor for cardiovascular death (p<0.0001). However, stratification of prognosis based on the presence of peak mPG elevation (mPG ≥ 5 mmHg) or the occurrence of exercise-induced pulmonary hypertension (EIPH) was not achievable. Furthermore, patients who showed an increase in SV in either preoperative or postoperative ESE showed the most favorable prognosis for cardiovascular death (p<0.001).

Conclusions

Exercise-induced systolic pulmonary artery pressure elevation was found to correlate with the mean pressure gradient postoperatively. Performing exercise stress echocardiography not only for preoperative diagnosis but also postoperatively is useful for prognostic evaluation. Patients with increased stroke volume exhibit a favorable prognosis.
Speckle tracking analysis during dobutamine stress echocardiography in patients undergoing percutaneous coronary intervention for chronic total occlusion
Authors: Onishi T , Iwakura K , Tanaka K , Watanabe H , Okamura A
Published: January 2025

Background

Dobutamine stress echocardiography (DSE) is often used as a non-invasive diagnostic modality for detection of myocardial ischemia and viability. A "biphasic response" in DSE can occur, in which contractility improves in dysfunctional segments with low dose stage and then becomes dysfunctional again at higher doses due to ischemia. We investigated if speckle tracking analysis during DSE can evaluate patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).

Methods

DSE was performed one day before CTO-PCI in consecutive 43 patients (25 female, age=67±12 years). Since 40 patients had 1 vessel, and 3 patients had 2 vessel CTO lesions, total of 46 regions were analyzed. Global (GLS) and regional longitudinal strain (RLS) were calculated as an averaged value of peak longitudinal strain in the apical 4-, 2-chamber, and long axis views at baseline echo, at low-dose, at high-dose DSE, and 6 months after CTO-PCI using available software (QLAB, Philips Medical Systems). Improvement in wall motion was defined as the change ratio in strain during DSE less than -10% and worsening was more than 10%. Improvement 6 months after CTO-PCI was defined as the change ratio in strain less than -10% and in left ventricular ejection fraction (LVEF) more than 5%.

Results

CTO-PCI was successfully done in all patients. GLS and RLS were feasible in all regions. Overall, GLS (-16.9±3.3% at baseline v.s. -18.6±3.4%, p<0.0001) and LVEF (56±8% v.s. 59±7%, p=0.0003) significantly improved 6 months after CTO-PCI. There was also significant improvement of RLS for the obstructed CTO regions (-14.0±4.2% v.s. -16.6±4.4%, p<0.005). During DSE, ventricular segments exhibited one of four response types. A. Biphasic response (n=23, 50%): improvement in wall motion at low dose with worsening at high dose DSE, B: Sustained improvement (n=15, 33%): keep improving in wall motion during DSE, C: Worsening (n=4, 9%): further deterioration of resting wall motion during DSE without any improvement, D: No change (n=4, 9%): no change in wall motion during DSE. Interestingly, the rate of improved RLS for obstructed CTO regions 6 months after CTO-PCI was significantly different in 19 (83%) for type A, 12 (80%) for type B, 3 (75%) for type C, 1 region (25%) for type D (p<0.05), although GLS in 14 (61%), 7 (47%), 3 (75%), 2 (50%) (p=0.8) and LVEF in 11 (46%), 5 (33%), 1 (25%), 0 (0%) (p=0.2) were similar.

Conclusion

Speckle tracking analysis is feasible during DSE. CTO-PCI may improve both global and regional cardiac functions in patients with myocardial viability.

A case of "biphasic response type"
Left anterior velocity reserve by adenosine is not related to angiographic severity of isolated left main stenosis: Potential relevance for revascularization decision making.
Authors: Armenis I , Leontiadis E , Tsiapras D , Kyrzopoulos S , Iakovou I , Athanassopoulos G D
Published: January 2025

Background

Revascularization of asymptomatic left main stenosis (LM) estimated by coronary angiography in the range of ambiguity (40-60%) necessitates further documentation by either intravascular imaging or fractional flow reserve. Distal left anterior descending artery velocity reserve (LADVR) by transthoracic Doppler echo has provided efficient prognostic yield for intermediate LAD lesions.

Purpose

Aim of the study was to assess the relationship between LADVR and LM stenosis and to evaluate the long-term cardiovascular outcome in patients with intermediate LM stenosis, following decision making for revascularization based on an efficient LADVR, on top of the dobutamine stress echo (DSE) result.

Methods

Eighty nine asymptomatic patients (age: 67±9 years, men/women: 70/19, ejection fraction EF: 52±6%, follow up: 50±25 months) were selected prospectively. They had an isolated intermediate stable LM stenosis (stenosis range 30-70%, with absence of hemodynamically significant LAD stenosis (<50%) and they were referred for DSE with a concomitant evaluation of LADVR after administration of adenosine. All patients had a negative DSE for ischemia with an estimated LADVR >2. Based on these data revasularization was deferred.

Distribution of patients according to % LM stenosis was: LM 30-40%: 55 patients /LM 40-50%: 25 patients /LM50-60%: 6 patients /LM60-70%: 3 patients

Results

LADVR was not related to age or EF and was similar among LM increments: LM30-40%: 2.9±0.6 vs LM40-50%: 2.6±0.4 vs LM50-60%: 2.8±0.8 (distribution of values: figure1)

A negative follow up for cardiac events was available in all patients. Moreover, 45 patients had an additional stress test negative for ischemia (either ECG or DSE/ SPECT) (LM30-40%: 30 patients, LM40-50%: 11patients, LM50-60: 2patients, LM60-70%: 2patients). LADVR was estimated during follow-up in 26±45 patients and it was <2 in 2 patients (both with a new significant LAD stenosis). Changes of LADVR during follow up compared to the initial LADVR were not related to LM stenosis ((% differences: figure2)

Conclusion

LADVR in the presence of an isolated LM disease is not related to the angiographically estimated stenosis. Moreover, evolution of LADVR is independent of the initial severity of LM stenosis. A negative DSE combined with adenosine LADVR>2 provides an efficient prognostic yield for a safe long-term outcome in isolated LM disease.
Left ventricular mass by three-dimensional echocardiography is associated with myocardial replacement fibrosis and ventricular arrhythmias in hypertrophic cardiomyopathy
Authors: Rella V , Delcea C , Clement A , Perelli F , Tomaselli M , Penso M , Buta A , Oliverio G , Castelletti S , Parati G , Crotti L , Badano L , Muraru D
Published: January 2025

Background

In hypertrophic cardiomyopathy (HCM) patients, quantification of left ventricular (LV) mass carries important prognostic implications. Two-dimensional echocardiography (2DE) has limited accuracy for LV mass calculation, due to plane position errors, geometric assumptions and asymmetric distribution of LV hypertrophy in HCM.

Purpose

We aimed to explore: (1) the accuracy of three-dimensional echocardiography (3DE) vs 2DE to quantify LV mass in HCM compared to cardiac magnetic resonance (CMR); (2) the relationship of 3DE LV mass with non-sustained ventricular tachycardia (NSVT) and late gadolinium enhancement (LGE)≥15% by CMR.

Methods

In consecutive HCM patients referred to our Cardiomyopathy Clinic between 2020 and 2023, 2DE and 3DE were used to assess LV mass. LV systolic function was assessed by 3DE ejection fraction (LVEF) and peak global 2D longitudinal strain (2DGLS). Clinical, 24h ECG Holter and CMR data were collected.

Results

A total of 180 HCM patients (pts, age 58±18 years, 55% men) were enrolled. Apical HCM was present in 56 pts (31%) and obstructive HCM in 69 pts (38%). Maximal LV wall thickness (MWT) by 2DE was 19.5±4.6 mm. LV mass was 150±51 g/m2 by 2DE, 80±25 g/m2 by 3DE, and 79±26 g/m2 by CMR. Fifty-seven pts (32%) had evidence of NSVT at ECG Holter monitoring. LGE≥15% was present in 32% pts.

Aim #1: In a subset of 63 pts who underwent CMR, 3DE LV mass was strongly correlated with CMR LV mass (r=0.85, p<0.001), while 2DE LV mass was not (p=0.38). LV mass by 3DE showed a better agreement with LV mass (bias 3.8 g/m2, LOA -25 to 32 g/m2) by CMR than 2DE (bias 68 g/m2, LOA -35 to 172 g/m2).

Aim #2: In the entire cohort, 3DE LV mass had a stronger association compared to 2DE LV mass with the presence of LGE≥15% (AUC 0.68 for 3DE versus 0.56 for 2DE, p=0.08) and NSVT (AUC 0.65 for 3DE versus 0.54 for 2DE, p=0.06). By multivariable analysis, LV mass by 3DE was an independent predictor of LGE≥15% (HR 1.03) and of NSVT (HR 1.03), outperforming 2DGLS and MWT in the latter regression. Using the Youden Index from ROC curve, the optimal cutoff for predicting LGE≥15% using 3DE mass was 87 g/m² (sensitivity 47%, specificity 91%). The addition of 3DE LV mass to a model including 2DE MWT, 2DE LV mass and 2DGLS had a significant incremental value for the prediction of LGE≥15% (Figure 1).

Conclusions

In HCM patients, LV mass by 3DE was strongly correlated to LV mass by CMR and was an independent predictor of significant LV myocardial fibrosis and ventricular arrhythmias. In centers with low access to CMR, implementation of 3DE to measure LV mass in HCM patients may improve arrhythmic risk stratification compared to 2DE.
Dynamics of the mitral valve annulus in hypertrophic obstructive cardiomyopathy patients undergoing septal myectomy: insights from 3D transesophageal echocardiography
Authors: Shaaban M , Emam A , Elgouhary M , Said F , Thabet N , Hekal S , Mahmoud-Elsayed H
Published: January 2025

Background

Mitral annulus (MA) dynamics in HOCM patients and the impact of surgical myectomy on them is not fully understood. This study aimed to evaluate the MA dynamics and their changes after septal myectomy in HOCM patients.

Methods

This prospective, single-center study included 26 HOCM patients undergoing septal myectomy. Intraoperative Three-dimensional Trans-Esophageal Echocardiography (3DTEE) for the mitral valve (MV) was performed pre- and post-surgery followed by offline analysis of the acquired volumes to assess MA dimensions and dynamics before and immediately after myectomy using a dedicated post-processing software (4D MV analysis, QLAB version 15, Philips Healthcare).

Results

Pre-operatively, throughout four phases of the cardiac cycle (late diastole, early systole, mid-systole, and late systole), there were no significant dynamic changes in MA dimensions, Specifically, the anteroposterior (AP) diameter (3.753 ± 0.48, 3.756 ± 0.48, 3.866 ± 0.49, and 3.997 ± 0.49 cm, respectively; P=0.286), inter-trigonal diameter (2.88 ± 0.59, 2.89 ± 0.58, 2.89 ± 0.58, and 2.93 ± 0.60 cm, respectively; P=0.982), inter-commissural diameter (3.52 ± 0.38, 3.519 ± 0.36, 3.509 ± 0.35, and 3.526 ± 0.37 cm, respectively; P=0.999), 3D saddle-shaped annulus area (11.336 ± 2.26, 11.346 ± 2.27, 11.599 ± 2.3, and 12.031 ± 2.41 cm², respectively; P=0.714), annulus height (1.135 ± 0.24, 1.154 ± 0.25, 1.164 ± 0.24, and 1.148 ± 0.24 cm, respectively; P=0.981), aorto-mitral angle (105.64 ± 11.7, 104.62 ± 11, 103.8 ± 9.4, and 104.9 ± 10.40, respectively; P=0.949), and saddling (0.322 ± 0.06, 0.328 ± 0.06, 0.33 ± 0.06, and 0.326 ± 0.07, respectively; P=0.231).

Post-operative comparisons revealed a notable _yet not statistically significant_ increase in the intercommissural and intertrigonal diameters in the mid systolic phase after myectomy that may be related to the relief of the obstruction. However, no statistically significant changes in MA dynamics throughout the four phases of the cardiac cycle regarding the AP diameter (P=0.939, 0.914, 0.965, and 0.505, respectively), inter-trigonal diameter (P=0.709, 0.701, 0.797, and 0.710, respectively), inter-commissural diameter (P=0.597, 0.990, 0.396, and 0.328, respectively), 3D saddle-shaped annulus area (P=0.854, 0.828, 0.880, and 0.619, respectively), annulus height (P=0.344, 0.318, 0.27, and 0.342, respectively), aorto-mitral angle (P=0.756, 0.702, 0.320, and 0.255, respectively), and saddling (P=0.1, 0.2, 0.062, and 0.067, respectively).

Conclusion

In HOCM patients, MA exhibits reduced dynamic motion, with a notable loss of normal systolic AP contraction and saddling. Immediate postoperative assessments did not demonstrate significant improvements in MA dynamics. Therefore, further longitudinal studies are necessary to assess long-term changes in MA dynamics due to LV remodeling following septal myectomy procedures.
Additive diagnostic value of 3D transesophageal echocardiography (3DTOE) in diagnosis of Infective endocarditis (IE)
Authors: Mladenovic Z , Milic M G , Djuric D J P , Jovic J Z , Djuric D J I , Ciric C N
Published: January 2025

Introduction

The clinical manifestations of infective endocarditis (IE) are highly polymorphic, complicating the diagnostic process and leading to delays in treatment, particularly in elderly or immunocompromised patients. Recent studies advocate for early surgery to improve prognosis in IE patients. Advanced surgical planning for the complex pathomorphological spectrum of IE lesions requires detailed anatomical visualization, which is enhanced by three-dimensional transesophageal echocardiography (3DTOE).

Purpose

This study analyzed the echocardiographic characteristics of complex IE patients referred for additional evaluation in a tertiary center and assessed the role of 3DTOE in their evaluation.

Methods

This prospective study included all consecutive patients hospitalized in a tertiary clinical center, referred for IE in Serbia from November 2017 to October 2023. Blood cultures, serological assessment, transthoracic echocardiography (TTE), 2D/3DTOE, abdominal sonography, and cerebral CT or MRI scans were systematically performed within 72 hours of admission. Fifty-nine patients with a definitive diagnosis of IE, according to Duke University criteria, who underwent 2D and 3DTOE at the initial diagnostic examination were analyzed. Echocardiographic findings were defined according to current guidelines, with destructive lesions including abscess, pseudoaneurysm, valve dehiscence, perforation, or chordal rupture.

Results

Echocardiographic findings (Table 1) revealed statistically significant differences between different echocardiography modalities. The most significant difference was observed between TTE and 3DTOE. However, results between 2D and 3DTOE did not reach statistical significance. TOE provided a more detailed description with a higher number of detected lesions, and 3DTOE was even more precise in identifying destructive lesions, particularly perforations (p<0.001). Concerning, Native Valve IE (NVE), Prosthetic Valve IE (PVE), and Cardiac Device IE (CD IE) groups (Table 2), vegetations were most frequently detected in the NVE and CD IE groups, while destructive lesions were predominant in the PVE group. 3DTOE detected longer vegetations and a higher number of destructive lesions, particularly in the PVE group.

Conclusion

3DTOE provides a more detailed and precise morphological description of complex destructive lesions of IE compared to TTE and 2DTOE, which is particularly important for patients with PVE.

Table 2
Role of 3D echocardiography for assessment of right ventricle -right atrial coupling in patients with pulmonary hypertension
Authors: Hristova K , Tselov N , Marinov R , Shahin T , Todorov I , Zlatancheva G , Tsonev S
Published: January 2025

RV function is of diagnostic and prognostic purpose in patients with pulmonary hypertension.

The aim of the study was to evaluate the ventricular -arterial coupling in patients with pulmonary hypertension , using 3D echocardiography/ 3DE/.

Methods

3D echocardiography was performed in total 85 patients - 20 normal volunteers, 33 patients with pulmonary hypertension and moderate TR and 32 with ASD / mean age 63 +/- 3.5 y/o/ for evaluation of RV global and regional EDV and EF. Conventional echo parameters as TAPSE, tricuspid annular peak systolic velocity S', FAC and pulmonary vascular resistance and mean PASP are also included, and blood analysis of NT -pro BNP as well, to describe better condition of presence of heart failure.

Results

RV global and regional EDV were significantly higher in group with ASD and heart failure and EF lower, comparable with patient with moderate TR and without heart failure and normals.

Groups with ASD and TR with HF shown lower ratio of EF/PASP, FAC/PASP, TAPSE/PASP, S'/PASP and higher mPAP. (p<0.05) RV global and regional EF/PASP and FAC/PASP are negatively correlated with mPAP, p<0.01.

RV global EF was correlated with mPAP and PVR in all groups./p<0.01/. Ratio of RV inflow, EF/PASP, FAC/PASP, TAPSE /PASP, S'/PASP is more significantly related with the condition of heart failure./p,0.05/. Fig 1.

Conclusions

RV ventricular-arterial coupling was associated with increased RV afterload in patients with pulmonary hypertensions. Regional RV systolic function in the inflow tract is more related with RV ventricular -arterial coupling in patients with pulmonary hypertension and heart failure and can be used as good prognostic marker for worsening of the prognosis.
Exploring three-dimensional right ventricular shape and function in tetralogy of fallot patients
Authors: Zwaan R R , Chen Y , Schneijdenberg J W , Bowen D J , Van Burken G , Bosch J G , Van Den Bosch A E
Published: January 2025

Background

Tetralogy of Fallot (ToF) accounts for approximately 7 to 10 % of all CHD and is commonly associated with failure of the right ventricle (RV). Parameters providing more insight into the mechanics of RV failure are needed to guide clinical decision making. As advancements in Three-Dimensional (3D) echocardiography (3DE) have enabled more detailed analysis of RV volume and function, the way is paved for new 3D derived parameters. We developed a custom software to assess 3D RV shape and function.

Purpose

The aim of this study was to evaluate the differences of 3DE derived RV geometry (curvature) and deformation parameters in adults with ToF and controls.

Methods

In 50 patients with ToF and 50 controls 3DE RV images were acquired. RV geometries from 3D datasets were segmented using commercially available RV analysis software (TomTec 4D-RV function 2.0) and processed using custom software (RV-dynamics) to calculate Curvature, Area Strain (AS) and Longitudinal Strain (LS). Parameters were measured globally and over different segments of the RV (i.e. septal body (SB), inferior free wall (IFW), anterior free wall (AFW), lateral free wall (LFW), apex (Ax), RV inflow tract (RVIT), RV outflow tract (RVOT), anterior boundary (AB) and posterior boundary (PB)).

Results

Globally and for all independent regions of the RV, AS was significantly reduced in patients with ToF as compared with healthy controls. Except for AFW, global and all regional values of LS were significantly reduced in patients with ToF as compared with healthy controls. Global AS and LS were strongly correlated with RVEF with values for r of -0.9 and -0.6 respectively. RV curvature differed over multiple segments, predominantly in the end-diastolic Ax and end-systolic PB and Ax regions.

Conclusion

The RV-dynamics software gives the opportunity to analyze 3D RV morphology and RV deformation parameters in the diseased RV in more detail. AS and LS may provide more detailed assessment of the functional condition of the diseased RV in ToF whereas curvature provides an interesting method for the quantification of RV remodeling. Further insight in the different mechanisms of dysfunction of the RV may improve clinical decision making.
Improving risk stratification in heart failure with reduced ejection fraction by using three-dimensional right ventricular ejection fraction
Authors: Dodita D , Memis H , Andreescu A , Mihalcea D , Velcea A , Spataru B , Hasouna E , Mihalache A , Badano L , Mihaila S , Vinereanu D
Published: January 2025

Background

In patients hospitalized for heart failure with reduced ejection fraction (HFrEF), the occurrence of right ventricular (RV) dysfunction emerged as a prognostic factor for morbidity and mortality. Standard two-dimensional echocardiographic (2DE) parameters have been utilized to assess risk of cardiac death in these patients, but their predictive accuracy varies across different cardiac conditions. This underscores the necessity for more reliable novel parameters, to improve prognosis and to guide therapeutical and interventional management.

Purpose

To assess independent and comparative prognostic utility of three-dimensional (3D) against standard 2D parameters of RV function in predicting mortality and HF hospitalization (HFH).

Methods

We prospectively enrolled 366 patients hospitalized for HFrEF (60±13 years, 81% men), of ischemic and non-ischemic etiology (51% vs. 49%). Patients underwent comprehensive 2D and 3D echocardiography, including full volume acquisition of the right (RV) and left ventricles (LV). By 2DE, we measured TAPSE, RV fractional area change (FAC), S’ systolic velocity, and RV global (GLS) and free wall longitudinal strain (FWLS). By 3DE, we measured RV volumes and RVEF, and derived RVFAC and TAPSE. Primary outcome was cardiac death (CD). Secondary outcome was heart failure hospitalization (HFH). Follow up was 24±8 months.

Results

Mean 3D LVEF was 31±10%, while mean 3D RVEF was 39±10%. Binary logistic regression identified 3D RVEF as an independent significant predictor of CD (β=-0.16, OR 0.84, 95%CI 0.81-0.89, p<0.001) and HFH (β=-0.09, OR 0.92, 95%CI 0.88-0.95, p<0.001), better than standard 2DE parameters, such as 2D RVFAC (β=-0.04, OR 0.96, 95%CI 0.93-0.98 for CD and β=-0.02, OR 0.97, 95%CI 0.96-0.99 for HFH, both p<0.05) and 2D TAPSE (β=-0.13, OR 0.88, 95%CI 0.82-0.95 for CD and β=-0.08, OR 0.92, 95%CI 0.86-0.99 for HFH, both p<0.05). Comparative ROC analysis showed that 3D RVEF was superior for predicting CD (Fig. A) and HFH (AUCs of 0.82 and 0.71, respectively) to 2D TAPSE (AUCs of 0.63 and 0.60, respectively), 2D RVFAC (AUCs of 0.62 and 0.60, respectively), and S’ (AUC 0.56 and 0.50, respectively), all p<0.05. Kaplan-Meier survival analysis (Fig. B) showed that a 3D RVEF of 35% (χ²=25.1, p<0.001) differentiates the best between survivors and non-survivors.

Conclusion

3D RVEF provides superior prognostic information for mortality and heart failure hospitalization in patients with HFrEF, better than 2D echo parameters. Inclusion of 3D RVEF in routine clinical assessment of patients with HFrEF might improve risk stratification and targeted interventions in this population.
Immediately improved diastolic function as determined by pulmonic vein Doppler-intraoperative TEE in TAVR patients and the impact of valvulo-arterial impedance
Authors: Rawangban P , Wuttichaipradit C
Published: January 2025

Background

A recent study demonstrates that most TAVR patients experience immediate improvement in diastolic function as determined by pulmonic vein Doppler (PvD) measurements. Valvulo-arterial impedance (Zva) is a marker of global LV load and represents both valvular and arterial load. Zva > 3.5 has been shown as a predictor of poor adverse outcomes. We hypothesize that Zva might have an effect on the change in pulmonic vein Doppler after TAVR.

Purpose

This study aims to demonstrate the impact of valvulo-arterial impedance and the immediate improvement of diastolic function in TAVR patients as assessed by pulmonic vein Doppler-intraoperative TEE.

Materials and Methods

Patients who underwent TAVR from January 2020 to September 2023 and were performed pulmonic vein Doppler by intraoperative TEE (right upper pulmonic vein from 90-110° mid-esophageal view) during TAVR and measured S-, D-, and A- wave velocity. We obtained the blood pressure and transthoracic echocardiographic parameters to calculate the Zva [(systolic blood pressure + mean pressure gradient across the aortic valve)/stroke volume index by LVOT doppler]. To compare the PvD change between Zva < 3.5 and Zva ≥ 3.5, use chi-square for categorical data and a paired t-test for continuous data.

Results

79 patients (mean age was 80.6 ± 5.6 years, 43 female) were enrolled in this study. S-wave was the only parameter with significantly increased velocity from baseline (33.2 ± 13.8 cm/s vs. 49.1 ± 18.6 cm/s, p < 0.001), whereas D-wave and A-wave did not significantly change from baseline (33.1 ± 14.5 cm/s vs. 33.3 ± 12.0 cm/s, p = 0.88; and 12.7 ± 7.8 cm/s vs. 13.3 ± 7.3 cm/s, p = 0.52, respectively). Of the 37 patients who had an S/D ratio < 1 at baseline, 26 of them converted to an S/D ratio > 1 immediately post-TAVR (Figure 1). In the group of Zva < 3.5, the number of patients who had PvD changed significantly compared with the group of Zva ≥ 3.5 (Figure 2).

Conclusion

The majority of patients in this study demonstrated that diastolic function improved immediately following TAVR using a pulmonic vein Doppler. S/D > 1 has improved significantly in the group with normal valvulo-arterial impedance (Zva < 3.5).

Figure 1

Figure 2
Tricuspid valve annulus remodeling and regurgitation analysis with 3-D transesophageal echocardiography after percutaneous transcatheter edge-to-edge repair
Authors: Maranzano G , Gripari P , Mantegazza V , Fusini L , Garlasche' A , Brusamolino M , Amelotti N , Ianniruberto M , Fazzari F , Cannata F , Ferrari C , De Marco F , Pepi M , Muratori M , Pontone G
Published: January 2025

Introduction

Tricuspid transcatheter edge-to-edge repair (Tr-TEER) is becoming an effective treatment for severe tricuspid regurgitation (TrR) in symptomatic patients who are high-risk candidates for surgery.

Purpose

Aims of the study were to assess immediate changes in tricuspid valve (TV) anatomy following Tr-TEER and to investigate the relationship between baseline geometry and residual intraoperative TrR.

Methods

Thirty-one consecutive patients (average age 77.3 years) with symptomatic severe TrR (≥ grade 4) underwent Tr-TEER. Intraoperative transesophageal echocardiographic 2D and 3D images were obtained before and immediately after the procedure. 3D datasets were analyzed offline using specialized software for 3D TV morphology analysis.

Results

All patients successfully underwent Tr-TEER: 24 patients (77%) achieved an optimal result with residual regurgitation ≤ 2, while 7 patients (23%) had a residual grade 3 or 4. The 3D datasets were suitable for analysis in 29 patients. Anatomic parameters of the TV, obtained via intraoperative transesophageal echocardiography before and after Tr-TEER, are presented in Table 1. The 2D and 3D annulus area, perimeter, diameter in the 2- and 4-chamber view, and minor and major diameter of the tricuspid annulus significantly decreased post-procedure. A significant reduction in TrR was noted regardless of annulus changes.

Conclusions

Tr-TEER is linked to a significant decrease in TrR and notable changes in TV geometry, particularly a substantial reduction in annulus area and perimeter. This may contribute to the effectiveness of Tr-TEER in promptly reducing TrR.
Intracardiac or transesophageal echocardiography for left atrial appendage occlusion? an updated systematic review and meta-analysis
Authors: Beneki E , Dimitriadis K , Theofilis P , Pyrpyris N , Kalompatsou A , Kostakis P , Koukos M , Tzimas G , Tsioufis K , Lancellotti P , Aggeli C
Published: January 2025

Background

Percutaneous left atrial appendage occlusion (LAAO) is typically performed under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. Intracardiac echocardiography (ICE) appears to be a potential alternative to guide implantation.

Purpose

We sought to perform a meta-analysis comparing ICE vs TEE for the guidance of percutaneous LAAO.

Methods

A comprehensive literature search was performed using MEDLINE, Scopus and Web of Science electronic databases from their inception to November 2023 regarding published abstracts and manuscripts. Studies reporting clinical outcomes comparing ICE vs TEE for percutaneous LAAO were included. Primary efficacy and safety outcomes included technical success and the occurrence of any reported procedure-related and device-related complication. Secondary outcomes included procedural characteristics such as procedural time, fluoroscopy time and the volume of contrast agent used.

Results

A total of 18 studies with 124,230 patients fulfilled the criteria. Outcomes assessed including procedure time between ICE vs TEE (risk ratio [RR], 1.01; 95% CI, 1.00-1.01), fluoroscopy time (MD: 1.45 minutes, 95% CI -1.32 to 4.22, p=0.30) and contrast medium volume (SMD: 0.02, 95% CI -0.23 to 0.26, p=0.89) were found to be similar between both groups. Technical success with higher odds was found with the use of ICE (OR: 1.36, 95% CI 1.14 to 1.63, p=0.006) and fewer devices employed in cases of ICE guidance (SMD: -0.22, 95% CI -0.43 to -0.01, p=0.04, I2=62%). There was also no significant difference in procedure- or device-related adverse events between both groups. Interestingly, patients undergoing LAAO under ICE guidance had higher risk for pericardial effusion/tamponade and iatrogenic residual shunts compared to those in the TEE group (11 studies, RR: 1.66, 95% CI 1.13 to 2.43, p=0.014) and (4 studies, RR: 1.53, 95% CI 1.12 to 2.09, p=0.02, I2=1%), respectively. More vascular complications were noted in cases of ICE (RR: 1.56, 95% CI 1.06 to 2.32, p=0.03).

Conclusions

Although TEE is the gold standard for perioperative guidance of LAAO, imaging with ICE is an effective alternative to TEE in LAAO procedures. However, further studies are needed to clarify safety of this new perioperative imaging technique.
Comparing fully automated 3DE quantification and cardiac magnetic resonance imaging for left ventricular volume and function evaluation in patients with dilated cardiomyopathy
Authors: Zoroufian A , Sheikh M , Asl Fallah S , Moradi M , Jalali A , Vakili-Basir A , Sahebjam M , Ashraf H
Published: January 2025

Background

Integration of artificial intelligence enhances precision, yielding dependable evaluations of left ventricular volumes and ejection fraction despite image quality variations. Dilated cardiomyopathy patients have low ejection fraction with dilated left ventricular volumes, which affect the diagnostic accuracy of automated 3D echocardiography. Establishing the diagnostic accuracy of fully automated 3DE quantification software, simplify and accelerate the measurement of left chamber volumes and ejection fraction.

Objective

In this manuscript, we present a cross-sectional study to assess and compare the diagnostic accuracy of automated 3D transthoracic echocardiography (3D TTE) to the standard cardiac magnetic resonance (CMR) imaging in patients with dilated cardiomyopathy.

Methods

In this cross-sectional study, 30 dilated cardiomyopathy patients with CMR imaging and comprehensive 3D TTE were included. 3D TTE and CMR imaging were performed within 24 hours. All 3D volume analyses were performed with fully automated quantification software using 3D images of 2,3, and 4-chamber views at the end of systole and diastole.

Results

Excellent Inter- and Intra-observer correlation coefficient was reported for automated 3D TTE software for all indexes. Automated 3D TTE software underestimated the mean value of LVESVI and LVESDI compared to the CMR. On the contrary, LVEF, LV Mass, LV Mass Index, and SV were overestimated. Contour correction was needed in 8 cases. In cases needing contour editing, no statistically significant difference was demonstrated except for LVEF and SV. Semiautomated 3D TTE software showed similar findings as automated, except that SV was underestimated. Correlation analysis demonstrated significant agreement between Automated 3D TTE software and CMR measurements for all indexes. Fully automated measurements exhibited excellent agreement for LVESVI (r=0.918) and LVEDVI (r=0.911), good agreement for SV (r=0.811), and acceptable agreement for LVEF (r=0.744). However, despite being significantly correlated, it did not reveal acceptable agreement for LV Mass (r= 0.498) and LV mass index (r=0.421). Semiautomated 3D TTE software revealed improved correlation for all indexes, except for LVEDVI and SV. Nevertheless, no significant difference was observed between the CMR agreement correlations with automated and semiautomated 3D TTE software measurements.

Conclusion

Automated 3D TTE software emerges as a rapid and viable imaging approach for evaluating the left ventricle's structure and function. Nevertheless, its volume assessments demonstrate a stronger correlation with CMR imaging compared to its functional assessments.

Agreement between 3D TTE and CMR

Inter- and Intra-observer correlation
The incidence and significance of the RAC sign in transthoracic echocardiography in the population of a tertiary hospital outpatient cardiology clinic
Authors: Budaj-Fidecka A , Gumiezna K , Glowczynska R , Grabowski M
Published: January 2025

Background

The RAC (retroaortic anomalous coronary artery) sign, visible in transthoracic echocardiography (TTE) as an abnormal tubular structure located retroaortically in the atrioventricular groove, is typical of an anomaly of the coronary artery origin.

Purpose

Assessment of the incidence of the RAC sign in the population of outpatient clinic of a tertiary academic hospital. Evaluation of the anatomy of coronary vessels in patients in whom the symptom was described. Assessment of the specificity of the RAC sign in the study population.

Methods

Consecutive patients, who underwent TTE in the outpatient clinic of the cardiology department between 04/2022 and 02/2024 were included in the prospective study. The echocardiography examinations were performed by a cardiologist with an EACVI (European Association of Cardiovascular Imaging) TTE certification. The anatomy of coronary vessels in patients with RAC was assessed by classic coronary angiography or computed tomography.

Results

2310 patients were included in the study. RAC sign was found in 8 (0,35%) individuals - 3 women (average age 70); 5 men (average age 58). In patients with RAC sign indications for TTE were as follows: history of anterior ST-segment elevation myocardial infarction (STEMI) treated by primary angioplasty of left anterior descending coronary artery (2 patients), history of inferior STEMI treated by primary angioplasty of right coronary artery (1 patient), history of pacemaker implantation (1 patient), history of myocarditis (1 patient), hypertension (1 patient), history of venous thromboembolism (1 patient), atypical chest pain (1 patient). Anomaly of the origin and retroaortic course of the coronary artery was confirmed by CT or coronary angiography in all subjects with RAC sign on TTE. In all patients with RAC sign, the retroaortic vessel was identified as circumflex artery (Cx). In 4 patients (50%), Cx originated from the right coronary artery, in 4 patients (50%) there was a direct origin of the Cx from the right sinus of Valsalva. In all patients the anomaly of the coronary vessel origin was not associated with increased risk of sudden cardiac death (interseptal course, course between large vessels and acute angle take-off were excluded). The specificity of the RAC sign was 100%.

Conclusions

The RAC sign is a relatively rare finding in the TTE evaluation. In our analysis, visualization of the retroaortic course of the coronary vessel was equivalent to the diagnosis of a mild anomaly of the origin and the retroaortic course of the circumflex coronary artery.
The pericardial fat marinade: a potential driver in myocardial hypertrophy and fibrosis development
Authors: Mahendran M , Elen E , Lenell J , Loganath K , Craig N , Dweck M R
Published: January 2025

Background

The myocardium is in direct contact with the epicardial fat. We hypothesized that surrounding cardiac adipose tissue might influence left ventricular (LV) structure and remodeling in patients with aortic stenosis. This study aimed to investigate the association between pericardial fat volume and markers of left ventricular function and myocardial fibrosis in patients with aortic stenosis.

Method

The studied subjects were participants in the CMRAS-cohort and included patients with aortic stenosis and healthy controls. All patients underwent comprehensive echocardiography and cardiac magnetic resonance imaging (CMR) with gadolinium contrast. Pericardial fat volume was calculated using manually adjusted contours in a short axis cine CMR stack. The relationship between pericardial fat volume and markers of myocardial remodeling and function, including LV mass, global longitudinal strain, ejection fraction, and myocardial fibrosis volume were examined with Pearson’s correlation and multiple linear regression.

Results

197 patients (152 patients with aortic stenosis and 45 controls) were included (median age 69 [IQR 12]; 66.5% male; peak velocity 3.5 ± 1.8 m/s; aortic valve area 0.99 [0.86] cm²; BMI 27.7 [6.7] kg/m2). The median pericardial fat volume was 145[92.4] mL. Pericardial fat volume was positively associated with left ventricular mass (r=0.442, p<0.001), fibrosis volume (r=0.395, p<0.001), global longitudinal strain (r=0.302, p<0.001) and diastolic function (E/e’ (r=0.262, p<0.001). After adjustment for age, body mass index, hypertension, diabetes mellitus and peak aortic velocity; pericardial fat volume remained a significant predictor of left ventricular mass and fibrosis volume.

Conclusion

In patients with aortic stenosis, pericardial fat volume was associated with higher left ventricular mass and increased myocardial fibrosis volume independent of patient age, aortic stenosis severity, obesity, hypertension and diabetes mellitus. Further investigation is required to assess how pericardial adipose tissue might accelerate myocardial hypertrophy, fibrosis and function.

Pericardial Fat Volume Associations
The effect of 4-month treatment with a dietary supplement containing glycosaminoglycans and fucoidanon endothelial glycocalyx integrity and vascular function in patients with psoriatic disease
Authors: Ikonomidis I , Pavlidis G , Katogiannis K , Katsanaki E , Thymis J , Kostelli G , Michalopoulou E , Vlachomitros D , Lazarou V , Theodoropoulos K , Vaiopoulos A , Lampadaki K , Papadavid E
Published: January 2025

Background/Introduction

Psoriatic disease is associated with impaired endothelial and vascular function.

Purpose

We investigated whether intervention with Endocalyx (Microvascular Health Solutions),a dietary supplement containing glycosaminoglycans and fucoidan, can improve endothelial glycocalyx integrity and arterial stiffness in patients with psoriatic disease.

Methods

Thirty patients with psoriatic disease were randomized to receive Endocalyx (n=15) or placebo (n=15) for 4 months. We measured at baseline and at 4 months of treatment: a)perfused boundary region(PBR) of the sublingual microvessels with a lumen diameter ranging from 4 to 25 μm, as a marker of endothelial glycocalyx integrity and b)carotid-femoral pulse wave velocity (PWV - Complior SP ALAM) and augmentation index (AI).

Results

Four months after treatment, patients under Endocalyx showed a significant reduction of PBR 4-25μm (2.10±0.31 vs. 2.31±0.20μm), PBR 10-19 μm (2.41±0.43 vs. 2.54±0.31μm), PBR 20-25 μm (2.62±0.42 vs. 3.02±0.30μm), PWV (9.4±1.8 vs. 10.4±2.2m/s) and AI[-4 (-39 – 16) vs. 9.8 (-8 – 23) %] (p<0.05 for all comparisons).No significant changes in the aforementioned markers were observed in placebo group (p>0.05; Table). In patients who were treated with Endocalyx, the percentage reduction of PBR 4-25μm was associated with the corresponding decrease of PWV (r=0.39, p=0.032) and with the improvement of AI (r=0.48, p=0.024) at 4 months.

Conclusions

Four-month treatment with Endocalyx may improve endothelial glycocalyx integrity and vascular function in patients with psoriatic disease.
Morphological and hemodynamic features of the carotid artery on doppler ultrasound in hypertensive patients
Authors: Phan H A O
Published: January 2025

Background

Vascular lesions in hypertensive patients often manifest in the entire vascular system, including the carotid artery. Evaluation of morphological changes, carotid artery function helps to treat, predict and prevent disease complications. We conducted the study with the following objectives: 1) Described the characteristics and morphology of the carotid artery on color Doppler ultrasound in hypertensive patients. 2) Determined the relationship between the carotid intima-media thickness (cIMT) on color Doppler ultrasound images with some clinical and subclinical characteristics and some risk factors in hypertensive patients.

Subjects and methods

A cross-sectional descriptive study on 64 hospitalized hypertensive patients.

Results

62.5% are female. Mean age 66.41±11.91. The right common cIMT 0.74 (0.7-0.81) mm; the left was 0.8 (0.7-0.8) mm; The average cIMT on both sides was 0.75 (0.75-0.79) mm. Mean peak systolic velocity of the right common carotid artery 58.03±14.74 cm/s; left side 60.71±15.73 cm/s. Right common carotid end-diastolic velocity 14.68±4.88 cm/s; left side 16.09±6.04 cm/s. Right common carotid resistance index 0.75±0.063; left side 0.74±0.067. There were 25 (39.1%) cases of right common carotid atherosclerotic plaque with the thickest 2.50±0.71mm and 33 (51.6%) cases of left common carotid plaque with the thickest 2.3 (1.99-2)mm. There were an independent correlation between age and sex with the cIMT on both sides with correlation coefficients of R=0.514, p=0.013; R=0.514, p < 0.0001, respectively.

Conclusion

There were a correlation between the common cIMT with age and sex, every 1 year increase will increase the thickness of the common cIMT by 0.005 mm. cIMT was higher than in men.