bluuebunny/crossref_metadata_2025 huggingface dataset:
Left atrial function and long-term survival after cardiac resynchronization therapy
Authors: Hammersboen L E R , Stugaard M , Puvrez A , Larsen C K , Remme E W , Kongsgaard E , Duchenne J , Galli E , Khan F H , Sletten O J , Penicka M , Donal E , Voigt J U , Smiseth O A , Aalen J M
Published: October 2024

Background

Left atrial (LA) reservoir strain after CRT has been linked to long-term outcome, but the role of LA function in response to cardiac resynchronization therapy (CRT) is incompletely understood. LA dyssynchrony during left bundle branch block has negative effects on LA function beyond LA reservoir strain. We hypothesized that correction of LA dyssynchrony after CRT has added value to LA reservoir strain as a marker of long-term outcome.

Purpose

To explore the role of LA function in long-term survival after CRT.

Methods

In a recent prospective multicenter study of 168 patients, LA segmental and global strains were measured by speckle-tracking echocardiography before and 7 ± 1 months after CRT. LA reservoir strain was measured as the difference between peak and minimum global strain during the atrial cycle and LA dyssynchrony as the time delay between onset systolic stretch of the interatrial septum and LA lateral wall. Since LA reservoir strain < 18% is associated with elevated LV filling pressure, we used 18% as cutoff and for LA dyssynchrony 43 ms (mean after CRT in the present study). All-cause mortality was used as clinical endpoint during follow-up.

Results

After 6 years ± 21 months (mean ± SD) follow-up, 35 (21%) patients died. LA reservoir strain was significantly lower (15 ± 9% vs 20 ± 10%, p = 0.003) and LA dyssynchrony numerically higher (61 ± 68 ms vs 39 ± 69 ms, p = 0.099) in patients who died compared to survivors. LA reservoir strain ≥ 18% after CRT was associated with favorable long-term survival (HR: 0.51, 95% CI: 0.26 - 0.98) (upper panel in the Figure). LA dyssynchrony was not independently associated with mortality. However, when used in concert with LA reservoir strain ≥ 18% after CRT, it identified patients with perticularly excellent long-term survival (HR: 0.17, 95% CI: 0.05 - 0.58 vs patients with reservoir strain ≥ 18% and persistent LA dyssynchrony) (lower panel in the Figure). Patients with preserved LA reservoir strain but persistent LA dyssynchrony had similar outcome as patients with reduced LA reservoir strain (HR: 0.98, 95% CI: 0.45 - 2.12).

Conclusion

LA reservoir strain ≥ 18% and absence of LA dyssynchrony is associated with excellent long-term survival after CRT.LA strain after CRT and survival
Which echocardiographic measure of longitudinal function is most informative?
Authors: Cunha De Almeida A , Stowell C C , Howard J P , Ng T , Cole G D , Bhattacharyya S , Sehmi J , Alzetani M , Demetrescu C D , Singh A , Mangion K , Rajani R , Rana B S , Francis D P , Shun-Shin M J
Published: October 2024

Background

The longitudinal function of the left ventricle can be quantified by measuring the myocardial excursion with or without normalising by the diastolic length to derive strain. Furthermore, these lengths can be determined from the curved myocardial length or in a straight-line from the mid-annulus to the apex parallel to the long axis. All four combinations have been advocated and used, but the optimal is unknown.

Purpose

Compare the prognostic information contained by these four measures of longitudinal function in a large retrospective cohort, with measurements performed by AI.

Methods

The cohort consisted of echocardiograms performed during 2015 at our institution for which mortality data were available. Our previously published AI based view classifier selected the apical 4-, 2-, and 3-chamber views from each study, before the endocardial contour and annular and apical points were segmented by another neural network. From this the curved and long-axis excursion was calculated, and then strain was derived using the diastolic length. Nested non-linear Cox-models including age and sex and each of the longitudinal measures were constructed, and the information contained by each variable was quantified via Chi-Square and compared using bootstrap methods.

Results

1733 patient studies were included, the median age was 64 (IQR 49 to 75) years and 51% were male. A total of 213 (14%) deaths occurred. The median excursion and strains were 3.25 cm (IQR 2.68 to 3.81) and -17% (IQR -20% to -14%) along the endocardial curve and 2.36 cm (IQR 1.88 to 2.87) and -14% (IQR -17% to -11%) along the long axis. All four longitudinal measures significantly added to a base model containing age and sex (p=0.003, p=0.005, p=0.005, p=0.002). Whilst the simple long axis excursion was numerically the most prognostic, none of the measures were significantly different from each other.

Conclusions

In this head-to-head AI-assisted retrospective cohort study using mortality as the endpoint, there was no good evidence that more complex measures of longitudinal function had better prognostic performance.Information provided by model componentsLong axis excursion calibration curve
The impact of preoperative four-chamber strain on failure of the maze IV procedure for atrial fibrillation: insights from conventional and speckle-tracking echocardiography
Authors: Kislitsina O N , Jankowski M , Rigolin V H , Thomas J D , Mehta C K , Hodges K E , Baldridge A , Kruse J , An S , Malaisrie S C , Cox J L , Johnston D R , Mccarthy P M
Published: October 2024

Background

Prior studies have linked decreased left atrial (LA) and left ventricular (LV) function to the failure of both catheter ablation and surgery for atrial fibrillation (AF). Yet, the effects of right atrial (RA) and right ventricular (RV) function on the failure of interventional therapy remain unexplored. This study evaluates four-chamber strain parameters using conventional echocardiography and speckle-tracking analysis to evaluate the contributions of preoperative left heart and right heart function to the failure of surgery for atrial fibrillation.

Methods

We retrospectively analyzed 821 patients who had surgical AF ablation, using pre- and postoperative data from electronic records to assess AF recurrence and thromboembolic events. Of these, 531 had LA ablation only and 290 had bi-atrial Maze-IV procedures. Four-chamber strain was evaluated via speckle-tracking on preoperative echos with TomTec Arena, excluding low-quality images. Univariate and multivariate logistic regression analyses were conducted to assess the influence of AF duration, LV ejection fraction, age, and gender on post-PAF surgery AF recurrence, thromboembolic events with results shown as odds ratios (ORs) in the table. An OR over 1.00 indicates a higher recurrence risk per variable increment. SAS software was used for all statistical analysis.

Results

In our cohort with a median age of 67.4±11.0 (46.2% female), unadjusted analyses revealed that increased LA and RA volumes and decreased RV free wall strain were significantly associated with AF recurrence post-surgical ablation. Conversely, each unit decrease in LA and RA peak reservoir strain corresponded to a 6% increase in the risk of AF recurrence, indicating an inverse relationship. Adjusted analyses for LA and RA end diastolic volumes and strain values showed a similar direction of association with AF recurrence, though these were not statistically significant. Similarly, lower LA and RA peak strains and larger atrial volumes were suggestive of an increased risk for postoperative thromboembolic stroke, but did not reach statistical significance, potentially due to the low event rate (1.8% of the cohort).

Conclusion

Conventional echocardiography offers a practical tool for identifying patients at high risk for AF recurrence and potential thromboembolic events after AF ablation surgery. Our study confirms that reduced preoperative LA, RA and RV strain values and enlarged volumes of LA and RA are strongly associated with AF recurrence following surgical ablation. Additionally, RA strain and volume are as predictive as LA metrics, underscoring their importance in risk stratification. These echocardiographic parameters may also hold value in forecasting the likelihood of postoperative stroke.
The left ventricular strain-volume loop in a healthy Dutch population: age- and sex related differences
Authors: Zwaan R R , Keuning Z A , Kerstens T P , Bowen D J , Hirsch A , Vos H J , Van Dijk A P J , Thijssen D H J , Roos-Hesselink J W , Van Den Bosch A E
Published: October 2024

Introduction

By combining left ventricular (LV) global longitudinal strain (GLS) with LV volume during the cardiac cycle, LV strain-volume loops can be generated. LV SV-loop derived parameters provide new insights into the interaction between cardiac contraction and volume in a variety of cardiac diseases (1,2) and may even have prognostic value. (3,4) Reference values for healthy individuals with attention to sex- and age-related differences have not been established yet. Therefore, the aim of this study is to provide reference ranges in a healthy adult population and investigate potential sex- and age-related differences of LV SV-loop characteristics.

Methods

In 125 healthy volunteers aged 18-72 years, apical 2-, 3- and 4-chamber views were acquired to measure GLS. Custom software was used to combine strain and volume data to construct SV-loops. Different parameters were derived: (i)linear slope of systolic strain-volume relation (S-Slope); (ii) early linear slope of systolic strain-volume relation (ES-Slope); (iii) early linear slope of diastolic strain-volume relation (ED-Slope); and (iv) uncoupling between systolic and diastolic strain-volume relation (UNCOUP).

Results

For the systolic strain-volume relation higher values were observed in females as compared with males with S-Slope values of 0.19 [0.17-0.22] %/mL m-² and 0.13 [0.11-0.15] %/mL m-² respectively. ED-Slope was higher in females as compared with males with values of 0.18 [0.09-0.28] %/mL m-² and 0.12 [0.06-0.18] %/mL m-² respectively. Relative coupling of the systolic and diastolic strain-volume relation was observed with a mean value of 0.34 ± 1.1. UNCOUP was correlated with age with a value for r of 0.4.

Conclusion

Higher values for the systolic and early-diastolic strain-volume relation in females can be reflective of different cardiomechanics as LV contraction is not only comprised of longitudinal but also circumferential and radial deformation. In line with current literature our custom software found relative coupling of the systolic and diastolic strain-volume relation in our cohort of healthy subjects. Towards older age relative uncoupling of the systolic and diastolic strain-volume relation was found.Figure 1.Strain-volume loop
The application of supine bicycle exercise stress echocardiograph for identification of susceptibility to acute mountain sickness
Authors: Xu Y U N , Wang Y I , Yin L
Published: October 2024

Background

Exposure to high altitude is likely to lead to acute mountain sickness (AMS). At present, there are no definite parameters that can accurately predict the occurrence of AMS.

Objectives

The purposes of this study are (1) to assess the relationship between stress echocardiographic parameters and AMS, (2) to identify the predictors of AMS at sea level by exercise stress echocardiography.

Methods

A total of 36 healthy adults were enrolled and underwent resting and exercise stress echocardiography on a supine bicycle at sea level. Heart rate (HR) and blood pressure (BP) were monitored during stress echocardiography. Left ventricular (LV) ejection fraction and E/e’ were calculated at rest and peak stage. Other right ventricular systolic function parameters and pulmonary artery pressure (PAP) were calculated at the same time, which included tricuspid regurgitation velocity (TRV), tricuspid annular peak systolic excursion (TAPSE), systolic PAP (sPAP), right ventricular (RV) dimension by 2D, right ventricular area at the end of diastole (RVAD), right ventricular area at the end of systolic (RVAS),RV fraction of area change (FAC), right ventricular outflow tract velocity time integral (RVOT VTI).Pulmonary vascular resistance (PVR) was calculated. All subjects ascended to 3600m within 24 hours by bus. AMS was identified by 2018 Lake Louise Questionnaire Score. Univariable and multivariable logistic regression analysis assessed independent factors associated with AMS.

Results

At the altitude of 3600m, 13 of 36 subjects had AMS, which defined as AMS (+) group. And the rest was AMS (-) group. There were no significant differences in HR, BP, and LV systolic and diastolic function between the two groups (P > 0.05). TRV, sPAP, and PVR were much higher at peak stage in AMS (+) group (P < 0.05). No significant differences were found in RV systolic function at rest and peak stage between the two groups. By multivariable logistic regression model, PVR and RVAD at peak stage were significantly associated with AMS occurrence (PVR-OR =1.962,95% CI: 0.689-0.973,p =0.002; RVAD-OR =1.962,95% CI: 0.638-0.967,p =0.005;). The cutoff value to predict AMS were 1.55 for PVR (AUC: 0.831) and 11.45 cm2 for RVAD (AUC: 0.802).

Conclusions

Supine bicycle exercise stress echocardiography is a useful and noninvasive technique to identify subjects susceptible to AMS. Subjects with higher PVR and RVAD at peak stage were associated with susceptibility to AMS.
Functional correlates of ischemic electrocardiographic changes during stress echocardiography. data form stress echo 2030 survey
Authors: Kobal S , Arbucci R , Zagatina A , Padang R , Peteiro Vazquez J , Boshchenko A , Celutkiene J , Saad A , Bursi F , Djordjevic-Dikic A , Lisi M , Manganelli F , Ciampi Q , Pellikka P A , Picano E
Published: October 2024

Background/Introduction

Cardiac stress tests are carried out in populations with a low probability of ischemic heart disease (IHD) much more frequently than in the past. Stress ECG remains a frequently used modality for the diagnosis of IHD in vast areas of the world with limited facilities.

Purpose

To assess the diagnostic value of stress ECG for diagnosing IHD using inducible regional wall motion abnormalities (RWMA) on stress echocardiography (SE) as the gold standard method of diagnosis.

Methods

The 12-lead ECG response was retrospectively analyzed in 4317 patients (age 64±13 years, 59.6% males) undergoing SE for chronic coronary syndromes who were prospectively recruited from 39 cardiac centers between March 2021 and February 2024. Exclusion criteria were left bundle branch block or pacemaker rhythm. ECG response was considered ischemic according to standard criteria (if ST-segment deviated >1.0 mm from baseline in ≥2 contiguous leads at 80 ms from J point) during an exercise (n=2980, 69.8%), dobutamine (n = 766, 18.0%), or vasodilator (n=519, 12.2%) SE. All patients underwent a comprehensive SE protocol with an assessment of wall motion score index (WMSI), B-lines (4-site simplified score), left ventricular contractile reserve (LVCR) based on force, coronary flow velocity reserve (CFVR) in the mid-distal left anterior descending artery (LAD), and heart rate reserve (HRR).

Results

ECG changes occurred in 641 patients (14.8%, Group 1) for the overall studied population. Compared to patients without ECG changes (Group 2, n=3676, 85.2%), patients with ECG changes showed higher values of peak WMSI and lower values of CFVR and LVCR (see table).Amongst patients without inducible RWMA (n=3553), there were 392 (11%) patients with an ischemic ECG at stress (89% specificity). Of 764 patients with inducible RWMA during SE, 249 had an ischemic ECG trace (sensitivity 33%). In patients without inducible RWMA, those with ischemic ECG changes showed similar abnormal stress B-lines (23% vs. 21%, p=0.719), LVCR (61% vs. 63%, p=0.602), CFVR (31% vs 33%, p=0.607) and HRR (37% vs 41%, p=0.097) compared to those without ECG changes. Amongst patients with inducible RWMA and ECG changes, CFVR was significantly lower in patients with ECG changes (39.2% and 60.8%, respectively, p<0.001).

Conclusions

Simple standard stress ECG diagnostic value in the current era in populations with a low probability of IHD seems to be low. However, during SE, stress-induced ischemic ECG changes are associated with more extensive RWMA and blunted global LVCR, with reduced CFVR in the LAD. Therefore, analysis of ST segment changes during stress imaging studies can offer additional, significant information.
Time to target heart rate in dobutamine stress echocardiography is shortened by using dynamic, but not isometric handgrip
Authors: Medilek K , Hrecko J , Parizek P
Published: October 2024

Background

Dobutamine stress echocardiography (DSE) is widely used for the detection of obstructive ischaemic heart disease. In our previous study we demonstrated that the magnitude of myocardial injury measured by hsTnT is associated with DSE duration. Shortening of DSE time is therefore desirable. Use of hangrip (HG) during DSE is generally recommended. However, there are no published studies comparing the efect of dynamic and isometric HG on the length of DSE.

Purpose

To compare the effect of dynamic and static HG on DSE duration.

Methods

211 patients undergoing DSE for ischaemia assessment were randomised into no HG (noHG, n=74), isometric HG (isoHG, n=68) and gynamic HG (dynHG, n=69) groups. All patients taking rate limiting medication were instructed to stop it 48 hours prior the test. DSE was performed according to the standard protocol (dobutamine infusion 5, 10, 20, 30, 40 ug/kg/min., increased in 3 min. intervals). HG was applied at the level of 40% maximum isometric muscular effort from the dobutamine dose of 20ug/kg/min. and atropine was administered in 1 min. intervals in 100 ug increments from the dose of 30 ug/kg/min. Patients who did not achieve their target heart rate (HR) or suffered from dobutamine side effects were excluded from the study.

Results

There were no differences in the groups characteristics (gender p=0.187, known ischaemic heart disease p=0.361, age p=0.128, basal HR p=0.367, target HR p=0.107, achieved HR p=0.257, positive test for ischaemia p=0.583). There was a significant difference in the time to target HR between dynHG and noHG groups (9.97±2.34 vs 11.96±3.02 min., p< 0.001) but not between isoHG and noHG groups (10.76±3.12 vs 11.96±3.02 min., p=0.058). Also, the was a similar difference in the length of dobutamine infusion between dynHG and noHG, but not between isoHG and noHG groups (11.76±2.37 vs 13.78±3.09 min., p< 0.001 and 13.34±4.90 vs 13.78±3.09 min., p=0.308, respectively). No significant correlation was found between the time to target HR and basal (r=0.43) or target HR (r=0.38).

Conclusion

Dynamic, but not isometric handgrip shortens the length of dobutamine stress echocardiography.
Predictive factors for recurrent tricuspid regurgitation after tricuspid annuloplasty: 3D echocardiography study
Authors: Verikas D , Krivickiene A , Jakuska P , Siudikas A , Vaskelyte J J , Ereminiene E
Published: October 2024

Introduction

There is growing concern about the recurrence of tricuspid regurgitation (TR) after tricuspid annuloplasty (TA) in individuals with functional tricuspid regurgitation (FTR). While TA is effective in treating FTR, a comprehensive understanding of the echocardiographic factors influencing TR recurrence is crucial.

Aim

This study aims to employ multivariate regression analysis to investigate the prognostic significance of tricuspid valve (TV) geometry and echocardiographic parameters associated with both RV geometry and function. The focus is on comprehending these relationships in the context of recurrent TR subsequent to TA.

Methods

This prospective observational cohort study aimed to explore factors contributing to recurrent tricuspid regurgitation (TR) after tricuspid annuloplasty (TA). The focus was on patients with moderate or severe functional TR due to left heart valvular disease, particularly severe mitral regurgitation, excluding those with ischemic heart disease. The cohort included 66 individuals undergoing preoperative assessments with 2D and 3D echocardiography, quantifying RV and right atrial (RA) geometry, functional, and tricuspid valve (TV) parameters. TR severity followed ESC guidelines. Patients were categorized into effective TA (50 patients) and recurrent TR (16 patients) groups, defined by mild-moderate TR and significant moderate-severe TR one year post-surgery, respectively. SPSS software facilitated statistical analysis, with adjusted logistic regression considering parameters such as age and gender.

Results

Among the patients (54% male, mean age 68±9 years), no significant differences were found in gender, left ventricular and atrial parameters, or preoperative TV orifice area between groups (recurrent TR vs. effective TA: 38 [33] mm2 vs. 29 [15] mm2, p=0.117). Univariate logistic regression analysis identified Septal-Lateral Systolic TA Diameter (OR 1.62), Septal-Lateral Diastolic TA Diameter (OR 1.99), and Major Axis Diastolic TA Diameter (OR 1.59) as key predictors. For diagnostic efficacy, ROC analysis revealed Major Axis Diastolic TA Diameter (AUC 0.848; cut-off 52.5 mm), TV Leaflet Tenting Volume (AUC 0.778; cut-off 5.1 ml), and RV Basal Diameter (AUC 0.763; cut-off 47.5 mm) as the most predictive parameters. The combined use of predefined RV basal diameter and Major Axis Diastolic TA Diameter showed the highest odds ratio for recurrent TR.

Conclusion

Key predictors, including Septal-Lateral Systolic and Diastolic TA Diameters, and Major Axis Diastolic TA Diameter, were identified, emphasizing their significance in understanding TR recurrence after tricuspid annuloplasty. The combination of predefined RV basal diameter and Major Axis Diastolic TA Diameter showed the highest odds ratio for recurrent TR, offering valuable insights for clinical assessment and preventive strategies.
Comparing the utility of 3D vs 2D left atrial volumes by echocardiography to predict stroke in the general population
Authors: Yafasov M , Javier Olsen F , Dyrby Johansen N , Grundtvig Skaarup K , Christian Hoejbjerg Lassen M , Soegaard P , Boje Jensen G , Schnohr P , Moegelvang R , Biering-Soerensen T
Published: October 2024

Background

Left atrial (LA) volume dilatation is associated with stroke in the general population. Two-dimensional echocardiography (2DE) is commonly used to measure LA size but is known to underestimate LA volumes compared to three-dimensional echocardiography (3DE). It is unknown whether this difference has clinical significance.

Purpose

We hypothesized that LA volumes by 3DE are more closely associated with stroke risk than 2DE in the general population.

Methods

We included 2,085 participants from a longitudinal cohort study from the general population who underwent 3DE and 2DE assessment of maximal and minimal LA volume index (LAVimax and LAVimin, respectively). After excluding participants with poor image quality, low volume rate, atrial fibrillation at baseline and non-sinus-rhythm during examination, a total of 1,956 participants were included for this analysis. The endpoint was stroke. Multivariable Cox regression models were adjusted for the CHA2DS2-VASc stroke risk score (age, sex, heart failure, hypertension, stroke, vascular disease, and diabetes).

Results

Mean age was 54±17 years, 43% were male, mean CHA2DS2-VASc score was 1.6±1.3. During a median follow-up of 4.8 years (interquartile range 4.3-5.5 years), 36 participants (1.8%) developed stroke. After multivariable adjustment, 2D LA volumes were not associated with stroke, whereas both 3D-LAVimax (HR 1.03 (95% CI 1.00-1.06), p=0.046, per 1 mL/m2 increase) and 3D-LAVimin (HR 1.05 (95% CI 1.02-1.08), p=0.002, per 1 mL/m2 increase) remained significantly associated with stroke (Figure 1). In addition, 3D-LAVimin showed the highest discrimination for predicting stroke with a C-statistic of 0.70 (95% CI: 0.59-0.80), which was significantly higher than 2D-LAVimax (C-statistic: 0.58 (95% CI 0.48-0.69); p=0.02), 2D-LAVimin (C-statistic: 0.54 (95% CI 0.42-0.65); p<0.001) and 3D-LAVimax (C-statistic: 0.62 (95% CI 0.52-0.73); p=0.004). 3D-LAVimin also showed incremental prognostic information when added to the CHA2DS2-VASc risk score (continuous net reclassification index 0.28±0.17; p=0.047).

Conclusion

Increasing 3D-LA volumes are significantly associated with higher risk of stroke in the general population which was not the case for 2D-derived LA volumes.
3D modelling-based left atrium geometry analysis to predict atrial fibrillation in patients with cryptogenic stroke
Authors: Martinez Vives P , Cecconi A , Vera A , Viliani D , Montejano S , Diego Nieto G , Benedicto Buendia A , Vilches Miguel L , Santos Martin B , Lopez Melgar B , Dominguez Arganda L , Alfonso F , Torrado Carvajal A , Jimenez-Borreguero L J
Published: October 2024

Introduction

Atrial fibrillation (AF) is a high prevalence condition associated with high morbidity and mortality. Its early diagnosis allows to initiate several prophylactic treatments that have proved to improve its prognosis. 3D modeling techniques allow to design accurate representations of cardiac cavities from diverse source images.

Purpose

We evaluated the association between new geometrical measurements obtained by 3D echocardiographic models of the left atrium (LA) and the presence of underlying paroxysmal AF in patients with cryptogenic stroke (CS).

Methods

3D LA volumes from a sample of consecutive patients aged ≥60 years old and admitted to our Stroke Unit with the diagnosis of CS from April 2019 to November 2020 were analyzed. 15 days ECG monitoring was performed after discharge to detect underlying paroxysmal AF. All 3D echo volumes were analyzed by a 3D modeling open-source application. From this analysis several LA geometry parameters were obtained: sphericity, elongation, flatness, major axis length, minor axis length, maximum 2D diameter (max2Ddiam) and surface-volume ratio (S/V). Functional atrial parameters (3D left atrial ejection fraction, LAEF) were also determined.

Results

36 patients were analyzed. Mean age was 78 ± 7 years old. 19% were diabetic, 58% had high blood pressure and 14% of patients had history of ischemic cardiomyopathy. Mean body-mass index was 26. These baseline characteristics were equally distributed between groups.

Baseline proBNP was significantly higher in patients developing atrial fibrillation (949 vs 275 pg/mL; p= 0,014.).

Maximum 2D diameter (max2Ddiam) and Surface-volume ratio (S/V) were the best predictors of AF (AUC of ROC curves: 0.69; 0.49 – 0.88 and 0.63; 0.42 – 0.84, respectively). An optimal cut-off point of 39 mm was selected for max2Ddiam and of 0.20 for S/V. These values were included in a multivariate model adjusted by baseline proBNP. A Max2Ddiam <39 mm and a S/V ≥0.20 were both significantly associated with the presence of paroxysmal AF (OR 6.96; p= 0.048 and OR 12.22; p = 0.043, respectively).

Conclusions

New geometrical atrial parameters can be obtained from echo 3D models and might be able to predict AF in patients with CS. Further analysis and larger samples are required to better understand these findings.TableFigure
Tricuspid regurgitation in rheumatic heart valve disease. New insights from 3D transthoracic echocardiography
Authors: Mahia P , Marcos Alberca P , Olmos C , Pozo E , Luaces M , Gomez De Diego J J , Rivadeneira M , De Agustin J A , Perez Villacastin J
Published: October 2024

Background

The assessment of tricuspid valve (TV) and functional tricuspid regurgitation (FTR) in left side valvular disease is crucial in assessing the need for surgical intervention. Despite the declining incidence of rheumatic disease, it remains a a common cause of valvulopathy. According to current guidelines, TV surgery is recommended in presence of severe TR or non-severe with annulus dilatation assessed by two-dimensional echo (2DE).

Objectives

To assess tricuspid annulus (TA) 3D dimensions in relation to the severity of tricuspid regurgitation (TR) and to identify new parameters associated with the presence of severe TR in this scenario.

Methods

Fifty patients (Age: 69±9, 82% women) with rheumatic heart disease without previous valve replacement and functional tricuspid regurgitation (FTR) were prospectively included. Two-dimensional echocardiography (2DE) and three-dimensional transthoracic full-volume datasets of the tricuspid valve (TV) were acquired. Two orthogonal planes corresponding to the anatomical antero-posterior (APD), septum-lateral (SLD), long intercommisural (LID), and area (A3D) of the TA were analyzed by 3D transesophageal echocardiography (3DTE) (Figure 1), in addition to 2D diameter. TR was graded into two groups: severe (n=14) or non-severe (n=26). The area under the curve (AUC), sensitivity (Se), and specificity (Sp) to identify the presence of severe FTR were calculated.

Results

All parameters differed significantly (p<0.05) between the two groups (2D: 18.6±1.9 vs. 23.3±2.0 mm/m2; APD 17.0±3.3 vs. 21.5±3.0 mm/m2; SLD: 18.9±2.0 vs. 22.5±2.0 mm/m2; LID: 20.9±2.6 vs. 26.1±3.5 mm/m2; A: 5.6±1.3 vs. 7.6±1.4 cm2/m2). 2D diameter (Cut-off point: 20.6 mm/m2, AUC: 0.850, Se: 86%, Sp: 72%), A3D (Cut-off point: 6.5 cm2/m2, AUC: 0.835, Se: 86%, Sp: 78%), and LID (Cut-off point: 23.3 mm/m2, AUC: 0.833, Se: 78.6%, Sp: 77.8%) were the parameters with the best performance for severe FTR detection.

Conclusions

New 3D-derived parameters provide relevant information in the assessment of TA and offer good diagnostic performance for identifying severe FTR in this subgroup of patients.2D/3D Echo TA measurements
Feasibility, accuracy, and reproducibility of device sizing in virtual reality for percutaneous left atrial appendage closure - a single center study
Authors: Heidari H H , Kanschik D K , Wolff G W , Maier O M , Kelm M K , Werner N W , Zeus T Z , Jung C J , Afzal S
Published: October 2024

Background

Left atrial appendage closure (LAAC) is a safe and effective procedure for stroke prevention in patient with non-valvular atrial fibrillation. Procedural planning and device sizing remains challenging due to the highly complex and variable three-dimensional (3D) anatomy of the left atrial appendage (LAA). Virtual reality (VR) is a innovative, recent technology allowing a superior spatial orientation visualization of 3D imaging datasets.

Purpose

Therefore, we aimed to evaluate feasibility and accuracy of LAA measurements in VR for device sizing in patients planned for LAAC.

Methods

Twenty-one patients (79±7 years, 62% male) with non-valvular atrial fibrillation scheduled for LAAC were randomly included in our study. Preprocedural a multi-slice computed tomography (MSCT) was performed for device sizing in all patients. MSCT-based 3D models were established and visualized in VR using a dedicated software (VMersive, Warsaw, Poland). LAA dimensions (Ostium, landing zone (LZ), and depth) were assessed directly in the virtual environment. Conventional measurements of LAA ostium, landing zone (LZ) and depth using commercially available software were compared to measurements in VR.

Results

3D reconstruction of MSCT datasets and visualization in VR were successfully performed automatically in all patients within a few seconds. MSCT and VR demonstrated good correlations for ostium minimum (r = 0.93), maximum (r = 0.8) and mean (r = 0.88, all p<0.001) diameters. Additionally, LZ minimum (r=0.84), maximum (r=0.86) and mean (r=0.9) diameters showed good correlation (all p<0.001). Moderate correlation was observed for depth measurements (r=0.76, p<0.001). Furthermore, intraclass correlation coefficients ranging from 0.88 to 0.98 denoted high inter- and intraobserver agreement.

Conclusion

Immersive VR allows highly feasible, accurate and reproducible measurements of the LAA dimensions directly in the virtual environment, hence enabling accurate device sizing for LAAC.
Reverse RV remodeling after isolated tricuspid valve surgery
Authors: Mane F , Luque M , Azzam I K , Melo C , Anguita Gamez M , Mahia P , Gomez De Diego J J , Olmos C , Luaces Mendez M , Vilacosta I , Perez-Villacastin J , De Agustin A , Maroto L , Carnero M , Pozo Osinalde E
Published: October 2024

Background

Impact of tricuspid regurgitation (TR) on right ventricular (RV) and atrial (RA) size and function is one of the main determinants of prognosis. However, there is scarce data about the recovery of right chambers after isolated tricuspid valve surgery (ITVS).

Purpose

Our aim is to evaluate postsurgical changes in right chamber morphofunctional parameters by echocardiography after ITVS.

Methods

We selected all the patients that underwent ITVS in our tertiary centre between 2009 and 2022 excluding those with congenital anomalies. Echocardiographic right ventricular classical parameters (RV diameters, RA area, TAPSE and fractional area change (CAF)) as well as myocardial deformation (free wall (FW)- and 4 chambers (4C)- global longitudinal strain (GLS)) were compared in baseline studies, early and late postsurgical periods.

Results

Among the 45 patients included (65 ± 2 years-old, 51% female, TRI-SCORE 2 [1-4]) surgical indication was functional TR in 51%, 29% underwent tricuspid valve repair and 71% replacement. The treatment was considered ineffective (postoperative TR ≥ moderate) in 9%. In the early postsurgical phase (1.9 [1.2 – 3] months) a significant reduction in basal (-17%, p<0.01), mid (-15%, p<0.01) and longitudinal (- 7%, p<0,01) RV diameters as well as RA area (-26%, p<0.01) was noted. These changes persist in the late postoperative period for basal (-16%, p<0.01) and mid (-20%, p<0.01) RV diameters and RA area (-19%, p=0.03). RV function parameters suffer significant reduction in the early phases: TAPSE (-39%, p<0.01), FAC (-24%, p<0.01), FW-GLS (-17.1%, p<0.01) and 4C-GLS (-16.3%, p<0.01). In later stages the major worsening in classical parameters persist: TAPSE (-28%, p=0.01) y FAC (-20%. P=0.01). However, strain variables recover to the baseline values. Postoperative RV reverse remodeling is reflected in Table and Figure.

Conclusions

Postoperative changes in echocardiographic right chambers features after ITVS suggest that myocardial deformation parameters should be the method of choice for follow-up of this surgical procedure.

Table. Comparison of baseline and postsurgical echocardiographic parameters.

Figure. Echocardiographic parameters evolution.TableFigure
Deep learning for fully automated echocardiographic measurements of left ventricular wall thickness and chamber dimensions in the parasternal long-axis view
Authors: Holmstrom V , Smistad E , Ostvik A , Holte E , Nyberg J , Lovstakken L , Dalen H , Grenne B
Published: October 2024

Background

Accurate quantification of left ventricular (LV) wall thickness and chamber dimensions in the echocardiographic parasternal long-axis view (PLAX) is crucial for clinical decisions in patients with heart disease. However, there is a need for more reproducible and time-efficient methods. Fully automated deep learning (DL)-based methods could address this need.

Purpose

To develop a DL-based method for fully automated measurements of LV wall thickness and chamber dimensions in PLAX, validate its performance in a large population cohort, and evaluate its capacity to differentiate between hypertensive and normotensive groups.

Methods

DL networks were trained on PLAX recordings from 207 subjects. The DL method performed cardiac segmentation, timing of end-systole and end-diastole, and measured LV wall thickness and chamber dimensions in PLAX. The model was validated in a large populational echocardiography dataset including a subset with test-retest evaluation. Agreement with expert reference measurements, test-retest reproducibility, and comparison of normotensive and hypertensive (defined as those on hypertensive medication or with systolic blood pressure >160 mmHg) groups were evaluated.

Results

In the populational study of 2047 subjects, the novel DL method demonstrated a feasibility of 97.6%. Strong agreement was observed between the automated DL method and expert readers in measuring end-diastolic septal thickness, posterior wall thickness, and LV diameter (bias 0.1 mm, 0.2 mm, and 2.2 mm, respectively, Figure 1). In a test-retest dataset (n=40, with 2 recordings per patient and 4 readers), the novel DL method displayed improved reproducibility compared to inter-reader measurements, with minimal detectable change for interventricular septal diameter 2.2 mm versus 2.6 mm, posterior wall diameter 1.2 mm versus 2.5 mm, and LV diameter 5.0 mm versus 6.3 mm (Figure 2). The DL method measured significantly wider septal diameter in the hypertensive group compared to normotensive group (p<0.001). Mean analysis time for wall thickness and chamber dimensions using the DL method was 1.2 seconds.

Conclusion

The novel DL method accurately measured LV wall thickness and chamber dimensions in the PLAX view, and demonstrated improved test-retest reproducibility compared to experienced echocardiographers. Additionally, it was able to detect significantly wider septal diameters in the hypertensive population. By providing fast and reliable measurements in retrospective data, and with potential for real-time measurements during image acquisition, this DL method has the potential to improve the yield, efficiency, and workflow in echocardiography.Bland-Altman posterior wall diameterTest-retest posterior wall diameter
Accuracy of right atrial pressure estimation by transthoracic echocardiography
Authors: Ruge M , Pancio G , Mehrotra P , Marhefka G
Published: October 2024

Background/Introduction

Transthoracic echocardiography provides an estimate of right atrial pressure (RAP) using the guideline-recommend method of measuring inferior vena cava (IVC) diameter and collapsibility. Despite being ubiquitously reported and necessary for the estimation pulmonary artery systolic pressure, the accuracy of this method for RAP estimation has not been rigorously validated.

Purpose

To evaluate the accuracy of the guideline-recommended method for the estimation of RAP by TTE.

Methods

A single center, retrospective chart review of patients who had a TTE and right heart catheterization (RHC) within 48 hours of each other from January 2018 to December 2020. Maximum and minimum IVC diameter were measured by trained study personnel. Accuracy was then stratified by the presence/absence of a history of two variables that could modify IVC diameter independent of RAP—syncope, which is associated with more dilated IVC in some studies and liver disease, which could result in compression (from parenchymal fibrosis surrounding the IVC) or dilation (from diversion of portal blood flow through the IVC among other mechanisms) of the IVC.

Results

The 117 patients who met inclusion criteria had a median age of 67 years old (interquartile range [IQR] 58 – 75) and median RAP of 13 mmHg (IQR 8 – 18) on RHC. The median time between TTE and RHC was 9.6 hours (IQR 3.8 – 24.5 hours) during which 24 (20.5%) patients received intravenous fluids (median 220 mL administered; IQR 145 – 320). Forty-three (35.9%) received diuretics between the studies with most patients receiving either 1 (26 patients, 61.9% of those who received diuretics) or 2 (13 patients, 31.0%) diuretic doses.

In evaluating accuracy, only 26 patient’s (20.5%) RAP by RHC fell within estimated RAP range by TTE (Figure 1). After excluding the 60 patients who received fluids and/or diuretics between the TTE and RHC, the TTE estimate was still only accurate in 13 (22.8%) patients. When analyzing how each subcomponent of the TTE guidelines for RAP estimation correlated with RAP via RHC, maximum IVC diameter and percent collapsibility had Pearson’s correlation coefficients of 0.47 and 0.24 respectfully (Figure 2A and 2B).

Past medical history was significant for syncope in 16 patients (13.7%) and liver disease in 8 patients (6.8%). Compared to those without each factor, the absolute accuracy of the TTE estimate was lower when stratified by a history of syncope (12.5% accurate vs 21.8%, p = 0.60) and liver disease (12.5% vs 21.2%, p = 0.90) though neither were statistically significant.

Conclusion

In this retrospective chart review, RAP estimation by TTE using the guideline-recommended method had limited accuracy. Prospective evaluation with minimal time between RHC and TTE is needed to validate the accuracy of the TTE guidelines.Accuracy of TTE for RAP estimationCorrelation between RAP & TTE Variables
Small heart size and premature death in 366,484 individuals with normal ejection fraction
Authors: Rowe S , Paratz E , Fahy L , Janssens K , Spencer L , D'ambrosio P , Strange G , Prior D , Playford D , La Gerche A
Published: October 2024

Background

In patients with preserved left ventricular ejection fraction (LVEF), small ventricular size has been associated with reduced functional capacity, but its impact on clinical outcomes is unclear.

Purpose

The goal of this study was to determine the relationship between small heart size and premature mortality within a large multi-centre adult patient cohort with transthoracic echocardiographic examinations.

Methods

We divided 366,484 individuals with LVEF ≥ 50% (including a sub-set of 279,442 individuals with high-normal LVEF ≥ 60%) by sex and increasing quartiles for LV end-diastolic volume (LVEDV), LVEDV indexed to body surface area (LVEDVi) and LV end-diastolic diameter to assess associations with 5-year mortality through linkage with the National Death Index.

Results

During 2-million person-years of follow-up, 65,241 deaths occurred. Increasing LV chamber size was associated with reduced odds of 5-year all-cause mortality, particularly for higher LVEF. As compared with the larger quartiles, the smallest cardiac size quartiles were associated with higher 5-year all-cause mortality, even after adjusting for age (Figure 1). The smallest LVEDVi quartile was associated with a 14% and 18% higher odds of 5-year all-cause mortality for males and females, respectively, with a greater effect with high-normal LVEF. For cardiovascular-related mortality, females in the smallest quartile for LVEDVi had a 17% increased odds of mortality, which increased to 30% in those with LVEF was ≥ 60%. In men, there was no significant association between smallest cardiac size and cardiovascular-related mortality.

Conclusions

In individuals with normal LVEF, small ventricular size is associated with increased mortality, particularly among females and those with higher LVEF.
Automated selection of echocardiographic views using a novel artificial intelligence software
Authors: Gessert N G , Szasz D , Wehle S , Chaudhari A , Waechter-Stehle I , Slivnick J A , Cotella J , Mor-Avi V , Lang R M
Published: October 2024

Background/Introduction

Evaluation of a single echocardiographic study involves sorting, selecting, measuring and interpreting a large number of images. As these steps are currently performed manually, this can turn into a repetitive, time-consuming and tedious task. Although the use of artificial intelligence (AI) software could potentially improve this entire workflow, most of the efforts have been focused on measurement automatization. Incorporation of automated selection of echocardiographic views could further optimize this process.

Purpose

We investigated whether an AI-derived measurements software can be supplemented by automated view selection using an AI model. We hypothesized that automated selection of echocardiographic views yields similar results compared to manually selected views when using the same tool for automated measurements in both groups (Figure 1, top).

Methods

We trained an AI model (convolutional neural network) to recognize the main standard 2D echocardiographic views. This model was trained on individual frames from 20,000 DICOM clips to predict a specific cardiac view, based on the view annotation provided by an echocardiography expert (ground-truth). We then selected a test set of 5,000 DICOMs where we applied the AI model to all images in the study. We selected the highest-ranking apical 2 chamber (A2C) and apical 4 chamber (A4C) images, based on the model’s output probability (Figure 1, bottom). For the same 21 studies, an expert selected the best A2C and A4C image for left ventricular volumes and ejection fraction measurements. Then, we ran Philips AutoMeasure both on manually and automatically selected images. We then compared the measurement values for statistical significance using a pair-wise t-test, see Figure 2.

Results

The AI model achieved an accuracy of 96% and AUC of 0.99 on the test set. The results obtained when comparing the automatic and manually selected images in the 21 studies are shown in Figure 2. For all the measured parameters, there was no statistically significant difference in mean values between both selection methods.

Conclusions

Manual and AI-derived selection of standard echocardiographic images do not lead to a statistically significant difference in automated measurements, suggesting that incorporation of automated view selection may contribute to improve daily echocardiographic workflow. Future research could aim in extending these findings to more cardiac views, parameters, and populations.Comparison of the approachesResults
Sex differences in diastolic function following myocardial infarction on doppler echocardiography
Authors: Chan N I , Atherton J J , Hammett C , Stewart P , Mallouhi M , Vollbon W , Parsonage W , Prasad S B
Published: October 2024

Background

Whilst females have relatively greater preservation of left ventricular ejection fraction (LVEF) following myocardial infarction (MI), they have higher rates of heart failure, presumably due to diastolic dysfunction (DD).

Objectives

This study sought to assess sex differences in LV diastolic function on Doppler echocardiography following MI.

Methods

Data on 2505 consecutive patients with a first-ever MI were included. Echocardiography was performed within 24 hours of admission. Significant DD was defined as grade 2+3 DD according to current ASE/EACVI guidelines. Diastolic function score (DFS) was calculated by summing the number of abnormal parameters out of the 4 key diastolic parameters (e’ velocity, E/e’ ratio, left atrial volume index [LAVI], tricuspid regurgitation velocity [TRV]).

Results

Compared to males, females were older, had greater co-morbidity, less 3-vessel disease, and a higher LVEF (55.0+9.8% versus 52.7±9.8%, p<0.001). LAVI, e’ velocity, E/e’ ratio, significant DD and DFS were significantly associated with female sex on univariate group comparisons. In multivariable models incorporating clinical, angiographic and echocardiographic data to determine independent predictors of diastolic parameters, female sex was independently associated with abnormal LAVI (OR 1.42, p=0.013), E/e’ ratio (OR 2.86, p<0.001), TRV (OR 1.83, p=0.005), significant DD (OR 2.12, p<0.001) and DFS (OR 2.60, p<0.001).

Conclusions

Female sex is a strong independent correlate of diastolic dysfunction on Doppler echocardiography in patients with a first-ever MI. This may explain the higher incidence of heart failure despite relatively preserved LVEF in females following MI.