bluuebunny/crossref_metadata_2025 huggingface dataset:
Right ventricular diastolic dysfunction in breast cancer patients undergoing chemotherapy
Authors: Sumin A , Slepynina YUA , Shcheglova AV , Ivanova AV , Borzyanitsa SM , Polikutina OM
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Right ventricular (RV) diastolic dysfunction has been recognized as an independent predictor of adverse events and mortality in a wide range of diseases (1,2). Experimental and clinical data indicate that pathophysiological factors induce the development of RV diastolic dysfunction first, and only later - systolic dysfunction (3). The aim of the study was to assess the right ventricle diastolic function in patients with breast cancer undergoing chemotherapy.

Material and methods

The study included 40 women receiving anthracycline-based chemotherapy for cancer, and 25 age-matched and comorbidity-matched women without cancer as a control group. RV systolic (s"t, Tei-index, and TAPSE) and diastolic (Et, At, Et/At, e"t, a"t, e"t/a"t) function parameters at baseline and after treatment were compared and evaluated.

Results

In cancer patients during anthracycline-based chemotherapy, no signs of cardiotoxicity were detected according to the indicators of the left ventricular ejection fraction and global longitudinal strain. Progressive decline in RV diastolic function was noted in patients receiving anticancer therapy. Et was 53.0 (46.0; 62.0) sm/sec in control, 50.0 (41.0; 53.0) sm/sec in cancer group before treatment, and  45.0 (41.0; 51.0) sm/sec after one-year treatment (p = 0.017 for trend). Et/At was 1.4 (1.28; 1.6), 1.34 (1.23; 1.58), and 1.12 (0.81; 1.35), respectively (p = 0.002 for trend). RV systolic function was without changes during treatment. TAPSE was 2.5 (2.2; 2.8) sm in control, 2.3 (2.2; 2.5) sm in cancer group before treatment, and  2.3 (2.0; 2.4) sm after one-year treatment (p = 0.091 for trend). 

Conclusion

Patients undergoing chemotherapy experience a decline in right ventricular filling rates despite not showing clear signs of anthracycline-associated cardiotoxicity. More research is needed to indicate the clinical and prognostic significance of such changes.
High frame rate blood speckle tracking echocardiography: left ventricle vortex analyisis in healthy children and in congenital heart disease
Authors: Cantinotti M , Marchese P , Assanta N , Van Den Eynde J , Franchi E , Shelby K
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

High-frame rate blood speckle tracking (BST) echocardiography is a new method, for the evaluation of intracardiac flow, independent of the insonation angle. Left ventricle, throughout cardiac cycle, creates a vortical flow still poorly analysed in children with congenital heart disease (CHD). Aim of this study is to evaluate the characteristics of left ventricular (LV) vortices in healthy children and in those with CHD.

Methods

Characteristics of LV vortices were acquired on standard 4-chamber view and BST images from 230 healthy children (median age 5.96 years, range 2.9-10.1 years) and 72 children with CHD (median age 1.33 years, IQR 0.2-7.12 years). Both groups were compared after propensity matching. Multiple linear regression was used to identify factors that independently influence vortex characteristics.

Results

Feasibility of vortex imaging was 97% for healthy children and 96.7% for CHD. After propensity matching, there were mild significant differences in vortex distance to apex, distance to interventricular septum, height, width, sphericity index. Indexed by BSA Vortex Area (VAi) was significantly higher on CHD patients than healthy subjects (p < 0.0001).  However, multiple regression analysis exposed significant associations of LV morphology with vortex characteristics: a VAi >0.98 can predict an abnormal LV morphology (Sensibility 73%, Specificity 83%). Furthermore, CHD involving LV volume or pressure overload were both associated with vortices localized closer to the IVS.

Conclusions

LV vortex analysis using high-frame rate BST echocardiography is feasible in healthy children and in those with CHD. Since vortices are associated with LV morphology and are altered in some CHDs, vortices might yield diagnostic and prognostic value. Future studies are necessary to further establish applications of vortex imaging in the clinical setting. Abstract Figure. Vortex in healthy children and in CHD
Evaluation by ultrasound of the velocity time integral in carotid stenosis
Authors: Perea O , Corneli MC , Perez Pardo N
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

 Atherosclerotic disease is one of the main causes of cerebrovascular accident. Doppler ultrasound is one of the most important tools in the diagnosis and quantification of such issues. The classics variables to assess through this method are peak systolic velocity (PSV) at the highest stenosis carotid level, diastolic velocity at such level and the PSV rate between the PSV at the stenosis level of the internal carotid artery (ICA) respect the PSV at the common carotid artery (CCA).

Objectives

Compare the correlation of the velocity time integral (VTI) and the ratio between VTI of ICA and CCA to identify carotid stenosis by carotid ultrasound.

Material and methods

We included patients that assist at the institution for a carotid ultrasound to identify a carotid stenosis, between 2017 and 2020. Correlation tests between continuous variables were applied according to the type of distribution. Pearson"s test for continuous variables with normal distribution and Spearman"s for those with abnormal distribution.Fig. 1

Results

Three hundred and forty two patients were included, 78% male, mean age 67 ± 8.

According to its distribution, the VTI ACI / CCA ratio obtained as the median is 5 cm (1.27-8). By dividing the VTI ratio by quartiles, we observe that the percentage of individuals with a higher degree of carotid obstruction, increase significantly as the quartile increase: 0%, 36.5%, 94.2%, 98.8 %. p: 0.0001.

Likewise, a high correlation value between the classical quantitative values and VTI and ratio of VTI at different grade of carotid stenosis was seen by carotid ultrasound (Table 1).

Conclusions

VTI and VTI ratio are parameters that show good correlation with the classical variables to assess a carotid stenosis by carotid ultrasound. In future investigations, the evaluation of these parameters could lead the estimation of the stenosis area, considering the principles of the continuity equation. Abstract Figure. Fig 1  Abstract Table. 1
Detection of a diastolic heart sound in children and young adults using high-frame-rate echocardiography
Authors: Mccrary AW , Moore C , Sturgeon G , Lefevre M , Kisslo JA , Von Ramm OT , Barker PCA
Published: February 2022

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Colin"s Kids, Inc. PO Box 93 Hopewell, NJ 08525

Introduction

The auscultatory finding of a fourth heart sound (S4) is clinically associated with a pathologic decrease in left ventricular compliance, but may be seen in healthy children by phonocardiography. High-frame-rate difference imaging (HFRDI) has demonstrated several propagating myocardial phenomena in the left ventricular (LV) lateral wall throughout the cardiac cycle, including during diastole. We hypothesize that these visualized wave phenomena correlate with physiologic and pathologic heart sounds.

Purpose

Using HFRDI, we sought to define the characteristics of a LV lateral wall late diastolic wave in healthy children and young adults.

Methods

HFRDI was obtained from the apical 4-chamber view with synchronized electrocardiogram (ECG) on the T5 system (Phased Array Research Scanner) acquiring images for this study between 587 and 1174 frames per second (depending on participant imaging characteristics). In addition, tissue Doppler images were acquired with synchronized ECG and phonocardiography (PCG) on a commercial ultrasound machine (Figure 1). Timing events were measured from the QRS onset on the ECG tracing. An S4 wave correlate was defined by meeting the following criteria: 1) occurring after the P wave on ECG; 2) at or after the onset of a’ on TDI; 3) occurring during the PCG S4; and 4) occurring prior to the S1 wave complex. The timing of the S4 wave in HFRDI was measured from the onset of QRS to the first appearance of the wave, and the wave velocity was calculated by measuring the length of the lateral wall and counting temporally calibrated image frames while the wave was visible.

Results

Nine healthy volunteers completed the imaging protocol with a median age of 20 years (range 6 – 22 years). A single, distinct late diastolic HFRDI wave was seen in all participants propagating from apex to base of the lateral LV free wall. This wave met the defined criteria to be a visual correlate of S4 in all participants. Measurements of correlated events are presented in Table 1. S4 propagating velocity was 2.96 ± 1.8 m/sec and occurred 25 ± 18 msec prior to the QRS onset. There is a strong positive correlation between age and S4 velocity [r(7) = 0.76, p = 0.019].

Conclusion

The S4 heart sound can be reliably visualized by high frame rate imaging and has similar characteristics in healthy children and young adults. Further definition of normal and abnormal S4 wave characteristics may lead to a novel tool in defining LV diastolic function. Abstract Table 1  Abstract Figure 1
Non-invasive left ventricular myocardial work in patients with chronic aortic regurgitation and preserved left ventricular ejection fraction
Authors: Meucci MC , Butcher SC , Van Der Velde ET , Ajmone Marsan N , Bax JJ , Delgado V
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

 Left ventricular global longitudinal strain (LV GLS) has been proposed as sensitive marker of myocardial damage in patients with chronic severe aortic regurgitation (AR) and preserved left ventricular ejection fraction (LVEF). However, LV GLS does not take into account the afterload.

Non-invasive LV myocardial work is a novel parameter of LV myocardial performance, which integrates measurements of myocardial deformation and non-invasive blood pressure (afterload).

Purpose

The aims of this study were: 1) to assess non-invasive LV myocardial work in patients with chronic AR and preserved LVEF and its correlation with other echocardiographic parameters, 2) to evaluate changes of LV myocardial work after aortic valve replacement or repair (AVR) and 3) to assess the relationship between LV myocardial work and post-operative LV reverse remodeling.

Methods

This retrospective study included fifty patients (53 ± 16 years; 68% men) with moderate or severe chronic AR and preserved LVEF, who underwent AVR. Non-invasive LV myocardial work indices were measured at baseline and post-operatively (between 2 and 12 months after surgery) and compared with previously reported normal reference ranges.

Results

Based on normal reference values, patients with chronic AR and preserved LVEF had preserved or increased values of LV global work index (LV GWI) (84% and 16%, respectively) and LV global constructive work (LV GCW) (78% and 22%, respectively) (Figure 1). In addition, LV global work efficiency (LV GWE) was preserved in all patients, despite 16 (32%) subjects had impaired values of LV GLS (<16.7.% in men and <17.8% in women). LV GWI and GCW showed a positive correlation with markers of AR severity and parameters of LV systolic function. AVR results in a significant reduction of myocardial work indices (p < 0.0001), with the exception of LV global wasted work, that did not change (p = 0.29). According to normal reference ranges, 15 (30%) patients had impaired values of LV GWI and LV GCW post-operatively, while LV GLS was impaired in 37 (74%) patients. The post-operative impairment of LV GWI demonstrated a stronger association with reduced LV reverse remodeling, as compared to the impairment of LV GLS (Figure 2).

Conclusions

Compared to afterload-dependent echocardiographic parameters, non-invasive LV myocardial work indices allow a better understanding of myocardial performance and energetics in the setting of chronic AR with preserved LVEF and could improve risk stratification. Abstract Figure.  Abstract Figure.
Left atrial volumetric/mechanical coupling index in the general population: distribution and prediction of incident atrial fibrillation
Authors: Benfari G , Skaarup KG , Johansen ND , Jensen GB , Schnohr P , Mogelvang R , Nistri S , Biering-Sorensen T
Published: February 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): The Copenhagen City Heart Study was funded by the Danish Heart Foundation, and the echocardiographic substudy was further funded by the Lundbeck Foundation.

Background

Atrial fibrillation (AF) represent a global health burden. Identifying people at risk based on echocardiography has always been challenging. Hence, we aimed to assess the distribution of left atrial volumetric/mechanical coupling index (LACI) in the general population and test its potential to predict incident AF.

Methods

In a large community-based population study, LACI was calculated by dividing the left atrial (LA) maximal volume by the a’ peak velocity obtained by color Tissue-Doppler Imaging. Clinical endpoint was incident AF. The exclusion criteria were history of AF or previous heart failure.

Results

A total of 1021 patients formed the study cohort (mean age 52.8 ± 13.3, 45% (n = 459) were male); Median LACI was 2.84 [IQR: 2.14-3.82], rarely exceeding the value of 6. During a follow-up period of 16.1 years (IQR15.6-16.3), 8.9 % (n = 91) of patients developed AF. LACI independently predicted AF (HR 1.11 [1.04-1.17], p = 0.001 unadjusted and HR 1.20 (1.06-1.35), p = 0.003 after a comprehensive multivariable adjustment (including clinical, biochemical, and echocardiographic variables). The Figure illustrates the strong relationship between LACI and the incidence of AF, almost linear, with no plateau effect. In a sensitivity analysis, the association between LACI and incident AF persisted in both hypertensive (HR 1.12 (1.05-1.19) p = 0.001) and non-hypertensive participants (HR 1.18 (1.03-1.35) p = 0.02). 

Conclusion

LACI is a measure of LA function which is routinely available and presents a skewed distribution towards low values in the general population. LACI independently predicts incident AF, irrespective the presence of systemic arterial hypertension. Abstract Figure
Echocardiographic-derived Pulmonary Artery Pulsatility Index: towards non-invasive evaluation of right ventricular function
Authors: Boretto P , Gravinese C , Frea S , Pidello S , De Ferrari GM
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. Pulmonary artery pulsatility index (PAPi)(1) is a powerful predictor of right ventricular failure in patients with acute inferior myocardial infarction(2) and in patients with heart failure undergoing LVAD implantation(3). PAPi derivation requires invasive right heart catheterism (RHC), thus limiting availability and seriate assessment of right ventricular function.

Purpose. Aim of the study was to evaluate accuracy and agreement of echocardiographic derived PAPi (ePAPi) compared to right heart catheterism derived PAPi in heart failure with reduced ejection fraction (HFrEF) patients.

Methods. ePAPi was defined as the ratio of pulmonary artery pulse pressure (sPAP – dPAP) to right atrial pressure (RAP). Systolic pulmonary artery pressure (sPAP) was determined from tricuspid regurgitation (TR) velocity using the simplified Bernoulli equation(4): sPAP = 4 x (peak TR jet velocity)2 + RA pressure. Diastolic pulmonary artery pressure (dPAP) was calculated as: dPAP = 4 x (end-diastolic pulmonary regurgitant velocity)2 + RA pressure. Simplified ePAPi, defined as peak TR pressure to RA pressure ratio was also investigated. Pearson and Spearman correlation tests were performed. A Bland-Altman plot analysis was performed to assess agreement between ePAPi and invasive PAPi. ROC curves were made to assess ePAPi accuracy in identifying patients with low PAPi (defined as PAPi < 2 and PAPi < 3.65).

Results. 66 HFrEF patients (age 59 ± 10 years, 63% males, mean EF: 35 ± 9%) underwent RHC and blinded echocardiogram in a single center Cardiology Departement. Mean invasive derived PAPi was 4.4 ± 3.6, while ePAPi was 3.9 ± 2.3. ePAPi showed an excellent correlation with invasive PAPi (Pearson r: 0.80, p < 0.001; Spearman rho: 0.83, p < 0.001) and good agreement as shown in Bland Altman plot (figure 1). In ROC analysis, ePAPi accurately identified patients with low hemodynamic PAPi < 2 (Sensibility: 100%; Specificity: 87.2%; AUC: 0.97; Youden criterion: ePAPi < 2.3) and PAPi < 3.65 (Sensibility: 81.8%; Specificity: 84%; AUC: 0.89; Youden criterion: ePAPi < 3.6)(figure 2). Simplified ePAPi also showed good correlation and agreement (Pearson r: 0.58, p < 0.001; Spearman rho: 0.81, p < 0.001).

Conclusions. In patients with HFrEF, echocardiographic derived PAPi showed a good agreement and correlation with invasive derived PAPi. ePAPi was also accurate in identifying patients with low PAPi values associated with poor outcomes and may be of interest for non-invasive right ventricular function seriate assessment. Further studies are needed to investigate prognostic implications. Abstract Figure.  Abstract Figure 2
Feasibility and role of echocontrast evaluation of patients with LVAD
Authors: Baroni G , Pergola V , Semeraro L , Mastro F , Dellino C , Aruta P , Cecchetto A , Previtero M , Florencis A , Tarzia V , Mele D , Gerosa G , Iliceto S
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

In patients with Advanced heart failure (AHF) long-term support with durable mechanical circulatory support (MCS) devices such as left ventricular assist device (LVAD) brings survival benefits and improvement in quality of life, compared with conventional medical treatments. Development of RVF in patients with LVAD has a direct effect on mortality and is associated with prolonged length of stay in intensive care unit and in-hospital stay and with poor quality of life. Purpose: the evaluation of clinical safety and feasibility of  echocontrast (EC) in patients implanted with 3 different types of LVAD (HeartWAre HVAD, Jarvik 2000, HeartMate 3); the assessment of the improvement in the visualization of heart structures; the intra and inter-operator agreement of RV measurements (FAC, TAPSE, sPAP, TR,  regional wall motion abnormalities) with and without contrast. Methods: Between 2014 and 2019, 43 patients were implanted with LVAD, in particular 7 (16%) patients were implanted with Jarvik 2000, 31 (72%) with HeartMAte 3, 5 (12%) pts with HeartWAre HVAD. Nine patients (21%) either had contraindication or refused contrast injection. In 3 (7%) patients, it was technically challenging to obtain apical images at all levels. Two (5%) patients lost their follow-up. Our final population was of 29 (67%) patients. We also assessed the reproducibility of these measurements between two different expert operators (blind analysis). Results:  We observed no allergic reaction to EC. Total 329 (64%) of 516 RV wall segments were available for qualitative analysis without contrast vs 451 (87%) with contrast (p < 0.001) with a significant improvement of the evaluability of regional contractility and FAC  (41% vs 90%, p < 0.001). Evaluation of TAPSE, TR and sPAP was similar with and without contrast (p = NS) All the RV parameters showed little inter-operator variability when measured with contrast. TAPSE, FAC, and RWMA showed an excellent reproducibility (ICC >0.86) while it was good for 2D-baseline derived parameters (ICC = 0.74) showing improvement of inter operator reproducibility in the evaluation of regional contractility in the contrast echocardiography modality. Conclusion: EC is safe with all the types of LVAD we examined. Accurate and reproducible visualization of RV is imperative for reliability of information, a routine use of EC could play a pivotal role in interpreting RV features.  EC improves RV morphologic and functional judgment; allowing greater accuracy and precision in the assessment of both global and regional RV functions. This finding may have important clinical improvement, especially in the future for analysis focused in RV prognostic role in LVAD patients
Prognostic value of Doppler coronary artery assessment in comparison with other echocardiographic prognostic parameters
Authors: Kalinina E , Guskova E , Popkova Y , Shmatov D , Zagatina A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary artery Doppler assessment during routine echocardiography is an established diagnostic tool, that was proved by previous investigators. The prognostic value of impaired coronary flow in left coronary artery was also recently shown in pilot studies [1, 2]. A low feasibility and unknown prognostic value in comparison with other traditional echocardiographic parameters in non-selected population are considered as the main limitations of this method.

Aim

To evaluate feasibility and the prognostic value of coronary artery ultrasound assessment in a non-selected population in everyday clinical practice in comparison with other echocardiographic parameters. Methods: 581 non-selected patients were screened in prospective cohort study. Left coronary artery flow was scanned in addition to conventional echocardiography. Follow-up period was 12 months. All-cause mortality, myocardial infarction, revascularization, and hospitalization due to heart failure decompensation were defined as major adverse cardiac events (MACE). Results: Feasibility of coronary artery visualization and Doppler assessment was 89.8%. Follow-up was available in 92% of patients; during this period 22 deaths and 1 non-fatal MI occurred, 116 patients had MACE. In univariable analysis age, global longitudinal strain (GLS), left atrium index and maximal coronary velocity were predictors for all-cause death (p < 0.006-0.0001), but ejection fraction was not (p < 0.29). In multivariable analysis maximal coronary velocity (HR: 1.02, 95%, CI: 1.01-1.03, p < 0.0006), age (HR: 1.06, 95%, CI: 1.01-1.11, p < 0.02), and left atrium index (HR: 1.05, 95%, CI: 1.01-1.08, p < 0.007) were independent predictors for all-cause death.  Maximal coronary velocity (HR: 1.02, 95%, CI: 1.01-1.03, p < 0.0001), age (HR: 1.03, 95%, CI: 1.01-1.05, p < 0.006), GLS (HR: 0.90, 95%, CI: 0.85-0.96, p < 0.0008) and left atrium index (HR: 1.02, 95%, CI: 1.01-1.04, p < 0.009) were independent predictors for MACE.

Conclusion

 Doppler coronary flow velocity scanning during routine echocardiography is a feasible and valuable tool for assessment of short-term prognosis in non-selected patients. Its short-term prognostic value is better than prognostic value of ejection fraction and global longitudinal strain for the same patients. Abstract Figure. Coronary flow velocity
Relationship between 3D and 2D global longitudinal strain in patients with acute myocardial infarction after percutaneous revascularization
Authors: Tomoaia R , Beyer RS , Zdrenghea D , Dadarlat-Pop A , Cismaru G , Gusetu G , Chetan IMI , Minciuna IA , Simu GR , Hada N , Ganea A , Pop D
Published: February 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): This research was funded by “Iuliu Haţieganu” University of Medicine and Pharmacy, Dept. of Cardiology, Cluj-Napoca, Romania. This paper was published under the frame of European Social Found, Human Capital Operational Programme 2014-2020, project no. POCU/380/6/13/125171

Introduction

Impaired longitudinal strain (GLS) is associated with increased wall stress following acute myocardial infarction (MI). However, little is known about the relationship between three-dimensional (3D)-GLS and two-dimensional (2D)-GLS. The aim of this study was to evaluate the relationship between 3D-GLS and 2D-GLS and also the association of 3D-GLS with specific biomarkers (NT-proBNP and Troponin) in patients with acute MI following percutaneous revascularization (PCI). 

Methods

We included 100 patients with acute MI after successful PCI with a left ventricular ejection fraction (LVEF) >40%. 2D-GLS and 3D-GLS were assessed using speckle-tracking echocardiography and plasma concentrations of NT-proBNP and high sensitive troponin were analyzed. 

Results

The patients had a mean age of 67.1 ± 13.1 years. 69 patients were diagnosed with ST-elevation MI (STEMI). Mean 3D-GLS was of -9.44 ± 4.35% and mean 2D-GLSwas of -10.1 ± 3.9%. 3D-GLS showed a strong correlation with 2D-GLS (r=-0.57, p < 0.001) and LVEF (r=-0.58,p < 0.001), a moderate correlation with NT-proBNP (r = 0.22), but no correlation with Troponin (r = 0.19). There was no difference (paired t-test) between 3D-GLS and 2D-GLS (p = 0.56, mean of differences of 0.65), but the limits of agreement were wide (-6.8% and  8.11%).

Conclusion

3D-GLS showed small bias compared to 2D-GLS, but wide limits of agreement. The correlation between 3D-GLS and NT-proBNP was only moderate in acute MI. 3D-GLS might offer additional advantages in patients with complex geometry after acute MI due to faster data acquisition and lack of geometric assumption,but future studies are needed to confirm its role. Abstract Figure. Relationship between 3D and 2D GLS  Abstract Figure. Corresponding Bland-Altman plots
No signs of diffuse myocardial fibrosis by T1 mapping in male elite endurance athletes
Authors: Andresen K , Klaeboe LG , Lie ØH , Broch K , Kvaslerud AB , Bosse GS , Hopp E , Haugaa KH , Edvardsen T
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Oslo University Hospital Rikshospitalet, Department of Cardiology, Oslo, Norway.

Background/Introduction: Observational data indicating increased prevalence of focal myocardial fibrosis in endurance athletes have raised concerns regarding the potential detrimental cardiac consequences of long-term athleticism. Cumulative exercise and competitive exposure has been associated with focal myocardial fibrosis visualised as late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) imaging. Reports of higher extracellular volume (ECV) in the remote myocardium of athletes with LGE have suggested that this fibrotic process may affect the entire myocardium. However, detailed data on exercise exposure and possible associations with diffuse myocardial fibrosis in endurance athletes are scarce.

Purpose

Our aim was to investigate the association between cumulative exercise exposure and diffuse myocardial fibrosis in male elite endurance athletes.

Methods

In this cross-sectional observational study we evaluated 27 healthy adult male elite endurance athletes age 41 ± 9 years and 16 healthy controls age 41 ± 12 years. All subjects underwent 3 T CMR including LGE and T1 mapping. The athletes detailed their exercise history from 12 years of age in a structured interview.

Results

Athletes had lower resting heart rate, enlarged cardiac chambers and increased left ventricular mass compared to controls, in accordance with the athlete’s heart phenotype (table 1). In contrast to what would have been expected in diffuse myocardial fibrosis, athletes had shorter native T1 time than controls (1214 ± 24 vs. 1268 ± 48 ms, p < 0.001). The native T1 time fell with increasing yearly exercise dose, accumulated exercise duration and accumulated exercise dose (r=-0.46, -0.51 and -0.53, p < 0.05 for all). In a stepwise multiple linear regression model, only the accumulated exercise dose was independently associated with native T1 time as shown in figure 1 (r = 0.53, p = 0.01). There was no clear difference in ECV between athletes and controls (22.5 ± 3.1 vs. 23.8 ± 2.0 %, p = 0.16), indicating that increased left ventricular mass in the athletes was balanced without disproportionate extracellular expansion. There was no association between exercise exposure and ECV. LGE was observed in 5 (19 %) of the athletes and none of the controls (p = 0.14). There was no difference in native T1 time (1220 ± 4 vs. 1212 ± 27 ms, p = 0.56) or ECV (22.0 ± 1.2 vs. 22.7 ± 3.4 %, p = 0.69) between athletes with or without LGE.

Conclusion(s): We did not observe signs of diffuse myocardial fibrosis in healthy elite endurance athletes. These results indicate that diffuse myocardial fibrosis is not highly prevalent in healthy athletes with extreme exercise exposure. Abstract Figure.  Abstract Figure.
Test-retest reproducibility of echocardiography and CMR in the same patients for assessing left atrial function
Authors: Alfuhied A , Gulsin GS , Brady EM , Yeo JL , Parke K , Marsh AM , Arnold JR , Mccann GP , Singh A
Published: February 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia

Background

 Cardiovascular magnetic resonance (CMR) has been shown to give higher left atrial (LA) volumes than trans-thoracic echocardiography (TTE) but the agreement and test-retest reproducibility of LA functional measure have not been directly compared in the same patient cohort.

Methods

 People with type 2 diabetes mellitus (T2D) without cardiovascular disease underwent TTE and CMR on the same day on two separate occasions with a mean period of 11± 4 days. TTE images were analysed using TomTec-ARENA (v2.4, 2D-CPA), where Medis Suite (v3.1, medical imaging system) was used for CMR images. The analysis included LA strain, corresponding to LA reservoir, conduit, and booster pump (contraction function), LA volumes, and LA emptying fraction (LAEF), which was calculated using area length method. Strain and volume were assessed on 4- and 2-chamber long-axis and average values were calculated for both modalities.

Results

 10 participants with T2D (mean age 65.6 ± 7.3 years, 50% male) were studied. CMR LA volumes were significantly higher and LAEF significantly lower compared to TTE (P < 0.01 for all), whilst reservoir strain on CMR was lower compared to TTE (29.2 ± 6.5 vs 33.8 ± 3.7, p = 0.04).  The inter-modality agreement was moderate for LA volumes and contraction strain (ICC ≥0.55) and poor for LAEF, strain at reservoir and conduit. Overall, the test-retest reproducibility of CMR was higher than for TTE, but the overall limits of agreement were not too dissimilar on Bland-Altman analysis (Table & Figure). TTE reproducibility was good for LA volumes and strain at conduit (CoV 18-24%, ICC ∼0.80) and moderate for LAEF, strain at reservoir and contraction. CMR showed excellent test-retest reproducibility for LA volumes, EF and strain at reservoir (CoV 7-20%, ICC ≥0.83).

Conclusion

 The test-retest reproducibility of CMR is slightly better than TTE for LA assessment using volumes and strain. LA volumes have superior reproducibility compared to functional LA parameters. Abstract Table: Test-retest reproducibility  Abstract Figure: Bland-Altman plot
A rare case report of severe cardiomyopathy associated with myotonic dystrophy type 2
Authors: Touma Anja M , Nijjar Prabhjot S , Manousakis Georgios E , Kamdar Forum
Published: February 2022

Background

Myotonic dystrophies (DM) are multi-systemic diseases characterized by muscle weakness and myotonia. Despite a growing appreciation for the cardiovascular manifestations in myotonic dystrophy type 1 (DM1), cardiac involvement in myotonic dystrophy type 2 (DM2) has been less well characterized. In patients with DM2, cardiomyopathy has rarely been described.

Case summary

This case report describes a rare case of DM2 associated cardiomyopathy. A 56-year-old male with DM2 who presented with palpitations and fatigue. Cardiac magnetic resonance (CMR) imaging confirmed a severely enlarged left ventricular cavity with a left ventricular ejection fraction of 28% consistent with severely reduced global systolic function. The lateral wall epicardium exhibited late gadolinium enhancement in a pattern seen in myotonic dystrophy-related cardiomyopathy.

Discussion

This case highlights the potential for significant cardiovascular involvement in DM2, as well as the importance of screening, including CMR imaging, and therapy in the myotonic dystrophy patient population.
Multilobulated Sinus of Valsalva Aneurysm Dissecting into the Interventricular Septum (DAIS) and Rupturing into Left Ventricle: A Case Report
Authors: Ghosh Soumitra , Bootla Dinakar , Barward Parag , Sharma Arun
Published: February 2022

Background

Dissecting aneurysm of sinus of Valsalva (SOV) into the interventricular septum is a rare entity. Multilobulated form of dissection rupturing into the left ventricle (LV) has never been reported in the literature.

Case summary

A 52-year-old male presented with dyspnoea and palpitation with wide pulse pressure and peripheral signs of distal run-off and a continuous murmur along the left parasternal area. Echocardiography revealed dilated right coronary cusp (RCC), which burrowed into the interventricular septum (IVS), forming multi-loculated cystic lesion which ruptured into LV with associated restrictive ventricular septal defect (VSD) and severe aortic regurgitation. Computed tomography (CT) angiography confirmed a 4.8 cm × 5.3 cm × 5.4 cm multiseptated aneurysm. The surgery involved excision of the aortic valve (AV) with the sinus, ligation of its penetrating portion at the crest of IVS, closure of VSD, and AV replacement. Postoperative echocardiography showed the complete collapse of the IVS component of the SOV aneurysm and the normally functioning mechanical AV.

Discussion

Dissecting aneurysm into the IVS is a rare variant of SOV aneurysm, usually arising from RCC. It is mostly congenital in origin and has wide variety of presentations like congestive heart failure, palpitations, recurrent syncope, chest pain, sudden cardiac arrest, infective endocarditis, cerebral infarction, or asymptomatic. Aortic regurgitation is present in 30–50% of cases. Conduction disturbances from first-degree block to complete heart block are common. Echocardiogram, CT angio, and magnetic resonance imaging are useful for diagnosis. Surgical repair is the only option for treatment.
Successful percutaneous coronary intervention to the left anterior descending artery in-stent chronic total occlusion via the left internal mammary artery graft: a case report
Authors: Khan Usman Azhar , Ahmed Mahmoud Saad , Monaghan Monica , Ramsewak Adesh
Published: February 2022

Background

Percutaneous coronary intervention (PCI) via left internal mammary artery (LIMA) graft is technically challenging, requires special consideration due to association with potential complications and therefore, infrequently performed. Data on in-stent chronic total occlusion (CTO) PCI via the LIMA graft is even rarer.

Case summary

A 59-year-old male with a background history of coronary artery bypass graft surgery and previous PCI, presented with progressive chest pain on mild exertion, in the setting of a chronic coronary syndrome. Transradial coronary angiography revealed significant native three-vessel disease with CTO of right coronary, left anterior descending (LAD) and left circumflex arteries. Left internal mammary artery-LAD was widely patent. The previous LIMA-LAD stent at the anastomosis had a CTO with severe in-stent restenosis (ISR) at the distal end of the stent in the native LAD. The distal LAD was filled from bridging collaterals. Following discussion at the heart team meeting, he underwent successful complex PCI of LAD CTO via the LIMA graft at the site of ISR of previous LIMA-LAD anastomosis stent, which was finally treated with drug-coated balloon (DCB) angioplasty.

Discussion

Recurrent angina post-coronary revascularization can be very challenging to manage by medical therapy alone. Percutaneous intervention of complex coronary lesions in these patients requires experience and skill, especially when approaching lesions using the LIMA as a conduit. The use of DCB for ISR management is a well-known strategy; however, adequate lesion preparation is the key to satisfactory outcome.
Eosinophilic myocarditis complicated by permanent atrioventricular nodal block: a case report
Authors: Messner Moritz , Mayr Agnes , Zaruba Marc-Michael , Poelzl Gerhard
Published: February 2022

Background

Eosinophilic myocarditis (EM) is a rare disease with different clinical pictures and disease courses. Little literature is available on the various courses of the disease.

Case summary

A previously healthy 44-year-old male patient presented with acute heart failure and developed complete atrioventricular (AV) block requiring pacing. Acute heart failure was managed with inotropic support, non-invasive ventilation, and implantation of a permanent AV-sequential pacemaker. Cardiac magnetic resonance imaging was suggestive of myocarditis and endomyocardial biopsy diagnosed EM histologically. Endomyocardial biopsy was essential for definite aetiologic assignment, thus dispelling initial reservations about immunosuppressive therapy. Final treatment strategy consisted of steroids and Azathioprine.

Discussion

Endomyocardial biopsy is essential to establish diagnosis and targeted treatment in EM, which can rapidly lead to life-threatening conditions. Left ventricular function recovered within 2 weeks in response to immunosuppression and the patient was consistently well during follow-up. Despite the otherwise good response to immunosuppression, complete AV block continued over time.
Discrimination Between Religious and Non-Religious Groups: Evidence from Marking High-Stakes Exams
Authors: Lavy Victor , Sand Edith , Shayo Moses
Published: February 2022

While religions frequently preach preferential treatment of fellow believers, the magnitude and economic implications of religiosity-based discrimination are largely unknown. Religiosity is often confounded with ethnicity, but it varies even within ethnicities and religious denominations. It is also seldom observed in administrative data. This paper exploits a setting that avoids these limitations. We analyse grading decisions in national matriculation exams in Israel, exploiting unique features that reveal student religiosity to the graders, and grader religiosity to the researcher. We find evidence of in-group bias between religious and non-religious groups, but in our setting this effect is very small. There seem to be two main reasons. First, religious in-group bias is limited to male graders only. Moreover, patterns of bunching in the grade distribution suggest the bias is primarily due to the religious—rather than secular—men. This is a small fraction of the grader population. A second potential reason is that many graders live in integrated communities. Our evidence suggests that living and working in close proximity to people with different levels of religiosity attenuates discrimination.
Wage Risk and the Skill Premium
Authors: Slavík Ctirad , Yazici Hakki
Published: February 2022

The skill premium has increased significantly in the United States in the last five decades. During the same period, individual wage risk has also increased. This paper proposes a mechanism through which a rise in wage risk increases the skill premium. Intuitively, a rise in uninsured wage risk increases precautionary savings, thereby boosting capital accumulation, which increases the skill premium due to capital-skill complementarity. Using a quantitative macroeconomic model, we find that the rise in wage risk observed between 1967 and 2010 increases the skill premium significantly. This finding is robust across a variety of model specifications.
Predicting the genomic resolution of bulk segregant analysis
Authors: Shen Runxi , Messer Philipp W
Published: February 2022

Bulk segregant analysis is a technique for identifying the genetic loci that underlie phenotypic trait differences. The basic approach is to compare two pools of individuals from the opposing tails of the phenotypic distribution, sampled from an interbred population. Each pool is sequenced and scanned for alleles that show divergent frequencies between the pools, indicating potential association with the observed trait differences. Bulk segregant analysis has already been successfully applied to the mapping of various quantitative trait loci in organisms ranging from yeast to maize. However, these studies have typically suffered from rather low mapping resolution, and we still lack a detailed understanding of how this resolution is affected by experimental parameters. Here, we use coalescence theory to calculate the expected genomic resolution of bulk segregant analysis for a simple monogenic trait. We first show that in an idealized interbreeding population of infinite size, the expected length of the mapped region is inversely proportional to the recombination rate, the number of generations of interbreeding, and the number of genomes sampled, as intuitively expected. In a finite population, coalescence events in the genealogy of the sample reduce the number of potentially informative recombination events during interbreeding, thereby increasing the length of the mapped region. This is incorporated into our model by an effective population size parameter that specifies the pairwise coalescence rate of the interbreeding population. The mapping resolution predicted by our calculations closely matches numerical simulations and is surprisingly robust to moderate levels of contamination of the segregant pools with alternative alleles. Furthermore, we show that the approach can easily be extended to modifications of the crossing scheme. Our framework will allow researchers to predict the expected power of their mapping experiments, and to evaluate how their experimental design could be tuned to optimize mapping resolution.
The genetic history of Mayotte and Madagascar cattle breeds mirrors the complex pattern of human exchanges in Western Indian Ocean
Authors: Magnier Jessica , Druet Tom , Naves Michel , Ouvrard Mélissa , Raoul Solène , Janelle Jérôme , Moazami-Goudarzi Katayoun , Lesnoff Matthieu , Tillard Emmanuel , Gautier Mathieu , Flori Laurence
Published: February 2022

Despite their central economic and cultural role, the origin of cattle populations living in Indian Ocean islands still remains poorly documented. Here, we unravel the demographic and adaptive histories of the extant Zebus from the Mayotte and Madagascar islands using high-density SNP genotyping data. We found that these populations are very closely related and both display a predominant indicine ancestry. They diverged in the 16th century at the arrival of European people who transformed the trade network in the area. Their common ancestral cattle population originates from an admixture between an admixed African zebu population and an Indian zebu that occurred around the 12th century at the time of the earliest contacts between human African populations of the Swahili corridor and Austronesian people from Southeast Asia in Comoros and Madagascar. A steep increase in the estimated population sizes from the beginning of the 16th to the 17th century coincides with the expansion of the cattle trade. By carrying out genome scans for recent selection in the two cattle populations from Mayotte and Madagascar, we identified sets of candidate genes involved in biological functions (cancer, skin structure, and UV-protection, nervous system and behavior, organ development, metabolism, and immune response) broadly representative of the physiological adaptation to tropical conditions. Overall, the origin of the cattle populations from Western Indian Ocean islands mirrors the complex history of human migrations and trade in this area.
Transcriptome-wide association study in UK Biobank Europeans identifies associations with blood cell traits
Authors: Rowland Bryce , Venkatesh Sanan , Tardaguila Manuel , Wen Jia , Rosen Jonathan D , Tapia Amanda L , Sun Quan , Graff Mariaelisa , Vuckovic Dragana , Lettre Guillaume , Sankaran Vijay G , Voloudakis Georgios , Roussos Panos , Huffman Jennifer E , Reiner Alexander P , Soranzo Nicole , Raffield Laura M , Li Yun
Published: February 2022

Previous genome-wide association studies (GWAS) of hematological traits have identified over 10 000 distinct trait-specific risk loci. However, at these loci, the underlying causal mechanisms remain incompletely characterized. To elucidate novel biology and better understand causal mechanisms at known loci, we performed a transcriptome-wide association study (TWAS) of 29 hematological traits in 399 835 UK Biobank (UKB) participants of European ancestry using gene expression prediction models trained from whole blood RNA-seq data in 922 individuals. We discovered 557 gene-trait associations for hematological traits distinct from previously reported GWAS variants in European populations. Among the 557 associations, 301 were available for replication in a cohort of 141 286 participants of European ancestry from the Million Veteran Program. Of these 301 associations, 108 replicated at a strict Bonferroni adjusted threshold ($\alpha$= 0.05/301). Using our TWAS results, we systematically assigned 4261 out of 16 900 previously identified hematological trait GWAS variants to putative target genes. Compared to coloc, our TWAS results show reduced specificity and increased sensitivity in external datasets to assign variants to target genes.
Genome-wide association study and functional follow-up identify 14q12 as a candidate risk locus for cervical cancer
Authors: Ramachandran Dhanya , Dennis Joe , Fachal Laura , Schürmann Peter , Bousset Kristine , Hülse Fabienne , Mao Qianqian , Wang Yingying , Jentschke Matthias , Böhmer Gerd , Strauß Hans-Georg , Hirchenhain Christine , Schmidmayr Monika , Müller Florian , Runnebaum Ingo , Hein Alexander , Stübs Frederik , Koch Martin , Ruebner Matthias , Beckmann Matthias W , Fasching Peter A , Luyten Alexander , Dürst Matthias , Hillemanns Peter , Easton Douglas F , Dörk Thilo
Published: February 2022

Cervical cancer is among the leading causes of cancer-related death in females worldwide. Infection by human papillomavirus (HPV) is an established risk factor for cancer development. However, genetic factors contributing to disease risk remain largely unknown. We report on a genome-wide association study (GWAS) on 375 German cervical cancer patients and 866 healthy controls, followed by a replication study comprising 658 patients with invasive cervical cancer, 1361 with cervical dysplasia and 841 healthy controls. Functional validation was performed for the top GWAS variant on chromosome 14q12 (rs225902, close to PRKD1). After bioinformatic annotation and in silico predictions, we performed transcript analysis in a cervical tissue series of 317 samples and demonstrate rs225902 as an expression quantitative trait locus (eQTL) for FOXG1 and two tightly co-regulated long non-coding RNAs at this genomic region, CTD-2251F13 (lnc-PRKD1-1) and CTD-2503I6 (lnc-FOXG1-6). We also show allele-specific effects of the 14q12 variants via luciferase assays. We propose a combined effect of genotype, HPV status and gene expression at this locus on cervical cancer progression. Taken together, this work uncovers a potential candidate locus with regulatory functions and contributes to the understanding of genetic susceptibility to cervical cancer.