bluuebunny/crossref_metadata_2025 huggingface dataset:
Fluid dynamics by 4D flow CMR in Marfan and Loeys-Dietz patients before and after valve sparing aortic root replacement
Authors: Ruiz Munoz A , Guala A , Dux-Santoy L , Rodriguez-Palomares J F , Galian-Gay L , Garrido-Oliver J , Morales A , Carrasco-Poves A , Valente F , Casas G , Johnson K , Wieben O , Evangelista A , Ferreira-Gonzalez I , Teixido-Tura G
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III (Spain), Sociedad Española de Cardiología

Introduction

Patients with Marfan or Loeys-Dietz syndrome present abnormal aortic flow patterns in the arch and the proximal descending aorta that may contribute to aortic dilation (1,2). Valve sparing aortic root replacement, which is effective in reducing the risk of aortic dissection in case of severe dilation, may also normalize flow patterns beyond the replaced aorta and potentially slow its progressive aortic dilation.

Purpose

To assess aortic flow dynamics in these patients with Marfan or Loeys-Dietz by 4D flow cardiovascular magnetic resonance (CMR) before and after valve sparing aortic root replacement (David surgery), and to compare the results with those of healthy volunteers (HV).

Methods

Patients with Marfan or Loeys-Dietz syndrome underwent two non-contrast enhanced 4D flow CMR, one before and another after undergoing David surgery. Healthy volunteers matched for age, sex and BSA were also included for comparison. Maximum velocity, in-plane rotational flow (IRF), systolic flow reversal ratio (SFRR) and wall shear stress (WSS) magnitude and its axial and circumferential components were obtained at 24 planes covering the thoracic aorta from the sinotubular junction to the descending aorta at the diaphragmatic level (3–5).

Results

Sixteen patients and 21 healthy volunteers were included. Demographic and clinical data is presented in Table. The mean time between the CMR prior and posterior to surgery was 15 months. Compared to HV, patients with CTD before intervention presented lower maximum velocity at the proximal ascending aorta (Figure 1A), lower IRF and circumferential WSS at the arch and the proximal descending aorta (Figure 1B and F), lower magnitude and axial WSS at the proximal ascending and descending aorta (Figure 1E and D), and increased SFRR at the proximal descending aorta (Figure 1C). The intervention completely restored maximum velocity and partially-restored physiological helical flow and circumferential WSS, but barely improved axial WSS and SFRR.

Conclusion

Valve sparing aortic root replacement in patients with Marfan or Loeys-Dietz syndrome partially restore to physiological level both in-plane rotational flow and circumferential wall shear stress in the descending aorta.
Apical sparing pattern during exercise echocardiography in patients with cardiac amyloidosis
Authors: Peteiro J , Combarro M , Barge-Caballero G , Bouzas-Mosquera A , De Andres F
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Apical sparing (AS) is an useful marker of cardiac amyloidosis (CA). However, this pattern can also be found in other conditions that lead to left ventricular hypertrophy (LVI), like hypertension (HT) or hypertropic cardiomyopathy (HCM). We aimed to assess the AS pattern at rest and exercise in patients with CA and LVI-no CA. We hypothesize that patients with CA may have the AS pattern preserved at exercise on the contrary to LVI-no CA, therefore increasing the specificity of this sign.

Methods

Teen patients with confirmed CA, 31 patients with LVI-no CA (17 HCM, 14 HT plus LVI), and 6 normal subjects were studied by treadmill exercise echocardiography, with assessment of global longitudinal strain (LS) and AS pattern at rest and at peak exercise (Pk-Ex). LVI-no CA and normal subjects should have age >60 y-o, no data of coronary artery disease, absence of ischemia, and LVEF>55%. A relative apical LS of 1.0, by the equation: average apical LS/(average basal LS + mid-LS)) was used for considering AS.

Results

Patients with CA were older (81±5 yo; LVI-no CA 70±8 yo; normal subjects 74±4 yo; p = 0.001), had lower LVEF (51±14; vs 66±9 the LVI-no CA, and 67±10 the normal subjects group; p = 0.001), and higher E/e´values (21±7, vs 18±10 the LVI-no CA, and 9±1 the normal subjects group; p = 0.03), but achieved similar workload in metabolic equivalents (METs) during exercise (6.3±2.9 METs vs 7.1±2.2 the LVI-no CA, and 7.6±2.7 METs the normal subjects group). AS at rest and Pk-Ex were 0.7±0.2 and 0.6±0.2 in LVI-no CA patients; 0.7±0.5 and 0.7±0.3 in normal subjects; and 1.6±0.8 and 1.2±0.4 in CA (<0.001 between groups either at rest or at Pk-Ex). The highest area under the ROC curve for diagnosing CA corresponded to AS at rest or Pk-Ex (0.86; 95% CI = 0.72–0.99, p = 0.001), followed by AS at Pk-Ex (0.81; 95% CI=0.63–0.99, p = 0.003), AS at rest (0.80; 95% CI=0.62–0.98, p 0.004) and AS at rest plus Pk-Ex (0.75; 95% CI=0.54–0.96, p = 0.02). Among CA patients 5/10 had AS at rest plus at Pk-ex, but none in non-CA subjects, given specificity and positive predictive value of 100%. (figure) In conclusion, AS during exercise adds information for the diagnosis of CA. In our sample, an AS pattern that persists during exercise was pathognomonic of cardiac amyloidosis.
Left ventricular response to short exercise in long term non-hodgkin lymphoma survivors
Authors: Bruin De- Bon H , Neppelenbroek S I M , Schuuring M , Kok W E M , Meregalli P G , Robbers L F H , Teske A J , Appelman Y , Bouma B J
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Echocardiographic left ventricular (LV) global longitudinal strain (GLS) may be used to detect subclinical ventricular dysfunction in patients who have received cardiotoxic chemotherapy. However, in some persons participating in recreational sports, GLS at rest may be lower than normal, but normalizes after a short exercise test as soon as resting heart rate (HR) is reached. The aim of the study was to determine GLS response to a short exercise test in patients treated for aggressive non- Hodgkin Lymphoma (NHL) compared to controls.

Methods

We conducted a cross-sectional study nested in a cohort of NHL survivors and their siblings served as controls . Survivors were treated 5 years ago or longer with a cumulative doxorubicin (anthracycline) dose of at least 250 mg/m2.

Transthoracic Echocardiography (TTE) was performed according to the guidelines.

First, GLS and LV ejection fraction (EF) were measured at rest. After 20 squats, GLS and EF measurements were repeated when the HR was comparable to the HR during rest measurements.

Results

In total 20 survivors (mean age 49 (± 13) years, 11 men (55%) were included and measurements were compared to 14 controls. (mean age 45 (± 8) years, 8 men ( 57 %).

In patients at rest, the EF was 52.6% ( ± 8.0%) and the GLS −16.1% ( ± 2.9%), compared to controls with an EF of 56.2% (± 3.4% ) (p-value 0.13) and GLS −18.0% (± 1.4 %) (p-value 0.031). All patients performed 20 squats and their EF increased to 55.0% (± 6.8%) and GLS −18.7% (± 3.8%) compared to controls in whom the EF increased to 62% (± 4.7%) (p-value 0.002) and GLS −21.3% (± 2.5%) (p-value 0.037) (Figure 1).

Conclusion

In addition to GLS measurement at rest, GLS after a short exercise test seems to be a promising tool to detect subclinical LV dysfunction in non-Hodgkin Lymphoma survivors. Further research in larger studies is needed to confirm these findings and to assess the association with clinical parameters.
Hepatic t1 mapping: a new easily obtained biomarker for heart failure patients undergoing cardiac magnetic resonance
Authors: Reis Santos R , Sousa Paiva M , Freitas P , Maltes S , Carvalho R , Certo Pereira J , Domingues M , Coutinho Santos A , Silva C , Guerreiro S , Abecasis J , Saraiva C , Mendes M , Ferreira A M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Hepatic venous pressure overload and subsequent liver damage are frequent in patients with Chronic Heart Failure (CHF) but are difficult to quantify except in the late stages of disease. Myocardial T1 mapping is now commonly performed in patients undergoing cardiac magnetic resonance (CMR), with short axis images usually intercepting the liver, therefore allowing the opportunistic measurement of hepatic T1 values.

Purpose

The aim of this study was to quantify hepatic T1 values in HF patients undergoing CMR, and to assess its clinical and prognostic significance as a biomarker in this setting.

Methods

Consecutive patients with CHF (LVEF ≤ 50%) who underwent CMR at a single centre since Jan2019 were retrospectively identified. Those with known chronic liver disease, cardiac amyloidosis or suspected alcoholic cardiomyopathy were excluded. Native myocardial T1 mapping [MOLLI 5(3)3 sequence] basal short axis images were used to measure hepatic T1, with the region of interest drawn in the liver, avoiding organ vessels. A control group of subjects without known cardiovascular disease (n=57) was used to define the limits of normality for hepatic T1 values. The clinical significance of hepatic T1 values was assessed by its relationship with markers of right-sided CHF, and its prognostic value by the association with cardiovascular mortality.

Results

A total of 267 patients (mean age 62±15 years, 69% men, 38% with ischemic cardiomyopathy) were included. Median LVEF was 35% (IQR 26 – 44%) and median RVEF was 51% (IQR 40 – 59%). Overall, 46 patients (17%) had hepatic T1 values above 684 ms (the upper limit of normal for controls). Patients with elevated hepatic T1 had significantly higher RV volumes and lower RVEF (all p values <0.03). Hepatic T1 values were significantly higher in patients with RVEF<45% and in those with moderate or severe tricuspid regurgitation (Figure 1), and were also inversely correlated with RVEF (Spearman R −0.20, p<0.001). During a median follow-up period of 17 months (IQR 11–24), there were 11 cardiovascular deaths. Elevated hepatic T1 was associated with an increased risk of this endpoint (HR 3.04, 95%CI 1.02 – 9.11, p = 0.047).

Conclusions

Hepatic T1 values can be easily measured in standard myocardial T1 maps, are associated with markers of right-sided heart failure, and have prognostic value in patients with HF. Further studies are warranted to assess the potential clinical usefulness of this new biomarker.
Systemic transit time correlates with renal cortical perfusion: a preliminary study
Authors: Gilles R , Pilet B
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

We sought to measure systemic transit time (STT) on MRI dynamic sequences of images in patients based on the recirculation time. In a subset of patients, using the same images, when the abdominal aorta and at least part of one kidney was available, we used a 2-compartment filtration model to approximate renal cortical plasma perfusion (RCPF).

Methods

This is a retrospective study in a single site MR unit. 218 patients underwent a standard myocardial MR imaging protocol on a 1.5 Tesla MRI system including a pulse-gated, free breathing, dynamic first-pass perfusion scan of 100 phases using a saturation recovery turbo-FLASH pulse sequence (TR = 172 ms / TE = 1.1 ms / flip angle = 5°). Motion correction was applied. All patients were injected intravenously with a bolus dose of gadoteratemeglumine followed by a 20 ml saline flush. On the 218 patients studied, 20 patients were excluded due to shunts:n=5, inadequate first pass perfusion signal:n=8, fitting script did not converge on a solution:n=7. Circular ROIs were placed in the RV (Right Ventricle) and LV (Left Ventricle)cavities. The time curves for each cavity’s signals were fitted to a time-sliding 3 component-LogNormal function using an in-house python script based on the lmfit package (Levenberg-Marquardt method) to determine systemic (STT) and pulmonary transit times (PTT). In a subset of 61 patients, an attempt to measure RCPF was undertaken. An elliptic ROI was drawn in the aorta to follow arterial input. A spline polygon ROI was placed on the visible renal cortical tissue. 14 sets of images were rejected for plasma perfusion analysis for different reasons (absence of suitable abdominal aorta image, absence of suitable renal cortical image, motion artifact, …). Plasma perfusion measurements were made using a 2-compartment filtration model.

Results

We studied 198 sets of MRI dynamic perfusion images. Our population consists of 65,7% men aged 53,0±16,9 (mean± SD) and 34,3% women aged 55,9 ± 14,1 (mean ± SD). Fitting of the experimental data was very good in most cases (mean R² for RV:0.981, max:0.997, min: 0.907, SD:0.014) (mean R² for LV: 0.994, max:0.999, min: 0.975, SD: 0.004). An example of experimental data fitting can be seen in fig. 1. STT values were as follows: mean = 14.3 s, SD = 3.0s, max = 27.1 s, min = 8.7 s. Measures of recirculation time were highly correlated on the RV and LV side (Pearson’s R =0,975; p < 0,001).

We found a significant correlation between STT and PTT (Pearson’s R = 0,521; p < 0,001). In the 47 patients where RCPF could be calculated, a significant negative correlation was found between STT and RCPF (Pearson’s R = -0,578; p < 0,001) (fig. 2).

Conclusions

Systemic transit time can be accurately measured on standard MRI perfusion scans and is negatively correlated with cortical renal plasma perfusion. Assessing systemic transit time using MRI dynamic perfusion imaging of the heart could be a usable surrogate for end-organ perfusion.
Natural shear waves show sequential changes in myocardial stiffness In paediatric multi-inflammatory systemic syndrome post COVID
Authors: Youssef A , Salaets T , Bezy S , Wouters L , Orlowska M , Caenen A , Duchenne J , Puvrez A , Cools B , Gewillig M , Dhooge J , Voigt J W
Published: June 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Egyptian ministry of research and higher education

Background

Multi-inflammatory systemic syndrome post COVID infection (MIS-C) in children causes myocarditis and affects myocardial diastolic function. Recent high frame rate echocardiography allows to assess myocardial shear waves (SW). SW are mechanical waves generated by mitral and aortic valve closure (MVC & AVC). Their propagation velocities are related to myocardial stiffness (MS), a determinant of diastolic function. Nevertheless, this has not yet been tested in paediatric cardiology and in this pathology.

Purpose

This study aimed at exploring the changes in natural SW propagation velocity as measure of myocardial diastolic properties in paediatric patients with MIS-C.

Methods

Seven MIS-C children (mean age 6.7 ±3.6 years) were prospectively followed over 6 months (group A). As a control group; one hundred-four healthy volunteers (HV) (mean age 10.2 ±4.4 years) were recruited (group B). High-frame rate echocardiography was used to obtain parasternal long axis views of all subjects at a frame rate of 1580 ±113 Hz. An anatomical M-mode was drawn along the interventricular septum and Tissue Doppler acceleration maps were extracted to measure SW propagation speed after MVC and AVC (Figure 1). Independent sample t-test was used to compare between both groups. Repeated measures analysis of variance (ANOVA) was used to show sequential changes during follow-up.

Results

SW propagation velocities were significantly higher among MIS-C patients than in HV group after both MVC (4.3 ±0.6 m/s vs 2.8 ±0.3 m/s respectively, p<0.001) and AVC (5.2 ±0.6 m/s vs 3.0 ±0.3 m/s respectively; p<0.001). Interestingly, SW propagation speeds in MIS-C patients declined significantly with myocardial recovery during course of disease (figure 2) and normalised 6 months post discharge (MVC: 2.9 ±0.3 m/s; P<0.001, AVC: 3.2 ±0.4 m/s; P<0.001) compared to admission.

Conclusions

SW speed found to be 1.5 to 1.7 fold higher with myocardial inflammation in MIS-C patients compared to HV. Values normalised within 6 months. These findings indicate that SW velocities can show sequential changes in the course of a disease and suggest that SW imaging has potential to serve as a new non-invasive diagnostic tool in paediatric cardiac diseases.
Cardiovascular magnetic resonance in neuromuscular disorders: looking ahead
Authors: Amador A , Martins Da Costa C , Calvao J , Marques C , Cabrita A , Pinho A , Santos L , Oliveira C , Madureira A , Martins E , Pinho T , Macedo F
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Neuromuscular disorders (NMD) have a wide range of different cardiac presentations. Cardiac magnetic resonance (CMR) has an established role in diagnosis and risk stratification. We sought to access how CMR performs in predicting events in a real cohort of NMD patients (pts).

Methods

We included consecutive pts followed in a tertiary clinical center with NMD from January 2012 to December 2018. Clinical and CMR data were collected. During follow-up (FUP), we considered major adverse cardiovascular events (MACE) as a composite of device implantation, ventricular tachycardia/appropriate shock therapy and death.

Results

A total of 65 patients (pts) were included, 33 (51%) women, with mean age of 32 ± 16 years. Most patients had myotonic dystrophy (34, 52%), followed by limb–girdle muscular dystrophy (22; 34%); the remained 9 (13%) had other NMD. About half had inferior limbs predominantly affected and 74% had none, mild or moderate functional impairment. Regarding cardiac manifestations, 18% had cardiac symptoms, 97% were in sinus rhythm, median PR and QRS duration were 169 (IQR 47) ms and 101 (IQR 11) ms, respectively; median BNP was 26 (IQR 25) mg/dl. Regarding CMR, 43,3% of pts had ≥ one abnormality. Six pts had left ventricle dilation and 7 had left ventricle ejection fraction (LVEF) 55%. Three pts had significant hypertrophy (>12 mm) and there were isolated cases of hypertrabeculation, segmental alterations or right ventricle dilation. Regarding tissue characterization, 2 pts had T2 hyperintensity, 8 had early gadolinium enhancement (EGE) and 22 had late gadolinium enhancement (LGE). LGE was located mainly intramyocardium (45%) or subepicardial (36%) and the most affected segments were basal and medium inferolateral (40%). During a median FUP of 77 (IQR 33) months there were 7 deaths, 8 implanted devices (4 pacemakers and 4 CRT-D, 3 in primary prevention) and one sustained ventricular tachycardia in holter; there were no shock therapies. Table 1 describes some CMR parameters according to the occurrence of events. Using Kaplan Meier curves, there were associations between LVEF<55% and presence of LGE with occurrence of allevents (log rank test, p = 0,002 and p = 0,045, respectively), but no association were found with age, LGE pattern nor number/distribution of affected segments. Using Cox Regression, we found that the LVEF<55% was associated with 6 fold higher risk of events (HR crude 6,15; 95% CI 1,65–22,93), that remained significant after adjusting for LGE (HR adjusted 4,81, 95% CI 1,07–15,9).

Conclusion

In our cohort, CMR LVEF<55% and the presence of LGE were significantly associated with events during FUP, reinforcing the role of this technique on risk stratification of NMD populations
Prognostic impact of disproportionate secondary tricuspid regurgitation
Authors: Cascella A , Gavazzoni M , Muraru D , Perelli F , Tomaselli M , Radu N , Parati G , Badano L P
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Current quantitative parameters used to assess the severity of secondary tricuspid regurgitation (STR) do not account for the size of the right ventricle (RV). To address this issue, the concept of proportionality of the severity of the STR to the size of the RV has been recently mutuated from the mitral regurgitation field to improve the prognostic stratification of patients with STR.

Purpose

We sought to compare the prognostic value of a classification of STR based on the proportionality of the regurgitant volume (Reg Vol) to the RV stroke volume with the guideline-recommended grading scheme of STR severity.

Methods

Patients with at least mild STR were prospectively enrolled and underwent complete 2D, Doppler and 3D echocardiography with the measurement of RV volumes. To determine STR proportionality status, we evaluated the difference between the measured and the theoretical RegVol of severe STR (the latter was defined as the RV stroke volume needed to have a regurgitant fraction [RF] ≥ 50% according to the actual RV stroke volume). This classification took into account a bias of 8 ml in the computation of Reg Vol, derived from Bland-Altman analysis (picture 1). Accordingly, patients were classified as non severe (NS_STR, measured RegVol< theoretical RegVol), severe proportionate (SP_STR, measured RegVol ≈ theoretical RegVol), and severe disproportionate (SD_STR, measured RegVol > theoretical RegVol) STR (picture 1). The incidence of the combined endpoint of heart failure (HF) hospitalization and death for any cause was used as the primary endpoint.

Results

We enrolled 333 consecutive patients (mean age 71±14 years, 53.3 % women). After a median follow up of 20 months (10–32), 134 patients (40.2%) reached the combined end point. Patients with SD_STR showed a significantly higher incidence of events (67.9%) in comparison to patients with SP_STR (40.6%, p = 0.005 for difference) and NS_STR (31.3%, p<0.001 for difference) (picture 2). At Cox multivariate analysis, the proportionality of STR (adjusted for age, atrial fibrillation, right atrial volume, RV free-wall longitudinal strain, and RV ejection fraction) independently correlated with the combined endpoint (adjusted hazard ratio: 1.785; 95% confidence interval [CI]: 1.249–2.550; p = 0.002). When tested with the same variables, the conventional STR severity grade lost its independent correlation with combined end point (p = 0.258).

Conclusions

Disproportionate STR is independently associated with all-cause mortality or heart failure hospitalization, and it improves the risk stratification of patients compared to the guideline-recommended grading scheme of STR severity.
Non-invasive in vivo thrombus imaging in patients with ischaemic stroke or transient ischaemic attack
Authors: Whittington B , Tzolos E , Bing R , Andrews J , Lucatelli C , Macaskill M , Clark T , Koglin N , Stephens A , Van Beek E , Dweck M , Williams M C , Whiteley W , Wardlaw J M , Newby D E
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Life Molecular Imaging provide reagents for GP1 production free of charge.

Background and Purpose

18F-GP1 is a novel positron-emitting radiotracer that has high and specific binding affinity for the activated glycoprotein IIb/IIIa receptor, a key receptor in platelet activation and thrombus formation. Preliminary studies 18F-GP1 demonstrated excellent in vivo binding properties which enabled detection of intravascular thrombosis in a range of conditions including coronary thrombosis, left ventricular thrombus, pulmonary thromboembolism, and deep vein thrombosis. In a pilot proof-of-concept study, we aimed to determine its potential clinical application in establishing the role and origin of thrombus in stroke .

Methods

Autoradiography of 18F-GP1 uptake was performed on post-mortem samples of infarcted brain tissue following an acute ischaemic stroke and from control brain tissue without stroke. Eleven patients with recent ischaemic stroke (n=9) or transient ischaemic attack (n=2) underwent 18F-GP1 positron emission tomography and computed tomography angiography at median of 11 (absolute range 2–21) days from symptom onset. 18F-GP1 uptake (quantified by maximum target-to-background ratio, TBRmax) was assessed in the carotid arteries and brain.

Results

Ex vivo autoradiography of post-mortem infarcted brain tissue showed focal uptake corresponding to intraluminal thrombus within the culprit vessel and downstream microvasculature. There was also evidence of lower diffuse uptake within some of the infarcted brain tissue reflecting microthrombi within regions of reperfusion haemorrhage. In vivo 18F-GP1 uptake was identified in 9 of 11 patients: 3 in the carotid arteries only, 3 in the brain only and 3 in both the brain and carotid arteries. In those with carotid uptake, 3 participants had >50% stenosis and 3 had non-stenotic disease. One case had bilateral stenotic disease (>70%) but only the culprit carotid artery demonstrated 18F-GP1 uptake. The average uptake was higher in the culprit (median TBRmax 1.55 [interquartile range 1.26–1.82]) compared with the contralateral non-culprit carotid artery (TBRmax 1.22 [1.19–1.6]). In those with brain 18F-GP1 uptake (TBRmax 6.45 [4.89–7.65]), areas of acute infarction on computed tomography correlated with brain 18F-GP1 uptake in 6 cases. There was no brain 18F-GP1 uptake in the 7 cases without CT-defined acute cerebral infarction.

Conclusions

18F-GP1 positron emission tomography and computed tomography angiography is a novel non-invasive method of identifying in vivo cerebrovascular thrombosis which holds major promise in understanding the role and origin of thrombosis in stroke.
Lower left ventricular cardiac strain in patients who recovered from COVID-19
Authors: Mojica Pisciotti M , Panovsky R , Holecek T , Opatril L , Feitova V
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic.

Introduction

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes the highly contagious coronavirus disease 2019 (COVID-19). This disease has been linked to several cardiac problems. Studying heart deformation with cardiovascular magnetic resonance feature-tracking (CMR-FT) might help detect subtle systolic or diastolic dysfunction in patients who recovered from COVID-19.

Purpose

We aimed to characterize the left ventricular strain in patients who recovered from COVID-19 by using cardiovascular magnetic resonance feature tracking (CMR-FT).

Methods

In this study, we compared a cohort of 55 patients who recovered from COVID-19 (age 48 ± 16 years, time between diagnosis and CMR 46 (34 to 166) days) to 44 sex- and age-matched control subjects (age 47 ± 16 years) with a CMR examination before March 1st, 2020. All the participants were examined in our hospital. By using CMR-FT, we determined the left ventricle (LV) global circumferential strain (GCS), global longitudinal strain (GLS), and global radial strain (GRS). LV clinical parameters were indexed to the body surface area. The student's t-test and Wilcoxon rank-sum test were used to compare normally and non-normally distributed variables. The adjusted P-value was obtained by using a false discovery rate correction.

Results

Although the left ventricular ejection fraction was significantly lower in patients who recovered from COVID-19 than in controls (64 (60 to 70) % vs. 68 (64 to 73) %, P-value = 0.022), the former had normal systolic LV function. At the same time, they had higher LV end-systolic indexed volume (23.0 (15.4 to 30.4) ml/m2 vs. 19.4 (15.2 to 24.4) ml/m2, P-value = 0.048). Regarding the global LV strain, all parameters were significantly lower in the patients who recovered from COVID-19 than in controls (GCS −17.1 (−18.4 to −15.4) % vs. −18.1 (−19.7 to −17.0) %, P-value = 0.004; GLS −17.3 (−18.7 to −15.6) % vs. −18.2 (−19.3 to −16.9) %, P-value = 0.011; GRS 28.1 (23.8 to 31.8) % vs. 31.6 (28.4 to 34.3) %, P-value = 0.004).

Conclusion

Compared to controls, patients who recovered from COVID-19 exhibit lower global left ventricular strain values assessed by CMR-FT.
Right atrial strain: what does it tell us about cardiac function and prognosis?
Authors: Curtis E , Lemarchand L , L'official G , Leurent G , Auffret V , Oger E , Donal E
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): New Zealand National Heart Foundation

Background

The role of speckle tracking echocardiography has been expanding thanks to its utility in detecting subtle changes in cardiac function, and has prognostic value(1). Right atrial (RA) strain has shown promise in prognostication amongst patients with pulmonary hypertension and heart failure. It is associated with RA size, RV function and IVC size. However, its clinical utility and application remain under investigation (2–5).

We sought to evaluate the associations of right atrial strain with both invasive and non-invasive measure of RV function and the association of RA strain with heart failure hospitalisations and death across a heterogeneous cohort.

Methods

A single-centre retrospective analysis of data from 225 consecutive patients (age 72 ±11.6 years old; male 56%) with both right heart catheterization (RHC) and TTE. Data regarding unplanned heart failure hospitalisations and date of death were recorded. Statistical analysis was performed using SAS 15.1 to assess the association between right atrial strain and prespecified echo and haemodynamic measures of right and left heart function and prognosis defined by heart failure hospitalisations and death.

Results

Over a median follow up of 28±16 months, there were 59 events. RA strain was associated with the following non-invasive and invasive measures of right heart function and left heart systolic function : TAPSE; RA size, RA pressure, RV strain, PAPi, RVSWI, RV FAC, LAVi, RV PA coupling (TAPSE/systolic PAP), LVEF, cardiac index, diastolic function (E/e’) with a p value of <0.05. Increasing atrial size was associated with lower values of R strain. Despite the association of impaired RV strain with prognosis, HR 2.94 (1.14 – 7.60), RA strain did not appear to be associated independently with prognosis HR 0.98 (0.95–1.0) P value = 0.0676.

Conclusions

Right atrial strain is independently associated with both invasive and non-invasive measures of RV function and may be a useful tool to help us assess right heart function. It did not appear to be associated with prognosis despite being independently linked with RV strain, which was strongly associated with prognosis in our cohort.
Cardiac magnetic resonance phenotypes and cardiovascular prognosis in classical vs cardiac variant of Fabry disease
Authors: Guida G , Attanasio A , Disabato G , Tondi L , Lombardi M , Camporeale A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Fabry disease (FD) is an X-linked lysosomal storage disorder due to a deficiency/absence of alfa-galattosidase A enzyme activity. More than 1000 GLA gene mutations have been identified to be causative of classical or late-onset clinical phenotype. Cardiac variants (p.N215S, p.F113L and IVS4+919G>A) cause a predominant late-onset cardiac involvement with minimal systemic manifestations compared to classical phenotype.1 Cardiac magnetic resonance (CMR) is widely used to assess FD cardiac involvement, thanks to its accuracy in quantification of left ventricular mass and to the possibility to perform a non-invasive tissue characterization.2 Since cardiac involvement is the main cause of FD morbidity and mortality,3 CMR findings play a prognostic role in FD.

Purpose

the aims of this study were: 1) to compare CMR phenotypes of FD patients with classical and cardiac variant of the disease; 2) to compare the prognostic role of CMR parameters in these two groups of FD patients.

Methods

study population included 128 FD patients (classical variant: 69%, cardiac variant 31%). Clinical characteristics and CMR findings were compared between classical and cardiac variant. CV events during follow-up were abstracted from the patients’ records and only first event after CMR was used for survival analysis. The composite endpoint was defined as the development of one of the following events: a) sustained or non-sustained ventricular tachycardia, b) bradyarrhythmias requiring pacing, c) heart failure hospitalization, d) atrial fibrillation, e) myocardial infarction and f) all-cause mortality.

Results

compared to patients with cardiac variant, FD patients with classical mutations were younger (39 [26–53] vs 46 [37–57], p = 0,050), with a more severe systemic involvement according to Mainz Severity Score index (MSSI: 20,50 [9,25–27,00] vs 9,00 [2,00–23,00], p = 0,003). Overall, 37% (48/130) of patients assumed FD specific treatment, most of them exhibiting a classical mutation (43/48 patients, p<0,001).No significant differences in CMR parameters were observed comparing the two groups of patients. The percentage of patients with LVH, LGE and low T1 values were similar in classical and cardiac variants. During a median follow-up of 36 [17–57] months, Kaplan Meier curves shows a similar event-free survival probability (Log-rank p = 0,362) between the two phenotypes (Fig. 1). In addition, presence of LVH and LGE were both associated with composite CV endpoint in these two groups of patients.

Conclusion

patients with cardiac variants of FD showed similar CMR phenotype and CV prognosis compare to patients with classical mutations. The presence of LVH and LGE play the same prognostic impact in both the clinical phenotypes. CMR assessment of cardiac involvement represents a pivotal step in the evaluation of FD patients irrespective of patients’ genotype.
Left atrial function as a determinant of symptoms in patients with severe degenerative mitral regurgitation
Authors: Paci G , Ingallina G , Margonato D , Italia L , Barki M , Slavich M , Ancona F , Stella S , Biondi F , Tavernese A , Belli M , De Bonis M , Castiglioni A , Maisano F , Agricola E
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Understanding the pathophisiology of symptoms onset in degenerative mitral regurgitation may be helpful in the management of asymptomatic patients.

Left atrium (LA) is far from simply being a passive connection chamber between mitral valve and pulmonary circulation, and the role of left atrial function as a predictor of symptoms onset has not yet been evaluated.

The increase in atrial pressure that causes elevation of pulmonary capillary pressures and the onset of dyspnoea may be driven by the reduction of left atrial compliance, which can be assessed by peak atrial longitudinal strain (PALS) derived from speckle tracking echocardiography.

Aim

To assess the role of left atrial function as a determinant of symptoms in patients with severe degenerative MR.

Methods

We analysed retrospectively all patients affected by severe degenerative MR evaluated for cardiac surgery between May 2019 and July 2022 at IRCCS San Raffaele Hospital. The cohort was divided in symptomatic (NYHA >I) and asymptomatic (NYHA =I) patients. A comprehensive assessment of LA function was performed including pulmonary venous blood flow, LA ejection fraction, LA fractional atrial change, and PALS. Patients with atrial fibrillation during echocardiographic evaluation, left ventricular disfunction and more than mild left heart valvulopathy associated with MR were excluded.

Results

The final study population consisted of 408 patients. The grade of MR, assessed by multiparametric approach, was not different between the two groups. Age, history of coronary artery disease, dyslipidaemia, hypertension and history of atrial fibrillation were found to be predictive on symptomatology. Fractional area change (OR: 0.89; CI:0.87–0.91, p <0.001), atrial ejection fraction (OR: 0.92, CI= 0.90–0.94, p <0.001), atrial volume(OR: 1.04, CI: 1.02–1.05, p<0.001), pulmonary artery systolic pressure(OR:1.09, CI:1.06–1.13, p<0.001) and longitudinal atrial strain (OR:0.88, CI:0.85–0.90, p<0.001) but not EROA ( OR:1.06, CI: 0.63–2.30, p = 0.8) were found to be predictive. On multivariate logistic regression, only indexed biplane LA volume (OR: 1.02, CI 1.00–1.07, p = 0.035) and PALS (OR: 1.02, CI: 0.87–0.94, p<0.001) were found to be predictive. The best PALS threshold to identify symptomatic patients was 22% (OR: 3.3, SE 67%, SP 87%).

Conclusions

LA function is a determinant of symptoms in severe degenerative MR. The reduction of PALS appears to be a predictor of symptoms and a value of PALS < 22% identified symptomatic patients with 85% specificity and 67% sensitivity.
Echocardiographic classification of anatomical diversity of the tricuspid valve: insights from the bright trial
Authors: Donal E , Schmitz T , Bekeredjian R , Nickenig G , Mollmann H , Von Bardeleben S R , Schmeisser A , Atmowihardjo I , Estevez R , Heitkemper M , Goebel B , Lurz P
Published: June 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Trial funded by Abbott

Background

As the treatment of tricuspid regurgitation with tricuspid transcatheter edge-to-edge repair (TEER) becomes more widespread, a better understanding of tricuspid anatomy is increasingly important to properly select patients for this therapy. The diversity of tricuspid anatomies in the real-world population is not well known, and strategies for characterization of some anatomic features are not well defined.

Purpose

To propose a method to accurately and consistently characterize the tricuspid valve anatomy with transthoracic and transesophageal echo in patients receiving tricuspid TEER and investigate the diversity of tricuspid valve anatomies reflected in a real-world population.

Methods

The bRIGHT trial is a prospective, single-arm, multi-center registry initiated to evaluate the safety and effectiveness of the TriClip transcatheter edge-to-edge repair (TEER) System in patients with severe tricuspid regurgitation (TR) in a real-world post-market setting. Detailed echocardiographic analysis was performed on subjects from 25 sites with available baseline echo. Subjects were evaluated for three key anatomical factors that are anticipated to be critical in determining the feasibility of TEER: number of tricuspid valve leaflets, degree of leaflet restriction, and coaptation gap size. Herein, we present a proposed method for characterizing these factors through echo analysis.

Results

Between August 2020 and July 2022, 312 patients subjects (age, 78.4±7.6 years, 54% women) at 25 sites were enrolled into the bRIGHT trial and 283 subjects had available baseline echo. Coaptation gap size was measured at the largest clippable location (Figure 1) and was found to range from 2.3 mm to 20.8mm (avg. 8.6 ± 3.3 mm). According to the analysis method proposed by Hahn et. Al, the majority of subjects were found to have 3 leaflets (80%), however 4 and 5 leaflet anatomies were also present (20% and 1% respectively). Severity of leaflet restriction was categorized according to a 4-grade scale. In the subjects studied, restriction severity ranged from none to severe, with 21% of subjects having no restriction, 65% displaying mild restriction, 12% displaying moderate restriction, and 2% severe restriction.

Conclusions

In this analysis of 283 subjects treated as part of the bRIGHT trial, a proposed method to accurately and consistently characterize the tricuspid valve anatomy from baseline echo was developed. The method reaved the broad range of tricuspid valve anatomies realized in this real-world population.

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Left atrial dynamics and the pulmonary circulatory-right ventricular uncoupling in patients with severe degenerative mitral regurgitation
Authors: Barki M , Paci G , Margonato D , Ingallina G , Morosato M , Stella S , Biondi F , Ancona F , Fanti D , De Bonis M , Castiglioni A , Maisano F , Slavich M , Agricola E
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The uncoupling of right ventricular (RV) function to pulmonary circulation (Pc) represents a prognostic index in patients affected by degenerative mitral regurgitation (DMR) undergoing surgical or percutaneous repair. In this context, the deterioration of Left Atrial (LA) dynamics favors the development of pulmonary venous congestion and vascular remodeling, triggering pulmonary hypertension (PH) and right ventricular (RV) dysfunction. However, the relationship between LA function and RV-to-Pc coupling is not well defined in this population.

Purpose

The aim of the study was to investigate the association between RV-to-Pc uncoupling, assessed by the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PAPS), and LA dynamics, evaluated with Speckle Tracking Echocardiography (STE), in patients with DMR.

Methods

351 consecutive patients with hemodynamically-significant DMR who were evaluated for cardiac surgery at San Raffaele Hospital and underwent a complete transthoracic and transesophageal echocardiography were retrospectively enrolled (mean age 59±14 years, 65% males). Patients were then stratified in two groups according to TAPSE/PAPS ratio (group I: TAPSE/PAPS >0.4 mm/mmHg; group II: TAPSE/PAPS ≤0.4 mm/mmHg). LA function was evaluated analyzing LA strain at peak relaxation (Global peak atrial longitudinal strain) and STE analysis was performed offline. All the patients enrolled were in sinus rhythm.

Results

At baseline, patients exhibited normal LV dimensions and function (EDVi 70±20 ml/m2, LVEF 63±6%), increased LA size (48±20 ml/m2) and a mean GPALS of 26±13%. Additionally, a preserved RV function and coupling with PC was found in the population in study (average TAPSE/PASP at admission: 0.84±0.2 mm/mmHg), with only 10% of the cohort exhibiting a reduced TAPSE/PAPS ratio. When stratified according to RV-to-PC coupling, patients with higher TAPSE/PAPS (>0.4 mm/mmHg) exhibited significantly higher values of LA reservoir strain (group I: GPALS 27.8±12.7% vs group II GPALS 22.7±11.3%; p = 0.04) (Figure 1, 2). Additionally, a direct correlation between LA-Strain values and TAPSE/PAPS ratio was noticed (r=0.3, CI 95% 0.21–0.5; p<0.001).

Conclusions

In DMR, there is a strong association between echo-derived measures of LA mechanics and RV to Pc uncoupling, with higher values of LA strain correlating with a better RV functioning and coupling. These results, although preliminary, suggest the importance of a multiparametric approach in the risk-stratification of these patients, potentially improving the long-term outcome.
Assessment of right atrial strain parameters in half marathon amateur runners
Authors: Szalek-Goralewska A , Dankowski R , Sacharczuk W , Ozegowski S , Walla W , Szyszka A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Endurance training may cause atrial remodeling and atrial arrhythmias in professional athletes. However, there is a lack of data on the right atrial (RA) adaptation to training and half marathon run in amateur runners. Recently introduced atrial deformation strain analysis allows to assess the RA function more precisely.

Purpose

The study aims to assess the influence of ten-weeks training and half marathon run on the RA strain parameters in non-elite athletes. It also investigates whether these changes affect the runner’s competitive performance. We hypothesized that the training and 21.0975 kilometers run itself cause functional atrial changes in recreational runners.

Methods

The study group consisted of 45 recreational runners with a mean age of 32.96 ± 5.12 years, 27 men. Two-dimensional, Doppler and speckle tracking echocardiography was performed before the ten-weeks training period (stage 1), 48 hours before (stage 2) and within 48 hours after (stage 3) the half marathon run. We measured RA volumes, ejection fraction and strain during reservoir, conduit and contraction phases at all stages (Figure). Training intensity was expressed in declared kilometers run per week.

Results

There were no significant changes in RA volumes and RA ejection fraction between stages. We did not notice significant differences in RA strains during reservoir, conduit and contraction phases between stages. Athletes who trained more intensively had significantly higher maximum RA volume at stage 1 (r = 0.32; p = 0.033) and at stage 3 (r = 0.44; p = 0.003). They had also larger RA area at stage 1 (r = 0.32; p = 0.030). Runners whose RA area was larger, achieved significantly better finishing race time (r = -0.49; p = 0.001). Higher RA volume correlated with better half marathon performance (r = -0.32; p = 0.039).

Conclusions

Ten-weeks training period and participation in half marathon run were not associated with RA dilatation or functional changes based on strain deformation analysis in amateur runners. However, we observed the influence of intensity of physical training on the enlargement of volume and surface area of the right atrium, which resulted in better half marathon finishing time.
Diagnostic performance of somatostatin receptor imaging by PET/CT in patients with cardiac sarcoidosis: a systematic review and meta-analysis
Authors: Ballo H , Doghman F , Knuuti J , Saraste A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Backgrounds

Somatostatin receptor (SSTR) based positron emission tomography/computed tomography (PET/CT) is a novel approach for detecting myocardial inflammation and, consequently, cardiac sarcoidosis (CS). However, the diagnostic performance of SSTR PET/CT was only evaluated in small studies.

Purpose

To evaluate the clinical performance of SSTR PET/CT in diagnosing CS.

Methods

PubMed, Embase, and Cochrane Library were searched from the earliest available date of indexing to December 2022 for studies evaluating the SSTR PET/CT for the evaluation of possible CS defined by the Japanese Ministry of Health, Labour and Welfare (JMHW) criteria. Studies were eligible if they were performed on patient level. The case reports and reviews were excluded. To calculate the overall performance of the diagnostic accuracy of SSTR PET/CT, a summary receiver operating curve (SROC) was done. The sensitivities and specificities of eligible studies were pooled. Heterogeneity was evaluated with the I² test. Sensitivity analysis excluding outliers was conducted.

Results

Six studies used SSTR PET/CT involving 104 patients (mean age 50 years, 45% male) fulfilled the inclusion criteria. All included studies used 68Ga-DOTATOC analogue. The pooled sensitivity of SSTR PET/CT for diagnosis of CS was 75.6% (95% CI 36.5–94.4%; I² = 34%), and the pooled specificity was 97.6% (95% CI 84.9–99.7%; I² = 0%) (Figure 1). SROC analysis demonstrated good overall accuracy for SSTR PET/CT (Figure 2). Moreover, the sensitivity analysis of SSTR PET/CT (5 studies) showed a pooled sensitivity of 80% (95% CI 58.9–92.5%; I² = 0%) and a pooled specificity of 97.1% (95% CI 82.3–99.6%; I² = 0%).

Conclusions

SSTR PET/CT is a useful adjunctive diagnostic tool in evaluating CS. Further large multi-center studies are warranted to validate the diagnostic accuracy of SSTR PET/CT for the diagnosis of CS.