bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for raised left ventricular filling pressure by cardiovascular magnetic resonance: prognostic insights from UK Biobank
Authors: Thomson R , Grafton-Clarke C , Swoboda P , Swift A J , Frangi A , Petersen S E , Aung N , Garg P
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute for Health and Care Research British Cardiovascular Society.

Background

Cardiovascular magnetic resonance imaging (CMR) can estimate left ventricular filling pressure (LVFP). The relationship between LVFP, determined by CMR measurements, and established risk factors for cardiovascular disease is unknown. This study quantifies these associations and investigates the prognostic value of CMR-derived LVFP compared to known risk factors for cardiovascular disease.

Methods

Using data from the UK Biobank prospective observational cohort study, CMR-derived LVFP was calculated using a model incorporating left atrial volume and left ventricular mass. Logistic regression was used to explore the relationships between raised LVFP (≥15mmHg) and typical cardiovascular risk factors. The non-linear relationship between LVFP and age was analysed using ordinary least squares regression and a restricted cubic spline of age with nine knots. Cox proportional hazards regression was used to analyse the relationships between typical cardiovascular risk factors and CMR-derived LVFP, and outcomes of incident heart failure and major adverse cardiovascular events.

Results

In this prospective population-based cohort study, 39,163 UK Biobank participants had CMR with adequate image quality.

In a multivariable logistic regression model, male sex (OR 4.55, 95% CI 3.85–5.42, p<0.001), age (OR 1.89, 95% CI 1.72 - 2.09, per decade increment, p<0.001), BMI (OR 1.57, 95% CI 1.48–1.67, per SD increment, p<0.001), and hypertension (OR 1.46, 95% CI 1.26–1.68, p<0.001) were associated with increased odds of raised LVFP (Figure 1a).

A non-linear regression model of the relationship between age and LVFP, adjusted for all covariables studied, showed little correlation between CMR-derived LVFP and age until 70 years, after which LVFP increased rapidly with age (Figure 2).

In multivariable Cox regression models, elevated CMR-derived LVFP was associated with increased hazard of incident heart failure (HR 3.31, 95% CI 1.99–5.49, p<0.001) but not MACE (HR 1.33, 95% CI 0.86–2.07, p = 0.20) (Figure 1b).

Conclusions

Raised LVFP, as determined using CMR, is independently associated with male sex, age, BMI and hypertension. CMR-derived LVFP is independently associated with incident heart failure. These findings may have implications for clinical risk stratification, targeted population screening strategies and public health measures to reduce the risk of heart failure development.
Comparison of the diagnostic accuracy of dynamic CT perfusion and cardiac CMR with quantitative perfusion: a subanalysis of ADVANTAGE II study
Authors: Mushtaq S , Andreini D , Conte E , Wang S , Marchetti D , Gaudenzi Asinelli M , Junod D , Bentivegna A , Schillaci M , Trabattoni D , Montorsi P , Galli S , Baggiano A , Bartorelli A , Pontone G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The ADVANTAGE II study has evaluated the performance of dynamic myocardial perfusion assessed by CT (CTP) in stented patient using ICA and in particular invasive coronary physiology (FFR and IMR) as gold-standard. Recently, quantitative myocardial blood flow (MBF) analysis using stress cardiac magnetic resonance (CMR) has been showed to detect obstructive coronary artery disease (CAD) and coronary microvascular dysfunction (CMD). In a substudy of ADVANTAGE II we aimed to evaluate the performance of quantitative stress CMR in comparison to CTP.

Methods

We present data from 39 subjects with clinically indicated ICA who underwent both vasodilator stress CMR using 1.5T MR scanner (General Electric) and dynamic stress myocardial CTP using a last generation scanner characterized by a 16-cm Z-axis coverage. In CMR Quantitative myocardial perfusion imaging was performed using the dual sequence technique (i.e. low-resolution slice for arterial input function and 2–3 short axis slices for myocardial perfusion). Resting MBF (rMBF), Stress MBF (sMBF), and myocardial perfusion reserve (MPR) were measured using Fermi deconvolution (Circle Cvi42). Quantitative perfusion results were displayed on color-encoded pixel-wise maps and on a 16-segment plot with segmental values listed.

Results

When FFR was used as gold standard the diagnostic accuracy of CTP was higher than those of CCTA (84.7% vs. 61.5%, p<0.001). When IMR was used as gold standard, diagnostic accuracy of CTP was higher than CCTA (82.9% vs. 59.3%, p<0.01, respectively). When the presence of at least one abnormal physiological parameter among FFR and IMR was used as gold standard, the diagnostic accuracy of CTP was higher than that of CCTA (90.8%vs 68%). Quantitative stress CMR using 2.2 ml/min/g as cut-off has a sensitivity of 83.3%, 77.7% and 100% vs QCA, FFR and IMR, respectively with higher performance of dynamic CTP in comparison to quantitative stress CMR.

Conclusions

In this substudy of ADVANTAGE II, we showed that global sMBF in MRI can accurately identify patients with CAD. Dynamic CTP seems to offer higher value of diagnostic performance in comparison to quantitative CMR that seems to be very promising, but more data are needed.
Radiomic analysis of computed tomography myocardial texture: a new tool to identify subclinical cardiac amyloidosis
Authors: Maragna R , Lo Iacono F , Guglielmo M , Chiesa M , Baggiano A , Fusini L , Volpe A , Tassetti L , Junod D , Gaudenzi M , Fontana M , Treibel T , Moon J , Corino V , Pontone G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac amyloidosis (CA) is an increasingly diagnosed disease sharing several phenotypical features with aortic stenosis (AS).

Purpose

As diagnosing the two diseases has crucial prognostic and therapeutic implications, this study aims to identify a set of stable and discriminative radiomic features derived from cardiac computed tomography to differentiate them.

Methods

Forty-two patients were included in the study. For each patient, 107 radiomics features were evaluated by means of geometrical transformations (translations) to the region of interests (ROIs) and intra class correlation coefficient (ICC) computation. A stratified 7-fold cross (k=7) validation was performed to split data into learning, validation and test set (Figure 1). Three features selection methods (Wilcoxon signed rank-based method and/or LASSO regression) and five machine learning classifiers.

Results

Ninety radiomic features satisfied robustness criteria and 10 were kept after feature selection. The best results were obtained using logistic regression classifier combined with Wilcoxon signed rank and LASSO regression, obtaining an accuracy of 95 ± 7% and sensitivity and specificity equal to 95 ± 12% in the test set. The Receiver Operating Curve (ROC) for this model on the test set showed an excellent area under the curve (AUC) of 0.94 (Figure 2).

Conclusions

The application of radiomics shows promising results in distinguishing left ventricle hypertrophy caused by CA from AS and might be used as a non-invasive tool able to support clinical decision making.
Fully Automated 3D echocardiographic algorithms: accurate and time saving - the answer for 3D in routine clinical practice?
Authors: Miranda Castilho B , Campos G , Almeida J , Veiga R , Coelho C , Cotrim N , Andrade B V , Moura A R , Saraiva M , Domingues K , Damasio A F , Teixeira R , Goncalves L
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

3D left ventricular ejection fraction (LVEF) quantification methods are more accurate and reproducible than 2D echocardiography, however, conventional 3D is time consuming and requires extensive user expertise, thus hindering its routine implementation in busy echocardiography laboratories and its use by inexperienced physicians. HeartModel A.I. (HM) is a simple, fast, recently validated 3D automated analysis software that detects LV endocardial surfaces and calculates LVEF. The aim of this work is to evaluate the performance of HM with experienced and inexperienced physicians, its time saving potential and to assess whether this software can be a better alternative to 2D measurements in routine echocardiography.

Methods

Prospective analysis of 30 nonconsecutive patients referred for transthoracic echocardiogram in a university hospital echocardiography lab, from 1st February 2021 to 31st March 2021. 2D biplane LVEF was measured by an experienced and inexperienced physician (less than 250 echocardiograms performed), then the same physicians used the automated analysis software to assess LVEF (blinded for each other results). The time to make the measurements was registered. Comparisons of agreement between LVEF measurements (experienced versus inexperienced physicians) included linear regression with Pearson correlation coefficients and Bland-Altman analyses to assess the bias and limits of agreement (defined as 2SD around the mean).

Results

A total of 30 patients were included, mean age of 68.6 ± 20.1 years and 60% male. HM showed significantly lower acquisition times in both inexperienced (72±17s versus 173± 44s, P<0.01) and experienced (56±12s versus 126±29s, P<0.01) physicians. The difference in time of acquisition between 2D and HM was approximately 101s for inexperienced users and around 70s for experienced users. Regarding LVEF assessment, HM acquisitions compared to 2D measurements showed stronger correlations between experienced and inexperienced physicians (r= 0,98, P<0,01 versus r= 0,92, P<0,01) with minimal bias (−0,5 versus −0,6) and stronger agreement (HM limits of agreement: ± 5,8% versus 2D limits of agreement: ± 12,5%)

Conclusion

3D LVEF assessment by HM significantly reduced acquisition times and exhibited higher interobserver agreement than 2D Simpson’s biplane method. These results suggest that automated 3D algorithms, such as HM, may play a key role in implementing 3D measurements in routine practice in busy echocardiography laboratories and allow the use of 3D echocardiography at early stages of physicians training.
Phenotyping of Heart Failure with preserved ejection faction using electronic health records and echocardiography
Authors: Pierre-Jean M , Marut B , Curtis E , Cuggia M , Bouzille G , Donal E
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): CHU de Rennes

Aims

Patients presenting heart failure (HF) symptoms with preserved left ventricular ejection fraction (HFpEF) are not a homogenous population. Different phenotypes can differ in prognosis and optimal management strategies. We sought to identify phenotypes of HFpEF by using the medical information database from a large University Hospital Center using machine learning.

Methods and results

We explored the use of clinical variables from electronic health records (EHR) in addition to echocardiography to identify different phenotypes of patients with heart failure and preserved ejection fraction. The proposed methodology identifies 4 phenotypic clusters based on both clinical and echocardiographic characteristics which have differing prognoses (death and cardio-vascular hospitalization).

Conclusion

This work demonstrated that AI derived phenotypes could be used as a tool for physicians to assess risk and to target therapies that may improve outcomes.
Echocardiographic markers in the diagnosis of cardiac masses
Authors: Paolisso P , Bergamaschi L , Canton L , Angeli F , Graziosi M , Magnani I , Rinaldi A , Armillotta M , Sansonetti A , Rucci P , Biagini E , Galie N , Foa A , Pizzi C
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The echocardiographic parameters required for a comprehensive assessment of cardiac mass (CMs) are still largely unknown.

Objectives

To identify and integrate the echocardiographic features of CMs that can accurately predict malignancy.

Methods

Observational cohort study of 286 consecutive patients who underwent a standard echocardiographic assessment for suspected cardiac mass between 2004 and 2022. A definitive diagnosis was achieved by histological examination or, in case of cardiac thrombi, with radiological evidence of thrombus resolution after an appropriate anticoagulant treatment. Logistic and multivariable regression analysis was performed to confirm the ability of 6 echocardiographic parameters to discriminate malignant from benign masses. The unweighted count of these parameters was used as a numerical score, ranging from 0 to 6, with a cut-off of >3 balancing sensitivity and specificity with respect to the histological diagnosis of malignancy. Classification tree analysis (CTA) was used to determine the ability of echocardiographic parameters to discriminate sub-groups of patients with a differential risk of malignancy.

Results

Benign masses were more frequently pedunculated, mobile, and adhered to the interatrial septum (p<0.001). Malignant masses showed a greater diameter and exhibited a higher frequency of irregular margins, an inhomogeneous appearance, sessile implantation, polylobate shape, and pericardial effusion (p<0.001). Infiltration, moderate-severe pericardial effusion, non-left localization, sessile, polylobate, and inhomogeneity were confirmed to be independent predictors of malignancy in both univariate and multivariable models. The predictive ability of the unweighted count of >3 was very high (>0.90) and similar to that of the previously published weighted score. The CTA generated an algorithm in which infiltration was the best discriminator of malignancy, followed by non-left localization and sessile shape. The percentage correctly classified by the CTA as malignant was 87.5%. Agreement between observer readings and cardiac mass histology ranged between 85.1–91.5%. The presence of at least 3 echocardiographic parameters was associated with a lower survival.

Conclusions

In the approach to CM, some echocardiographic parameters can serve as markers to accurately predict malignancy, thereby informing the need for second-level investigations and minimizing the diagnostic delay in such a complex clinical scenario.
Prognostic significance of size and function of the subpulmonary left ventricle in patients with a systemic right ventricle
Authors: Surkova E , Constantine A , Xu Z , Segura T , Bispo D , West C , Senior R , Dimopoulos K , Li W
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Systolic dysfunction of the systemic right ventricle (SRV) is a well-recognized predictor of adverse events in adults with transposition of great arteries (TGA) after atrial switch repair or with congenitally corrected TGA (ccTGA). The prognostic role of subpulmonary left ventricle (LV), however, remains unclear.

Purpose

To assess the prognostic significance of echocardiographic parameters of subpulmonary LV size and systolic function.

Methods

All adult patients with the SRV who underwent transthoracic echocardiography in 2010–2018 at a large tertiary referral centre were identified from a digitally recorded echocardiographic database. Biventricular size and function were assessed at the most recent exam. The study endpoint was all-cause mortality and heart or heart-lung transplantation.

Results

We included 180 patients, 100(55.6%) male, mean age 42.4±12.3 years, of whom 103(57.2%) had undergone Mustard/Senning operations and 77(42.8%) had ccTGA. One half of patients were in NYHA class ≥2 and 113 (63.5%) were receiving heart failure medication(s).

During a follow-up period of 4.9[3.8–5.7] years, 28(15.6%) patients died and 4(2.2%) underwent heart or heart-lung transplantation. Univariable predictors of death or transplantation included older age, NYHA class III/IV, history of atrial arrhythmias, presence of pacemaker or cardioverter-defibrillator, high BNP, and echocardiographic markers of both SRV and subpulmonary LV size and function (Figure 1). On multivariable Cox analysis, indexed LV end-systolic diameter (ESDi; HR 2.77 [95%CI 1.35–5.68], p = 0.01), LV fractional area change (FAC; HR 0.7 [95%CI 0.57–0.85], p = 0.002), SRV basal diameter (HR 1.66 [95%CI 1.21–2.29], p = 0.005), and SRV FAC (HR 0.65 [95%CI 0.49–0.87], p = 0.008) remained predictive of mortality or transplantation. On ROC analysis, subpulmonary LV parameters performed better than SRV markers in predicting death or transplantation (Figure 2).

Conclusions

A raised LV ESDi and reduced LV FAC were strongly associated with mortality and heart or heart-lung transplantation independent of SRV size and function. Accurate echocardiographic assessment of the subpulmonary LV is therefore essential for risk stratification and management of patients with the SRV and should be a part of routine echocardiographic protocols.
Computed tomography-derived myocardial extracellular volume in patients with severe aortic stenosis: correlation with markers of ventricular dysfunction
Authors: Reis Santos R , Lopes P M , Albuquerque F , Freitas P , Silva C , Guerreiro S , Abecasis J , Santos A C , Saraiva C , Brito J , Goncalves P A , Teles R C , Almeida M S , Mendes M , Ferreira A M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Myocardial fibrosis is a potential adverse prognostic marker in patients with severe aortic stenosis (AS) and can be quantified using non-invasive imaging measures, such as the extracellular volume fraction (ECV). Although computed tomography (CT) for transcatheter aortic valve replacement (TAVR) planning was originally developed to assess the aortic valve complex and access routes, it has evolved to include the measurement of ECV for myocardial tissue characterization.

Aim

This study aimed to determine associations between CT-derived ECV (ECVCT) and clinical and echocardiographic markers of ventricular function in patients with severe AS referred for TAVR-planning CT.

Methods

Single-center prospective study enrolling all consecutive patients with severe symptomatic AS referred for TAVR-planning CT between April and November 2022. CT was performed on a 192-slice dual-source 3rd generation scanner (Siemens Somatom Force) and ECVCT was acquired during TAVR-planning using an additional 5-minute post-contrast low-radiation-dose prospective acquisition. ECVCT was calculated as the ratio of change in CT attenuation (Hounsfield units [HU]) of the septal myocardium and the left ventricle (LV) blood pool before and after contrast administration, according to the equation: ECVCT = (1 – hematocrit) x (DHUmyo/DHUblood) – Figure 1A.

Results

A total of 102 patients were included (mean age 81 ± 7 years; 46% male; mean valvular transaortic gradient 51 ± 14 mmHg; mean aortic valve area 0.7 ± 0.2 cm2; mean LV ejection fraction (EF) by 2D echocardiogram 57 ± 11%). No patient had a clinical diagnosis of cardiac amyloidosis. Overall, the mean ECVCT value was 33.4 ± 7.0%. Myocardial ECVCT values significantly differed between AS subtypes, with higher values in patients with low-gradient AS (n=13, 13%; ECVCT 40.3 ± 4.8% vs 32.4 ± 6.7%, p<0.001) - Figure 1B. Additionally, myocardial ECVCT values correlated with markers of LV and right ventricular (RV) dysfunction, including lower LV EF (r = -0.354, p<0.001), worse LV global longitudinal strain (r = 0.420, p = 0.002), reduced TAPSE (r = -0.230, p = 0.043) and RV S wave by tissue doppler imaging (r = -0.321, p = 0.010) and higher NT-proBNP values (r = 0.347, p = 0.002).

Conclusions

In patients with severe AS scheduled for TAVR-planning CT, ECVCT values are significantly higher in those with low-gradient AS and correlated with several measures of biventricular dysfunction. This CT parameter may be useful to identify a subgroup of patients with higher risk of adverse prognosis.
Right ventricular strain: A powerful prognosticator for patients with tricuspid regurgitation
Authors: Curtis E , L'official G , Lemarchand L , Leurent G , Oger E , Donal E
Published: June 2023

Funding Acknowledgements

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

Background

Right ventricular (RV) characteristics are extremely important for heart failure patients and especially in patients with a tricuspid regurgitation. Right heart catheterism is advocated by guidelines. Echocardiography alone is challenging due to complexity of the right heart but retains promise. Speckle tracking allows the detection of subtle changes that may be missed by the naked eye and other quantitative methods. We sought to assess the utility of RV strain (free wall) to assess prognosis and build a multivariate prediction model based on clinical, echocardiographic and hemodynamic data.

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. The echocardiograms were read at the corelab. The association between RV strain (free wall) and prespecified echo and haemodynamic measures of right and left heart function and prognosis defined by heart failure hospitalisations and death was recorded. A multivariate predictor model was computed using SAS 15.1

Results

Over a median follow up of 28±16 months, there were 59 events. Main data are summarized in table I. Abnormal RV strain was independently associated with prognosis HR 3.63 (1.43 – 9.22). This was the must echo-parameters. The other key parameters were: creatinine clearance HR 0.88 (0.79 – 0.98), TAPSE HR 0.73 (0.57 – 0.93], RA area HR 1.44 (1.19 – 1.75), RA pressure HR 1.65 (1.34 – 2.04) and mean pulmonary artery pressure HR 1.39 (1.08 – 1.78).

Conclusions

RV strain is a strong "predicator" and appears to perform better than traditional echocardiographic measurements. Prospective studies would support the impact of RV strain especially in patients with heart failure and tricuspid regurgitation.
The role of transoesophageal echocardiography in diagnosis and management of patients with embolic stroke of undetermined source
Authors: Karakosta M , Ntiloudi D , Kalesi A E , Vassaki M , Ntalekou K , Archontikis A , Arnas N , Miaris N , Giagkou K , Zachos P , Destounis A , Theodosis-Georgilas A , Pisimisis E , Kasinos N
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

About 25–30% of the cases of ischemic stroke have no established etiology after standard diagnostic evaluation and are classified as embolic strokes of undetermined source (ESUS). Transoesophageal echocardiography (TOE) may provide additional information in the evaluation of patients with ESUS and change the secondary prevention management.

Purpose

In this retrospective study we examined the role of TOE in diagnosis and further management of patients with ESUS.

Methods

Patients with ESUS (18 to 60 years old) with no comorbidities were examined at the echocardiography laboratory of our hospital, from April 2018 until August 2022. All patients were thoroughly assessed with transthoracic echocardiography and had no abnormal findings. Atrial fibrillation was excluded by ambulatory electrocardiography. All patients were examined for presence of patent foramen ovale (PFO), aortic atheromatosis and left atrial appendage thrombus. The size of PFO shunt was classified based on the number of microbubbles seen in the left atrium during the first three cardiac cycles after the infusion of agitated saline. The presence of 1–5 microbubbles was classified as small shunt, 6–25 as moderate and >25 as large. Patients with large shunts and RoPE score >6 were referred to occlusion. Τ - test was used to compare the means of the variables and a p value 0.05 was considered statistically significant.

Results

In this study, 200 patients with ESUS (134 males), of mean age 52.6 (SD=9.8 ears), were enrolled. In 52 of them TOE determined the etiology of stroke. The presence of PFO was found in 70 (35.0%) patients. Of those, 17 (24.3%) had a small shunt, 20(28.6%) a moderate and 32 (45.7%) had a large shunt and were referred to occlusion. Patients with PFO were younger (mean age 47.2 years, SD 11.2, p<0.001) than those without PFO (mean age 54.8 years, SD 8.6) (Diagram 1). Furthermore, 20 (10.0%) patients were diagnosed with atheromatosis of ascending aorta and aortic arch ≥grade 2. Patients with aortic atheromatosis were older (mean age 58.1 years SD 7.6) than those without atheromatosis (mean age 51.9 years, SD 9.8, p = 0.008) (Diagram 2). Finally, TOE did not reveal left atrial appendage thrombus in any of the examined patients.

Conclusion

TOE revealed the etiology of stroke in about 25% of our patients, which consequently changed their secondary prevention management.
Contemporary early left ventricular thrombus resolution by echocardiography: insight from a longitudinal multicenter registry
Authors: Mantovani F , Bursi F , Pedone C , Celeste F , Passarini G , Concilio C , Formigaro L , Turina M C , Malagoli A , Pistelli L , Zito C , Benfari G , Bartolacelli Y , Barbieri A , Pepi M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Multicenter longitudinal data are lacking regarding the incidence and the time needed for total left ventricular thrombus (LVT) regression obtained with contemporary antithrombotic regimens diagnosed with modern echocardiographic technology.

Purpose

To quantify the effect of antithrombotic therapy on LVT evolution using sequential up-to-date echocardiography in a large cohort of patients with LVT.

Methods

Ten centers were involved in this observational prospective multicenter study. LVT was defined as an echo-dense mass adjacent to a hypokinetic or akinetic myocardial segment. To be distinguishable from the underlying myocardium, a clear thrombus–blood interface was required and the LVT had to be visible on at least 2 views during the cardiac cycle. Initial follow-up echocardiograph was scheduled at 14±7 days (T0) and 42±7 days (T1). The early resolution was defined when LVT was no longer detected at T1. The use of different anticoagulant regimens and ultrasound contrast was left at the discretion of attending physicians, according to good clinical practice.

Results

From October 2020 to November 2022, 99 patients with LVT (mean age 66 ± 11 years, 80% men) were identified with echocardiography, in 53% ultrasound contrast was used. Early resolution of LVT was observed in 42%. Echocardiographic characteristics by early resolution of LVT are shown in Table. The independent correlates of early LVT regression were smaller baseline LVT area, higher LVEF, and mobile LVT (p<0.05).

Conclusions

In this large and well-characterized present-day cohort of patients with LVT, early regression by echocardiography was achieved in less than half of the patients and was mostly related to the size of the LVT and heart function rather than treatment despite a high proportion of antithrombotic therapy. The next step will be to assess the impact of LVT persistence on subsequent clinical outcomes.
The impact of real-time guiding by deep learning on test-retest variability of automated left ventricular systolic function measurements
Authors: Pettersen H , Saeboe S , Pasdeloup D , Olaisen S , Oestvik A , Boen G C , Langoey P K , Jakobsen P O , Smistad E , Stoelen S , Grenne B , Loevstakken L , Dalen H , Holte E
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian University of Science and Technology, St. Olavs University Hospital, Central-Norway Health Authority.

Background

Left ventricular (LV) ejection fraction (EF) and left ventricular volumes are key parameters for characterisation of cardiac function. Test-retest variability of EF and LV end-diastolic volume (EDV) are dependent on image quality and analyses. Foreshortened LV recordings cause inaccuracies in estimation of EF and EDV. Real-time guiding of LV length using deep learning (DL) could improve standardization of image acquisition and reduce variability of automated analyses of EF (auto-EF) and EDV (auto-EDV).

Purpose

To study the impact of real-time feedback of LV length using a robust deep-learning (DL) software during echocardiography on variability of automated analyses of EF (auto-EF) and EDV (auto-EDV).

Methods

Patients with mixed cardiac pathology were consecutively included if they were in sinus rhythm without need for contrast. Three consecutive echocardiograms were performed; the first and second by two of three experienced sonographers (Sonographer 1 and 2) and the third (reference) by one of four cardiologists in random order, all affiliated to an EACVI accredited echocardiographic laboratory. All exams included the standard apical views, and the reference exams also included tri-plane recordings of the LV. All measurements were done retrospectively using automated algorithm for measuring. LV volumes were measured in four- and two-chamber views and averaged by the method of discs’ formula. LV EF was calculated as biplane measurements. The coefficients of variation (CV) between sonographers and cardiologists were compared for both LV EF and end-diastolic LV volume from biplane measurements. One-way ANOVA was used to estimate within-patient variation for automated and manual measurements.

Results

A total of 47 patients (47% women) were included with mean (SD) age 64 (15) years. There was no significant difference in CV for neither auto-EF nor auto-EDV using the DL tool (Table) compared to standard care. Manual and automated measurements of LV volumes and EF correlated well with R 0.91 and R 0.74, respectively (only data for EF shown in the figure).

Conclusion

Real-time guiding did not significantly reduce variation of automated analyses of LV volumes and EF when used by experienced sonographers. Further studies are needed to evaluate the effect of real-time guiding to optimize LV acquisition in inexperienced users.
Photon-counting detector CT enables more precise assessment of coronary artery stenosis
Authors: Balogh H , Vertes M , Nagy N , Kerkovits N , Vecsey-Nagy M , Boussoussou M , Vattay B , Szilveszter B , Merkely B , Maurovich-Horvat P , Simon J
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Hungarian Academy of Sciences.

Introduction

In contrast to conventional energy-integrating detectors, photon-counting detector (PCD) CT translates the photon energy directly to electric signal, which allows image acquisition with lower noise and improved spatial resolution.

Objective

The aim of our study was to assess coronary stenosis by comparing conventional CT and PCD-CT.

Method

In our retrospective study, we included patients who underwent coronary CT angiography (CCTA) performed by PCD-CT between January and December 2022. The control population consisted of consecutive patients who underwent coronary CCTA with a 280-slice CT. In our study, heart transplanted patients, patients with stent, pacemaker or valve implantation, or non-diagnostic image quality were excluded. The degree of coronary stenosis was evaluated according to the following classification: normal coronary artery (0%), minimal (1–24%), mild (25–49%), moderate (50–69%), severe stenosis (70–99%) or occluded coronary artery (100%).

Results

A total of 812 consecutive patients were included in our study (n=401 control, n=412 PCD-CT). There was no difference between the two groups in mean age (58.1±11.9 vs. 58.7±12.8 years) and sex (48.4% vs. 42.6% female). We found a significant difference in the degree of CAD between conventional CT and PCD-CT as follows: normal coronary arteries 29 vs 26%; minimum 23 vs 31%; mild 20 vs 23%; moderate 15 vs 10%; severe 12 vs 9%; occluded 3 vs 2%, respectively (all p<0.001).

Conclusions

According to our preliminary results, PCD-CT is less likely to overestimate the degree of stenosis and can detect smaller plaques more precisely.
Left atrial pump strain predicts mortality in patients undergoing transcatheter aortic valve implantation
Authors: Winkler N , Anwer S , Reeve K A , Rumpf M , Tsiourantani G , Tanner F C
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Swiss Heart Foundation, Novartis Foundation.

Introduction

Speckle-tracking echocardiography is an increasingly important tool for the assessment of degenerative aortic stenosis (AS), the most common valvular heart disease in the Western world with growing prevalence in the aging population. Left atrial reservoir (LARS) and pump strain (LAPS) were studied for their association with all-cause mortality in AS patients undergoing transcatheter aortic valve implantation (TAVI).

Purpose

To investigate left atrial function assessed by LARS and LAPS and its association with all-cause mortality during long-term follow-up after TAVI.

Methods

From our prospective AS registry, 198 patients with severe AS were identified who underwent TAVI and had a comprehensive echocardiographic examination prior to the procedure, allowing full target analysis with TomTec Image Arena. All-cause mortality was defined as the endpoint.

Results

Left atrial volume index (LAVI) was increased (mean (SD): 46.9 ml/m2 (16.5)) and left atrial deformation (LARS (21.7 % (6.9); LAPS (−9.5 % (4.5)) impaired in the study population, while left ventricular ejection fraction (LVEF) (56.7 % (11.5)) was preserved. During a median follow-up time of 1835 [IQR 1371 – 2337] days, 70 patients (35.4 %) died. There was no significant difference between women and men. LARS and LAPS were lower in non-survivors (20.3 % (6.7) and −8.4 % (4.1), respectively; Figure 1) than survivors (22.5 % (6.9); P = 0.034 and −10.1 % (4.6); P = 0.012; Figure 1), while LAVI did not differ (P = 0.175). In univariable Cox regression models, LAPS was associated with all-cause mortality (HR 1.06 [95% CI 1.01 – 1.12]; P = 0.029; ꭓ2 5.03; ꭓ2 P = 0.025), while LARS was not (HR 0.97 [0.94 – 1.01]; P = 0.120; ꭓ2 2.50; ꭓ2 P = 0.114). In bivariable models, association of LAPS with mortality was independent of gender (data not shown), STS-Score, LVEF and LAVI (Figure 2). Likelihood ratios revealed that inclusion of LAPS to STS-Score, LVEF or LAVI improved the fitness of predictive models (Figure 2), while that of LARS did not (data not shown).

Conclusions

LAPS was associated with mortality after TAVI, while LARS and LAVI were not. The association of LAPS was independent of STS-Score, LVEF, and LAVI and showed potential incremental value for assessment of outcome association. Hence, left atrial dysfunction as reflected by LAPS was a predictor of mortality and may be a useful follow-up parameter after TAVI.
CCTA characteristics of vulnerable plaques preceding acute coronary syndromes-a comparative analysis between STE- and NSTE-ACS
Authors: Opincariu D , Rat N , Gorea Stanescu A , Blindu E , Matyas B , Kovacs I , Benedek I , Benedek T
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the University of Medicine, Pharmacy, Science and Technology „George Emil Palade“ of Târgu Mureș Research Grant number 510/13/17.01.2022.

Background

CCTA adverse plaque features, that illustrate increased vulnerability, have been established as significant predictors for adverse events in patients with coronary artery disease. Decades of research have benchmarked the implication of vulnerable plaques (VP) in the occurrence of acute coronary syndromes (ACS). Still, there is little information concerning the interrelation between VP features and the subsequent type of ACS.

Aim

We sought to identify specific characteristics of future culprit vulnerable plaques, in a comparative analysis between the type of ACS they trigger, in patients undergoing CCTA and plaque analysis for stable chest pain.

Material and Methods

We conducted a prospective analysis, with a 3 year follow-up, on 50 subjects who underwent CCTA evaluation for stable chest pain. Coronary plaques were analyzed at baseline, for lesions that presented moderate stenosis, with at least one vulnerability marker (LAP, PR, NRS, SCs), which became culprit lesions during follow-up. Patients were initially divided into 2 groups (gr.1 – with STE-ACS, n=13) gr.2 – patients with NSTE-ACS, n=37). The secondary analysis divided the population in 3 groups gr.1-patients with UA (n=28); gr.2- with STEMI (n=13); gr.2 –with NSTEMI (n=9).

Results

The time to the occurrence of an ACS was higher for STE-ACS compared to NSTE-ACS (169.9±177.4, p<0.001), which was similar when comparing NSTEMI vs. UA vs. STEMI (p = 0.0001). The lowest degree of stenosis was present for VP that had triggered NSTEMI (p = 0.03). Evaluation of plaque composition revealed that the STE-ACS group presented higher non-calcified (171.6±63 vs. 130.6±80.1 mm3 p = 0.04) and lipid rich (19.9±16.7 vs. 11.42±10.5 mm3, p = 0.04) volumes, with no other differences regarding plaque composition and morphology. Plaques that had triggered STEMI during follow-up, presented highest non-calcified (p = 0.01) and lipid rich (p = 0.01) volumes. The greatest number of plaques with over 2 vulnerability markers per lesions were found in NSTEMI precursor lesions compared to UA and STEMI (77.8% vs. 53.8% ±25%, p = 0.01).

Conclusions

Compared to NSTE-ACS triggering lesions, vulnerable plaques that precede STEMI-ACS present a more lipid rich, non-calcified phenotype. NSTEMI precursor lesions are heterogeneous, with a low calcium volume and increased number of vulnerability markers, while VPs triggering unstable angina are calcified, with a low lipid rich volume and spotty calcifications.
Implications of methods for calculating the left ventricular outflow tract area in aortic stenosis severity grading
Authors: Lozano Edo S , Calvo-Asensio M , Sanz-Ros J , Rodriguez-Serrano M , Buendia-Fuentes F , Navarrete J , Sorolla J A , Osa-Saez A , Martinez-Dolz L , Aguero J
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): - Spanish Ministry of Economy and Competitiveness through the Carlos III Institute of Health-Fondo de Investigación Sanitaria.

- Post-residency research contract. Medical Research Institute Hospital La Fe (IIS La Fe), Valencia, Spain.

Introduction

Aortic valve area (AVA) calculation by continuity equation is a fundamental aspect to estimate aortic stenosis (AS) severity. The estimation of the left ventricular outflow tract (LVOT) area is a source of technical variability in the calculation of AVA that can lead to errors in severity grading. Formulas for calculating LVOT diameter (LVOTd) based on body surface area (BSA) and patient height have been proposed, but their impact on reclassifying patients based on severity has not been described.

Purpose

To evaluate the differences in AS grading according to the LVOT area used in the calculation of the AVA.

Methods

We retrospectively analyzed (2019–2022) 1722 echocardiograms with a diagnosis of AS and with the following variables reported: AVA calculated using the continuity equation, height and weight of the patient. Predicted LVOTd by BSA was calculated by the formula: (5.7*BSA + 12). Predicted LVOTd by height was calculated as: (5.78 * height + 12.1).

Results

LVOT area and AVA from predicted LVOTd based on BSA and height showed slightly higher values. The AVA based on the LVOTd predicted by BSA was associated with a lower prevalence of severe AS, as well as a lower prevalence of discordant cases (mean gradient <40 mmHg and AVA <1 cm2) (Table). The AVA based on both methods of predicted LVOTd led to a reclassification from severe (by the standard method) to non-severe in a significant percentage of patients (13.6% for the BSA-predicted method, and 8.7% for the height-predicted method). For the AVA predicted by BSA, the "downgrade" of AS severity was more frequent (23.3%) in patients in the quartile with the highest BMI (>30 kg/m2), while the degree of obesity did not affect the method predicted by height.

Conclusion

Despite suppressing the potential errors derived from the LVOTd measurement, the AVA based on predicted LVOTd methods using BSA or height lead to a significant percentage of reclassification in terms of severity and prevalence of discordant severe AS due to low gradient. In obese patients, the method predicted by BSA is highly discordant and the method predicted by the patient's height is preferable.
Aortic stenosis progression by different echocardiographic parameters: which one should we use?
Authors: Lozano Edo S , Sanz Ros J , Calvo Asensio M , Navarrete J , Sorolla J A , Buendia Fuentes F , Rodriguez Serrano M , Martinez Dolz L , Osa Saez A , Aguero J
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): - Spanish Ministry of Economy and Competitiveness through the Carlos III Institute of Health (Fondo de Investigación Sanitaria).

- Post-residency research contract. Medical Research Institute Hospital La Fe (IIS La Fe), Valencia, Spain.

Introduction

Aortic stenosis (AS) is a significant health problem, particularly in older individuals, and is the most common valve disease necessitating surgical or percutaneous intervention. Echocardiography is central in the diagnosis, management and assessment of disease progression of AS patients. AS severity grading is based on 3 parameters: aortic valve area by continuity equation (AVA), mean gradient (MG), and peak aortic valve velocity (Vmax). Although the AVA is relevant in low gradient situations, its calculation is more complex and therefore may show greater technical variability. Knowing the differences between the 3 parameters to assess progression may be useful in clinical practice.

Purpose

Assess the differences between the 3 main quantitative parameters to detect the progression of disease in patients with AS.

Methods

We retrospectively analyzed a cohort of 130 patients with a diagnosis of isolated AS (without other valve disease) and 2 echocardiograms performed at an interval of more than 1 year, in which the AVA calculated using the continuity equation was measured. The annual rate of change of AVA, MG, and Vmax, and the proportion of patients with progression based on predefined criteria (AVA decrease >0.2 cm2, MG increase > 10 mmHg, and Vmax > 30 cm/s) were analyzed.

Results

The mean interval between the 2 echocardiograms was 26 (9) months. Globally, the annual rate of change was small for the 3 parameters, with a higher proportion of relevant progression considering Vmax (49.2%), and lower for MG (28.5%), being intermediate for AVA (36.1%) (Table). Of the 47 patients with AS progression by AVA criteria, progression by Vmax criteria was observed in 32 patients (68%), and only in 19 patients (40%) by MG criteria.

Conclusions

Although the criterion for progression of AS based on Vmax is considered in the clinical practice guidelines, in many patients it is not associated with relevant changes in AVA or MG. Discrepancies on AS progression across different parameters is frequent and may lead to inconsistent decision making.
Right ventricular strain by speckle tracking echocardiography in patients with systemic scleroderma and absence of pulmonary hypertension
Authors: Karapedi E , Tsagaropoulos A , Kalavri E , Giannakopoulou I , Antoniades K , Hamodraka E , Tsoukas A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

In patients with scleroderma the morphological remodeling and alteration of right ventricular (RV) function begins even before the setting of pulmonary artery hypertension (PAH). These alterations are associated with worse outcomes and high mortality rate as 30% of deaths are attributed to cardiovascular causes followed by respiratory causes (17%).

Purpose

Early detection of RV dysfunction is possible using advanced imaging techniques and can lead to specific therapeutic management before installation of PAH and clinical signs and symptoms of heart failure . Purpose of this study is to evaluate new indices, based on speckle tracking echocardiography, for identification of subclinical RV systolic failure.

Methods

Thirty (30) scleroderma patients without any signs or symptoms of PAH and forty (40) healthy subjects were included in the present study. Two-dimensional echocardiography (2DE) and two-dimensional speckle-tracking echocardiography (2DSTE) were performed. All the usual 2DE, Doppler and tissue Doppler imaging measurements were obtained for the evaluation of RV function. Moreover, TAPSE, maximum systolic myocardial velocity from TDI of lateral tricuspid valve annulus (SRV), auto RV global longitudinal strain (aRVGLS) and auto RV free wall longitudinal strain (aRVFWLS) by 2DSTE were measured. aRVGLS and aRVFWLS are new indices, with appropriate RV function echo logistics in new technology echo systems, independent from known manual measurements.

Results

In scleroderma patients significantly higher systolic pulmonary artery pressure was recorded, although it remained within normal limits in both groups (24.6+-5.4mmHg vs 19.2+-5.9 mmHg) . Scleroderma patients had significant decreased RV systolic function with significantly lower TAPSE and SRV. Both aRVGLS and aRVFWLS were also lower in scleroderma patients compared to the control group (−18.6+-2.7 vs −23.1+-2.3 % and −25.4+-3.1 vs −26.4+-2.2 % respectively). aRVGLS was the best significant predictor of early RV systolic impairment in patients with scleroderma.The difference in aRVFWLS was not significant.

Conclusions

Scleroderma is a severe systematic disease associated with high mortality rates. RV remodeling, dysfunction, and progressive pulmonary artery hypertension are among the most important internal organ manifestations of this disease. Early detection of RV dysfunction before installation of pulmonary hypertension is possible by 2DSTE, and may be helpful to guide further therapy in these patients.