bluuebunny/crossref_metadata_2025 huggingface dataset:
Left atrial function in patients with heart failure with mid-range and preserved ejection fraction
Authors: Stevanovic A , Stankovic I , Ilic Pasquali N
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction Little is known about the left atrial (LA) function in patients with heart failure with mid-range and preserved ejection fraction (EF). We explored LA function in patients with heart failure with mid-range ejection fraction (HFmrEF) and compared to that in patients heart failure with preserved ejection fraction (HFpEF).

Methods

A total of 66 HF patients (35 HFpEF and 31 HFmrEF) were included in the study. Left venticular EF, global longitudinal strain (GLS) and the mitral E/e" ratio were measured in all patients. LA function was assesed by measuring phasic changes in LA volume - maximal LA volume, pre-atrial contraction volume and minimal LA volume. All volumes were indexed to body surface area before calculating the indices of LA function: LA total emtying fraction (reservoir function), LA passive emptying fraction (conduit function) and LA active emptying fraction (pump function).

Peak LA strain during ventricular systole (S-LAs) and peak LA strain during atrial systole (S-LAa) were measured also as LA functional parameters (reservoir and pump function). Conduit function of LA was derived as difference of S-LAs and S-LAa.

LA deformation was also assessed by strain rate at different phases of the cardiac cycle. Strain rate analysis was used to measure peak LA strain rate during ventricular systole (SR-LAs), during early LV filling (SR-LAe) and during atrial contraction (SR-LAa).

Results

There were no significant differences in GLS and the mitral E/e’ between patients with HFmrEF and HFpEF (p > 0.05 for all). Significantly lower values of LA total emptyng fraction (47.6 ± 13.0 vs 38.9 ± 11.8, p = 0.006), LA passive emptyng fraction (26.6 ± 13,2 vs 20.9 ± 9.4, p = 0.049) and LA active emptyng fraction (33.0 ± 10.0  vs. 26.0 ± 9.7, p = 0.005) were observed  in HFmrEF tham HFpEF patients, respectively.

Significantly lower values of S-LAs (27,3 ± 5,8 vs 22,3 ± 8,0, p = 0,004), S-LAa (12,8 ± 4,0 vs  10,3 ± 3,7, p = 0,01) (Figure 1), SR-LAs (1,40 ± 0,42 vs 1,18 ± 0,43, p = 0,045), SR-Lae (-1,47 ± 0,56 vs -1,13 ± 0,51, p = 0,012) and SR-LAa (-1,90 ± 0,50 vs -1,64 ± 0,55, p = 0,044) were obtained in group of HFmrEF patients.

Conclusions

All components of left atrial function were worse in patients with HFmrEF than in those with HFpEF, despite similar GLS and mitral E/e" ratio. Clinical and prognostic implications of these observations warrant futher research. Abstract Figure.
Left ventricular myocardial work indices and invasive measurement of stroke work: a correlation study
Authors: Landra F , Chiantini B , Mandoli GE , Barilli M , Merello G , De Carli G , Sciaccaluga C , Lisi M , D" Ascenzi F , Fineschi M , Iadanza A , Bernazzali S , Valente S , Cameli M
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

A novel echocardiographic method allows to non-invasively assess myocardial work using pressure-strain loops. Even though left ventricular myocardial work has already emerged as a promising prognostic tool for various pathological conditions, its relationship with invasively-derived corresponding indices has not been assessed in humans yet.

PURPOSE

This study aimed to explore the correlation between left ventricular myocardial work (LVMW) indices and invasively-derived left ventricular stroke work index (LVSWI) in a cohort of patients with advanced heart failure (HF) considered for heart transplantation.

METHODS

All consecutive patients with advanced heart failure considered for heart transplantation from 2016 to 2021 that had already performed right heart catheterization (RHC) as part of the workup and with an available echocardiographic exam were included (n = 91). Myocardial work analysis was performed in 44 patients, according to exclusion criteria. Conventional LV functional parameters and LVMW indices, including LV global work index (LVGWI), LV global constructive work (LVGCW), LV global wasted work (LVGWW), LV global work efficiency (LVGWE) and other were calculated and compared with invasively measured LV stroke work index (LVSWI).

RESULTS

Median time between RHC and echocardiography was 0 months [interquartile range (IQR): 0 – 1]. Median age was 60 years (IQR: 54 – 63). For the most part, etiology of HF was non-ischemic (61.4%) and all patients were either on class NYHA II (61.4%) or III (27.3%). Median left ventricular ejection fraction was 25% (IQR: 22.3 – 32.3), median NT-proBNP 1377 pg/mL (IQR: 646 – 2570). Among conventional parameters of LV function, LV global longitudinal strain (LVGLS) significantly correlated with LVSWI (r = - 0.337; p = 0.031), whereas LVEF did not (r = 0.308; p = 0.050). With regard to LVMW indices, some of them demonstrated correlation with LVSWI, particularly LVGWI (r = 0.425; p = 0.006), LVGCW (r = 0.506; p = 0.001), LV global positive work (LVGPW; r = 0.464; p = 0.003) and LV global systolic constructive work (LVGSCW; r = 0.471; p = 0.002).

CONCLUSIONS

Among left ventricular myocardial work indices, LVGCW correlated better with invasively-derived stroke work, thus representing a powerful and reliable tool for a more comprehensive evaluation of myocardial function. Abstract Figure. Study flow chart  Abstract Figure. Correlation results
Pathophysiological alterations of left ventricular myocardial systolic function during normal pregnancy assessed by speckle tracking echocardiography: a prospective cohort echocardiography study
Authors: Tryfou E , Kostakou P , Kostopoulos V , Mahairiotis C , Mihas K , Olympios C , Paraskevaidis I , Kouris N
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Pregnancy induces a variety of haemodynamic and morphological changes, leading to the amplification of cardiac pumping function. These changes do not cause any significant left ventricular (LV) dysfunction by using conventional echocardiographic indices, but it is not fully elucidated whether subclinical or/and reversible myocardial dysfunction is provoked during pregnancy. Two-dimensional speckle tracking echocardiography (2D-STE) can detect subclinical myocardial dysfunction even when conventional echocardiography reveal LV normal ejection fraction (LVEF).Purpose: The aim of this study was to evaluate whether LV systolic performance is impaired during normal low risk pregnancy by using both conventional 2D and 3D echo indices and 2D-STE.  Materials and methods: One hundred and twelve consecutive pregnant women without any history of heart disease were prospectively recruited. They underwent serial echocardiographic evaluation in each pregnancy trimester (1st: 8th-12th week, 2nd: 22th-26th week, 3rd: 32-36th week) and 6 months after delivery (time indicated as 4). LV dimensions, relative wall thickness (RWT), 2D-LVEF, 3D-LVEF, systolic S wave from Tissue Doppler Imaging, LV global longitudinal strain (LVGLS), LV global circumferential strain (LVGCS) and LV-twist were measured and compared to 31 nulliparous women of similar age, who served as a control group (c).Results: Progressive eccentric LV hypertrophy was observed during pregnancy, which was subsided postpartum (p1-2 = 0.08, p2-3= 0.002, p3-4 = 0.001, p1-3 < 0.001, p1-4= 0.789), while no significant change in LV dimensions was found. 2D-LVEF, 3D-LVEF and S wave values were not significantly different among the three trimesters, postpartum and controls. LVGLS progressively decreased during pregnancy (1st:-21.71 ± 2.13%, 2nd: -21.20 ± 2.30%, 3rd: -19.82 ± 2.10%,4th: -21.81 ± 2.05%, c: -21.71 ± 2.2[E1]%,overall p < 0,001 ) and returned to normal during puerperium. No significant difference was noted in LVGCS (1st: -18.08 ± 5.54%, 2nd: -18.57 ± 3.41%, 3rd: -18.20 ± 3.33%,4th: -17.95 ± 3.39%,c: -18.8 ± 2.2% , p > 0.3). LV-Twist was significantly higher in the 1st trimester compared to controls (p= 0.04) and remained constantly high during the rest of the pregnancy and puerperium (1st:13.80 ± 5.09°, 2nd :13.46 ± 5.35°, 3rd:13.58 ± 4.32°, 4th:13.37 ± 4.26°, c: 11.5 ± 4.3°,  ).Conclusion: Left ventricular subclinical dysfunction seems to occur in the longitudinal axis even in low risk individuals with normal pregnancy.  Increased torsional movement of the heart seems to counterbalance the temporal impairment of longitudinal systolic function.
A check of the grading system among the 2009 and 2016 EACVI/ASE left ventricular diastolic function guidelines statistically and invasively
Authors: Barakat A , Alsaadi A,R
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Al-mouwasat University Hospital and University Heart Surgery Center in Damascus, Syrian Arab Republic.

Background

Left ventricular diastolic function assessment undergoes continuous updates. EACVI/ASE 2016 guidelines handles with this case, which is an expert consensus and simplified update of the 2009 recommendations. As stated in the latest guidelines, studies need to check that the simplicity does not affect much the accuracy.

Aim

This study compares the corresponding subgroups between the 2009 and 2016 EACVI/ASE guidelines, for the assessment of left ventricular diastolic function statistically. Furthermore, it invasively validates of the relation between the grading results of each guidelines and  the measured LV filling pressure during catheterization lab.

Methods

124 patients underwent transthoracic echocardiography just before angiography. A trained echo cardiographer obtained E/A mitral flow, Av E/e", LAVI, TR, septal and lateral e" and other supportive parameters to assess LV diastolic function and filling pressure according to 2009 and 2016 EACVI/ASE guidelines algorithms and we compared the results with LV pre-a wave during catheterization with a cut-off >12mmhg considered elevated.

Results

EACVI/ASE 2016 resulted in {normal (46.77%), Grade I (29.03%), Grade II (10.48%), Grade III  (7.26%) and indeterminate (6.45%)}, while EACVI/ASE 2009 resulted in {normal (39.52%), Grade I (25%), Grade II (13.71%), Grade III  (7.26%) and indeterminate (14.52%)} with no statically significant difference between subgroups. EACVI/ASE 2016 vs. 2009 in assessment LV filling pressure (odds ratio =0.51 and p value = 0.034. EACVI/ASE 2016 sensitivity and specificity were (0.36, 0.94 ) respectively and EACVI/ASE 2009 sensitivity and specificity were (0.63, 0.80) respectively. All results are summarized in (tables: 1 + 2+3 + 4+5 + 6).

Conclusion

This study found that the updated and simplified 2016 EACVI/ASE guidelines algorithm did not affect statistically the grading results of 2009 EACVI/ASE. Even more, 2016 had a higher relation between diastolic subgroups and invasively measured LV filling pressure which reflects the higher specificity than 2009. On the other hand 2016 was less able to detect elevated LV filling pressure which reflects a lower sensitivity than 2009. 2016 was more specific but less sensitive than 2009. There were no statistically significant difference between the means of invasively measured LV filling pressures among both guidelines. Abstract Figure.  Abstract Figure.
Endogenous Cushings syndrome is associated with impaired myocardial work efficiency
Authors: Sahiti F , Morbach C , Ehrlich K , Detomas M , Kroiss M , Lengenfelder B , Gelbrich G , Frantz S , Fassnacht M , Heuschmann PU , Hahner S , Stoerk S , Deutschbein T
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Ministry of Research and Education within the Comprehensive Heart Failure Center, Würzburg

OnBehalf

STAAB Cohort Study and CV-CORT-EX Study

Background

Endogenous Cushing’s syndrome (CS) is associated with increased cardiovascular morbidity and mortality. Long-term remission (LTR) after successful treatment is considered to positively affect the cardiovascular system including the heart. Left ventricular (LV) myocardial work (MyW) based on pressure-strain loops is a novel tool to non-invasively assess LV performance and is considered less load-dependent than LV ejection fraction (LVEF) and global longitudinal strain (GLS). We analyzed LV function in patients with overt CS and CS in LTR in comparison to healthy individuals derived from a local population-based cohort.

Methods/Results: In a cross-sectional analysis, we compared n = 31 comprehensively characterized patients with overt CS (mean age 48 ± 12 years, 71% women) and 49 patients with CS in LTR (53 ± 12 years, 77% women) with a control group who underwent transthoracic echocardiography. As control group, we analyzed a population-based sample of apparently healthy individuals (in sinus rhythm, free from CV risk factors, and no significant valve disease) from a population-based cohort: n = 439, 49 ± 11 years, 56% women. MyW assessment was performed off-line using EchoPAC (GE, version 202).

Systolic and diastolic blood pressure, HbA1c, and body mass index were significantly higher in patients with either overt CS or CS in LTR when compared to healthy participants (without significant differences between both patient groups). LVEF was equal between all three groups, but GLS was significantly lower in healthy participants and tended to be lower in LTR when compared to patients with CS. Global work index was equal between all three groups, but global wasted work was significantly higher in CS patients when compared to healthy participants, resulting in lower global work efficiency (Table).

Conclusion

In contrast to LVEF as established parameter of cardiac function, myocardial work analysis revealed functional alterations in patients with current and previous cortisol excess when compared to healthy individuals derived from a population-based sample. CS patients´ hearts appear to perform larger amounts of wasted work even during long-term remission. Abstract Figure.
Right ventricle function before and after different types of cardiac surgery
Authors: Zagatina A , Kim G , Kappushev R , Pyagay V , Shmatov D
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Right ventricular (RV) dysfunction is an established independent predictor for adverse prognosis in a heterogeneous group of cardiac surgery patients (pts). However, there is lack of information about normal and abnormal dynamics of echocardiographic parameters for different types of cardiac surgery.

The aim of the study was to define changes in RV parameters after cardiac surgery.

Methods

sixty-five pts (39 men, 62 ± 9 years old) were selected into prospective study (NCT03953755). There were the groups of pts with left-sided valves surgery with/ without tricuspid valve (TV) repair, and pts with left-sided coronary artery bypass surgery without lesions of right coronary artery were included control group. A transthoracic echocardiography assessment before and an average of 101 days (88-115) following the operation was performed. Tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), strain of the RV free wall (SRV), and right atrial volume were assessed in groups of patients with and without tricuspid valve repair as in CABG-group. Follow-up during 12 months was available in all pts.

Results

Valve repair for secondary tricuspid regurgitation was performed in nineteen patients undergoing left-sided valve surgery. Thirty-six patients had repair and/or replacement of left-sided valves without a tricuspid valve operation. There was a strong correlation between TAPSE, FAC, and RV strain before the operation (R = 0.61-0.67, p < 0.000001). However, there was no correlation between TAPSE and FAC; TAPSE, and RV strain after the operation. TAPSE and RV strain significantly decreased after the operations and were below the normal range in both the groups with valve surgery, whereas, the CABG group showed only significantly TAPSE decreasing, RV strain was unchanged. TAPSE was 20 ± 5mm vs. 13 ± 2 mm, p < 0.0003 for the group which underwent tricuspid valve repair; 22 ± 4mm vs. 14 ± 4 mm, p < 0.0000001 for the group with tricuspid valves which were not operated on; 25 ± 6mm vs. 16 ± 3 mm, p < 0.009 for CABG group. There was no difference in TAPSE and SRV ranges among patients with and without tricuspid valve repair. Dynamics in SRV didn’t correlate with patients’ clinical status or with normalized right chambers volumes. An increase in FAC correlated with a decrease in right chamber sizes after operations (R=-0.46, p < 0.03). More prominent decreasing in TAPSE was connected in adverse events during follow-up (dTAPSE 6.7 ± 3.5 mm vs. 12.7 ± 5.1 mm, p < 0.02)

Conclusion

TAPSE significantly decreases in all patients after CABG or valve cardiac operations with/without tricuspid valve repair, range of TAPSE were below normal standard in all patients. However more severe decreasing in TAPSE is connected with further adverse outcomes.
Subclinical myocardial dysfunction identified with speckle tracking echocardiography in young adults patients recovered from asymptomatic or mildly symptomatic SARS-CoV-2 infection
Authors: Barosi A , Bergamaschi L , Cusmano I , Colombo C , Gherbesi E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Myocardial strain assessed with speckle tracking echocardiography is a sensitive marker of cardiac dysfunction, with long-term prognostic value in many cardiac conditions. Both left ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) were affected by severe SARS-CoV 2 infection but little is known about cardiac involvement in patients with asymptomatic/mild disease that did not require hospitalization. 

Aim

To assess if subclinical myocardial dysfunction could be identified using LV-GLS and RV-LS in patients with previous asymptomatic/mild SARS-CoV 2 infection.

Methods

40 young adults patients (70% males, mean age 24.4 ± 8.4 years), who had a confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or only mildly symptomatic, without previous known comorbidities/cardiovascular risk factors, were retrospectively included. Patients underwent standard transthoracic echocardiogram and speckle tracking echocardiographic study at least 3 months after diagnosis. A total of 44 age, sex, and body surface area comparable healthy subjects were used as control group. 

Results

LV-GLS was within normal limits but significantly lower in the cases group compared to controls (-22.7 ± 1.6% vs. -25.7 ± 2.3%; p < 0.001). Left ventricular ejection fraction (63.3 ± 4.1% vs 63.9 ± 4.6%; p = 0.5), tricuspid annular plane systolic excursion (24.3 ± 3.7 vs. 23.7 ± 3.3; p = 0.5) and RV-LS (-23.2 ± 3 vs. -23.6 ± 2.7; p = 0.6) were comparable between the two groups.

Moreover, in the infection group, there were 25 subjects (30.1% vs 9.6% in the control group, p < 0.001) with a regional peak systolic strain of the left ventricle below -16% in at least two segments. At multivariable logistic regression corrected for age, gender and body surface area, previous SARS-CoV-2 infection was an independent predictor of reduced LV-GLS values (p < 0.001).

Conclusion

SARS-CoV-2 infection may affect left ventricular deformation in 30% of young adults patients despite an asymptomatic or only mildly symptomatic acute illness. 

Speckle tracking echocardiography could help in early identification of patients with subclinical cardiac involvement. Since long-term complications of COVID-19 are not yet known, myocardial deformation imaging could be important for risk stratification, treatment and planning of long-term follow-up.
Left atrial mechanical dyssynchrony: an independent predictor of left ventricular reverse remodelling after cardiac resynchronization therapy
Authors: Hammersboen LER , Aalen JM , Puvrez A , Remme EW , Donal E , Duchenne J , Voigt JU , Galli E , Khan FH , Sletten OJ , Smiseth OA , Stugaard M
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Institute for Chirurgical Research - Oslo University Hospital

Introduction

Left bundle branch block (LBBB) leads to left ventricular (LV) mechanical dyssynchrony. Since the left atrium (LA) and the left ventricle (LV) are anatomically connected, dyssynchronous LV contractions may be transmitted to the LA causing LA dyssynchrony and disturbed LA function.

Purpose

To investigate if LA dyssynchrony induced by LBBB predicts LV reverse remodelling after cardiac resynchronization therapy (CRT).

Methods

In a prospective study, myocardial strain was measured by speckle-tracking echocardiography in 171 heart failure patients with LBBB, before and 6 months after CRT. LA dyssynchrony was measured as the time delay between onset systolic stretch of the interatrial septum and the LA lateral wall (white arrows in Figure), and LV dyssynchrony as the time from onset septal shortening to onset lateral wall shortening. Septal flash was assessed visually. Response to CRT was defined as at least 15 % reduction in LV end systolic volume at 6 months follow up.

Results

The figure shows a representative LBBB patient with LA and LV dyssynchrony which was abolished by CRT. For the whole study population, LA dyssynchrony was 104 ± 77 ms (mean ± SD) before CRT, and decreased to 43 ± 70 ms (p < 0.0001) after CRT. There was a significant correlation between LA and LV dyssynchrony (r = 0.68, p < 0.0001).

LA dyssynchrony correlated with LV reverse remodelling after CRT (p = 0.009), and multivariable analysis revealed that LA dyssynchrony was an independent predictor of CRT response (β=-0.046, p = 0.04) when combined with septal flash, QRS duration and QRS morphology (Table).

Conclusions

Patients with LBBB had marked LA dyssynchrony which was attributed to direct LV-LA mechanical interaction. Furthermore, LA dyssynchrony was an independent predictor of LV reverse remodelling after CRT. These findings suggest that assessment of LA dyssynchrony should be part of the echocardiographic evaluation in patients with dyssynchronous heart failure. Abstract Figure.
AI do it better. Reproducibility of fully automated versus manual analysis of left ventricle function using a new software
Authors: Di Candia A , Castaldi B , Cati A , Basso A , Fumanelli J , Sabatino J , Di Salvo G
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): University Hospital of Padua

Background/Introduction: Ejection fraction (EF) is a parameter widely used in Echolab to evaluate left ventricular function. Recently, in parallel with the growing interest in artificial intelligence (AI), attemps have been made to create automated systems for EF assessment, in order to reduce time and improve the accuracy of the analysis.

Purpose

to compare results of different methods of EF assessment: visual estimation (visual EF), manual and fully automated analysis.

Methods

28 consecutive pediatric patients were enrolled. This cohort of previously healthy patients was screened at our Center for cardiac evaluation within 6 months after an asymptomatic or paucisymptomatic COVID19 infection. All they were in sinus rhythm. Optimized apical 4- and 2- chamber views were collected for each patient using Canon Aplio i900. Off-line EF assessment was first evaluated visually by pediatric cardiologists with experience in echocardiography, then performed by both fully automated analysis (AI) using two different methods (Automatic Simpson -AI Simpson- and Wall Motion Tracking -AI WMT-) and pediatric cardiologists through manual tracing of endocardial border (Manual Simpson and Manual WMT respectively).

Operators were blinded to the AI analysis. To measure intraobserver variability, evaluations of 16 patients’ datasets were performed twice by both operators and AI.

Results

Patients’ demographic data were: age 9,8+/-4,7 years; males 22 (78%); height 134,3+/- 34,9 cm; weight 41,8+/-28,7 kg; BSA 1,2+/-0,4 mq, HR 85+/-15/min.

The time taken for off-line analysis was 0.3-0.7 minutes, 1-1.5 minutes, 1-3 minutes and 3-4 minutes, respectively for AI WMT, AI Simpson, Manual WMT and Manual Simpson.

As expected, visual EF showed high intraobserver variability and a poor reproducibility (ICC 43%). AI analysis revealed a good to excellent reproducibility (ICC from 80% to 99%, depending on the method used). WMT methods had the best reproducibility both for manual tracing of endocardial border and fully automated analysis (Table 1).

The comparison between different methods (Table 2) showed a good agreement between AI Simpson and AI WMT (mean bias 2,9, from -3,2 to 9,0, ICC 86%). A moderate correlation was found between different methods of AI analysis while only poor correlation was found between manual Simpson and manual WMT (Table 2).

Conclusion(s): Automatic Simpson and Wall Motion Tracking are two different fully automated methods which can be used for left ventricular function assessment. AI reproducibility is high for both methods, higher for WMT. WMT method is also less time consuming and improves reproducibility of manual tracing of endocardial borderd analysis. Abstract Table 1. Echocardiographic measurements  Abstract Table 2. Comparison between different me
Infective endocarditis in octogenarians: a retrospective study in a single surgical center
Authors: Scheggi V , Merilli I , Ceschia N , Vanni F , Alterini B , Stefano PL , Marchionni N
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Infective endocarditis (IE) is a severe disease associated with high morbidity and mortality. The EURO-ENDO registry reported a mean age of 59.25 ± 18.03 years; 46.3% of patients were over 65 and 12.0% over 80 years. Little is known about the best management of elderly patients with IE. In these patients, surgery may be challenging.

Purpose

We aimed to determine the clinical and echographic characteristics, the therapeutic strategy, and the outcome of IE in octogenarians.

Method

We retrospectively included in the analysis 457 consecutive patients with definite active IE in a single surgical centre. Descriptive statistics are reported as mean ± standard deviation (SD) or median ± interquartile range (IQR) for continuous variables with normal and non-normal distribution and as frequencies and percentages for categorical variables. Between-groups comparisons were assessed by Student’s t-test, Mann-Whitney U test, Kruskal-Wallis, or chi-square test, as appropriate. Univariate long-term survival was analysed by the Kaplan-Meier method.

Results

In our cohort, octogenarians were 17% of the whole population (N = 77). In patients under the age of eighty, males were mostly involved with a sex ratio exceeding 2:1. This ratio was inverted in older people, where the female gender represented 57% of the total (0.001). Staphylococcus aureus (10.4 vs 20.5%, p =0.038) and Enterococci (29.9 vs 16.3%, p =0.008) were significantly less and more frequent than in younger people, respectively. Comorbidities were more frequent in elderly patients, such as hypertension (80.5 vs 53.2%, p = 0.001), dyslipidaemia (42.7 vs 27.3%, p = 0.008), and history of cancer (29.9 vs 19.2%, p = 0.036). Consequently, EUROSCORE II was higher (median ± IQR 19.18 ± 19.0 vs 11.9 ± 5.7, p = 0.001). In octogenarians, IE was more frequently left-sided (98.7 vs 89.2, p = 0.009) and complicated less often with peripheral embolism (31.2 vs 43.9%, p = 0.038). We found no differences between the two groups for the type of infected valve (native or prosthetic), the severity of valve dysfunction, paravalvular extension, and vegetation length. Octogenarians were more often excluded from surgery despite indication (19.5 vs 7.7%, p = 0.016) and had higher thirty-day (11.7 vs 7.9%, p = 0.001) and three-year (45 vs 30%, p = 0.001) mortality than younger patients.

Conclusions

Octogenarians represent a considerable proportion of overall cases of IE, with specific clinical and microbiological characteristics. Older patients are more often excluded from surgery, and the overall prognosis is poor. Abstract Figure.
Left ventricular lobal longitudinal strain as a prognostic marker in low-risk patients undergoing TAVI
Authors: Byczkowska K , Gil RJ , Pawlak A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Left ventricular global longitudinal strain (LV GLS) correlate with the risk of symptoms, irreversible myocardial damage and progressive myocardial fibrosis. LV GLS detects subtle changes in LV function that precede those of LVEF and is associated to outcomes after TAVI.

Purpose

Evaluation of the LV GLS as the prognostic parameter in patients low-, intermediate and high-risk patients undergoing TAVI and its potential relationship with frailty syndrom.

Methods

The study included 105 patients (mean age 82.36 ± 4.5) with severe AS treated with TAVI at the Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior in Warsaw. Each patient had laboratory tests, ECG, echocardiography (LV GLS) and was assessed based on the STS scale and the Katz frailty scale. Follow-up observations were carried out at 1 month and 1 year.

Results

In the study population 46% were men, the mean age was 82.36 ± 4.5 years, the mean STS score was 7.03 ± 4.24. The mean pre-TAVI LVEF was 54.51 ± 6.44% (in 87 (82.8%) patients above 50%). The mean LV GLS before TAVI was -12.82 ± 1.94%. AVAI area was 0.38 ± 0.08 cm/m2, and the mean gradient through the stenotic aortic valve was 51.69 ± 10.66 mmHg.

LV GLS was significantly improved in patients after TAVI. LV GLS analysis showed change from -12.82% before TAVI, to -14.35% after 1-month follow-up and -14.47% at 1-year follow-up (p ≤ 0,05, p ≤ 0,05 respectively). LV GLS of -11% was a cut-off value determining the risk of death after 1 year post-TAVI (p < 0,001). The area under the curve was 0,87, which was a statistically significant result that can be used as a significant prognostic factor. In low-risk patients there was a significant improvement of LV GLS in 1-year follow-up, compared to patients with STS 4-8% (p ≤ 0.01) and in patients with STS> 8% (p ≤ 0, 05) (Tab. 1).

Logistic regression analysis showed that the change of LV GLS at 1 year significantly correlated with Katz frailty score at 1-month and 1-year follow-up ((p ≤ 0,01, p ≤ 0,01 respectively) (Tab. 2).

Conclusion

LV GLS of -11% was a cut-off value distinguishing patients with increased risk of death after TAVI. In low-risk patients the improvement in LV GLS indicates a favorable reverse myocardial remodeling after TAVI and better prognosis after TAVI, which was not observed in the intermediate- and high-risk patients. Abstract Figure.  Abstract Figure.
Prospective study comparing simultaneous transthoracic and transesophageal echocardiography aortic stenosis assessment
Authors: Schwartzenberg S , Vaturi M , Kazum S , Monakier D , Ofek H , Sagie A , Kornowski R , Shapira Y
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Transthoracic echocardiography (TTE) is the gold-standard for aortic stenosis (AS) assessment. Transesophageal echocardiography (TEE) can be used alternatively, but measurement of hemodynamic components can be affected.

Purpose

We aimed to compare head-to-head TTE vs transesophageal echocardiography (TEE) assessment of AS.

Methods

We prospectively studied 56 patients with ≥moderate AS who underwent TTE (TTE1) and consecutive conscious sedation with simultaneous TEE and TTE (TTE2). Echocardiographic variables and AS types measured by TEE vs TTE2 and by TEE vs TTE1 were compared using paired tests and chi square tests. Based on conservative vs actionable implication, AS types were dichotomized into Group-A, comprising moderate and Normal-Flow Low-Gradient, and Group-B, comprising High-Gradient, Low Ejection-Fraction Low-Flow Low-Gradient, and Paradoxical Low-Flow Low-Gradient AS.

Results

TEE vs simultaneous TTE2 comparison demonstrated higher mean gradients (31.7 ± 10.5 vs 27.4 ± 10.5mmHg) and velocities (359 ± 60.6 vs 332 ± 63.1cm/sec) with TEE, but lower left ventricular outflow velocity-time-integral VTI1 (18.6 ± 5.1 vs 20.2 ± 6.1cm), all  p < 0.001. This resulted in lower aortic valve area AVA (0.8 ± 0.21 vs 0.87 ± 0.28cm2), p < 0.001, and a net relative-risk of 1.86 of Group A to B upgrade.  TEE vs (awake-state) TTE1 comparison revealed a larger decrease in VTI1 due to higher initial awake-state VTI1 (22 ± 5.6cm), resulting in similar Doppler-velocity-index (DVI) and AVA decrease with TEE, despite slight increase in mean gradients of 0.8mmHg (-1.44 to 3.04 CI) and in velocities of 10cm/sec (-1.5 to 23.4 CI). This translated into a net relative-risk of 1.92 of Group A to B upgrade vs TTE1.

Conclusions

TEE under conscious sedation overestimates AS severity compared with both awake state TTE and simultaneous sedation state TTE, accounted for by different Doppler insonation angle obtained in transapical vs transgastric position. The net result is a smaller DVI and AVA by TEE vs TTE. TEE carries a high sensitivity but a low specificity for severe AS compared with TTE during awake state. Abstract Figure. Spectral Doppler w/TTE vs simultan. TEE  Abstract Figure. Cardiac CT planes simulating TTE vs TEE
The prevalence and significance of mitral annular disjunction on clinical outcomes in patients undergoing mitral valve surgery
Authors: Bennett S , Tafuro J , Duckett S , Heatlie G , Kwok CS
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Mitral annular disjunction (MAD) is a common structural abnormality involving a distinct separation of the left atrium/mitral valve annulus and myocardium continuum. MAD is commonly associated with altered mitral valve annular dynamics, increased left ventricular and mitral valve apparatus stress and potentially life threatening arrhythmias. At present there is limited data on the prevalence and significance of MAD in patients requiring mitral valve surgery.

Purpose

To ascertain the prevalence, extent and significance of MAD on a general cohort of patients with mitral valve disease who required mitral valve surgery. Primary outcomes included: duration of surgery, need for re-do operation (any cause), neurological and gastro-intestinal complications, cardiogenic shock and mortality. These were assessed during the surgical hospitalisation period.

Methods

The local cardiothoracic database within a large tertiary centre was used to identify all patients who underwent mitral valve surgery between 2013 and 2020. From this, patients who were found to have a transthoracic echocardiogram (TTE) pre and post mitral valve surgery were included. Two experienced sonographers retrospectively reviewed and analysed each TTE. The data collected included: presence, location and extent of MAD (pre and post-surgery). The local cardiothoracic database and electronic patient records were reviewed for primary outcomes.

Results

A total of 187 patients were included (age: 65.6 ± 13.7 years, 74.2% males). The most common reason for mitral valve surgery was mitral valve prolapse (31.6%), remaining aetiologies included functional MR, ischemic MR, infective endocarditis, rheumatic mitral stenosis and congenital abnormalities. Surgical intervention included: leaflet repair ± annuloplasty ring (57.2%), bio-prosthesis (19.8%) or mechanical prosthesis (23.0%). Pre surgery, MAD was present in 32.6% of all patients and was most commonly seen in patients with mitral valve prolapse (21.3%). In patients with MAD, the averaged MAD length was 8.4 ± 3.9mm (median 7 [IQR: 5-11]). Post-surgery, MAD was only identified in 2 patients, both of whom had mitral valve repair± annuloplasty ring. As seen in Table 1, there were no significant differences in clinical outcomes in patients with or without MAD.

Conclusion

MAD is common in a cohort of patients requiring mitral valve surgery. Surgical intervention is able to correct MAD in the vast majority of patients and its presence does not affect immediate post-surgical outcomes. Abstract Table 1.
Echocardiographic diagnosis of aortic valve strands: case series and literature review
Authors: Garcia Olea A , Ramirez-Escudero Ugalde G , Maeztu Rada M , Garcia Ibarrondo N , Codina Prat M , Manzanal Rey A , Asla Ormaza C , Ruiz Gomez L
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction. Aortic valve Lambl’s excrescences (LE) were first described as histopathological findings in 1856. Since then, most research on these structures consist of case reports and studies conducted to elucidate their thrombogenic role. Indeed, their nomenclature has differed on time, receiving names such as fibrous bands or strands, so features of patients with these conformations remain imprecise. 

Purpose. To elucidate the demographic characteristics of patients with aortic valve strands detected by echocardiography. 

Methods. We conducted a literature review in MEDLINE database for studies on aortic valve fibrous bands, strands or LE on humans, with no date restrictions and full text filter. Papillary fibroelastoma was not included in the search according to the histological differences of this neoformation. We screened these articles and removed incorrect matches, studies that did not differentiate between mitral and aortic strands and those which lacked an echocardiographic diagnosis. We added the cases of patients with aortic valve strand label in our laboratory database. Demographic variables present in the studies were extracted, summarized in a table and analyzed with descriptive statistics.

Results. The literature review disclosed 97 studies, out of which 53 fulfilled the inclusion criteria. The most common exclusion reasons were histopathological instead of echocardiographic diagnosis and absence of information of the LE location. A case series of 3 patients from our laboratory was added. Among the 560 cases of strands, aortic native valves (278, 49.6%) were more affected than prosthetic ones (68, 12%), most without predisposing valvular disease. Reports in women were similar to those in men (272 vs 259), and most registries showed a balanced gender proportion. The weighted mean age was around 54 years old, although strands were also found in newborns and 80-year-old men. The etiological study of cryptogenic stroke was, in most cases, the reason for the diagnostic echocardiogram performance (149, 26.6%), followed by endocarditis suspicion (46, 8.2%), while the studies conducted to assess aortic regurgitation or stenosis causes were predominant in case reports. The terms "strands" and "LE" were equally used in the studies on aortic fibrous bands.

Conclusion. Current evidence suggests that aortic valve strands are predominant in middle-age men or women with healthy native valves, especially in those patients whose echocardiography is performed searching for thrombogenic causes or endocarditis. Further prospective studies with a selective focus on LE search would help to precisely define the demographic features of patients presenting these structures. Abstract Figure. Summary table of articles and features  Abstract Figure. Case series image
Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis
Authors: Stassen J , Ewe SH , Butcher SC , Ammanullah MR , Hirasawa K , Singh GK , Ding ZP , Pio SM , Chew NWS , Sia CH , Kong WKF , Poh KK , Marsan NA , Delgado V , Bax JJ
Published: February 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741

Background

Moderate aortic stenosis (MAS) is associated with an increased risk of adverse events. Although left ventricular (LV) diastolic dysfunction (DDF) has shown to carry an unfavorable prognosis in severe AS, the prognostic value of LV DDF in MAS has not been investigated.

Purpose

To investigate the prognostic impact of LV DDF in patients with MAS and preserved LV ejection fraction (EF).

Methods

LV diastolic function was evaluated in patients with MAS (aortic valve area >1.0 and ≤1.5cm2)  and preserved LVEF (≥50%) using echocardiography according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement (AVR).

Results

Of 1247 patients (age 74 ± 10 years, 47% men) with MAS and preserved LVEF, 396 (32%) had normal diastolic function, 316 (25%) had indeterminate diastolic function and 535 (43%) had DDF. Patients with DDF were more likely to be female, had more comorbidities (hypertension, atrial fibrillation, chronic kidney disease) and were more symptomatic (NYHA ≥2) than patients with normal diastolic function. Patients with DDF also had smaller aortic valve area and higher peak aortic velocities than patients with normal/indeterminate diastolic function. During a median follow-up of 53 (26 – 81) months, 484 (39%) patients died. For the composite endpoint, 770 patients (62%) underwent AVR (n = 376) or died (n = 394) during a median follow-up of 37 (IQR 15 – 62) months. Patients with DDF had significantly lower survival rates (p <0.001) and event-free survival rates (p = 0.015) compared to patients with normal/indeterminate diastolic function (Figure 1). On multivariable analysis, DDF was independently associated with all-cause mortality (HR: 1.368; 95% CI: 1.085 – 1.725; p = 0.008) and the composite endpoint of all-cause mortality and AVR (HR: 1.241; 95% CI: 1.035 – 1.488; p = 0.020) (Figure 2).

Conclusion

LV DDF is associated with worse outcomes in patients with MAS. Assessment of LV diastolic function may contribute significantly to risk stratification of patients with MAS. Abstract Figure.  Abstract Figure.
Left atrial reservoir strain is an independent prognostic predictor in patients undergoing percutaneous mitral valve repair
Authors: Galli E , Hubert P , Vely M , Panis V , L"official G , Donal E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial reservoir strain (LARS) is a well-known prognostic predictor in several cardiac diseases. Aim of the presence study was to assess the value of LARS in predicting the occurrence of major adverse cardiovascular events (MACEs) in patients undergoing percutaneous mitral valve repair (PMVR)

Methods and results

112 patients (62% males, age: 74 ± 10 years) undergoing PMVR for severe primary (n = 71, 63%) or secondary MR were retrospectively included in the study underwent a comprehensive echocardiography before the procedure. Thirty-eight MACES occurred during a median follow-up of 18 months. At multivariable Cox-regression analysis, ischemic cardiomyopathy [HR 2.41 (1.11-5.24, p = 0.02)], indexed left atrial volume [HR 1.01 (1.00-1.01), p = 0.03], and LARS [HR 0.93 (0.88-0.99), p = 0.03] were all significant predictors of MACEs. A cut-off of 13% for LARS (AUC 0.66, p = 0.008) was able to predict MACEs with a 71% sensitivity and 41% specificity (Table 1).

Conclusions

LARS is an independent predictor of MACEs in patients undergoing percutaneous mitral valve repair, independently of the etiology of mitral regurgitation. Abstract Figure.
Factors associated with favorable outcomes in patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) with the mitraclip device
Authors: Andrianiaina H , Bonnet G , Torras O , Arregle F , Nguyen N , Resseguier N , Bonnet J-L , Habib G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Transcatheter edge-to-edge mitral valve repair (TEER) has over the years become a viable alternative to surgery in high-risk patients with severe symptomatic mitral regurgitation (MR). Selection of optimal candidates who will benefit from the procedure remains challenging.

Our study aims to determine clinical, echocardiographic and procedural factors associated with favorable outcomes after mitraclip implantation. 

Methods

We retrospectively analyzed the data concerning patients who underwent MitraClip implantation for symptomatic severe MR in our institution. 

All patients underwent a clinical evaluation and a transthoracic echocardiography before the procedure, and at follow up (between one and up to three months after the index procedure). 

A clinical endpoint combining absence of cardiovascular death, absence of rehospitalization for heart failure and improvement of at least 1 class New York Heart Association NYHA at three months, was used to define a good response.

Results

Among 109 patients referred to our institution for TEER since January 2018, 106 had a successful clip implantation and were included in our study. 76 of them had a primary MR and 30 others a secondary mitral regurgitation (SMR). The primary endpoint was achieved in 65% of those patients.  Reduction of MR severity to less than grade 2+ was achieved in 87% of the patients. 

A high body mass index (p = 0.03), a high level of NT-proBNP at admission (p = 0.02), the association with at least a moderate tricuspid regurgitation prior to mitraclip implantation (p = 0.02) and a severe residual mitral regurgitation (p = 0.01) were predictive of a worse outcome in all patients. In the group of secondary MR, patients who reached the primary endpoint had significantly a lower telediastolic diameter (p = 0.02). A post procedural transvalvular mitral gradient superior to 4.4 mmHg was associated with a worse prognosis in patients with primary mitral regurgitation (p = 0.004) but not in the group of secondary mitral regurgitation (p = 0.7). Furthermore, the ratios EROA/LVEDV and VR/LVEDV defining proportionate mitral regurgitation were not correlated to any benefit in the secondary MR group. 

Conclusion

Our study in real life patients found some elements supporting the results of former studies about predictors of outcomes after mitraclip treatment. Tricuspid regurgitation prior to the procedure and an elevated mitral valve pressure gradient after clip implantation are correlated with a worse prognosis. In accordance with recent literature, an elevate mean gradient seems to have less impact on prognosis in SMR, fostering to get optimal MR reduction in those patients. Identifying criteria that would predict insufficient benefit of Mitraclip implantation is necessary to avoid futility.