bluuebunny/crossref_metadata_2025 huggingface dataset:
Left atrial strain determinants across heart failure stages; insight from MASCOT registry
Authors: Benfari G , Mandoli GE , Magne J , Miglioranza M , Ancona R , Reskovic Luksic V , Pastore MC , Santoro C , Michalski B , Muraru D , Donal E , Cosyns B , Edvardsen T , Popescu B , Cameli M
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

MASCOT investigators

Background

Few studies analyzed left atrial (LA) peak atrial longitudinal strain (PALS) determinants, particularly across heart failure (HF) stages. We aimed to analyze the pathophysiological and clinical PALS correlates in a large international prospective registry.

Methods

This is a multicenter prospective observational study enrolling 745 patients with HF stages 0-C from July to October 2018. Data included PALS and left ventricular global longitudinal strain (LV-GLS). Exclusion criteria were: valvular prosthesis; atrial fibrillation; cardiac transplantation; poor acoustic window.

Results

Median global PALS was 17% [24-32]. 29% of patients were in HF-stage 0/A, 35% in stage-B, and 36% in stage-C. Together with age, the echocardiographic determinants of PALS were LA volume and LV-GLS (overall model R²=0.50, p < 0.0001). LV-GLS had the strongest association with PALS at multivariable analysis (beta:-3.60 ± 0.20, p < 0.0001). Among HF-stages (Figure 1), LV-GLS remained the most important PALS predictor (p < 0.0001) whereas age was only associated with PALS in lower HF-stage 0/A or B (R=-0.26 p < 0.0001, R=-0.23 p = 0.0001). LA volume increased its association to PALS moving from stage 0-A (R=-0.11; P = 0.1) to C (R=-0.42; P < 0.0001). PALS was the single most potent echocardiographic parameter in predicting HF stage (AUC for B vs. 0/A 0.81, and AUC vs. 0/A for C 0.76). PALS remained independently associated with HF stages after adjusting for ejection fraction, E/e’ ratio and mitral regurgitation grade (p < 0.0001).

Conclusion

Although influenced by LV-GLS and LA size across HF-stages, PALS is incrementally and independently associated with clinical status. LA function may reflect a substantial part of the hemodynamic consequences of ventricular dysfunction. Abstract Figure 1
Prevention of trastuzumab-related cardiotoxicity in HER-2 positive breast cancer patients
Authors: Ferri L , Bergamini C , Springhetti P , Niro L , Cerrito LF , Schiavone A , Dal Porto M , Setti E , Benfari G , Rossi A , Fiorio E , Ribichini FL
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Trastuzumab (TZ) is a key therapy for HER-2 positive breast cancer that may have different side effects on the cardiovascular system. One of the most concerning complications is cancer therapy-related cardiac dysfunction (CTRCD). In literature there are conflicting data about the efficacy of heart failure drugs like ACE-inhibitors, ARBs and beta-blockers to prevent such an event. 

Purpose

Aim of this study is to describe our experience on cardioprotective drugs in preventing TZ-related CTRCD.

Methods

105 consecutive women affected by HER-2 positive breast cancer treated with TZ referring to our echo-lab were enrolled in our single center prospective study. 3 patients were excluded due to an early TZ suspension not related to cardiovascular complications. Thus 102 patients (97,1%) were eligible for analyses. 86 of these (84,3%) were also treated with Anthracyclines. All patients underwent consecutive transthoracic echocardiography (TTE) before starting TZ and then every 3 months up to 12 months. 2D-Speckle tracking analysis was performed at baseline and at each examination using Tomtec software. A complete clinical evaluation was also performed at each follow up. LV systolic dysfunction was defined as an absolute reduction of LVEF >10% from baseline to LVEF < 53% or a relative reduction of GLS >15% from baseline and a reduction of LVEF >10% from baseline. 

Results

Overall, before starting TZ, 12 patients were taking ACE-inhibitors or ARBs (11,8%) and 5 patients beta-blockers (4,9%). CTRCD occurred in 11 patients (10,8%), among these 9 (81,8%) weren’t taking any heart failure drugs and 5 (45,5%) didn’t present any cardiovascular risk factor. We observed no significant association among cardiovascular risk factors.  Use of potential cardioprotective drugs before TZ administration seems to reduce the risk of development of myocardial dysfunction (relative risk 1,67; 95% confidence interval [CI], 0,41 to 6,82; P > 0.05). No clear association was found between any cardiovascular risk factors and CTRCD (relative risk 0,81; 95% confidence interval [CI], 0,26 to 2,47; P > 0.05).

Conclusions

In HER-2 positive breast cancer patients treated with TZ an early treatment with ACE-inhibitors or ARBs and/or beta-blockers is associated to the prevention of CTRCD. CTRCD seems not to be related to the presence of cardiovascular risk factors. Abstract Figure. Baseline patient characteristics
Reduced longitudinal strain in the left ventricular inferior wall predicts malignant arrhythmia in non-ischemic heart failure. A DANISH substudy
Authors: Winslow UC , Thune JJ , Elming MB , Philbert BT , Svendsen JH , Pehrson S , Jons C , Bundgaard H , Kober L , Risum N
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Small studies have suggested that poor regional myocardial function may be associated with malignant arrhythmias, in particular around the inferior-posterior region. We tested this hypothesis in a subgroup of patients from the DANISH trial.

METHODS

From two centers, 317 patients with non-ischemic heart failure (LVEF < 35%) from the DANISH trial were evaluated by 2D-strain echocardiography. Regional strain was calculated as the average longitudinal strain in basal-, midventricular- and apical segments in each of the six left ventricular walls. Reduced regional function was defined as below-median regional strain. The endpoint was a composite of sudden cardiac death (SCD), sustained VT, admission with ventricular arrhythmia, and appropriate therapy from a primary prophylactic ICD. Time-to-first-event analysis was performed using Cox models.

RESULTS

Mean age at inclusion was 62 years (72% male), median LVEF was 25% (IQR 20-30) median inferior strain was -8.7% (IQR -12.3; -4.9). After a five-year follow-up, 43 events were observed. Reduced inferior strain was associated with the composite endpoint in univariate analysis with a HR 2.08(95% CI 1.11-3.90), P = 0.021. After multivariate adjustment for clinical and echocardiographic parameters, inferior strain remained an independent predictor with a HR 2.78(95% CI 1.39–5.56), P = 0.004. Strain measurements in no other region were associated with the endpoint in the multivariate analysis. In subgroup analysis of patients in the two lower age tertiles (<68 of age) we found that reduced inferior- and posterior strain were associated with development of the composite endpoint after multivariate adjustment with HRs of 3.25(95% CI 1.41-7.53), P = 0.006 and 2.51(95% CI 1.14-5.53), P = 0.022.

CONCLUSIONS

Low inferior-posterior strain was associated with a 2-3-fold increase in risk of malignant arrhythmia and SCD in patients with non-ischemic heart failure. Abstract Figure.
CHA2DS2VASC score for predicting atrial fibrillation in patients with cryptogenic stroke
Authors: Vera Sainz A , Cecconi A , Ximenez-Carrillo A , Ramos C , Martinez-Vives P , Lopez Melgar B , Sanz A , Ortega G , Aguirre C , Gamarra A , Montes A , De Rueda C , Vivancos J , Alfonso F , Jimenez Borreguero LJ
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Society of Cardiology

Introduction

CHA2DS2-VASc Score is widely used to predict thromboembolic risk in patients with Atrial Fibrillation (AF). However the role of CHA2DS2-VASC score for predicting AF in patients with cryptogenic stroke (CS) remains unknown.

Methods

Sixty-three consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale≥4 of unknown etiology, were prospectively recruited. They were classified according to

CHA2DS2-VASc Score: group 1 (score ≤ 5), and group 2 (score >5). The primary outcome measure was the occurrence of AF during clinical follow-up.

Results

Twenty-six (41%) patients had a CHA2DS2VASC score > 5 (group 2). Patients in this group were older (81 ± 5.5 vs 75 ± 8 years; p < 0.001) and more frequently female (73% vs 43% p = 0.019). Patients in group 2 present more often hypertension (84% vs 43% p = 0.001), diabetes (38% vs 11%, p = 0.009) , dyslipidemia 77% vs 49%, p = 0.024), and a prior history of coronary artery disease (27% vs 5%, p = 0.026). Notably, patients with higher CHA2DS2VASC showed worse left atrial ejection fraction (41.7 ± 13.1 vs 52.2 ± 15%, p = 0.009) and worse left atrial strain reservoir (21.5 ± 7.1 vs 33.8 ± 11%, p < 0.001), conduct (9.5 ± 4.8 vs 16.6 ± 8.4%;p < 0.001) and contraction (12 ± 4.6 vs 17.2 ± 7.3, p = 0.002). During follow-up AF was detected more often in group 2 (42% vs 11% p = 0.006). In multivariate analysis CHA2SD2VAS > 5 was an independent predictor of AF in patients with CS (HR 7.3 [95% CI 1.2-45.6] p = 0.032)

Conclusion

A CHA2DS2VASC score >5 is an independent predictor of AF in patients with CS. This score provides a new clinical tool to inform clinicians with regards to the optimal treatment of these challenging patients
Right ventricular free wall longitudinal strain (RVFWSL) a new outcome predictor in patients candiate for TAVI
Authors: Dellino CM , Pergola V , Torresan F , Baroni G , Cecchetto A , Aruta P , Florencis A , Fraccaro C , Tarantini G , Mele D , Iliceto S
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

right ventricular systolic dysfunction is considered an outcome  predictor in various cardiac diseases, sometimes stronger than ejection fraction (EF). We assume that right ventricular dysfunction, calculated with echocardiography in patients candidate for trans-catheter aortic valve implantation (TAVI), could be an outcome predictor. Purpose: evaluate the prognostic value of pre-TAVI right ventricular free wall longitudinal strain (RVFWSL) in patients with severe aortic stenosis undergoing TAVI. Methods: retrospective analysis of 100 patient underwent transfemoral TAVI in our hospital from January 2015 to September 2019, with at least a pre-TAVI and post-TAVI echocardiography. For each patients we collected clinical and echo data before and after TAVI and during the follow-up; we measured RVFWSL off-line at the same time. We considered the value of [23.3]% the cut-off of normality for RVFWSL. The primary end-point was a composite of death from any cause and hospitalization for heart failure. Results: the median age of the patients was 81 years (79-83) and EF was preserved in most patients (median 56%, 55-58,28%). At a median follow-up of 1023 days (630-1387), the univariate analysis demonstrated a predictive of a reduced RVFWSL before TAVI (< [23.3]%, P = 0.015) and EF < 50% (P = 0.014). Cox regression analysis found that pre-TAVI reduced RVFWSL (HR 2.875, I.C. 95% 1.113-7.425;  P = 0.03)  and  EF < 50%  (HR  2.511,  I.C.  95%  1.07-5.892; P = 0.03) were independently associated with composite end-point of the study. Moreover, a reduced EF associated with RVFWSL < [23.3]% had an incremental value in predicting the outcome (P = 0.021). Conclusions: among patients with severe aortic stenosis undergoing TAVI, a reduced pre-implant RVFWSL is able to predict long-term outcome.
Deformation analysis in post-hospitalised patients with moderate SARS-CoV-2 infection
Authors: Valatsou A , Tsartsalis D , Dimitroglou Y , Tolis E , Banos A , Sfendouraki E , Fragoulis C , Patsourakos D , Koukos M , Kalompatsou A , Chrysochoou C , Pirounaki M , Aggeli C , Vassilopoulos D , Tsioufis K
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

SARS-CoV-2 infection is associated with multiple cardiac manifestations (1,2). Global longitudinal strain (GLS) by speckle tracking echocardiography (STE) is a novel transthoracic echocardiography (TTE) measure of myocardial deformation, which could early recognize subclinical cardiac injury in COVID-19 patients (3,4).

Purpose

We aimed to explore GLS profiles in post-hospitalized COVID-19 patients to identify features of eventual subclinical cardiac injury and to investigate the possible correlation with the severity of infection.

Methods

We enrolled 33 patients (mean age 59.2 ± 13, 64% men) with positive SARS-CoV-2 RT-PCR, hospitalized for moderate COVID-19 disease, with no admission to intensive care unit. Patients were submitted to TTE 1-2 months after discharge.  Images were anonymised and analysed offline by two accredited cardiologists. Clinical parameters and laboratory findings from hospitalization were also collected.  Acute myocardial infarction and pulmonary embolism were exclusion criteria.

Results

Mean duration of hospitalization was 12.9 ± 8.0 days. Study population had normal systolic function with a mean LV ejection fraction 58.6% (±3.6) while the majority of patients had relative low values of LV global longitudinal strain, mean 15.2% (±2.3). Arterial hypertension was present in 51.5% of patients and a history of previous myocardial infarction was referred in 6.1% of the population. Only 24.2% of patients had elevated troponin levels during the previous in-hospital period (mean maximal value of hs-troponin  was 18.1 ±16.6 pg/mL) whereas  81.8% had abnormal D-Dimers values (mean 2424 μg /L, range ±2825) and 93.1% had high hs-CRP values (138.2 ±92.0 mg/L) . Duration of hospitalization had strong significant correlation with D-Dimers (rho: 0.708, p: <0.001) and hs CRP (rho:0383, p:0.028) and  marginal association with troponin ( rho: 0.335, p:0.056). Moreover, global longitudinal strain showed significant association with duration of hospitalization (rho:-0.545, p: 0.007). Traditional systolic indices as LVEF and the various diastolic parameters  showed no significant association with severity of disease reflected by the duration of hospitalization and the other clinical and laboratory biomarkers.

Conclusion

Cardiac manifestations of SARS-CoV-2 infections could be present in mild to moderate disease and seems to associate with the severity of infection. The novel echocardiographic parameters such as GLS could add valuable information and identify  possible subclinical cardiac injury often unrecognized by traditional TTE examination.
The effect of urgent blood pressure lowering on left atrial mechanics in patients with hypertensive episode in emergency setting
Authors: Dinc Asarcikli L , Sert S , Can F , Osken A , Unal S
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial (LA) dilatation and dysfunction are early manifestation of hypertension and represent end-organ damage. Hypertension is a well-known risk factor for atrial fibrillation. Long term effect of hypertension on the left ventricle and left atrium was well-studied before. In this study, we aimed to investigate the acute effect of urgent blood pressure reduction on the left atrial strain.

Methods

We prospectively enrolled 52 consecutive patients (age: 67.5 ± 8.9 years, 48.1% male) (Fig1) admitted to our emergency department with a hypertensive attack. All patients underwent baseline standard echocardiographic evaluation. 2D images from apical 4-chamber view were recorded for offline analysis. Reservoir (PALS) and contractile (PACS) left atrial strain measurements were performed by automated software using the onset of QRS as a reference point. Patients with systolic dysfunction, acute coronary syndrome and any rhythym other than sinus or with poor echogeneicity were excluded. All measurements were repeated after achieving target blood pressure reduction and analyzed.

Results

Urgent blood pressure reduction result in improvement in LA contractile strain (PACS) and LVEF and increase in heart rate and RV systolic function while LV dimensions, LA volumes and LAVI were decreased. There is a statistically significant negative moderate relationship between absolute change of DBP and absolute change of PALS (r=-0.423; p = 0.002). There is a statistically significant negative and weak correlation between the absolute change in SBP and the absolute change in PACS (r=-0.280; p = 0.044).

Conclusion

Assessment of LA strain by 2D speckle tracking echocardiography is easy to apply and noninasive method to quantify LA function even in emergency setting. This study showed that LA contractile strain (PACS) rather than LA reservoir strain (PALS) was significantly affected from LV end diastolic pressure. Abstract Figure 1  Abstract Figure 2
Long term left ventricular impairment after SARS-COV2 infection
Authors: Brito J , Silva P , Valente Silva B , Pereira S , Silverio Antonio P , Morais P , Rigueira J , Placido R , David C , Silva D , Fernandes S , Ribeiro J , Pinto FJ , Almeida A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The impact of acute infection by SARS-COV2 on the cardiovascular system has been previously reported in the literature, with a higher propensity in patients with more serious pattern of disease and pro-inflammatory status. Nevertheless, the long-term burden and sequels of COVID-19 on the cardiovascular system is still unknown.

Purpose

To evaluate the long-term impact of COVID-19 on left ventricular function in patients with severe clinical presentation requiring intensive care hospitalization.

Methods

 

This was a single-center observational, prospective study which included patients requiring admission to the Intensive Care Unit (ICU) due to COVID-19 infection from January to November 2020. All discharged patients were contacted to perform a clinical, electrocardiographic and echocardiographic evaluation and those who accepted were included on the protocol. Baseline and clinical characteristics were collected from clinical reports. For the global longitudinal strain (GLS) analysis all patients with significant wall motion abnormalities and valvular cardiopathy were excluded. Statistical analysis was performed with Mann-Whitney and a safety cut-off was established with ROC curve analysis.

Results

 

A total of 43 patients were included (mean age 64 ± 12, 67.4% males). During SARS-COV2 infection 49% presented with severe ARDS and 51% with moderate, 35% required invasive mechanical ventilation, 14% noninvasive mechanical ventilation and 52% with high nasal flow cannula. On the follow-up analysis, fatigue was the most reported in symptom (52% patients) and the majority did not present other signs or symptoms suggestive of heart failure, with the mean NT-proBNP of 49 ± 389 pg/dL. The standard ECG and echocardiogram did not show significant changes with a mean LVEF of 58 ± 7.8 and mean TAPSE of 21 ± 4. The strain analysis showed low value of GLS (mean GLS of -17.14 ± 2.36) for a reference cut-off of -18%, suggesting subclinical left ventricular dysfunction in this subset of patients with preserved ejection fraction. Maximum CPR values during ICU did not correlate either with the extent of disease evolvement in CT (p= NS) or ARDS severity (p= NS). Nevertheless, maximum CPR correlated significantly with GLS reduction (R = 0.44, p = 0.019). A CPR value higher than iger30mg/dL had 100% specificity for GLS reduction and a cut-off of 14gm/dL reported a sensitivity of 65% and specificity pf 75% for reduction in GLS.

Conclusion

In our study, we reported subclinical impairment in left ventricular function detected with global longitudinal strain after serious infection with SARS-COV2. The detected myocardial dysfunction was related with higher inflammatory as expressed by CPR values. Long-term monitoring of these patients should be undertaken in order to timely detect late complications. Abstract Figure.
Same-day air pollution and ABCDE stress echo results: nitrogen dioxide increases vulnerability to pulmonary congestion
Authors: Ciampi Q , Russo A , Villari B , Mangia C , D"alise C , Ballirano A , Campagnano E , Picano E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

StressEcho 2030 study group

Background

Air pollution affects same-day hospital admissions for acute coronary syndromes, decompensated heart failure and arrhythmias. The present study hypothesis is that air pollution also may affect results of comprehensive cardiac functional testing unmasking a pre-clinical vulnerability.

Aim

To assess the effects of air pollution on stress echocardiography (SE) performed with ABCDE protocol

Methods

We enrolled 1292 patients with chronic coronary syndromes referred for clinically-driven dipyridamole ABCDE-SE (score results from 0= all parameters normal, to 5, all abnormal). Same day values of 5 pollutants were obtained on the same morning of testing (average of 4 hours) from publicly available data sets of regional authority of environmental protection. Air pollution score (APS) of 5 items included fine (PM 2.5) and <10 µm diameter particulate matter, ozone (O3), sulfur dioxide and nitrogen dioxide (NO2). According to predetermined, internationally established thresholds, APS ranged from 0 (all parameters normal or near normal, index value ≤3 in the 1 to 10 scale of UK government air quality index 2014) to 5 (all parameters abnormal).

Results

There was no significant correlation (r=-0.032, p = 0.276) between SE score (0.82 ± 1.08) and APS (1.96 ± 1.09). When individual pollutants were evaluated with individual items (from A to E) of SE score, NO2 concentration was correlated with rest (r=.089; p = 0.001) and peak stress B-lines in step B (r=.099; p < 0.001). Patients with abnormal (> 2) B-lines at peak stress (n = 247) were compared with those with normal (≤ 1) response (n= 1, 045). B-liners showed higher values of same-day NO2 (median value 23.1 [I.Q. range 16.2-31.0] vs 19.7 [12.5-27.4] µg/m3, p< 0.001) and PM 2.5 (22.0 [9.1-23.5] vs 17.6 [8.6-22.2] µg/m3, p< 0.001), with lower values of O3, a secondary pollutant destroyed by NO2 (44.9 [26.7-59.5] vs 48.4 [28.5-67.4] µg/m3, p= 0.040). At multivariable logistic regression analysis (Figure), NO2 predicted stress B-lines with age, hypertension, diabetes, and reduced (< 50%) ejection fraction.

Conclusion Air pollution may modulate cardiac functional testing results. Higher concentration of NO2 and PM 2.5 are associated with more frequent pulmonary congestion mirrored by B-lines at rest and during stress. The increased inflammatory stress mediated by NO2 and PM 2.5 may increase the permeability of the alveolar capillary barrier to any given rise in pulmonary wedge pressure. Abstract table
Dobutamine stress echocardiography during covid-19 pandemic: impact on volume and positivity rates in a tertiary hospital
Authors: Dimitroglou Y , Kalompatsou A , Tsartsalis D , Giannoulis E , Koukos M , Solomou E , Angelis A , Patsourakos D , Valatsou A , Zisimos K , Fragkoulis C , Christofi A , Liakos C , Aggeli C , Tsioufis K
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The emergence of coronavirus 2019 infection (covid-19) was accompanied by severe social and economic restrictions and applied significant pressure to the healthcare systems. The first pandemic wave started in March to May 2020 and was characterized by the peak of confinement measures and lockdown application. The second wave started in September and peaked in November to December 2020 and was characterized by improved healthcare organization but significant burden for the hospitals and intensive care units. Dobutamine stress echocardiography (DSE) is used for evaluation of ischemia in patients with known or suspected coronary artery disease.

Purpose

To compare DSE volume and positivity rates between 2019 and 2020 time periods in a department of a public tertiary hospital.

Methods

We retrospectively analysed DSE studies performed in our department in 2020 including the peak of covid-19 restrictions and compared the data to the 2019.

Results

Volume of DSE studies decreased from 1516 in 2019 to 996 in 2020 (-34.3%). The study volume reduction was greater in April (-93.7%) and May (-54.5%) when the covid-19 restrictions were at the peak. Great decreases were also recorded in November (-46.8%) and December (-53.5%) when the second wave of covid-19 disease emerged. Conversely, small increases were recorded in September (7.1%) and October (10.6%) (figure 1). Regarding positivity rates, a statistically non-significant increase was recorded (33.6% vs 34.2% in 2019 and 2020 respectively, p = 0.73). Interestingly a statistically significant increase in positivity levels was recorded during the period March to May 2020 compared to the same period of 2019 (44.7% vs 36.9%, p = 0.029). On the contrary, positivity rates were decreased at the period September to December (27.1% vs 34.2%, p = 0.019) (figure 2).

Conclusions

Volume of DSE studies was significantly reduced in 2020 when compared to 2019 during respective peaks of the pandemic and the accompanying restriction measures. Positivity rates were higher during the first pandemic wave, possibly due to decreased hospital attendance of mildly symptomatic patients in combination with stricter admission criteria at the emergency department. Lower positivity rates during the second pandemic wave possibly reflect an adjustment of both healthcare systems and patients to the new conditions imposed by the covid-19 pandemic. Abstract Figure 1  Abstract Figure 2
Prognostic value of different echocardiographic indices reflecting right ventriculo-arterial coupling in a large cohort of patients with various cardiac diseases
Authors: Florescu D , Muraru D , Florescu C , Volpato V , Tomaselli M , Caravita S , Gavazzoni M , Parati G , Badano LP
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction – Non-invasive parameters used to assess right ventricular (RV) function, i.e. tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), RV ejection fraction (RVEF), and RV free-wall longitudinal strain (RVFWLS) have shown their prognostic implications. However, since they are extremely load dependent, they do not provide an accurate representation of the RV intrinsic performance. On the other end, invasive indices of RV-arterial coupling (RVAC) derived from pressure-volume loops are not routinely performed, rising the urgency for more feasible, and reliable non-invasive estimates of RVAC.

Purpose – To: i. evaluate the prognostic value of echocardiography-derived RVAC surrogates: RVEF/systolic pulmonary artery pressure (sPAP), RVFWLS/sPAP, TAPSE/sPAP, FAC/sPAP, and RV stroke volume/end-systolic volume (SV/ESV), ii. identify the cut-off values associated to all-cause mortality; and iii. compare their prognostic value with that of classical parameters of RV function.

Methods – We prospectively enrolled 366 patients with various cardiac diseases, undergoing clinically-indicated comprehensive two- and three-dimensional echocardiography.

Results – During a mean follow-up of 7.6 ± 1 years, 80 (21.9%) patients died. At univariable Cox regression, most of the echocardiographic parameters were related to all-cause mortality. The echocardiographic parameters with significance at univariable analysis (p < 0.01) were included in a multivariable regression model. Left ventricular ejection fraction (LVEF), RVEF, TAPSE, RVEF/sPAP and RVFWLS/sPAP remained independently associated to all-cause mortality (p < 0.05 for all). Subsequently, they were tested in receiving operator characteristics (ROC) curves. At ROC analysis, RVEF/sPAP (area under the curve, AUC = 0.807, p < 0.001) and RVFWLS/sPAP (AUC = 0.743, p < 0.001) showed the greatest predictive value (p < 0.001 between them). However, all RV parameters significantly improved their prognostic values after indexing for sPAP (p < 0.01 for all). The best cut-offs to predict the outcome were 1.5 for RVEF/sPAP (specificity 71%, sensitivity 83%) and 0.67 for RVFWLS/sPAP (specificity 72%, sensitivity 68%). At Kaplan-Meier analysis, patients with reduced RVAC (less than the predefined cut-offs) had significantly lower probability of survival (p < 0.001 for all).

Conclusion – RVAC surrogates provide incremental prognostic value compared to standard RV functional measurements. RVEF/sPAP, with a cut-off value of 1.5, was the best parameter for risk stratification, and was independently related to all-cause mortality. Abstract Figure. Prognostic value of RVAC surrogates  Abstract Figure. Kaplan-Meier curves survival probability
Impact of endocardial leads on the effectiveness of interventional edge-to-edge repair of tricuspid regurgitation
Authors: Goebel B , Salomon C , Abdulrahman M , Richter S , El Garhy M , Costello-Boerrigter L , Lapp H , Lauten P
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

A considerable proportion of patients who are considered for percutaneous tricuspid valve edge-to-edge repair (pTVR) interventions have endocardial lead induced tricuspid regurgitation (TR). The aim of this study was to examine the impact of lead-leaflet interaction on the effectiveness of pTVR.

Methods

For each patient, the lead position within the tricuspid valve (central, commissural, or towards one of the three leaflets) and the type of lead-leaflet interaction (leaflet impingement or adhesion) were identified during thorough 2D/3D transthoracic and transesophageal echocardiography examinations. Before and after pTVR, echocardiographic data, including 3D full-volume datasets, were obtained and quantified. TR severity was graded from 1+ to 5+, based upon the effective regurgitant orifice area by the PISA method (EROAPISA) and the vena contracta area (VCA3D) as measured by multiplanar reconstruction from a 3D color Doppler loop. Maximal diastolic tricuspid annulus area from a 3D zoom image, tricuspid tenting area, and right atrial volume were quantified. Right ventricular assessments included ejection fraction (RVEF3D) and diastolic (RVVd3D) and systolic (RVVs3D) volumes. 

Results

Out of 99 patients who underwent pTVR at our hospital, 38 patients had implanted cardiac devices of the following types: pacemakers (n = 25, 66%), cardiac defibrillators (n = 7, 18%), and biventricular pacemakers (n = 6, 16%). In 24 (63%) of these device patients, TR grade was ≤2+ after pTVR. In 14 of the device patients, TR grade remained severe after intervention (Grade 3+ in 15%, grade 4+ in 11%, and Grade 5+ in 11% of the device group). In comparison, in 78% of patients without endocardial leads, moderate TR was achieved after pTVR. Figure 1 shows the distribution of lead positions within the tricuspid valve. A relevant lead-leaflet interference (rLLI) for pTVR interventions was defined as impingement or adhesion in the target area of the coaptation device (anteroseptal or posteroseptal). Binary logistic regression analysis showed an increase risk (Odds ratio 11, R2 0.34, 95% CI 0.019-0.44, p = 0.003) for a suboptimal pTVR result (TR grade > 2+ after intervention) in patients with rLLI. Although patients with rLLI (n = 17) had significantly higher VCA3D values as compared to patients without rLLI (n = 21), it was not predictive for pTVR results. Echocardiographic parameters of right ventricular and tricuspid valve dimensions showed only a trend to higher values in the group with rLLI (Table 1).

Conclusion

  Endocardial lead induced TR negatively impacts the effectiveness of pTVR irrespective of the initial degree of TR. Abstract Figure.  Abstract Table 1 Echocardiographic parameters
Percutaneous paravalvular leak closure: a single-centre experience of 54 cases
Authors: Vertesaljai M , Denes M , Temesvari A , Fontos G , Andreka P
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

 Clinically significant paravalvular leak (PVL) occurs in 5-10% of patients undergoing surgical aortic and 5-17% patients undergoing surgical mitral valve replacement and even more often after trancutaneous aortic valve implantation (TAVI). Surgical repair of a PVL is associated with a 30-day mortality of approximately 10%. Percutaneous closure of PVL (pPVLC) has emerged as an alternative to surgical repair.

Aim

 We retrospectively analysed the success rate and clinical outcomes of patients with significant PVL, who were turned down from re-do cardiac surgery, and treated with pPVLC  at our tertiary referral centre.

Methods

 Patients who were admitted for pPVLC  between 27th of September, 2009 and 21st of April, 2021 were enrolled into the study. 30-day and 1-year mortality rates were assessed. Technically successful pPVLC was defined as stable device position, and minimum 1 grade reduction in PVL severity.

Results

 pPVLC was performed in 54 cases (32 males, 22 females, mean age: 69.5 ± 10.9 yrs). The main indication for closure was heart failure (81%) and haemolysis (19%). The median time since  valve surgery was 4.5 yrs (IQR: 0.9-15.2 yrs). Regarding the leaks, 70% (n = 38) were in mitral position (mechanical vale: 33 cases, bioprosthesis: 5 cases) and 30% (n = 16) in aortic position (mechanical valve: 12 cases, bioprosthesis: 2 cases, TAVI: 2 cases). A total of 53 leaks were identified in mitral position (one leak: 25 cases, two leaks: 11 cases, three leaks: 2 cases), and 25 leaks in aortic position (9 cases, 5 cases and two cases resp.). In mitral position 1 device was used in 73% of cases, 2 devices in 21%, and 3 devices in 6%. In aortic position: 62%, 19%, and 19 % resp. Techinal succes was achieved in 49 case (91%).  The 30-day mortality was 8%, the 1-year mortality 21%.

Conclusions

 Patients with significant PVL represent an extreme or even prohibitive surgical risk cohort. In these high risk individuals percutaneous PVL offers a safe alternative to surgical PVL repair and appears particularly effective in patients presenting with heart failure or haemolysis.
Echocardiography is inferior to computed tomography in predicting balloon expandable transcutaneous implantation valve size in routine clinical setting-single centre study
Authors: Medilek K , Bis J , Polansky P , Dusek J , Brtko M , Kvasnicka T , Tuna M , Praus R , Ballon M , Stasek J
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Transcatheter aortic valve replacement (TAVR) became standard of care for selected patients with severe aortic stenosis. Computed tomography (CT) and 2D/3D echocardiography (ECHO) are used for aortic annulus sizing. As a result of increasing number of TAVR more imaging specialists participate in pre-procedural TAVR assessment.

Purpose

The aim of this study was to compare accuracy of ECHO aortic annulus measurements vs CT based parameters for Edward Sapiens TAVR in such environment.

Methods

Data of 145 consecutive patients with TAVR (Sapiens XT or Sapiens 3S) were analysed retrospectively. One radiologist and six echocardiographers trained in aortic annulus size measurements participated in pre-procedural aortic anulus assessment. Aortic annulus area and area derived diameter were measured/calculated in each patient from 3D ECHO data set acquired from mid-oesophageal view and from CT data set, using multiplanar reconstruction. 2D ECHO aortic annulus size was measured from mid-oesophageal 120º view in early systole. 

Results

139 (96%) patients had favourable TAVR result (max. mild aortic regurgitation, single valve implanted). 3D ECHO aortic anulus area and area derived diameter were smaller than corresponding CT parameters (464 ± 99 vs 479 ± 88 mm2, p < 0.001 and 24.2 ± 2.7 mm vs 25.0 ± 5.5, p = 0.002, respectively) and differed between echocardiographers (p < 0.001). 2D ECHO anulus measurement were smaller in comparison to both CT and 3D ECHO area derived diameter (22.6 ± 2.9 vs 25.0 ± 5.5mm, p = 0,013 and 22.6 ± 2.9 vs 24.2± 2.7mm, p < 0.001, respectively). In implanted valves with favourable procedure result, concordance of CT and 3D ECHO aortic annulus area with manufacturer recommended ranges was 79.4% vs 61% (p= 0.001) and for area derived diameter 80.1% vs 61.7% (p = 0.001). Using 3D ECHO measurements 33% of the patients would have hypothetically received inappropriate valve size.

Conclusion

3D ECHO aortic annulus measurements are generally smaller then CT ones. If 3D ECHO based parameters only were used for TAVR (Edward Sapiens) size selection, it would have resulted in underestimation of the valve size in up to 1/3 of the patients. CT aortic annulus size assessment should be preferred method over 3D ECHO in daily practice. Abstract Figure 1  Abstract Table 1
Variability of right ventricular linear measurements of size and function using a standardized echocardiographic protocol
Authors: Strachinaru M , Ren C , Geleijnse ML , Spitzer E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Right ventricular size and function have a prognostic value not only in right heart conditions (pulmonary hypertension, congenital heart disease), but also in left ventricular (LV) disease states. The right ventricle (RV) has a unique shape, for which a simple geometrical model is not achievable as is the case for the LV. In clinical practice simple measurements are used for the RV, since these are considered to be most reliable  and reproducible: linear cavity dimensions, tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler systolic velocity s’ at the tricuspid annulus. The latest RV quantitation guidelines made important modifications to RV measurements, in particular, by shifting from the apical 4-chamber view to the RV focused apical view. Very scarce data exist on the variability of these measurements.

Purpose

In this study we aim to analyze the intra and inter-observer variability of the linear measurements of RV size and function using a standardized methodology.

Methods

A mixed cohort, randomly selected from the echocardiographic database, comprising 50 patients, was retrospectively analyzed. We measured linear diameters (basal = 1, longitudinal = 2, mid = 3) in apical RV-focused view, TAPSE and s’. Based on computer simulations, we propose a step-by-step approach: tracing the longitudinal diameter as perpendicular to the mid of the basal and generally parallel with the interventricular septum, and the mid as perpendicular to the middle of the longitudinal (Figure). Two observers measured independently the same images at baseline, three (inter-observer) and six months (intra-observer).

Results

The longitudinal diameter had the lowest relative bias (3% inter and 4% intra-observer), followed by the basal (7% and 2%), and mid (6% and 6%). The limits of agreement (LOA) were small for s’ (-3 to 1 intra and -1 to 1mm inter-observer), TAPSE (-6 to 5 and -3 to 3mm), and larger for diameters (1=-5 to 10 and -8 to 6; 2=-13 to 17 and -11 to 6; 3=-11 to 7 and -9 to 4mm). ICCs for individual measurements were very good (1= 0.94 intra and 0.94 inter; 2 = 0.78 and 0.94; 3: 0.72 and 0.56; TAPSE: 0.86 and 0.94; s’=0.94 and 0.98), p < 0.001 for all (Table).

Conclusion

A systematic approach to linear RV-focused apical view measurements may lead to reproducible results. It is essential that size measurements be performed in the RV focused view. Our study shows best consistency and reproducibility for the basal diameter and the linear functional parameters.  Echocardiographic laboratories may benefit from implementing a consistent analysis protocol and assessing its reproducibility. Abstract Figure: linear RV measurements  Abstract Table: variability results
Geometrical changes of the left ventricle and cognitive impairment in hypertensive patients
Authors: Pal T , Preg Z , Nemes-Nagy E , Balint-Szentendrey D , Nyulas K , German-Sallo M
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

 From the view of the heart-brain axis, several biomarkers have been suggested for the assessment, eventually for the prevention of cognitive impairment. Remodeling of the left ventricular (LV) structure could be such a marker. Purpose: This study aimed to investigate the relationship between cognitive functions and left ventricular geometrical structure. Methods: We enrolled 512 consecutive hypertensive patients (mean age 68 ±9.5 years, females: 51%, males 49%), the mean blood pressure was 135/81 mmHg (±19/11 mmHg). Cognitive abilities were measured with two questionnaires the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), considering cognitive impairment under 24 and 26 points respectively. Measures of the left ventricular structure were performed with transthoracic echocardiography using left ventricular mass indexed to body surface area (LVMI) and relative wall thickness (RWT). Cut off value for LV geometrical changes were: LVMI 115 g/m2 in males and 95 g/m2 in females and RWT 0.42 mm. IBM SPSS v20. was used for statistical analyses. Results: Normal geometry of LV was present in 7.4% and remodeling of LV in the studied group was: concentric remodeling in 16.8%, concentric hypertrophy in 61.9% and eccentric hypertrophy in 13.9%. Lower MoCA scores were observed in LV hypertrophy (22.6 vs. 23.4, p = 0.08). Patients with LV concentric hypertrophy had significantly lower cognitive scores compared to eccentric hypertrophy (mean MoCA 22.4 vs. 23.8 p = 0.02; mean MMSE 26.1 vs. 27.0 p = 0.02). Increased RWT alone were associated with poorer cognition (mean MoCA 22.58 vs. 23.89 p = 0.009; mean MMSE 26.17 vs. 26.99 p = 0.02).  Higher LVMI negatively correlated with MoCA scores (p = 0.018, r=-0.105), but not with MMSE scores (p = 0.216, r=-0.006). Conclusions: Left ventricular hypertrophy and even changes in relative wall thickness may cause cognitive impairment. Preventing LV geometrical changes may prevent the deterioration of cognitive abilities.
Two-dimensional echocardiographic scoring system of the left ventricular filling pressure and clinical outcomes in heart failure with preserved ejection fraction
Authors: Murayama M , Iwano H , Obokata M , Harada T , Omote K , Tsujinaga S , Chiba Y , Ishizaka S , Motoi K , Nakabachi M , Nishino H , Yokoyama S , Nishida M , Kurabayashi M , Anzai T
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Japan Society for the Promotion of Science (JSPS)

Introduction

Elevated left ventricular (LV) filling pressure in non-decompensated state is a powerful indicator of worse clinical outcomes in heart failure regardless of LV ejection fraction. However, its detection is often challenging in heart failure with preserved ejection fraction (HFpEF).

Purpose

This study aimed to elucidate the predictive value of recently proposed echocardiographic parameter of LV filling pressure, Visually assessed time difference between the Mitral valve and Tricuspid valve opening (VMT) score in HFpEF.

Methods

We retrospectively analyzed 310 well-differentiated HFpEF patients in stable conditions. Using two-dimensional echocardiographic images, time sequence of opening of mitral valve and tricuspid valve was visually assessed in the apical four-chamber view and scored to 0 to 2 (0: tricuspid valve first, 1: simultaneous, 2: mitral valve first). When the inferior vena cava diameter was dilated, 1 point was added and VMT score was calculated as four grades from 0 to 3. Based on the previous study, VMT≥2 was regarded as a sign of elevated LV filling pressure (Figure 1). LV diastolic function was graded according to the guidelines. The primary endpoint was defined as a composite of cardiac death and heart failure hospitalisation during the two years after echocardiographic examination.

Results

During the follow-up period, 55 events (18%) occurred, including four cardiac deaths and 51 heart failure hospitalisations. Kaplan-Meier curves demonstrated that VMT≥2 (n = 54) was associated with worse outcomes compared to patients showing VMT ≤ 1 (n = 256) (log-rank test P <0.001). Furthermore, VMT≥2 was associated with worse outcomes when tested in 100 HFpEF patients with atrial fibrillation (log-rank test P = 0.026) (Figure 2). In the adjusted model including age, systolic blood pressure, serum albumin level, and the LV diastolic function grading, VMT≥2 was independently associated with the primary outcome (hazard ratio: 2.23; 95% confidence interval: 1.17 to 4.24, P = 0.014). Additionally, the nested regression model showed that VMT scoring provided an incremental prognostic value over clinically relevant variables (age, sex, the plasma brain natriuretic peptide level, atrial fibrillation) and LV diastolic function grading (chi-square 10.8 vs 16.3, P = 0.035).

Conclusions

In patients with HFpEF, the VMT score was independently and incrementally associated with adverse clinical outcomes. Moreover, it discriminated worse clinical outcome even in HFpEF patients with atrial fibrillation. Abstract Figure. VMT scoring  Abstract Figure. Kaplan-Meier analysis
Evaluation of cardiac function by two-dimensional speckle tracking echocardiography in uncomplicated COVID-19 survivors
Authors: Akbulut M , Tan TS , Gerede DM , Kozluca V , Dincer I
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

5COVID-19 is a multi-systemic infectious disease. Nearly 20-30% of hospitalized patients have evidence of acute myocardial involvement, portending a poorer prognosis. However, not much is known about the long-term cardiac effects of the disease. Also, there is a growing concern about the cardiac sequelae of COVID-19 among survivors. In this study, we aimed to investigate the long-term cardiac effects in patients with prior mild-moderate COVID-19 infection, using both conventional and speckle tracking echocardiographic imaging modalities. A total number of 58 patients who have been diagnosed with COVID-19 within the previous six months and 20 age-, sex- and risk factor-matched healthy adults were included. All patients underwent a comprehensive echocardiographic examination. Both conventional and two-dimensional speckle tracking echocardiographic measurements were done. Also, serum cardiac biomarkers were obtained on the day of echocardiographic examination. Compared with healthy controls, COVID-19 survivors had similar left and right ventricular systolic function at six months. Also, left and right atrial peak systolic strain values did not differ between the groups. Long-term cardiac sequelae of COVID-19 infection are still widely unknown, resulting in concern among survivors. This study is valuable in putting forth the unaffected systolic and diastolic myocardial function on long-term in uncomplicated COVID-19 cases and may decrease the survivors’ anxiety and the number of unnecessary applications to cardiology clinics. Abstract Figure. Left ventricle strain analysis  Abstract Figure. Right ventricle strain analysis