bluuebunny/crossref_metadata_2025 huggingface dataset:
Torsional dynamics and 2D speckle tracking in heart failure with reduced ejection fraction on patients taking sacubitril/valsartan and naive
Authors: El Shafey WED , Elmelegy EHAB , Mousa WALAA , Shafek MENA
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

ARNI has been shown to be superior to enalapril in long term reducing the mortality and hospitalization of heart failure (HF). However short-term effect on diastolic function remain unclear. We sought to evaluate 6 months" effects of ARNI on left ventricular (LV) diastolic parameters determined by speckle tracking and tissue Doppler imaging.

Objectives

This study aims to evaluate the torsional dynamics and 2D speckle tracking in heart failure with reduced ejection fraction on patients taking angiotensin receptor neprilysin inhibitors (ARNI) and non.

Methods

This study was carried out in Menoufia university hospitals included 60 patients of HFrEF during the period from august 2019 to January 2020. (50%) of patients was treated with traditional treatment of heart failure and the remaining was treated with ARNI. Data were collected including history and clinical examination. ECG and speckle tracking and tissue Doppler imaging was done to evaluate the diastolic function.

Results

Our results showed no significant difference between the two groups at baseline. There was significant improvement of the LV diastolic function. Untwist time and untwist onset showed the highly significant parameters of improvement.

Conclusion

This study concluded that ARNI showed short term improvement of diastolic function of the left ventricle that can be detected by STE.

Comparison between the studied groups re Echocardiographic diastolic parameters after 6 months ARNI Traditional P-value (Sig.) Count 30 30 Diastolic dysfunction grade Grade 1 9 (30%) 1 (3.3%) 0.008 (S) Grade 2 18 (60%) 22 (73.4%) Grade 3 3 (10%) 7 (23.3%) Other doppler diastolic parameters E/A 0.93 ± 0.30 1.16 ± 0.26 0.002 (S) E/e" 9.1 ± 1.9 10.8 ± 1.6 <0.001 (HS) TR velocity (m/s) 2.6 ± 0.3 2.8 ± 0.3 0.003 (S) Speckle diastolic parameters Untwist rate (°/s) -65.4 ± 5.2 -60.4 ± 4.5 <0.001 (HS) Untwist onset (ms) 96.8 ± 16.2 106.1 ± 15.7 0.028 (S) Shows comparison between ARNI vs Traditionally treated patients and how the parameters of conventional and STE was improved in favor of diastolic parameters. Abstract Figure. Baseline vs 6 months inbetween studied g
Longitudinal change in cardiac structure and function following acute coronary syndrome stratified by culprit coronary artery lesion site
Authors: Ravnkilde K , Skaarup K , Grove GL , Modin D , Nielsen AB , Falsing MM , Iversen AZ , Pedersen S , Fritz-Hansen T , Galatius S , Jespersen T , Shah A , Gislason G , Biering-Soerensen T
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Acute coronary syndrome (ACS) has adverse consequences for the myocardium and subsequent cardiac function and structure. No reports exist comparing the differences in impact of culprit coronary artery lesion site on longitudinal remodeling and changes left ventricular structure and function.

Method

A total of 299 ACS patients treated with PCI were included in the present study. All patients had two echocardiographic examinations performed. The first was performed median 2 (IQR: 1; 3) days following PCI, while the second was performed median 240 (IQR: 81; 881) days after the first. Patients were grouped based on culprit coronary artery lesion (left anterior descending artery (LAD), right coronary artery (RCA) and circumflex artery (Cx)). Patients with multiple lesions were excluded from the present study. Univariable linear regression analysis was utilised to assess the association between culprit coronary artery lesion site and longitudinal change in cardiac structure and function.

Results

Mean age was 63 ± 11 years and 77% were male. At follow-up, mean left ventricular ejection fraction was 42 ± 9% and global longitudinal strain (GLS) was -13 ± 4%. Culprit coronary artery lesion was allocated as follows; 168 ACS patients were treated in LAD, 95 patients were treated in RCA, and 36 patients were treated in Cx. In the linear regression analysis, LAD patients displayed a greater improvement in GLS (b =-0.116, p = 0.048) compared to the two other lesion sites. LAD patients had the poorest GLS at both baseline and follow-up echocardiography (Figure). RCA lesions were associated with the largest decrease in left atrial maximum volume (LAVmax) (b = -0.156, p = 0.011) and the largest increase in relative wall thickness (RWT) (b = 0.139, p = 0.030), consequently resulting in an LAVmax smaller and an RWT larger at follow-up than other lesion sites (Figure). Lastly, Cx lesions were significantly associated with the largest decrease in ratio between peak early diastolic transmitral flow velocity and peak early diastolic mitral annular tissue velocity (E/e’) (b = -0.262, P <0.001). Cx lesion patients were observed to have elevated E/e’ at baseline, which generally normalised at follow-up (Figure).

Conclusion

The present study suggests that culprit coronary artery lesion site has a differential impact on cardiac remodeling. This information can potentially aid the clinical understanding of cardiac structure and function following ACS according to coronary artery lesion site.

Abstract Figure
Left atrial strain reservoir in monitoring heart transplant paediatric patients
Authors: Borrelli N , Panebianco M , Di Salvo G , Alfieri S , De Angelis D , Chinali M , Amodeo A , Parisi F , Guccione P
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

In heart transplant (HT) patients, high LV filling pressure is considered a marker of rejection and predictive of increased mortality.

Purpose

Our study aims to correlate echocardiographic parameters to left-ventricular end diastolic pressure (LVEDP) at cardiac catheterization in transplant recipients.

Methods

This was a retrospective study of 50 HT patients (54% male) who underwent heart transplantation in paediatric age (0-18 years-old). The echocardiographic evaluation was performed within three weeks from the left heart cardiac catheterization. From apical view, we measured: left atrial strain (LAS) indices [atrial contraction (εac), LA filling (reservoir phase, εres), and LA passive emptying (conduit phase, εcon)], mitral doppler E/A, E/e’, global longitudinal strain (LVGLS) and strain rate.

Results

Median LVEDP was 10 mmHg (IQR 8.25-12 mmHg) and had the best correlation with decreased εres (r= -0.56, p < 0.0001). The other LAS indices and mitral E/e’ correlated less strongly with LVEDP (εac: r= -0.42, p = 0.004; εcon: r= -0.55, p= 0.0001; E/e’: r = 0.28, p = 0.04). E/A, LVGLS and LVGLS rate did not correlate with LVEDP. By ROC analysis, εres ≤ 16.3% was predictive of elevated LVEDP with a good sensitivity (86%) and moderate specificity (57%). A multivariate analysis produced εres as the best predictor (p = 0.0001) for high LVEDP.

Conclusions

Non-invasive εres seems to be a good surrogate of invasive LVEDP. Monitoring εres may be of value in HT patients to survey for rejection and graft disfunction.

Abstract Figure. Scatter plots LVEDP-εres correlation
Variations in regional strain under different afterload conditions may help to identify ischemic myocardium
Authors: Hortegal R , Cancellier R , Maduro Y , Cavalcanti LH , Vasconcelos LA , Paladino Filho AT , Nakayama L , Franchini K
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

 Acute coronary syndromes are a major health problem worldwide. The Speckle Tracking Imaging has been proposed as adjunctive for diagnosis and prognosis purposes in the context of NSTE-ACS.

Purpose

We sought to determine the regional myocardial strain in ischemic versus non-ischemic segments in subjects with NSTE-ACS, before and during acute pressure overload.

Methods

Data from 2D-echocardiography were obtained from 21 patients (mean age, 50 ± 10 years) undergoing cinecoronariography for NSTE-ACS indications. A blinded observer performed an offline analysis to obtain  the Systolic Positive Peak (P), Systolic Peak Strain (S), Peak Strain (G) and Time to Peak Strain (TTP) of each segment acquired before and during pressure overload-induced by left hand-grip (42± 8 Kg) combined with simultaneous pneumatic constriction of the right arm and both lower limbs. Moreover, LVEF and GLS were also calculated. A second blinded observer labelled the ischemic regions according to AHA-16 Bull’s eye using data from cinecoronariography.

Results

The handgrip manuever caused mild reductions in the median LVEF (56 %; IQR 48 -58% vs 54%; IQR 51-56%) as well as the median GLS (-17%; IQR-19%-15% vs -16%; IQR -19-15%). For the analysis of regional myocardial function, we obtained 360 segments (29% labelled as ischemic) with optimal tracking quality. Mean regional strain changes during pressure overload were significantly different in ischemic vs non-ischemic segments for Peak S ( 1,07% x -0.5%; p-value <0,01) and Peak G (0.85% x -0.65%; p-value < 0.01)(Table). Notably, however, we found marked increases in the systolic deformation, restricted to the apical ischemic segments during pressure overload (Figure).

Conclusions

Our data point to a distinct increase in the systolic deformation of the apical segments in contrast to the overall reductions in the GLS and  EF in the ischemic left ventricle.

Non- Ischemic segments N = 256 Ischemic segments N = 104 Baseline Handgrip Variation (%) Baseline Handgrip Variation (%) p-value* Peak P 0.33(0.57) 0.36(0.7) 0.03(0.7) 0.50(0.7) 0.57(0.8) 0.07(0.8) 0.32 Peak S -17.9(4.4) -16.8(5.3) 1.07(4.1) -16.6 (5.2) -17.2(5.6) -0.5(4.8) 0.0006 Peak G -18.5 (4.2) -17.68 (4.6) 0.85 (3.7) -17.3 (4.5) -18 (4.6) -0.65(4.2) 0.0005 TTP 377(62) 384(66) 6.5(52) 387(65_ 388(62) 1.15(46) 0.17 * t- test comparing the variations baseline-handgrip between the two groups (ischemic versus non-ischemic. Peak P= positive systolic peak; Peak S= systolic peak; Peak G= peak strain; TTP= time to peak Abstract Figure
Cardiac function during COVID-19 intensive care unit hospitalisation - deformation analysis and outcomes
Authors: Loncaric F , Fernandes JF , Sitges M , Stessel B , Dubois J , Van Halem K , Herbots L , Bijnens B
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020 European Commission Project H2020-MSCA-ITN-2016

Background

Although the cardiac burden of COVID-19 has been demonstrated, follow-up imaging studies are scarce. The aim was to use speckle-tracking deformation imaging (STE) to prospectively assess cardiac function during intensive care unit (ICU) hospitalisation, comparing ventricular and atrial function of COVID-10 patients that died and those that were discharged.

Methods

In a single-centre, COVID-19 patients (n = 41) (71% male, aged 65 ± 11 years) were prospectively followed with echocardiography as part of ICU treatment. The left and right ventricles (LV, RV, respectively) were studied with STE in the 4-chamber cardiac view. The endpoint was defined as death or ICU discharge. Average values of the strain parameters from the first and final scans in the ICU, respectively, were calculated for the two outcome groups.

Results

Endpoint was not reached in 15% (n = 6) at the time of analysis. The remaining patients (n = 32) were 69% male, aged 66 (interquartile range (IQR) 60-72) years, and with an ICU mortality 26% (n = 9). The median spent in ICU was 24 (IQR 15-43) days. On average, echocardiography was performed three times during ICU hospitalisation, amounting to 103 examinations. The changes in cardiac strain are shown in Table 1. The change in LV longitudinal strain during ICU hospitalisation is shown in Figure 1.

Conclusion

Worsening of LV strain and lack of improvement of RV strain is linked to higher mortality in the ICU. The assessment of cardiac function might contain prognostic information in COVID-19 patients that are admitted to the ICU.

Patients discharged from thee OCU (n = 23) Patients that died in the ICU (n = 9) P value Initial echo in the ICU LV strain, % (IQR) 18.00 (15.6-19.95) 14.4 (10.56-20.42) 0.158 RV strain, % (IQR) 16.00 (14.70-20.05) 15.50 (10.38-23.70) 0.712 Final echo before discharge LV strain, % (IQR) 17.35 (15.13-18.98) 13.20 (10.75-15.40) 0.007 RV strain, % (IQR) 17.65 (16.83-19.60) 15.75 (10.68-20.43) 0.438 ICU - intensive care unit; IQR-inter-quartile range Abstract Figure 1
Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity
Authors: Santoro C , Soloperto R , Casciano O , Esposito R , Lembo M , Canonico M , Arpino G , Giuliano M , De Placido S , Esposito G
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure.

Purpose

To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography.

Methods

Fifty Her-2 positive breast cancer women (age = 53.6 ± 11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction < 50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline >15%.

Results

None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p < 0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p < 0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=-0.40, p = 0.006) and after TRZ completion (r=-0.62, p < 0.0001).

Conclusions

Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients.

Abstract Figure.
The influence of afterload on left ventricular contractility: 2D-strain and dyssynchrony in stress echocardiography
Authors: Karev E , Verbilo S , Malev E , Prokudina M , Suvorov A
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background Hypertensive response to exercise (HRE) has negative prognostic value but its impact on the  left ventricle (LV) contractility and on stress echocardiography (SE) results remains controversial. The global longitudinal strain (GLS) and LV dyssynchrony changes in response to afterload increase were shown even in patients with narrow QRS at rest, but not on exertion.

Purpose We aimed to analyze the relation between the blood pressure (BP) during SE and LV GLS and dyssynchrony changes.

Methods We performed exercise SE on treadmill in 96 patients without coronary artery stenosis (invasive or CT coronary angiography). Patients divided into two groups: HRE (n = 41) and normal response to exercise (NRE) (n = 55). We analyzed GLS and standard deviation of time between the onset of QRS and segmental longitudinal strain peaks (STE-TIME SD) using speckle tracking and 3d-ejection fraction (EF) at rest and on exertion.

Results 2D-EF increase was higher in patients with NRE, but 3D-EF did not differ between groups. Wall motion abnormalities (WMA) on peak stress were detected more often in patients with HRE who had higher wall motion score index (WMSI). GLS on exertion and its increment were lower in HRE group (Fig. 1 - "Bull’s eye" diagrams of GLS at rest and on exertion in patient with NRE (upper panel) and HRE (lower panel)). Among dyssynchrony markers we revealed higher values of STE-TIME SD on exertion in HRE group (Table 1). Moreover the analysis showed positive correlations between BP level on exertion and peak GLS (r = 0.56, p < 0.0001), GLS increase (r = 0.54, p < 0.0001) and STE-TIME SD on exertion (r = 0.27, p < 0.02)

Conclusions HRE is associated with less increment in GLS and 2D-EF on exertion. Besides LV dyssynchrony signs can appear in response to exaggerated afterload increase even in patients with narrow QRS complexes.

Patients with HRE more often show stress-induced WMA and have greater WMSI on exertion in absence of coronary artery lesions, thus HRE can alter the specificity of the test in transient ischemia detection.

Table 1 HRE NRE p Δ-2D ejection fraction 5.0 (4.0; 7.0) 10.0 (8.0; 12.5) <0.0000001 Δ-3D ejection fraction 8.25 (4.0; 8.25) 8.24 (8.15; 11.65) 0.09 Wall motion abnormalities on exertion 46.34% 1.8% <0.00001 Wall motion score index 1.0 (1.0; 1.18) 1.0 (1.0; 1.0) 0.00013 GLS on exertion -21.0 (-22.0; -19.0) -24.0 (-26.5; -23.0) <0.0000001 ΔGLS 0.0 (-1.0; 2.0) 4.0 (2.0; 6.0) <0.0000001 STE-TIME SD-IMPOST 42.0 (35.0; 53.0) 35.0 (27.5; 45.0) 0.012 Left ventricle systolic function and dyssynchrony in two groups. Abstract Figure 1.
The utility of a novel approach to quantify dyssynchrony by multidetector computed tomography
Authors: Onishi T , Koyama Y , Inoue K , Iwakura K , Okamura A , Iwamoto M , Watanabe S , Nagai H , Hirao Y , Tanaka K , Tanaka N , Okada M , Sumiyoshi A , Yoshimoto I , Fujii K
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Quantification of left ventricular (LV) dyssynchrony is of great interest for resynchronization therapy (CRT). Recently, cardiac computed tomography (CCT) is feasible for evaluation of dyssynchrony. Our aim was to assess a novel simplified approach using CCT to quantify LV dyssynchrony.

Methods

We studied 346 consecutive patients with a wide range of QRS width and ejection fractions (EF). Electrocardiogram-gated contrast-enhanced 256-slice multidetector CT (Brilliance 256 iCT, Philips Medical Systems) was performed before CRT. After CCT scan, the LV endocardial boundaries from short-axis images reconstructed at 5% increments of cardiac cycle were automatically detected, and a time from R-wave to maximal wall motion was calculated for each of the 16 standardized segments for all slices using software "Myocardial Contraction Map" (Argus, Inc Ehime, Japan). The standard deviation of all segments modified by mean heart rate (%SD) was respectively calculated as the global parameter of dyssynchrony. LVEF was also measured using MDCT.

Results

%SD was feasible in all patients, respectably. %SD was significantly different between the different QRS duration groups; narrow QRS (<120ms): 9 ± 5%, relatively wide QRS (120-150 ms): 11 ± 6%, and significantly wide QRS (>150 ms): 14 ± 7% (p <0.001). Moreover, there was significantly difference in %SD between the different morphology groups; normal: 9 ± 7%, Non-left bundle branch block (Non-LBBB): 10 ± 6%, LBBB: 17 ± 7% (p <0.001).

Conclusion

This novel simplified approach by CCT can quantify dyssynchrony in different QRS duration and morphology groups. This method has promise for clinical applications to the evaluation of patients for CRT.

Abstract Figure.
Evolution of coronary artery calcium and absolute myocardial perfusion after percutaneous revascularization: a 3-year serial hybrid [15O]H2O PET/CT imaging study
Authors: De Winter RW , Schumacher SP , Stuijfzand WJ , Van Diemen PA , Everaars H , Bom MJ , Van Rossum AC , Van De Ven PM , Appelman Y , Lemkes JS , Verouden NJ , Nap A , Raijmakers PG , Knaapen P
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background. The value of serial coronary artery calcium (CAC) scores to predict changes in absolute myocardial perfusion and epicardial vasomotor function is poorly documented.

Purpose. This study explored the association between progression of CAC score and changes in absolute myocardial perfusion.

Methods. Fifty-three patients with single-vessel coronary artery disease (CAD) underwent [15O]H2O Positron Emission Tomography/Computed Tomography at 1 month (baseline), 1 year, and 3 years after percutaneous coronary intervention (PCI) to assess CAC scores, hyperemic myocardial blood flow (hMBF), coronary flow reserve (CFR) and cold pressor test MBF (CPT-MBF), within the context of the VANISH (Impact of Vascular Reparative Therapy on Vasomotor Function and Myocardial Perfusion) trial. Relationships between baseline CAC score and evolution of perfusion indices were explored with a mixed model-analysis.

Results. Baseline CAC score was 0 in 9%, 0.1-99.9 in 40%, 100-399.9 in 36% and ≥400 in 15% of patients, respectively. In higher baseline CAC groups, scores increased more over time (overall p < 0.01). Mixed model-analysis allowed for averaging perfusion indices over all time points: hMBF (3.74 ± 0.83; 3.33 ± 0.79; 3.08 ± 0.78 and 2.44 ± 0.74 mL·min-1·g-1) and CFR (3.82 ± 1.12; 3.17 ± 0.80; 3.19 ± 0.81; 2.63 ± 0.92) were lower among higher baseline CAC  groups (p < 0.01; p = 0.03). However, no significant interaction was found between baseline CAC groups and time after PCI for all perfusion indices, denoting that evolution of perfusion indices over time were not significantly different between CAC groups. Furthermore, CAC progression was not correlated with evolution of hMBF (r = 0.08, p = 0.57), CFR (r = 0.09, p = 0.53) or CPT-MBF (r = 0.03, p = 0.82) during 3 years follow-up.

Conclusions. Higher baseline CAC was associated with lower hMBF and CFR. However, both baseline CAC and its progression were not associated with evolution of absolute hMBF, CFR and CPT-MBF over time, suggesting that CAC score and progression of CAC are poor indicators of change in absolute myocardial perfusion.
Computed tomography coronary angiogram in left main stem disease: how does it fare against invasive coronary angiography?
Authors: Liu S , Tyebally S , Ramasamy A , Bajaj R , Bajomo T , Nadarajan N , Menezes L
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Computed Tomography Coronary Angiography (CTCA) is increasingly being used to detect and exclude the presence of coronary artery stenosis. Published studies to date comparing CTCA to invasive coronary angiography (ICA) have focused on epicardial vessels other than the left main stem (LMS) (1 - 4). Despite the diagnostic accuracy of CTCA specifically for LMS disease being unknown, it has been used in a recent multi-centre trial (5).

Purpose

To evaluate the diagnostic performance of CTCA compared with ICA for the detection and visual grading of native Left Main Stem lesions. 

Methods

Retrospective study of patients who underwent CTCA and ICA within 12 months as part of a Quality Improvement project, with no prior coronary intervention. CTCA LMS lesions were graded by consensus of 3 independent blinded reviewers using the Coronary Artery Disease - Reporting and Data System (CAD-RADS) (none, minimal, mild, moderate and severe) and ICAs were similarly evaluated by consensus of 2 independent, blinded reviewers. Moderate and severe LMS lesions were considered clinically significant.

Results

A total of 53 subjects underwent both CTCA and ICA (70% male, mean age: 62). 66% of LMS lesions were found to be significant on ICA. Compared to ICA, CT angiography has a sensitivity of 83% and a specificity of 89% for detecting a significant LMS stenosis of 50% or more, with a positive predictive value of and a negative predictive value of 94% and 73% respectively. CTCA for detecting a significant LMS stenosis has a AUC of 0.88.  In stenosis grading, CTCA correlated with ICA at the same CAD-RADS level in 53% of cases, with over-estimation in 19% and under-estimation in 28% of cases. 

Conclusion

In this retrospective single centre study of patients with native coronary vessels, CTCA is shown to be accurate in identifying significant LMS lesions detected on ICA. However, at a level of stenosis grading, there is significant inter-modality discrepancy with CTCA associated with over- and under-estimation of LMS lesion severities compared with ICA.

Diagnostic Performance of CTCA vs ICA Significant LMS lesion ICA positive ICA negative CTCA positive 29 2 CTCA negative 6 16 Diagnostic Performance of CTCA vs ICA in significant LMS lesions Abstract Figure. Significant LMS lesions:CTCA performance
CCTA-derived functional and morphological features and their comparative performance in predicting impaired coronary vasodilatation by PET-myocardial perfusion imaging
Authors: Kalykakis G , Antonopoulos A , Pitsariotis T , Siogkas P , Exarchos T , Kafouris P , Liga R , Giannopoulos A , Scolte A , Kaufmann P , Parodi O , Knuuti J , Fotiadis D , Neglia D , Anagnostopoulos C
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported in part from European Regional Development Fund, Operational Programme “Competitiveness, Entrepreneurship and Innovation 2014-2020 (EPAnEK)”, titled: The Greek Research Infrastructure for Personalized Medicine (pMED-GR) , no. GR 5002802 ,and by Greece and the European Union (European Social Fund-ESF) through the Operational Programme «Human Resources Development, Education and Lifelong Learning 2014-2020» in the context of the project “Assessment of coronary atherosclerosis: a new complete, anatomo-functional, morphological and biomechanical approach”, Project no. 504776

onbehalf

EVINCI-SMARTOOL

Background/Objectives: The relationship between biomechanical characteristics of a coronary lesion with myocardial blood flow has not been studied. We investigated the relationship between local endothelial shear stress (ESS) and computed tomography coronary angiography (CTCA)-derived anatomical and plaque characteristics data with impaired vasodilating capability assessed by positron emission tomography myocardial perfusion imaging (PET-MPI).

Methods

A total of 92 coronary vessels of 53 patients who have undergone both CTCA and PET-MPI with 15O-water or 13N-ammonia were analysed. PET was considered abnormal when > 1 contiguous segments showed both stress Myocardial Blood Flow (MBF) ≤2.3mL/g/min and Myocardial Flow Reserve (MFR) ≤2.5 for 15O-water or <1.79 mL/g/min and ≤2.0 for 13N-ammonia respectively.  CTCA images were used to assess stenosis severity, lesion specific total plaque volume (PV), non-calcified PV and calcified PV as well as plaque phenotype. ESS was calculated for the full length of a lesion (total), as well as in the proximal, minimum lumen area and distal lesion segments.

Results

ESS was weakly correlated with total PV (rho = 0.273, p = 0.008), non-calcified PV (rho = 0.247, p = 0.017) and the volume of necrotic core (rho = 0.242, p = 0.02). ESS increased progressively with stenosis severity (p ≤ 0.001). ΕSS was also higher in functionally significant vs. non-significant lesions (10.4 [8.04-54.4] Pa vs. 3.9 [2.32-7.29] Pa, p ≤0.001). Addition of ESS to stenosis severity improved prediction (Δ[AUC]:0.113, 95% CI: 0.055 to 0.171, p = 0.0001) of functionally significant lesions.

Conclusion

There is a weak positive association between lesion-specific ESS and plaque volume. ESS increases progressively with stenosis severity and is higher in functionally significant lesions by PET-MPI. The addition of ESS to CTCA-anatomical information improves prediction of an abnormal PET-MPI result.
Impact of coronary atherosclerotic plaque metrics and CT reader skills on inter-observer variation of repeated on-site CT-FFR
Authors: Vilades Medel D , Bos L , Jimenez Kockar M , Altisent O , Rodriguez O , Alomar X , Schuijf J , Leta R
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background and Purpose

 

Little is known about the on-site CT-FFR inter-reader reproducibility and its variability in different atherosclerotic plaque scenarios. The aim of this study was to determine the variation of repeated CT-FFR analyses between two CCTA readers with different training skills across different atherosclerotic features. 

Methods

 

Patients referred for invasive coronary angiography who accepted to undergo a CCTA/CT-FFR study were prospectively included. Patients with contraindications for CCTA, atrial fibrillation, chronic total occlusions or previous coronary revascularization were excluded. Quantification of atherosclerotic plaque metrics and CT-FFR was performed for each coronary vessel by two different CT readers, one Level I and one Level III. Inter-reader agreement for CT-FFR was assessed using kappa index, Bland-Altman and Lin’s concordance correlation agreement (LCCA). The impact of each atherosclerotic feature was assessed by dividing the dataset based on the corresponding median and assessing inter-reader variability for both the lower and upper half.

Results

47 patients (137 vessels) were included. Mean age was 66 ± 10 years, 89% were males, 63% had hypertension, 76% dyslipidemia and 38% diabetes. Degree of stenosis was moderate (50-69%) in 29% and severe (≥70%) in 28% of vessels with a positive CT-FFR (≤0.80) in 39%. CT-FFR showed good correlation between the two readers based on a kappa index of 0.77 with a mean CT-FFR difference of -0.017 ± 0.12. The inter-reader agreement was good in the main epicardial vessels (LCCA of 0.70 for LAD, 0.74 for LCX and 0.76 for RCA, p < 0.001 for all) and better in proximal than in distal segments (LCCA of 0.83 vs 0.63, p < 0.001). Likewise, in different atherosclerotic plaque scenarios, the agreement was better in those vessels with lower plaque volume, less calcified and longer lesions (see table 1). 

Conclusions

 

In our cohort, on-site CT-FFR showed good inter-reader agreement without relevant impact by reader experience level and atherosclerotic plaque features.

Table 1 Mean difference Bland-Altman Lin’s concordance correlation coefficient p value Plaque volume < median (556 mm3) -0.01 ± 0.12 0.85 <0.001 Plaque volume > median (556 mm3) -0.035 ± 0.13 0.64 <0.001 Calcified plaque burden < median (34%) -0.03 ± 0.11 0.82 <0.001 Calcified plaque burden > median (34%) -0.02 ± 0.14 0.75 <0.001 Lesion length < median (55 mm) -0.005 ± 0.12 0.68 <0.001 Lesion length > median (55 mm) -0.031 ± 0.12 0.83 <0.001 *p values indicate inter-reader agreement by two independent observers for each category
Early results for iCMR in atrial flutter
Authors: Tomala J , Ulbrich S , Richter U , Huo Y , Gaspar T
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 As a standard of care, ablation of typical atrial flutter involves performing cardiac catheterization under x-ray fluoroscopy. The unique ability of magnetic resonance (MR) to provide real-time functional imaging in multiple views without ionizing radiation exposure has the potential to be a powerful tool for diagnostic and interventional procedures. Real-time MR imaging-guided radiofrequency (RF) ablation has been used as a part of clinical trials.

Objective

 To implement the MR imaging-guided RF ablation of typical atrial flutter in the clinical routine.

Methods

 From January to July 2020, 15 consecutive patients with typical atrial flutter have been referred for ablation. Patient preparation, conscious sedation and groin puncture took place inside the 1.5 Tesla MR scanner as a part of an MR-only workflow. The catheter advancement as well as the RF ablation procedure have been performed under direct visualisation of catheters with integrated micro-coils using an interactive sequence with active tip tracking and automatic slice positioning in the plane where the catheter tip has been detected. During catheter advancement a single frontal plane has been used to visualize the passage of the catheter through femoral veins and inferior vena cava. With both diagnostic and ablation catheters in the right atrium, an axial stack of balanced steady-state free precession acquisitions has been acquired and used to reconstruct planes in the short- and long cardiac axis. These have been used to provide a "left- and right anterior oblique" view familiar to an interventional electrophysiologist. The subsequent catheter placement and ablation have been performed under direct visualisation in these two planes (see figure).

Results

 The ablation was successful in 14 patients, one patient had to undergo a conventional procedure on the following day. The mean time to reach right atrium and coronary sinus was 4 [3,5] and 7 [6,10] minutes, respectively. The mean total ablation duration and procedure time was 18 [12,26] and 43 [33,58] minutes, respectively. There were no adverse events.

Conclusion

 The implementation of the MR imaging-guided RF ablation of typical atrial flutter in the clinical routine is feasible and leads to similar success rates and procedure times as the conventional fluoroscopy-based ablation.

Abstract Figure.
Interaction of stroke volume and myocardial phenotype in patients with severe aortic stenosis referred for intervention: outcome data from the BSCMR AS700 study
Authors: Thornton GD , Musa TA , Rigolli M , Loudon M , Chin C , Pica S , Malley T , Foley JRJ , Vassiliou VS , Davies RH , Captur G , Dobson LE , Singh A , Treibel TA
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

onbehalf

The BSCMR Valve Consortium

Background

 Patients with low-flow aortic stenosis (LF-AS) have higher mortality than those with high-flow severe AS.  The conventional echocardiographic definition of LF-AS is an indexed stroke volume (SVi) <35ml/m2. Whether this cut-off translates to cardiac magnetic resonance (CMR), and how CMR SVi associates with myocardial remodelling (volume/function/scar) and survival is unclear.

Purpose

 To determine the association between CMR SVi, myocardial remodelling and survival in severe symptomatic AS. 

Methods

  In a multi-centre longitudinal outcome study of patients with severe AS listed for either surgical (SAVR) or transcatheter aortic valve intervention (TAVI) at six cardiothoracic centres, survival was assessed and stratified by SVi. Patients underwent preprocedural echocardiography and CMR between January 2003 and May 2015.  Standardised core-lab analyses on pre-procedural CMR for biventricular volumes, function and scar quantification were performed. All-cause and cardiovascular mortality were tracked for a minimum of two years after AVR.

Results

 A total of 674 patients with severe AS (age 75 ± 14years; 63% male, aortic valve area 0.4 ± 0.1 cm2/m2) were included.  Patients with low SVi by CMR <35ml/m2 were older and had a greater burden of comorbidities (atrial fibrillation [AF], diabetes, high BMI). Independent predictors of SVi were age, AF, increased left atrial volume, aortic valve regurgitant fraction and left ventricular mass (LV) mass index (by CMR). There was no difference in SVi with choice of intervention (TAVI vs SAVR) or presence of late gadolinium enhancement. In multivariate analysis (Table 1), SVi was associated with cardiovascular mortality in the whole cohort (HR 0.97, 95%CI 0.95-0.99, p = 0.02), and all-cause mortality after TAVI (HR 0.97, 95%CI 0.95-0.99, p = 0.006) but not SAVR (p = 0.6). Adjusted mortality hazard increases below 50ml/m2 and plateaus between 35-40ml/m2 (Figure 1A), adjusted for LGE, STS score (Society of Thoracic Surgery score) and wall thickness.

Conclusion

SVi by CMR is an independent predictor of cardiovascular mortality. Mortality hazard increases progressively below a SVi of 50mL/m2.

Abstract Figure 1
Assessment of myocardial deformation with CMR: a comparison with ultrasound speckle tracking in a cohort of highly trained endurance athletes
Authors: Domenech-Ximenos B , Sanz-De La Garza M , Sepulveda-Martinez A , Lorenzatti D , Simard F , Crispi F , Perea RJ , Prat-Gonzalez S , Sitges M
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Plan Nacional I.D., Del Programa Estatal de Fomento De La Investigación Científica y Técnica de Excelencia, Subprograma De Generación Del Conocimiento, Ministerio de Economía y Competitividad 2013.

Background

 Myocardial deformation integrated with cardiac dimensions provides a comprehensive assessment of the ventricular remodelling patterns induced by cumulative effects of intensive exercise. Feature tracking(FT) can measure myocardial deformation from cardiac magnetic resonance(CMR) cine sequences; however, its accuracy is still scarcely validated.

Purpose

 Our aim was to compare FT’s accuracy and reproducibility to speckle tracking echocardiography (STE) in highly trained endurance athletes (EAs).

Methods

 93 EAs (>12 hours training/week during the last 5 years, 52% male, 35 ± 5.1 years) and 72 age-matched controls underwent a resting CMR and a transthoracic echocardiography to assess biventricular exercise-induced remodelling and biventricular global longitudinal strain (GLS) by CMR-FT and STE.

Results

  High endurance training load was associated with larger bi-ventricular and bi-atrial sizes and mildly reduced systolic function of both ventricles (p < 0,05). Strain values (both by CMR-FT and STE) proportionally decreased with increasing ventricular volumes potentially depicting the increased volume and functional biventricular reserve that characterize EAs heart. Strain values were lower when assessed by CMR-FT as compared to STE (p < 0.001), with good reproducibility for the LV (bias = 3.94%, LOA= ± 4.27%) but wider variability for RV strains (Figure 2).

Conclusions

  Biventricular longitudinal strain values were lower when assessed by FT compared to STE. Both methods were comparable when measuring LV strain but not RV strain. These differences might be justified by FT’s lower in-plane spatial and temporal resolution, which is particularly relevant for the complex anatomy of the RV.

Abstract Figure. Fig 1. Bland-Altman plots; FT vs STE.
Additional prognostic role of strain with stress cardiac magnetic resonance (PROGRESS)
Authors: Guglielmo M , Fusini L , Baessato F , Loffreno A , Muscogiuri G , Baggiano A , Del Torto A , Scafuri S , Babbaro M , Mollace R , Guaricci AI , Mushtaq S , Conte E , Pepi M , Pontone G
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Stress cardiovascular magnetic resonance (S-CMR) has been recognized as a reliable technique for the diagnosis and prognostic stratification of patients with known or suspected coronary artery disease (CAD). Recently, the novel technique of feature-tracking (FT) strain has been applied to S-CMR in order to improve the risk stratification of patients. However, no data are available on the prognostication role of FT strain in patients undergoing a S-CMR with dypiridamole. Aim of this study is to assess the additional role of FT strain in the long-term risk stratification of a large population of patients with known or suspected CAD undergoing a S-CMR with dypiridamole.

Methods

731 consecutive patients (age: 63 ± 10 y, male 84%) with stable typical or atypical symptoms suggesting possible cardiac ischemia underwent dipyridamole S-CMR. The patients were followed up for 5.8 ± 1.2 years. CMR-FT analysis of steady state free precession (SSFP) short and long axis cine images obtained in rest and stress conditions was performed in each patient to obtain 2D global peak systolic rest and stress longitudinal (GLS), circumferential (GCS) and radial strains (GRS). Major adverse cardiac events (MACE) were defined as myocardial infarction and cardiac death.

Results

 MACE occurred in 64 (8.7%) patients. Patients experiencing MACE showed higher indexed left ventricular (LV) end-diastolic (EDVi), end-systolic (ESVi) volumes and lower LV ejection fraction (LVEF), higher late-gadolinium enhancement (LGE) presence and reduced both rest and stress GLS, GCS and GRS. At multivariable analysis, LVEDVi (HR 1,01 [95% CI 1.001-1.022]) and LGE (HR 2.399 [95% CI 1.322-4.355] were independently associated with MACE (p = 0.027 and p = 0.04 respectively).  By Kaplan-Meier analysis, patients with stress GLS ≥  -15.35% had significantly reduced event-free survival compared with those with stress GLS < -15.35 (log-rank p = 0.001). A model based on stress GCS > - 15.3% plus LVEDVi showed a similar prognostication value of a model made of LVEDVi plus LGE.

Conclusions

In patients with known or suspected CAD undergoing S-CMR with dypiridamole, a model based on LVEDVi plus stress GCS owns a prognostication value similar to LVEDVi plus LGE.
The role of circumferential strain in the differential diagnosis of cardiomyopathies with left ventricular hypertrabeculation
Authors: Szucs A , Gregor ZS , Kiss AR , Horvath M , Farsang V , Szabo LE , Toth A , Dohy ZS , Czimbalmos CS , Merkely B , Vago H
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported by the ÚNKP-19-3-II New National Excellence Program of the Ministry for Innovation and Technology

Dilated (DCM), hypertrophic (HCM) and noncompaction cardiomyopathy (NCMP) are genetically and morphologically overlapping diseases, however they differ in clinical manifestation, treatment and prognosis. Cardiac MRI feature-tracking might help to differentiate between these cardiomyopathies with left ventricular (LV) hypertrabeculation.

We aimed to describe the differences in the functional and strain parameters of NCMP patients with good LV ejection fraction (EF, NCMP-G) compared with patients with HCM, and NCMP patients with reduced EF (NCMP-R) compared with patients with DCM .

We included 62 NCMP patients from which 31 had good LV function and 31 had decreased LV-EF. The NCMP-G group was compared with an HCM population (n = 31) and the NCMP-R group was compared with a DCM group (n = 31) matching in age and sex (age, EF; NCMP-G 46.0 ± 13.0 years, 65.5 ± 5.3% vs. HCM 47.2 ± 14.4 years, 74.8 ± 6.3%; NCMP-R 54.5 ± 12.1 years, 32.8 ± 10.1% vs. DCM 50.8 ± 16.7 years, 34.0 ± 8.2%). 

1.5 T Philips Achieva and Siemens Aera MRI machines were used for the scans, Medis Suite program was used for analysis and MedCalc software for statistics, p < 0.05 was considered statistically significant.

Significant differences were found between the functional parameters of HCM and NCMP-G patients, while the DCM and NCMP-R groups differed only in the trabecular mass values (LV-trab, NCMP-G vs. HCM: 26.2 ± 7.5 vs. 30.7 ± 7.0 g/m2, NCMP-R vs. DCM:  48.2 ± 13.2 vs. 42.1 ± 10.1 g/m2, p < 0.05). The global longitudinal strain values of the studied populations were not significantly different, however the global circumferential strain (GCS) values were significantly better in patients with HCM and DCM compared with the NCMP groups (GCS, NCMP-G vs. HCM: -31.2 ± 4.9 vs. -43.0 ± 8.4%, NCMP-R vs. DCM: -11.7 ± 7.3 vs. -16.9 ± 6.1%). The average circumferential strain values of the LV basal, mid and apical parts were significantly better in the HCM and DCM groups compared with the NCMP groups (NCMP-G vs. HCM: -35.7 ± 9.5 vs. -50.5 ± 14.1%, NCMP-R vs. DCM: -29.5 ± 13.2 vs. -15.6 ± 6,7%).  We assessed the cut-off point of the average LV apical circumferential strain to differentiate the studied populations (HCM vs. NCMP-G cut-off: -47.3% sens.: 83.9%, spec.: 67.7%, AUC: 0.81; DCM vs. NCMP-R cut-off: -19.3% sens.: 83.9%, spec.: 83.9%, AUC: 0.86).

The diverse circumferential strain values of the hypertrabeculated LV apical third could help the differential diagnosis of NCMP, DCM and HCM.
Leaflets fusion length in bicuspid aortic valve is related to ascending and aortic root dilation and ascending aorta wall shear stress
Authors: Guala A , Evangelista A , La Mura L , Teixido-Tura G , Dux-Santoy L , Ruiz-Munoz A , Cinque A , Valente F , Lopez-Sainz A , Galian-Gay L , Gutierrez L , Gonzalez-Alujas T , Sao-Aviles A , Ferreira I , Rodriguez-Palomares JF
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Spanish Ministry of Science, Innovation and Universities, Instituto de Salud Carlos III

Background

Bicuspid aortic valve (BAV) is the most common congenital heart defect, consisting in the fusion of two aortic valve leaflets. Altered flow patterns have been related to aortic wall degeneration in BAV patients and may be responsible for the high prevalence of aortic disease in these patients. A number of studies on excised BAV or using advanced imaging modalities reported a wide variability of fusion extent between leaflet, but no previous study assessed whether leaflet fusion length may be used to stratify BAV patients.

Purpose

We aimed to test whether leaflet fusion extent can be quantified by cardiac magnetic resonance imaging (CMR) and whether it is related to aortic dilation and flow abnormalities in non-dysfunctional BAV.

Methods

One hundred and twenty BAV adults with no previous aortic or aortic valve surgery or significant valvular disease were consecutively enrolled. Patients with two sinuses of Valsalva (true BAV) or fusion of the left and non-coronary cusps, both being rare forms of BAV, were excluded. Twenty-eight healthy volunteers were also included for comparison. A 4D flow CMR sequence was acquired and circumferential wall shear stress and pulse wave velocity were assessed in the ascending aorta. A stack of double-oblique cine images of the aortic valve were used to quantify the length of the fusion between leaflets.

Results

The length of the fusion between leaflets was effectively measured in 112/120 patients (93%). Reproducibility was good (ICC = 0.826). Fusion length varied greatly (range 2.3 – 15.4 mm, 7.8 ± 3.2 mm, tertiles cut-off points were 6 and 9.3 mm). After correction for age, BSA, stroke volume and BAV fusion morphotype, fusion length was independently associated with diameter at the sinus of Valsalva (p = 0.002). Moreover, once corrected for age, stroke volume and ascending aorta pulse wave velocity, fusion length was positively related to ascending aorta diameter (p = 0.028). The comparison of maps of circumferential peak-systolic WSS in healthy volunteers (left) and BAV patients pertaining to the three leaflet fusion length tertiles is shown in Figure 1. Circumferential WSS progressively increase with larger fusion length. This trend was statistically significant (p < 0.05) in the right and outer regions of the proximal and mid ascending aorta.

Conclusions

Bicuspid aortic leaflet fusion length varies considerably and it is independently associated with ascending aorta and aortic root dilation, possibly through flow alterations.

Abstract Figure 1