bluuebunny/crossref_metadata_2025 huggingface dataset:
Olive extract enriched with hydroxytyrosol improves cardiac and vascular function in patients with stable coronary artery disease: a double-blind, placebo-controlled trial
Authors: Katogiannis K , Chania C , Tsoumani M , Brinia E , Pavlidis G , Thymis J , Tsilivarakis D , Kountouri A , Korakas E , Lambadiari V , Skaltsounis L , Tseti I , Iliodromitis E K , Andreadou I , Ikonomidis I
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Olive Heart Operational Programme Competitiveness, Entrepreneurship and Innovation 2014–2020 (EPAnEK)

Aims

We investigated the effect of olive extract enriched with hydroxytyrosol, on vascular and myocardial function markers in patients with stable coronary artery disease (SCAD).

Methods

In a prospective, cross-over, double-blind, placebo-controlled, clinical trial, 30 patients with stable CAD were randomly assigned to an oral supplement containing olive oil extract enriched with hydroxytyrosol (OOHT) or placebo for one month and then were crossed over to the alternate treatment (placebo or OOHT for one more month). We measured a) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), b) flow-mediated dilation (FMD), c) Coronary Flow Reserve (CFR) and markers of LV diastolic function by Doppler echocardiography d) Pulse Wave Velocity (PWV) e) oxidative/nitrosative stress and inflammatory biomarkers and blood lipids at baseline and after one month treatment.

Results

Treatment with OOHT improved PBR, FMD, CFR and PWV compared to baseline (1.81±0.35 vs 1.77±0.40 μm p = 0.04 3.71±2.12 vs 6.51±2.31%, p<0.001;2.37±0.40 vs 2.45±0.41, p = 0.030 and 11.03±1.81 vs 11.78±2.34 m/sec, p = 0.002), while there was no effect after placebo (p>0.05). Compared to baseline, treatment with OOHT reduced malondialdehyde (MDA) a marker of lipid peroxidation (2.10±1.37 vs 1.69±0.83 mmol/lt, p = 0.045), oxidized LDL, triglycerides, PCSK9 and CRP blood levels (p<0.05) in contrast to placebo. There was a parallel improvement of E’ of the mitral annulus and deceleration time of the E wave of mitral inflow after OOHT (p<0.05) but not after placebo.

Conclusions

Olive extract enriched with hydroxytyrosol improves endothelial and arterial function likely by reducing oxidative and inflammatory burden leading to improved LV diastolic function after one month of treatment in patients with stable CAD.
Effect of glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors and their combination on left atrial strain and arterial function
Authors: Katogiannis K , Thymis J , Kousathana F , Pavlidis G , Korakas E , Kountouri A , Prentza V , Tsilivarakis D , Lambadiari V , Ikonomidis I
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

We investigated the effects of insulin, glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on left atrial function of patients with type 2 diabetes mellitus and we searched for a relation with arterial function.

Patients and methods

A total of 201 patients (59,5±9,1 year old, 161 male) with type 2 diabetes mellitus treated with metformin were randomized to insulin (n= 50 served as controls), liraglutide (n=51), empagliflozin (n=50) or their combination (GLP-1RA+SGLT- 2i) (n= 50) as add-on. We measured at baseline and 6 months posttreatment: (a) perfused boundary region of the sublingual arterial microvessels (marker of endothelial glycocalyx thickness), (b) pulse wave velocity (PWV) and central systolic blood pressure, (c) global left ventricular Longitudinal strain, (d) left atrial strain.

Results

Six months after intervention, all patients improved left atrial reservoir strain (GLP1RA 30,7±9,3 vs 33,9±9,7%, p = 0,011/SGLT2i 30±8,3 vs 32,3±7,3%, p = 0,04/ GLP1&SGLT2i 29,1±8,7 vs 31,3±8,2, p = 0,007) in comparison with controls (33±8,3% vs 32,8±7,4, p = 0,829). Also, patients treated with GLP1RA and their combination improved left atrial conduction strain (p<0.05). GLP-1RA or GLP-1RA+SGLT-2i provided a greater improvement in GLS compared with insulin or SGLT-2i (controls –18,5±3,9% vs − 19,1±3%, p = 0,202/GLP1RA –18,2±4,1% vs –19,1±3,5%, p = 0,03/SGLT2i –19±4,1% vs − 19,1±3,8%, p = 0,764/GLP1&SGLT2i –16,7±3,9% vs –17,5±4,3%, p = 0,026). SGLT-2i or GLP-1RA and SGLT-2i showed a greater decrease of PWV (Controls 12,06±3,02 vs 11,62±2,79 m/sec, p = 0,142/ GLP1 11,54±2,91 vs 11,45±2,52 m/sec, p = 0,822/ SGLT2 11,86±2,51 vs 11,33±2,28 m/sec, p = 0,047/ GLP1&SGLT2 12,01±2,46 vs 10,85±1,79 m/sec, p = 0,021) and central and brachial systolic blood pressure than insulin or GLP-1RA. At baseline, there was a correlation of LA reservoir strain with PWV (r =−0,209, p = 0,008), central SBP (r =−0,151, p = 0,030), EF (r=0,214, p = 0,004), GLS (r =−0,279, p = 0,009). At 6 months follow up, there was a correlation of LA reservoir strain with PWV (r=0,217, p = 0,003), central SBP (r =0,214, p = 0,004), EF (r=–0,221, p = 0,049), GLS (r =0,275, p = 0,014).

Conclusions

Treatment with GLP-1RA, SGLT-2i, and their combination for 6 months showed a greater improvement of left atrial function compared to insulin treatment in parallel with improvement arterial and myocardial function.
Impaired endothelial glycocalyx, vascular dysfunction and myocardial deformation four months after Covid-19 infection are partially improved at twelve months
Authors: Katogiannis K , Ikonomidis I , Kountouri A , Mitrakou A , Thymis J , Korakas E , Pavlidis G , Andreadou I , Chania C , Thomas K , Antoniadou A , Lambadiari V , Filippatos G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

COVID-19 patients present impaired subclinical markers of cardiovascular and endothelial function. Subclinical myocardial and vascular dysfunction during COVID-19 disease have been associated with worse outcomes and higher mortality risk.

Purpose

We investigated the effect of COVID-19 infection on markers of endothelial, vascular and myocardial function at four and twelve months after the infection

Methods

We recruited 70 patients who were examined in a dedicated post-COVID-19 outpatient clinic during a scheduled follow-up visit at four and twelve months after a confirmed COVID-19 infection and 70 healthy individuals with similar clinical characteristics. At four and twelve months we measured (i) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), (ii) flow-mediated dilatation (FMD), (iii) coronary flow reserve (CFR) by Doppler echocardiography, (iv) pulse wave velocity (PWV) and central systolic blood pressure (cSBP), (v) global left and right ventricular longitudinal strain (GLS), (vi) myocardial global work index (GWI) global constructive work (GCW), global wasted work (GWW) and the myocardial global work efficiency (GWE) and v) malondialdehyde (MDA), an oxidative stress marker.

Results

At four months, COVID-19 patients displayed higher values of PBR5–25 compared to control group (p<0.001) which increased at twelve months (p<0.001). FMD, PWV and cSBP values were similar between 4 and 12 months (p>0.05 for all the comparisons) and higher than those in controls (p<0.001, p = 0.057, p = 0.003 respectively). At four months, COVID-19 patients presented impaired CFR and LVGLS values which were improved at twelve months (p = 0.002, p = 0.069 respectively), though remained impaired compared to controls (p = 0.003 for all the comparisons). At four months, COVID-19 patients had impaired RVGLS values which were significantly improved at twelve months (p = 0.001) and showed no statistically significant difference compared to controls (p>0.05). COVID-19 patients at four months display higher myocardial wasted work and decreased myocardial efficiency compared to controls (p = 0.01, p = 0.006, respectively). There was a modest improvement in GWW and GWE at twelve months, (p = 0.043, p = 0.001, respectively); however, these markers remained impaired compared to controls (p>0.05). At four months, MDA was higher in COVID-19 patients compared to control group and significantly decreased at twelve months (p<0.001); however, these values remain higher than in controls (p = 0.002).

Conclusions

SARS-CoV-2 causes endothelial and cardiovascular dysfunction which are partially restored at twelve months after the infection.
Effect of Sacubitril/Valsartan and enalapril on left ventricular function in patients with hematologic malignancies after bone marrow transplantation
Authors: Katogiannis K , Ikonomidis I , Stamouli M , Makavos G , Tsilivarakis D , Koliou G A , Vythoulkas D , Tsirigotis P
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background and Aims

Chemotherapy is known for its potential adverse effects on myocardium. Optimal medical treatment for heart failure may reverse myocardial dysfunction in the early stages of toxicity development. We hypothesized that early initiation of treatment with sacubitril/valsartan (s/v) or enalapril (ena) might prevent cardiotoxicity.

Patients and methods

90 patients (mean age 45.7 ± 14,1 years old, 52 male) with preserved ejection fraction, who suffered from hematologic malignancies (lymphoma, leukemia) and underwent bone marrow transplantation, were randomized to receive sacubitril/valsartan 24/26 mg bid daily or enalapril 5 mg bid daily or placebo. We measured at baseline, before transplantation and after six months: i) Global Longitudinal Strain (GLS) of left ventricle (LV) by speckle tracking imaging, ii) myocardial global work index (GWI), global constructive work (GCW), global wasted work (GWW) and myocardial global work efficiency (GWE), by longitudinal strain-peripheral blood pressure loops, and iii) Left Ventricular Ejection Fraction (LVEF Simpson’s Method).

Results

The two treatment groups had similar age, sex atherosclerotic risk factors and cardiotoxic medication before and after bone marrow transplantation.

Compared to baseline, patients treated with sacubitril/valsartan or enalapril for six months did not show a deterioration of LV GLS (−19.8±2.8 vs −19.3±4.1%, p = 0.403 for s/v, −20.3±2.8 vs −20.0±3.6%, p = 0.634 for ena). Conversely, patients treated with placebo for six months, presented a significant impairment of LV GLS (−20.9±2.1% vs −18.5±2.2, p = 0,001).

No significant changes were found in LVEF after treatment with sacubitril/valsartan or enalapril for six months (57.5±4.9 vs 57.9±6.8%, p = 0.826 for s/v, 58.8±5.4 vs 60.7±7.1%, p = 0.419, for ena), while a borderline deterioration was noticed after treatment with placebo for six months (60.6±5.4 vs 57.7±6.7%, p = 0,045).

We did not notice any alteration in GWi, GCW, GWW, GWE in patients treated with enalapril. On the other hand, in patients treated with sacubitril/valsartan GWE was improved (94.2±3.1 vs 95.8±1.8 %, p = 0.030) and GWW was diminished (111.5±75.7 vs 86.4±43.1 mmHg%, p = 0.045), while GWI and GCW did not show any significant alteration. Conversely, in the placebo group, GWI was reduced (1909.9±336.4 vs 1727.9±340.9 mmHg%, p = 0.027), GWW was increased (80.7±60.6 vs 110.6±65.1 mmHg%, p = 0.045), GWE was diminished (95.9±2.1 vs 94.1±3.9 %, p = 0.039) and GCW did not change.

Conclusions

Treatment with sacubitril/valsartan or enalapril prevented deterioration of myocardial function six months after bone marrow transplantation in patients with hematologic malignancies and preserved ejection fraction. Moreover, sacubitril/valsartan showed a more favorable effect on myocardial work.
Impact of Covid-19 and pandemic restrictions on post infarction myocardial scar evaluated on cardiac magnetic resonance
Authors: Enrico Tadiello M D , Anna Piccoli M D , Giovanni Benfari P H D , Eleonora Bonvicini M D , Giovanni Puppini M D , Flavio Ribichini P R O F
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Italy was one of the first nations in the world to face the threat of COVID-19. Data suggest that mortality from cardiovascular causes increased during the pandemic period, compared with a reduction of the number of hospitalizations for the same cause1–2.

Purpose

Extension of myocardial damage after a cardiac ischemic event is strongly related to patient's short- and long-term prognosis. Aim of this retrospective study is to evaluate the impact of COVID-19 and pandemic restrictions on the extension of the post-infarct myocardial scar, assessed by cardiac magnetic resonance imaging.

Methods

Fifty consecutive patients hospitalized for acute myocardial infarction who underwent CMR were retrospectively enrolled: 30 patients in the pre-COVID period (from January 2015 to February 2020) and 20 in the pandemic period (from March 2020 to June 2021). We selected only patients with no previous history of ischemic heart disease. Clinical, anamnestic and imaging data (echocardiography and cardiac magnetic resonance) were collected.

Results

Patients of the two groups did not differ in clinical characteristics, except for the absence of women in the pandemic group (23% vs 0%, p = 0.02). Drugs and treatments used, severity of coronary artery disease and echocardiographic parameters were similar in both groups. The number of segments with transmural fibrosis was larger in COVID group (5.9 vs 4.2, p = 0.05, considering 17 myocardial segments on a bull eyes map). Furthermore in COVID group end diastolic volume was larger (101.3 vs 86.9 ml/mq, p = 0.08) and left ejection fraction was lower (36.0 vs 41.4%, p = 0.18), although not statistically significative. Right ventricle ejection fraction was significatively lower (59.0 vs 63.2%, p = 0.04).

Conclusion

Patients admitted during pandemic waves had a larger myocardial scar, bigger left ventricular volume and lower ejection fraction. According to literature, this have mainly been caused by the long presentation time from symptoms to hospital admission3. Considering that the extension of the post-infarct myocardial scar visible on cardiac magnetic resonance imaging strongly correlates with the short- and long-term prognosis4-5, these data suggest that COVID 19 had and will have in the coming years a significant impact on mortality from myocardial infarction.
Artificial intelligence-based point-of-care lung ultrasound for screening Covid-19 pneumoniae: comparison with CT scans
Authors: Kaneko T , Kuroda Y , Yoshikawa H , Uchiyama S , Nagata Y , Matsushita Y , Hiki M , Minamino T , Takahashi K , Daida H , Kagiyama N
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Although lung ultrasound has been reported to be a portable, cost-effective, and accurate method to detect pneumonia, it has not been widely used because of the difficulty in its interpretation.

Purpose

We aimed to investigate the effectiveness of a novel artificial intelligence-based automated pneumonia detection method using point-of-care lung ultrasound (AI-POCUS) for the coronavirus disease 2019 (COVID-19).

Methods

We enrolled consecutive patients admitted with COVID-19 who underwent computed tomography (CT) in August and September 2021. A 12-zone AI-POCUS was performed by a novice observer using a pocket-size device within 24 h of the CT scan. Fifteen control subjects were also scanned. Additionally, the accuracy of the simplified 8-zone scan excluding the dorsal chest, was assessed. More than three B-lines detected in one lung zone were considered zone-level positive, and the presence of positive AI-POCUS in any lung zone was considered patient-level positive. The sample size calculation was not performed given the retrospective all-comer nature of the study.

Results

A total of 577 lung zones from 56 subjects (59.4 ± 14.8 years, 23% female) were evaluated using AI-POCUS. The mean number of days from disease onset was 9, and 14% of patients were under mechanical ventilation. The CT-validated pneumonia was seen in 71.4% of patients at total 577 lung zones (53.3%). The 12-zone AI-POCUS for detecting CT-validated pneumonia in the patient-level showed the accuracy of 94.5% (85.1% – 98.1%), sensitivity of 92.3% (79.7% – 97.3%), specificity of 100% (80.6% – 100%), positive predictive value of 95.0% (89.6% − 97.7%), and Kappa of 0.33 (0.27 – 0.40). When simplified with 8-zone scan, the accuracy, sensitivity, and sensitivity were 83.9% (72.2% – 91.3%), 77.5% (62.5% – 87.7%), and 100% (80.6% – 100%), respectively. The zone-level accuracy, sensitivity, and specificity of AI-POCUS were 65.3% (61.4% – 69.1%), 37.2% (32.0% – 42.7%), and 97.8 % (95.2% – 99.0%), respectively.

Conclusion

AI-POCUS using the novel pocket-size ultrasound system showed excellent agreement with CT-validated COVID-19 pneumonia, even when used by a novice observer.
Association between change of albuminuria and left ventricular diastolic function in type 2 diabetes
Authors: Wu M Z , Huang J Y , Ren Q W , Tse H F , Yiu K H
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Albuminuria is associated with left ventricular (LV) hypertrophy and diastolic dysfunction in patients with type 2 diabetes (T2DM), however the role of change in albuminuria and cardiac structure and function changes remain unclear. The aim of our study was to investigate the impact of change in albuminuria on changes of echocardiography parameters.

Methods

Patients with T2DM without cardiovascular disease at baseline were recruited from 2012 to 2016. All patients were performed with detailed echocardiography examination and received urine albumin to creatinine ratio (UACR) or 24-h urine albumin excretion (UAE) test at baseline and follow-up. Multivariable linear regression was applied to estimate the association between albuminuria and changes of echocardiography parameters.

Results

A total of 199 patients with T2DM were recruited (female, 47.2%; mean age, 61±10 years). Patients were divided into 4 albuminuria change groups according to baseline UACR or UAE level, 8 patients were in macroalbuminuria to none-macroalbuminuria group, 93 in none-macroalbuminuria-stable group, 68 in macroalbuminuria-stable group, and 30 in none-macroalbuminuria to macroalbuminuria group. There was a significant difference in the change of LV diastolic function (estimated by average E/e’) by albuminuria change groups (mean [SD] average E/e’: macroalbuminuria to none-macroalbuminuria, −1.40 [2.83]; none-macroalbuminuria-stable, 0.64 [2.16]; macroalbuminuria-stable, 0.97 [2.59]; non-macroalbuminuria to macroalbuminuria, 1.27 [2.71]; P=0.04). However, the changes in LV mass index (LVMi), ejection fraction (LVEF), E/A, and left atrial volume index (LAVi) between patients in different albuminuria change groups were insignificant. Multivariable regression demonstrated non-macroalbuminuria to macroalbuminuria was associated with increase in average E/e’, compared to patients with macroalbuminuria to none-macroalbuminuria (ß = 1.92, P < 0.05) after adjusting age, sex, hypertension, body mass index, eGFR, and diabetes duration.

Conclusion

The progression of none-macroalbuminuria to macroalbuminuria was associated with greater deterioration of LV diastolic function.
Gender-related differences in aortic diameters: why do we use the same cutoff?
Authors: Carrero M C , Matta M G , Masson G G , Constantin I , Benger J , Makhoul S S , Cintora F , Bagnati R , Baratta S J , Toldo C M , Schiavone L , Ayon M , Ventrici F , Manganiello C F , Asch F M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patient’s body size and gender are major determinants of aortic dimensions. Even though female gender is associated with smaller aortic dimensions, surgery indication for thoracic aorta aneurysms is still based mainly on absolute diameters without considering gender. Therefore, if 4 cm is the number which allows us to discriminate aortic dilation in women is still controversial.

Objective

to compare the upper limit of normal (ULN) and Z score between genders in the population of the MATEAR Study (prospective nationwide multicenter registry in Argentina) and to determine the usefulness and fairness of the guideline’s recommendations about aortic diameters in women.

Methods

It was a prospective nationwide registry (53 centers). We included 1,000 healthy adult individuals (mean age: 38.3±12.7 years) being 553 women (56.7% Caucasian, 38.3% Native Americans). Echocardiograms were performed in all patients measuring aortic dimensions at 6 levels following the current standard recommendations: aortic annulus, aortic sinuses, sinotubular junction (STJ), proximal ascending aorta, aortic arch, and proximal descending aorta. Absolute diameters and indexed diameters by body surface area and height were compared between men and women, as well as the estimated ULN in order to analyze discrepancies of the recommended ULN (4cm) in female individuals.

Results

Table 1 shows the baseline characteristics of the study population by gender. The mean age was similar in both sexes (39.1±13.4 years in women and 37.2±12.3 years in men). Women had lower values in all anthropometric parameters, they were 13 cm shorter than men, and had lower left ventricular diameters, ventricular mass, septal thickness and medium blood pressure. The aortic measures at the six levels revealed that women had lower absolute aortic diameters in all aortic segments. However, when the indexed parameters were analyzed in the aortic root and STJ, women presented lower height indexed diameters but higher BSA/indexed diameters (Table 2 and Figure 1).

Regarding the Z score evaluation, we found that the recommended ULN (4 cm) was higher in women than men, with a Z score equivalent to 3.61 and 2.34 respectively. Moreover, in our registry 3.62 cm was the ULN in women which corresponded to a Z score of 2.5.

Conclusions

As was suggested in previous studies aortic diameter indexed by height or BSA appear to be the most appropriate measurements for considering aortic dilatation. In our registry, women showed lower absolute aortic diameters in all segments placing the recommended ULN of 4cm as a misguided value for considering aortic dilatation in women. Therefore, gender should always be taken into account when defining aortic dilatation.
Symplified pulmonary ultrasound in heart failure patients with preserved systolic function
Authors: Tsverava M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

About 1/3 of patients with heart failure (HF) have normal Ejection Fraction (HFpEF). Pulmonary congestion and Oedema is useful marker of HFpEF. The aim of this study was to determine the place of pulmonary ultrasound in patients with DHF.

Methods

We studied 250 patients with II-IV NYHA class HF from which 70 patients had HFpEF (I gr) and 100 patients Left Ventricular Diastolic Dysfunction but without signs of HF (control, II gr). All participants undergone standard EchoCG examination. Sonographic evaluation of a lung was done in horizontal or vertical positions of patient, from 10 points of thoracic wall (5 points from each side), which corresponded to the projection of lower, middle and upper lobes of a right lung and upper and lower lobes of left lung.

Results

In patients with HF we significantly often found multiple (3 or more) B-lines or "Comet tail Phenomenon" (CTPh), which was registered in 91.1%. In 40.0% of control group patients we also registered B-lines, but the count of them in was less than 3 lines per each registration point (the difference between control an HF groups was significant). The count of points from where the CTPh was registered was 6.8 in HFpEF gr. and 0.7 in control gr.

The B-lines where registered from 3 or more points of thoracic wall in 82.86% of patients of I gr and only 5% in II gr participants. In HF groups CTPh was prominent, protracted and multiple while in the control group it was single and short lasting, like lightening. There was good correlation between the count of B-line registration points from the thoracic wall and the heart failure NYHA class (r=0.56), left ventricular systolic (r=0.40) and diastolic (r=0.32) diameters and negative MAPS and TAPS (r=-0.42 and 0.41 respectively).

Conclusion

Thoracic US is sensitive and accurate method for evaluation pulmonary congestion in patients with HFpEF. The US sign of pulmonary congestion in HF are B-lines or "Comet tail phenomenon", which is protracted, prominent, multiple and registered from larger area of thoracic wall (3 points or more).
Prognostic implication of left atrial strain in patients presenting early recurrence of atrial fibrillation after totally thoracoscopic ablation
Authors: Kim J H , Jeon K N , Park S , Jeong D S , Chung S , Bak M J , Kim E K , Chang S A , Lee S C , Park S W
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Backgrounds

Atrial fibrillation (AF) event during blanking period is a risk factor for late recurrence of AF in patients undergoing AF ablation. The aim of this study was to investigate clinical implications of left atrial (LA) strain for long-term outcome in patients experiencing early AF after totally thoracoscopic ablation (TTA).

Methods

A total of 128 patients who underwent totally TTA between 2012 and 2015 were enrolled from a tertiary center. Peak longitudinal LA strain was measured preoperatively. Early AF was defined as any AF events detected on 12-lead electrocardiogram or 24-hour Holter monitoring within 3-month blanking period after TTA. The primary outcome was recurrent AF at 5 years after TTA excluding blanking period.

Results

Of 128 patients, 42 (32.8%) experienced early AF during 3 months of blanking period after TTA. Patients experiencing early AF had a significantly higher risk of 5-year AF recurrence after blanking period compared with those without early AF (72.7% vs. 29.6%; adjusted hazard ratio [HR] 2.99; 95% confidence interval [CI] 1.69–5.27; p<0.001). Among 42 patients experiencing early AF, LA strain ≥18.6% was the only independent predictor of 5-year AF recurrence. Compared with patients with LA strain <18.6%, those with LA strain ≥18.6% had a significantly lower risk of 5-year AF recurrence (17.0% vs. 64.8%, adjusted HR 0.23, 95% CI 0.06–0.96, p = 0.044).

Conclusions

In patients undergoing TTA, early AF during blanking period was a risk factor of late recurrence. Among patients experiencing early AF, LA strain was an independent predictor for long-term AF recurrence.
Distinguishing left ventricular hypertrophy from hypertrophic cardiomyopathy in adolescents - a longitudinal observation study
Authors: Forsaa M , Smedsrud M K , Haugaa K H , Bjerring A W , Fruh A , Sarvari S I , Landgraff H W , Hallen J , Edvardsen T
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): MF: The South-Eastern Norway Regional Health Authority [grant number 2017207]. KHH, MKS: Norwegian Research Council [grant number 309762 ProCardio].

Background

Distinguishing athlete´s heart from hypertrophic cardiomyopathy (HCM) can be challenging. There is a lack of data describing physiological and pathological remodelling in adolescents.

Purpose

The purpose of this study was to compare development of left ventricular (LV) hypertrophy in adolescent athletes to HCM genotype positive adolescents.

Methods

Athletes and age- and sex-matched HCM genotype positive adolescents underwent echocardiography at baseline and at follow-up, minimum two years later. Echocardiographic parameters were evaluated by pediatric reference values (Z-scores). LV hypertrophy was defined as Z-score >2 for intraventricular septum diameter (IVSd) or posterior wall thickness (LVPWd).

Results

Seventy-six athletes were compared to 63 (1 proband, 62 family members) HCM genotype positive adolescents (37% vs 44% female, p = 0.36, mean age baseline 12.1±0.2 vs 12.4±1.4 years, p = 0.10). Mean follow-up-time was alike by protocol (3.1±0.2 vs 3.2±1.3 years, p = 0.59). LV hypertrophy was found in a similar proportion of athletes and HCM genotype positive adolescents (28% vs 30% at baseline, p = 0.75, 30% vs 32% at follow-up, p = 0.80). Compared with athletes, interventricular septum was thicker in HCM genotype positive adolescents at baseline (Z IVSd 1.4±0.9 vs 2.7±5.2, p = 0.03). Left ventricular volumes were greater in athletes (Z LVEDV 1.0±0.6 vs −0.1±0.9, p<0.001). Septum thickness increased only in HCM genotype positive adolescents (Z IVSd progression rate −0.17(SE0.05), p = 0.001 vs 0.54(SE0.16), p = 0.001, p for interaction <0.001). There was no difference in LVPWd (0.6±1.3 vs 0.8±0.8, p = 0.13).

Conclusions

LV hypertrophy was observed in nearly 1/3 of both athletes and HCM genotype positive adolescents in the first longitudinal study comparing these populations. We found a significant difference in progression of LV hypertrophy, with increasing septum thickness only in the HCM genotype positive adolescents. These findings highlight the importance of repeated examinations to distinguish physiological from pathological remodelling.
Accuracy of pulmonary venous flow quantification by 2D phase contrast cardiac magnetic resonance
Authors: Faessler S , Falcao M , Tenisch E , Roy C , Rodrigues D , Stuber M , Piccini D , Schwitter J , Prsa M , Rutz T
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Determination of pulmonary venous flow by cardiac magnetic resonance (CMR) is frequently required in patients with complex congenital heart disease (CHD) lesions. Although new advanced imaging techniques like 4D flow are increasingly available, standard 2D phase contrast (2DPC) sequences remain the most frequently used method for quantification of flow. However, little is known on the accuracy of 2DPC flow measurements in the pulmonary veins.

Purpose

This study therefore aims to investigate the accuracy of pulmonary venous flow quantification by 2DPC.

Methods

Patients with CHD underwent a CMR on a 1.5T scanner. 2DPC flow sequences (typical temporal resolution 35–50ms, inplane spatial resolution 1.3–1.8 mm2, VENC 80–100) were acquired in the ascending aorta (AA), main, right and left pulmonary arteries (MPA, RPA, LPA), as well as left (LPV) and right (RPV) pulmonary veins. Pulmonary venous flow was compared to pulmonary arterial flow in all patients and to aortic flow in patients without left to right (L-R) shunt using Bland-Altman plots and Pearson’s correlations.

Results

Twenty CHD patients (age 27±3, range 7; 53 years, 7 women, tetralogy of Fallot N=7, Ross operation N=1; Fontan N=4, transposition of great arteries N=2, atrial septal defect N=2, Turner syndrome 1, Ebstein N=1, valvulopathies N=2) were included.

Table 1 shows absolute flow values of the different vessels. Bland-Altman analyses and correlations (Table 2) showed a good agreement of total pulmonary venous (PV) to flow in the ascending aorta (group without shunt) and the sum of flow of both branch pulmonary arteries. However, agreement of total PV with MPA flow as well as of LPV and RPV with the respective branch pulmonary artery flow was reduced.

Conclusions

Total PV flow determined by 2DPC shows a good agreement with flow in the ascending aorta and the sum of the branch pulmonary arteries. Flow turbulences due to the pathologies of the right ventricular outflow tract probably contribute to the reduced agreement of total PV and MPA flow. However, the reduced agreement of the flow in left/right pulmonary veins and their respective branch pulmonary arteries underlines the need for newer advanced flow quantification techniques to improve accuracy of pulmonary venous flow measurements.
Prognostic value of mitral regurgitation in patients with heart failure undergoing cardiac resynchronization therapy
Authors: Duarte F , Santos I , Barradas M I , Oliveira L , Monteiro A , Machado C , Dourado R , Martins D
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac resynchronization therapy (CRT) is a well-established treatment for specific groups of heart failure (HF) patients. CRT improves outcomes in ischemic and non-ischemic HF patients, depending on different predictors. Mitral regurgitation (MR) is a common echocardiographic finding with uncertain reported impact on prognosis.

Purpose

We sought to investigate clinical outcomes in HF patient undergoing CRT according to MR severity, for both ischemic and non-ischemic HF etiology. A transthoracic echocardiogram was performed before and 1-year after device-based therapy to all patients (in doubtful cases, a cardiac magnetic resonance imaging was also performed to evaluate the mitral regurgitant volume).

Methods

Single-center retrospective study of consecutive patients submitted to CRT implantation. Patients were stratified attending to MR at baseline and after CRT, as having significant (moderate and severe MR) or non-significant MR. The primary endpoint was a composite of major adverse cardiac events (MACE), including HF hospitalization or all-cause mortality. Sustained ventricular arrhythmic events were the secondary endpoint.

Results

117 HF patients (mean age 71.1 ± 10.6 years, males 67.5%) were enrolled, 31.6% had an ischemic HF etiology and 23.9% were included in the baseline significant MR (SMR) group. Regarding baseline characteristics, 40.2% had atrial fibrillation (AF), 23.9% obstructive pulmonary disease (COPD) and 9% peripheral artery disease (PAD). Patients in SMR group had more dyslipidemia (p = 0.026) and lower left ventricular ejection fraction (median 25% vs 32%, p = 0.001).

At 1-year of follow-up, 11.1% had significant MR, most (61.5%) with the same MR baseline degree and presented with higher NYHA class (p = 0.032). During the follow-up, 15.4% reached the primary endpoint while 8.5% the secondary endpoint. Ischemic etiology (p = 0.204, p = 0.191) and the severity of baseline MR (p = 0.106, p = 0.213) did not predict any of the endpoints. On the contrary, male gender (p = 0.033), alcohol consumption (p = 0.003), PAD (p = 0.004) and COPD (p = 0.005) were independent predictors for MACE endpoint at a multivariable analysis. For the secondary endpoint, PAD (p = 0.020) and AF (p = 0.001) were both significant predictors. Significant MR after CRT implantation was an independent strong predictor only for MACE outcome (HR 4.37, p = 0.014).

Conclusions

Baseline significant MR was not associated with clinical outcomes after CRT implantation. However, MR at follow-up was a strong determinant of higher mortality and HF hospitalizations in more symptomatic patients, regardless of HF etiology.
Speckle tracking echocardiography in the assessment of left ventricular systolic function in patients with autoimmune disorders: review and meta-analysis
Authors: Gegenava T , Gegenava M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Autoimmune disorders, namely Systemic lupus erythematosus (SLE) and Systemic Sclerosis (SSc) are characterized with high incidence of cardiovascular morbidity and mortality. Autopsy data shows high prevalence of myocardial involvement in these patients, however left ventricular systolic dysfunction is diagnosed in few of them, due to low sensitivity of current diagnostic tools.

Purpose

The present study aimed to perform an extensive systemic review and meta-analysis of the current case-control studies based on the assessment of the left ventricular systolic function with advanced echocardiographic methods such as speckle tracking echocardiography (STE) derived left ventricular global longitudinal strain (LV GLS), which has been proven to be a more sensitive tool for the detection of subtle myocardial changes in different entities.

Methods

The objectives, literature search strategies, inclusion and exclusion criteria, outcome measurements, and methods of statistical analysis were analyzed according to an established protocol of the Cochrane collaboration steps and meta-analysis of observational studies in epidemiology recommendations (MOOSE).

Results

A total of 420 papers were collected according to our searching criteria, of those 9 studies including 462 SLE patients and 356 controls and also 8 studies including 660 SSc patients and 370 controls with evaluated LV GLS were selected. We found, that overall patients with SLE exhibited lower levels of LV GLS as compared to controls: [Std. Mean Difference, (95% CI) −1.35 (−1.86 to −0.83); p<0.00001]. From selected 9 studies, one study had performed three-dimensional (3D) STE derived LV GLS assessment, including 34 SLE patients and also 34 controls. Subgroup analysis showed that 3D STE derived LV GLS was significantly lower in SLE patients as compared to healthy controls [Std. Mean Difference, (95% CI) −1.17 (−1.69 to −0.65); p<0.00001]. LV GLS was significantly lower in SSc patients in every reported study as compared to controls: [Std. Mean Difference, (95% CI) −2.26 (−2.88 to −1.64); p<0.00001]. Moreover, some studies showed significant association between deteriorated LV GLS and cardiovascular events in SLE and SSc patients.

Conclusions

LV systolic function as measured by LV GLS is significantly affected in SLE and SSc patients. Meta-analysis suggests that in autoimmune disorders STE derived LV GLS assessment potentially represents a new tool in the detection of subtle myocardial changes even at subclinical stage of the heart failure and therefore may improve risk-stratification in patients with SLE and SSc.
Artificial intelligence to improve ischemia prediction in rubidium positron emission tomography
Authors: Frey S , Haaf P H , Caobelli F , Tsirkin A , Oehri C , Ruff P , Zellweger M J
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Patients are referred to coronary artery disease (CAD) testing based on their pre-test probability (PTP). The available, easy-to-use risk prediction tools use three variables only and their diagnostic accuracy is limited. Artificial intelligence-based tools incorporate multiple variables and could improve PTP assessment due to the resulting combinatorial power. The factors in the AI model are not seen as independent individual values, but are recognized as patterns derived by a combinatorial analysis of the individual metabolic profile of each patient.

Purpose

We aimed to compare the diagnostic accuracy of a novel, artificial intelligence-based tool with commonly used PTP tools to predict ischemia.

Methods

Consecutive patients (n = 2417) referred for Rubidium-Position Emission Tomography (PET) were evaluated. PTP was calculated using the ESC 2013/2019 and ACC 2012/2021 guidelines, and a memetic pattern-based algorithm (MPA) model incorporating symptoms, vitals, ECG and laboratory findings. Five risk categories (very low to very high risk) were defined (<5%, 5–15%, 15–50%, 50–85%, >85%). Ischemia was defined as summed difference score (SDS) ≥2 on PET. Receiver operator characteristics were calculated and compared using the DeLong method.

Results

Known CAD, ischemia and scar (detected on PET) were present in 46.3%, 37.1% and 24.6%, respectively. The MPA model was most accurate to assess PTP of ischemia (AUC: 0.758, ESC 2013: 0.661, ESC 2019: 0.673, ACC 2012: 0.585, ACC 2021: 0.667, p<0.0001 each) as depicted in figure 1. The MPA’s sensitivity and negative predictive value to rule-out ischemia were 99.1% and 96.4%, respectively. The model allocated patients more evenly across risk groups, reduced the proportion of patients in the 15–85% range by 29% (ACC 2012) to 51% (ESC 2013), and was the only risk tool to correctly estimate ischemia prevalence in the very low risk group (table 1).

Conclusion

The MPA model significantly improved PTP assessment of ischemia. The MPA model has originally been derived on the endpoint coronary stenosis >50% and validated in three clinical studies (1–3). This study now confirms that the MPA model applied to the endpoint ischemia outperforms the current risk assessment tools and is most accurate to assess PTP. It enables clinicians to safely exclude ischemia based on readily available variables without advanced testing. It could be used to improve risk stratification of patients and to significantly reduce unnecessary non-invasive functional tests.
Left ventricular longitudinal strain: a useful tool in the evaluation of patients with Takotsubo syndrome
Authors: Karakosta M , Miaris N , Maritsa D , Skantzikas P , Boukis D , Plaitis A , Konstantara A , Ntiloudi D , Archontikis A , Kalesi A E , Destounis A , Zachos P , Kasinos N , Pisimisis E , Theodosis-Georgilas A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

In contrast with the usual type of Takotsubo syndrome (TS), where apical wall motion abnormality occurs, the less common patterns (mid-ventricular, basal, and focal) are often misdiagnosed.

Purpose

In this retrospective study we examined the role of global (GLS) and territorial longitudinal strain with speckle tracking in the evaluation of patients with TS.

Methods

Patients with TS were examined at the echocardiography laboratory of our general hospital, from August 2019 until August 2022. Left ventricular ejection fraction (LVEF) and GLS were calculated and territorial longitudinal strain was assessed.

Results

Out of 21 patients with TS (19 females), of median age 67.5 years (range 33.0 – 87.0 years), 11 (52.4%) had apical distribution, 6 (28.6%) mid-ventricular, 2 (9.5%) basal and 2 (9.5%) focal. Of those, 3 were excluded from the study due to insufficient echocardiographic image quality.

Patients with apical pattern had median LVEF 37% (range 23–51%) and GLS −7.6% (−5.8 to −12.5%), patients with mid-ventricular pattern had median LVEF 40% (35–50%) and GLS −14.2% (−9.3 to −16.5%) and patients with basal pattern had median LVEF 52% (47–56%) and GLS −16.5% (−14.6 to −18.4%). In the first case of focal distribution, wall motion abnormality was found at the anterior septal wall, and LVEF was calculated 46% and GLS −12.8%. In the second case, abnormality was found at the inferoposterior wall and LVEF was calculated 56% and GLS −17.3%.

Patients with apical TS had median strain of basal territory −11.7%, mid territory −3.7% and apical territory +3.6%. Patients with mid ventricular TS had median strain of basal territory −10.2%, mid territory −6.5% and apical territory −19.7%. Patients with basal TS had median strain of basal territory −4.3%, mid territory −16.4% and apical territory −29.1%.

Conclusion

GLS and territorial longitudinal strain reflect the reduction in left ventricular systolic function and the distribution of wall motion abnormalities in patients with TS, which further supports the initial diagnosis.
Temporal changes in PET myocardial perfusion imaging over 15 years: patient characteristics and imaging findings
Authors: Sager D F , Garefa C , Tsinaridis A , Pazhenkottil A P , Giannopoulos A A , Kaufmann P A , Buechel R R , Benz D C
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): DF. Sager was supported by the Swiss Academy of Medical Sciences and the G.&J. Bangerter-Rhyner Foundation through the “Young Talents in Clinical Research” program.

Background & Purpose

Positron emission tomography (PET)/computed tomography (CT) myocardial perfusion imaging (MPI) is guiding the assessment and management of patients with suspected or known coronary artery disease for over 30 years. Its clinical dissemination and technological evolution might have altered the clinical phenotype of referred patients. The aim of the present study was to investigate temporal trends in patient characteristics, imaging findings of PET/CT MPI and outcome over the course of 15 years.

Methods

In this cross-sectional cohort study, 1366 patients who underwent PET/CT between 2001 and 2015 were retrospectively included. Patients were grouped together into three 5-year study groups (group 1: 2001–2005 / group 2: 2006–2010 / group 3: 2011–2015) and assessed for patient demographics and characteristics, serological biomarkers, relative and quantitative PET findings, and mortality. Vital status was obtained from medical charts and/or death notices.

Results

Across study groups, mean age (p<0.001) and creatinine (p = 0.006) increased while the prevalence of typical angina (p<0.001) and known coronary artery disease (p = 0.003) decreased (Table). There were no temporal changes in neither the prevalence of dyspnea (p = 0.480) and diabetes mellitus (p = 0.146) nor median body mass index (p = 0.064), NT-proBNP (p = 0.532) and troponin (p = 0.385). Although the prevalence of ischemia (p = 0.019) and scar (p = 0.003) decreased over time, median myocardial flow reserve (MFR) worsened (p = 0.001). Over a median follow-up of 5.3 years [interquartile range 3.3–7.4] annualized mortality increased across groups in parallel to the changes in MFR (Figure).

Conclusion

The clinical phenotype of patients referred for PET/CT MPI has changed marginally between 2001 and 2015. The temporal trend towards older, less symptomatic patients with lower prevalence of ischemia and scar but worse MFR and higher mortality highlights the importance of assessing diffuse atherosclerosis and microcirculation beyond focal stenosis to improve risk stratification.
Multimodality imaging assessment of mitral annulus disjunction in consecutive patients
Authors: Figliozzi S , Lo Monaco M , Cannata F , Catapano F , Stankowski K , Fazzari F , Monti L , Bragato R M , Condorelli G , Francone M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Mitral annulus disjunction (MAD) has been investigated through trans-thoracic-echocardiography (TTE) and cardiac magnetic resonance (CMR) in different study cohorts and has been assumed either to represent a structural risk marker of sudden cardiac death or a benign, incidental finding. The imaging modality used to assess MAD might impact its prevalence and clinical significance.

Purpose

To assess the prevalence of MAD in consecutive patients undergoing TTE and CMR.

Methods

We retrospectively searched for MAD in consecutive patients undergoing TTE and CMR within six months, one from each other, at our center from March 2021 to April 2022. MAD was assessed in standard echocardiographic and CMR long-axis views and was defined as a ≥ 2 mm displacement between the left atrial wall-mitral valve leaflet junction hinge and the top of the left ventricular wall. Cases of pseudo-MAD and true-MAD were defined by MAD presence, respectively, during only systole and both systole and diastole.

Results

124 patients (47 women; mean age: 59 years ± 17) were included. According to CMR, 38 patients (31%) presented with a structurally normal heart, and 37 (30%) presented with MAD. Patients with MAD presented more frequently MVP (27% vs. 1%; P<0.001), whereas patients without MAD were more frequently affected by non-ischemic cardiomyopathy (30% vs. 11%; p = 0.02). The two groups did not differ in age, sex, cardiac risk factors, symptoms, left ventricular volumes, ejection-fraction, pre-contrast T1- and T2-mapping, mitral annulus dimension and mitral regurgitation.

MAD prevalence was higher by CMR than by TTE (30% vs. 8%; P=0.028). There was a low inter-modality agreement for the detection of MAD presence (Cohen's kappa=0.34) and a moderate agreement for MAD extent (ICC=0.71; 95% LOA 0.59, 0.8, p<0.05). Median MAD extent reported CMR and TTE were 2.6 mm (IQR 2.05–3.75 mm) and 4 mm (IQR 2.65–4.65 mm) respectively. All patients showing MAD at TTE demonstrated it at CMR too. Cases of true-MAD were observed at CMR (14% of the total cohort) but not at TTE.

Conclusion

In this cohort of consecutive patients, MAD was missed by TTE in more than 2 out of 3 patients exhibiting it at CMR. The high prevalence of MAD at CMR and the absence of significant association between this phenomenon and morpho-functional or structural alterations argue in favor of a benign finding at CMR. TTE detected MADs with higher extents compared to CMR. Further longitudinal studies are needed to evaluate the imaging-modality-related clinical relevance of MAD to improve patients’ risk stratification.