bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term changes in myocardial function after CABG assessed by speckle tracking echocardiography
Authors: Braun C , Weijner-Mik P , Szymczyk E , Kasprzak J D , Lipiec P
Published: January 2025

Introduction

Speckle-tracking echocardiography (STE) is an advanced imaging technique for assessing myocardial function, which is more sensitive and specific than standard parameters in detecting subtle changes in myocardial function.

Purpose

We evaluated global and regional left ventricular (LV) and left atrial (LA) function changes in patients undergoing coronary artery bypass grafting (CABG) using standard and advanced echocardiographic techniques.

Methods

The study group included 83 patients (72 men, 11 women; mean age 65,1±8,4 years) scheduled for CABG due to multivessel coronary artery disease (CAD). All patients underwent pre- and postoperative transthoracic echocardiographic examinations (TTE). Offline analysis of global functional parameters was performed, including left ventricular ejection fraction (LVEF), global systolic longitudinal strain (GLS), and global peak longitudinal strain (GPLS). Regional systolic and diastolic left ventricular function was analyzed by measuring peak systolic strain rate (SRS), peak diastolic longitudinal strain rate in the early (SRe) and late phase (SRa), and the post-systolic index (PSI). LA strain was also assessed. During the 2nd examination (7,9±3 days), 68 patients had sufficient image quality for analysis. 42 patients attended the 3rd examination (9±2,3 months). 30 patients attended the 4th examination (60,3±5,1 months). Results were compared to the 1st examination. Nine deaths were recorded in the study group.

Results

The mean baseline LVEF was 46±10%. During 2nd TTE, we noticed a reduction of LVEF to 41±10% (p=0.0016). LVEF remained reduced during the 3rd TTE, but returned to baseline at the 4th examination (50±8%). There was a significant decrease in global strain parameters observed during 2nd TTE. GLS decreased from -12,63±3,5% to -10,61±5,25% (p<0.0001), and GPLS from -13,46±3,4% to -11,77±4,52% (p<0.0001). Global strain parameters recovered at the 3rd and 4th examinations, with no significant differences from the 1st examination. Regional systolic and diastolic deformation parameters followed a similar trend, though only SRS showed a significant persistent reduction during the 4th TTE (0,73±0,15/s) compared to the 1st (0,82±0,17/s, p=0.0290). CABG did not impact LA function.

Conclusion

CABG leads to a significant postoperative decrease in global longitudinal LV deformation, which recovers over the long term. Revascularized territories show a similar trend. Recovery of global and regional strain parameters occurs earlier than LVEF recovery. CABG does not significantly impact LA function as assessed by STE.
Right ventricular strain as prognostic marker in patients with heart failure receiving sacubitril/valsartan: a sub-analysis of DISCOVER-ARNI, a multicenter Italian study
Authors: Pastore M C , Mandoli G E , Giannoni A , Ginetti F R , Correale M , Brunetti N D , Guaricci A I , Piscitelli L , Degiovanni A , Patti G E , Malagoli A , Moderato L , Carluccio E E , Cameli M
Published: January 2025

Background

Angiotensin receptor/Neprilysin inhibitors (ARNI) have shown to considerably improve the clinical outcome of patients with heart failure and reduced ejection fraction (HFrEF). Identifying individuals who may benefit from ARNI the most could markedly enhance patient management. The aim of this sub-analysis of DISCOVER-ARNI was to evaluate the prognostic significance of speckle tracking echocardiography (STE) parameters in patients undergoing ARNI.

Methods

DISCOVER-ARNI multicenter Italian register retrospectively enrolled 341 patients with HFrEF referred for ARNI. Clinical, biohumoral and echocardiographic evaluation was performed at baseline. Among those with available right ventricular STE data, long-term follow-up was conducted by telephone interview or on-site visits. The primary composite endpoint included all-cause or cardiovascular mortality, HF hospitalization, heart transplantation, left ventricular assist device (LVAD) implantation.

Results

Overall, 136 HFrEF patients were included (mean age 65±10 years, 82% male). Mean follow up was 40±18 months: 32 patients reached the primary endpoint (14 deaths of which 10 cardiovascular deaths, 22 hospitalization, 3 heart transplantation, 1 LVAD implantation). Patients with events had higher LV volumes and EF, lower but preserved tricuspid annular plane systolic excursion (TAPSE) and higher systolic pulmonary artery pressures, reduced LV, left atrial (LA) and free wall right ventricular longitudinal strain (fwRVLS). Using Cox Proportional Hazard Model including LVEF, TAPSE, LV strain, LA strain, fwRVLS, the latest emerged as the sole independent predictor of the combined endpoint(odds ratio=1.12 [1.05;1.2], p=0.001). Receiver operating characteristic (ROC) curves determined that fwRVLS=-20% was the optimal prognostic cut-off(AUC=0.70). Kaplan Meier survival curves, demonstrated effective risk stratification of fwRVLS>-20% for the primary endpoint.

Conclusions

fwRVLS by STE holds promise as a valuable parameter to assess response to ARNI therapy in terms of overall survival, HF hospitalizations, heart transplantation or LVAD implantation.
Association between left atrial mechanics parameters and thromboembolic risk at 10 years in a cohort of patients with atrial fibrillation
Authors: Islas F , Molina-Merlos P , Gutierrez E , Gil-Abizanda S , Perez De Isla L , De Agustin J A , Olmos C
Published: January 2025

Background

Atrial fibrillation (AF) is a significant risk factor for the occurrence of stroke. Thromboembolic risk in patients with AF is estimated using the CHADS2 and CHA2DS2-VASc scales. In previous studies, a correlation was observed between different echocardiographic parameters of left atrium mechanics and thromboembolic risk in patients with AF. Our main objective is to evaluate the association between atrial strain measured and the occurrence of thromboembolic events in patients with AF.

Methods

Prospective cohort of patients with AF, who underwent a transthoracic echocardiogram with 3D wall-motion tracking (3DWMT) in 2014 and who were followed up between 2014 and 2022. The association of different clinical and echocardiographic variables, including left atrial strain, with the occurrence of embolic events was analyzed.

Results

Of the 102 patients studied in 2014, 99 had follow-up recorded and were finally included in the study. The mean age of our population was 78.7 ± 9.9 years, and 49 (49.5%) are women. The incidence of embolic events at 10 years was 34.3%. Patients with thromboembolic events had significantly higher CHADS and CHA2DS2-VASc scores (Figure). No significant association was found regarding biventricular systolic and left atrium morphological parameters and thromboembolic events (Table). However, we observed lower left atrium reservoir strain values in patients with embolic events, compared to those without embolisms (7.19% (3.54) vs 8.97% (5.15), p = 0.055) (Figure).

Conclusions

In our cohort of patients with AF, we found a statistically significant association between CHADS and CHA2DS2-VASc and the incidence of embolic events at follow-up. Left atrial reservoir strain was the only echocardiographic parameter significantly associated with the occurrence of thromboembolic events.

The incorporation of atrial mechanics parameters to traditional thromboembolic risk scales could provide additional value for the prediction of events in patients with AF.

Table Figure
Mechanical dispersion predicts long-term survival of dialysis-dependent patients with preserved ejection fraction
Authors: Stankovic I , Stefanovic M , Vranic I , Jemcov T , Maksimovic A , Zec N , Markovic R , Kusic Milicevic J , Neskovic A N
Published: January 2025

Background

Since cardiovascular disease is a major cause of death in patients with chronic kidney disease (CKD), echocardiographic risk stratification of CKD patients may be clinically important, especially if left ventricular (LV) systolic function is still preserved.

Purpose

To investigate the prognostic implications of conventional (LV mass) and advanced echocardiographic parameters [global longitudinal strain (GLS) and mechanical dispersion] in dialysis-dependent patients with preserved left ventricular ejection fraction (LVEF).

Methods

A total of 78 patients with LVEF≥50% were prospectively enrolled and followed for 60 months for all-cause death. LV mass was calculated using the ASE/EACVI recommended formula for estimating LV mass from LV linear dimensions and indexed to body surface area (LVMI). Longitudinal myocardial strain was measured by speckle-tracking echocardiography. The duration of mechanical contraction was determined as the time from the ECG R-wave to peak longitudinal strain in each of 18 LV segments. Mechanical dispersion was defined as the difference between the longest and shortest time intervals.

Results

In univariable analysis, age [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.01-1.07, p=0.014], diabetes mellitus (HR 2.16, 95%CI 1.03-4.52, p=0.042), LVMI (HR 1.02, 95%CI 1.01-1.03, p=0.001), GLS (HR 0.77, 95%CI 0.66-0.88) and mechanical dispersion (HR 1.01, 95%CI 1.01-1.02, p<0.001) were all predictive of all-cause mortality. The results of the multivariable Cox regression model are shown in the Figure: in addition to age, mechanical dispersion, LVM and GLS were found to be independent predictors of death from any cause. Patients with mechanical dispersion ≥260 ms had worse survival (HR 3.74, 95% 1.51-9.27) than those with a lesser degree of dispersion (p=0.004).

Conclusions

In dialysis-dependent patients with preserved LVEF, higher extent of mechanical dispersion is associated with worse long-term survival. Higher LV mass and reduced GLS were also identified as independent predictors of survival. Echocardiography-derived parameters may be useful for risk stratification in this vulnerable patient population.
Utility of left atrial strain in differentiating between cardiac amyloidosis and hypertrophic cardiomyopathy
Authors: Serrano Lozano D , Margarida De Castro A , Cuesta Cosgaya J M , Santiago Setien I , Lerena Saenz P , Fernandez-Valls Gomez M , Llano Cardenal M F , Zarauza Navarro J , Coroas Pascual C , Rodriguez De Rivera Socorro M , Abia Sarria L , Munoz Prejigueiro L , Carreiro Da Cunha E , Alarcos Blasco H , Ruisanchez Villar C
Published: January 2025

Introduction and Objectives

Cardiac amyloidosis (AL) is a disease characterized by the abnormal accumulation of anomalous proteins in cardiac tissue, while hypertrophic cardiomyopathy (HCM) is a hereditary cardiac disease characterized by abnormal thickening of the cardiac muscle, associated with tissue fibrosis and cardiac dysfunction in its natural progression. The echocardiogram has emerged as a fundamental tool in the diagnosis and follow-up of these patients, and strain analysis techniques can provide highly useful additional information on cardiac function in these patients, especially in the early stages of the disease. We questioned whether it might be useful in differentiating between these two diseases.

Methods

This retrospective analysis included adult patients who had undergone echocardiography at our center during the years 2023-2024. A total of 52 patients with a confirmed diagnosis of transthyretin AL confirmed by scintigraphy and/or biopsy, and another group of 51 patients with a confirmed diagnosis of HCM and ICD carriers for being high-risk patients were included. Various left atrial strain values (Reservoir, Conduit, and Pump) were analyzed. Descriptive statistics were calculated for each group and segment, and the Mann-Whitney U test was used to compare the groups.

Results

Patients with AL showed significantly lower absolute strain values compared to patients with HCM in all three analyzed varieties (Reservoir, Conduit, and Pump) with p<0.01 for all comparisons. The mean strain in the HCM group was 18.57 for reservoir strain, -11.85 for conduit strain, and -6.94 for pump strain; while the mean in the AL group was 9.28, -6.93, and -3.10, respectively.

Conclusions

Our study found significant differences in left atrial strain values between patients with HCM and patients with transthyretin AL. These findings suggest that left atrial strain analysis could be useful in evaluating cardiac function, follow-up, and differential diagnosis between patients with AL and HCM, especially in the earlier stages of the disease, where it is more challenging to establish a reliable diagnosis.

HCM Vs amyloidosis
Global longitudinal strain as a prognostic index of significant coronary artery disease
Authors: Koulaouzidis G , Kalaitzoglou M , Kleitsioti P , Xanthopoulou S , Mourvetidis P , Kaimakami M , Tsaousidis A , Tzalamouras V , Giannakopoulou P , Mavrogianni A D , Henein M Y , Zarifis J
Published: January 2025

Introduction

Speckle tracking Echocardiography (STE) has recently gained significant value in echocardiography practice. Its role in stable coronary artery disease, however, remains controversial.

Purpose

The purpose of this study is to assess the diagnostic value of Global Longitudinal Strain (GLS) in predicting significant Coronary Artery Disease (CAD).

Methods

This is a prospective study of 103 symptomatic patients who were referred to our hospital for invasive coronary angiography to exclude CAD. An initial echocardiogram including GLS was performed in all. Patients with acute coronary syndrome, history of CAD, heart failure, left ventricle wall motion abnormalities or significant valve disease were excluded. Patients were diagnosed as having significant CAD if the angiogram confirmed ≥50% stenosis in one or more of the coronary branches. The sensitivity and specificity of GLS in predicting the presence of CAD was assessed.

Results

The study included 103 patients (with a mean age of 63.8 ± 9.3 years), 78.6% were males. A history of arterial hypertension was present in 63.1% of the patients, dyslipidemia in 77.7%, diabetes in 22.3% and peripheral arterial disease in 11.7%. 71.9% of the subjects smoked and 24.3% had family history of premature CAD. Finally, 8.7% had atrial fibrillation and 5.8% had chronic kidney disease. Among the 103 patients, 47 (45.6%) were found to have significant CAD, while the remaining 56 (54.3%) had either non-significant CAD or normal coronary arteries. Patients with significant CAD had lower GLS values than those with non-significant CAD (-15.73 ± 2.64% vs. -17.6 ± 1.85%, p=0.001). GLS values ranging from -16.25 to -14.45 can predict significant CAD. Sensitivity and specificity values ranged from 56%-75% and 69%-83% respectively, considering the type of the coronary lesion, as it is demonstrated in Table 1.

Conclusions

Resting myocardial GLS can be considered a predictive index of significant CAD in symptomatic patients, for better stratification. These findings need to be confirmed in larger multicenter setting.
Haemodynamic and cardiac mechanical adaptations following isometric exercise training in patients with heart failure with preserved ejection fraction.
Authors: Edwards J , Jalaludeen N , Marciniak A , Sharma R , O'driscoll J
Published: January 2025

Background

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical condition associated with impaired haemodynamics and subclinical cardiac dysfunction. Aerobic exercise training is a viable intervention to improve outcomes; however, adherence is poor. Isometric exercise training (IET) is a time-efficient exercise mode that has been demonstrated to produce significant cardiovascular adaptations. However, no research to date has investigated the effects of IET in patients with HFpEF.

Purpose

This study aimed to perform the first randomised controlled trial on the effects of IET on resting blood pressure and cardiac mechanics in patients with HFpEF.

Methods

38 medically optimised HFpEF patients were randomised to a 4-week IET intervention (wall squat or handgrip), or a non-intervention control group. Resting clinic systolic (sBP), mean (mBP) and diastolic (dBP) blood pressure and cardiac mechanics were recorded pre and post the 4-week study period. We measured global longitudinal strain (GLS) and left atrial reservoir strain (LAr) via 2D speckle tracking echocardiography. Data is reported as mean±standard error.

Results

Thirty-three participants completed the study (18 IET, 15 control). Following the 4-week intervention, there was a significant reduction in resting sBP (-8.52±2.7mmHg, p=0.003), mBP (-4.94±2mmHg, p=0.018) and dBP (-4.62±1.8mmHg, p =0.016) in the IET group compared to the control group. There was a significant improvement in GLS (1.98±0.8%, p=0.015) and LAr (4.59±1.7%, p=0.012) following IET compared to the control group.

Conclusion

This novel study supports IET as an effective therapeutic intervention to improve cardiovascular modulation in patients with HFpEF. Larger-scale, multi-centre research is needed to establish the wider utility of IET in HFpEF with potential for future guideline implementation.
Myocardial work in patients with dilated cardiomyopathy and advanced stage of heart failure
Authors: Toader D M , Paraschiv A , Munteanu O , Craciun-Mirescu A , Hadareanu D , Stanisor R , Chitu M , Donoiu O , Militaru S , Istratoaie O , Militaru C
Published: January 2025

Background

Left ventricular myocardial work (MW) assessed by echocardiography is a new index of myocardial performance. This imaging tool incorporates afterload determination using cuff blood pressure and thus provides a more load-independent measure compared with GLS.

Purpose

The study aimed to find a link between MW indices at discharge and complications like cardiac rehospitalization and death two tears follow-up in patients with dilated cardiomyopathy (DCM) and advanced stage of heart failure.

Methods

The study included 76 patients with dilated DCM(50% of ischemic etiology), left ventricle ejection fraction (LVEF) below 40%, and NYHA class IV of heart failure (HF). All the patients underwent a complex echocardiographic evaluation according to the latest guidelines. We used an E95 machine for image acquisition and an ECHOPAC 204 for image postprocessing, using the automated functional imaging (AFI) technique. The noninvasive systolic cuff pressure measurement was performed during image acquisition. Four indices were calculated: global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). The patients were followed for two years.

Results

1. 24 patients presented rehospitalization for HF decompensation (31.57%), and 23 (30.26%) patients died during follow-up. 2. The patients with ischemic etiology of DCM presented lower values of MW parameters compared with patients without coronary artery disease: GWI: 653.92 (SD 330.58) vs. 586,89 (SD 284.48), GCW 937.81 (SD 388.15) vs. 849.6 (SD 349.86), GWW 244.81 (SD 121.29) vs 203.23 (SD 97.16), GWE 74.89 (SD 9.45) vs 75.78 (SD 9.01). 3. The MW parameters in DCM patients with cardiovascular death and rehospitalization were lower compared with DCM patients without rehospitalization and cardiovascular death were GWI: 455.3 (SD 285.14) ( P = 0.0001) and 555.33 (SD 210.42) (P = 0.0002); GCW: 700.69 (SD 353.104) ( P = 0.0001) and 826.875 (SD 291.29) (P = 0.0031); GWW: 215.87 (SD 88.96) (P = 0.8771) and 248.45 (SD 108.03) (P = 0.2517); GWE: 71.39 (SD 8.77) (P = 0.0005) and 73.45 (SD 7.19)(P=0.0031).

Conclusion

1. MW indices values were comparable in patients with ischemic and nonischemic DCM and advanced stage of heart failure. 2. GWI, GCW, and GWE at discharge were significantly lower in DCM patients with rehospitalization and cardiac death compared with DCM patients without complications during two years of follow-up.

MW indices calculation
Right ventricular strain as a predictor of trastuzumab-induced chemotherapy-related cardiac dysfunction: a meta-analysis
Authors: Jain H , Goyal A , Singh J , Jain J , Odat R M , Patel N , Khan S , Mallik S , Scott I , Ahmed R
Published: January 2025

Background

Trastuzumab (TZ) is an effective chemotherapeutic drug associated with left ventricular dysfunction, leading to cardiotoxicity. Two-dimensional speckle-tracking echocardiography has demonstrated efficacy in predicting TZ-induced cardiotoxicity; however, its role using right ventricular (RV) strain parameters remains unclear.

Purpose

The current meta-analysis compared pre- and post-TZ RV strain parameters measured on two-dimensional speckle-tracking echocardiography.

Methods

A systematic search was conducted across PubMed/MEDLINE, Embase, and Cochrane Library from inception until June 2024. The outcomes of interest were the RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWLS). RevMan version 5.4 was used to pool standardized mean differences (SMD) with their corresponding 95% confidence intervals (CI) using the inverse-variance random-effects model. Statistical significance was set at p<0.05.

Results

Four studies involving 275 patients with cancer were included in this meta-analysis. The mean age of the patients was 53.35 ± 11.1 years. Pooled analysis demonstrated that TZ-based chemotherapy resulted in a statistically significant reduction in RV GLS [SMD: -0.58; 95% CI: -0.94, -0.22; p=0.001] and RV FWLS [SMD: -0.54; 95% CI: -0.99, -0.08; p=0.02].

Conclusion

Following TZ-based chemotherapy, RV subclinical damage ensues, leading to the deformation of RV mechanics. This meta-analysis demonstrated a reduction in RV GLS and RV FWLS following TZ-based chemotherapy, as detected by speckle-tracking echocardiography. Further multicenter randomized studies are required to validate the findings of the present meta-analysis.
No impairment of cardiac function after mild SARS-CoV-2 infection in elite athletes
Authors: Schellenberg J , Matits L , Bizjak D , Kirsten J , Kersten J
Published: January 2025

Background

Possible mild myocardial involvement has been observed in the form of reduced left ventricular global longitudinal strain (LV GLS) in athletes after SARS-CoV-2 infection compared to healthy athletes. It is not yet clear whether these minor changes are caused by SARS-CoV-2 or are possibly due to detraining.

Purpose

This study investigates whether there are potential changes in LV and right ventricular (RV) GLS and global circular strain (GCS) in elite athletes (INFAt) before and after SARS-CoV-2 infection and whether there are differences in cardiac function between post-infection INFAt and healthy control athletes (CON).

Methods

In this single-center substudy, transthoracic echocardiography was performed in 32 elite athletes participating in endurance, strength and mixed sports. 16 INFAt (22.63±5.34 years, 10 male) were examined before (t0) and at a median of 52 days after (t1) SARS-CoV-2 infection and matched by gender, age and sport with healthy controls (CON). LV GLS and GCS were determined in four-, two-, and three-chamber views and RV free wall longitudinal strain/global longitudinal strain (RV FWSL/RV GLS) in RV focused four-chamber apical view. Left atrial strain was determined in form of left atrial reservoir strain (LASr), left atrial conduit strain (LAScd) and left atrial contraction strain (LASct) in the apical four-chamber view. Strain values were assessed offline by a blinded investigator.

Results

There was no change in LV GLS (t0 -21.8 vs. t1 -21.7, p=0.649), GCS basal (t0 -32.9 vs. t1 -26.6, p=0.403), GCS midventricular (t0 -23.7 vs. t1 -29.9, p=0.589) and RV FWSL (t0 -31.9 vs. t1 -33.0, p=0.326) or RV GLS (t0 -29.1 vs. t1 -28.7, p=0.626) in INFAt from from pre to post-SARS-CoV-2 infection. Overall LV GLS (-21.7 vs. -22.7, p=0.318), GCS basal (-26.6 vs. -25.8, p=0.409) and GCS mid-ventricular (-29.9 vs. -29.0, p=0.788) and routine echocardiography parameters were not different between INFAt and CON. Only left atrial parameters were significantly different with high normal values in INFAt for LASr (INFAt 47.8 (40.5 – 51.8) vs. CON 30.5 (27.7 – 32.9), p < 0.001) and LASct (INFAt -12.8 (-17.9 – -6.7) vs. CON -4.9 (-14.25 – -1.8), p = 0.050).

Conclusions

We did not detect cardiac involvement in the form of a significant reduction of left or right ventricular strain within INFAt before and after SARS-CoV-2 infection nor between INFAt and CON. Cardiac function does not appear to be impaired in athletes with mild infection. Studies on left and right ventricular changes in athletes or in the general population with moderate and severe disease courses are required, as are studies on other viral infections, to issue a specific recommendation on return-to-play after viral infections.
The utility of right ventricular strain in assessing cardiac function in athletes
Authors: Baptista Carvalho A , Mendes L
Published: January 2025

Background

Athlete's heart can resemble changes seen in cardiomyopathies. Assessing right ventricular (RV) function is critical for overall cardiac evaluation. Traditional measures like Tricuspid Annular Plane Systolic Excursion (TAPSE) are widely used for their simplicity but may not fully capture global RV function or detect early myocardial dysfunction. More recently RV free wall strain (RVFWS) appears to offer a more comprehensive assessment of RV mechanics.

Aim

To evaluate the utility of RVFWS in evaluating athlete's heart, assessing its effectiveness as a diagnostic tool in distinguishing the athlete’s cardiac adaptations.

Methods

We did a retrospective analysis of right ventricle’s free wall longitudinal strain in a group of professional football players compared to healthy male individuals. A GE Vivid E95 echocardiographic ultrasound system and EchoPAC V.206 software (GE Vingmed Ultrasound AS, Horten, Norway) were used. The statistically analysis was performed on SPSS v.27.

Results

All athletes were male (N=107), with a median age of 24 years (range 21-30). The control group consisted of 71 healthy males with an average age of 26±4 years. Right ventricular free wall strain (RVFWS) did not significantly differ between groups (p = 0.898), measuring -23.4 ± 3.6% in athletes and -23.8 (-25.9 - -21.7%) in controls. However, both pulmonary acceleration time and indexed right atrium volume were significantly higher in athletes (p <0.001).

Conclusion

This study revealed no significant difference in RV free wall strain (RVFWS) between athletes and healthy individuals, suggesting RVFWS could help detect pathological changes in athletes.

Descriptive analysis

RVFWS example
Efficacy of the party balloon inflation maneuver comparing with the valsalva maneuver for diagnosis of PFO and HOCM in transthoracic echocardiography
Authors: Kito K , Okamoto M , Shirakura K , Kobayashi H , Chikuda I , Nishikawa J , Iseki Y , Katayama T , Sajima T , Kawashima H , Yamamoto H , Watanabe Y , Yokoyama N , Kozuma K , Kataoka A
Published: January 2025

Background

Previously, we reported clinical cases where the party balloon inflation manoeuvre (PBIM) proved more effective than the conventional Valsalva manoeuvre (VM) in diagnosing patent foramen ovale (PFO) and hypertrophic obstructive cardiomyopathy (HOCM). Additionally, increased venous return with PBIM was observed using hepatic vein flow assessed by transthoracic echocardiography (TTE). PBIM may offer enhanced visualisation of provocation, especially in cases where VM is insufficient. However, the haemodynamic evidence for the efficacy of PBIM with the optimal protocol compared to VM for PFO and HOCM has not been established.

Purpose

This study aimed to demonstrate the superiority of PBIM over the conventional VM and establish the optimal PBIM protocol for diagnosing PFO and HOCM through two experiments.

Methods

(Experiment 1) To understand the characteristics of party balloons, we measured the diameters and corresponding pressures of two commercially available balloons of different sizes (23 and 30 cm, referred to as a smaller balloon (SB) and a larger balloon (LB), respectively). (Experiment 2) We studied 23 healthy adult volunteers (physicians or sonographers, mean age 36 ± 10 years, 78% male), to investigate the haemodynamic effects of PBIM using protocols derived from the results of Experiment 1. Haemodynamic parameters, such as right ventricular inflow-velocity time integral (RV inflow-VTI) representing PFO haemodynamics and left ventricular end-diastolic diameter (LVDd) representing HOCM haemodynamics, were assessed by TTE during (for HOCM) and after (for PFO) the manoeuvre. These parameters were compared among PBIM, rest, and VM.

Results

Experiment 1: Figure 1 shows that both the SB and LB reached their peak pressures at diameters of 5 cm and 7 cm, respectively, and the pressures stabilised around a diameter of 15 cm. Experiment 2: Based on Experiment 1, four different PBIM protocols were used, SB inflated to 5 cm and 15 cm, and LB inflated to 7 cm and 15 cm. RV inflow-VTI increased in all PBIM protocols compared to VM (p <0.01). However, no significant differences were observed among all PBIM protocols (Figure 2A). LVDd decreased in all PBIM protocols compared to VM (p <0.01). Specifically, LVDd was significantly smaller when the SB was inflated to a diameter of 15 cm compared to the LB inflated to a diameter of 15 cm (p <0.05) (Figure 2B).

Conclusions

PBIM can effectively provoke the haemodynamic changes associated with PFO and HOCM compared to VM, potentially leading to a more accurate diagnosis. Notably, using a smaller balloon may be more advantageous for diagnosing HOCM.

Figure 1

Figure 2
Exploring stress echocardiography in coronary artery disease: insights from a tertiary echocardiography center
Authors: Gardikioti V , Kalesi A , Karakosta M , Archontikis A , Zampelis D , Ntiloudi D , Plaitis A , Skantzikas P , Tzinieris T , Kalivi A , Konstantara A , Destounis A , Theodosis-Georgilas A , Patsourakos N , Kasinos N
Published: January 2025

Background/ Introduction

Stress echocardiography (SE) is an established functional test with high sensitivity and specificity for diagnosing obstructive coronary artery disease (CAD).

Purpose

The present study aimed to document the experience of a tertiary hospital’s echocardiography center in using dynamic echocardiography to assess myocardial ischemia.

Methods

The study was performed retrospectively, including all patients who underwent SE at our center from January 2021 to December 2021. The goal for each test was to reach 85% of the age-predicted maximal heart rate (HR) (220 minus the subject’s age). The adopted Dobutamine stress protocol involved a continuous intravenous infusion of Dobutamine in 3-minute increments, starting at 10μg/kg/min and gradually increasing to 50μg/kg/min. Handgrip exercises were typically used, along with a small dose of intravenous atropine (0.25mg, up to a maximum of 1 mg) if the endpoint was not reached. Parasternal and apical echocardiographic views were obtained at all stages, and a contrast agent was used when appropriate. All tests were conducted under continuous 12-lead electrocardiographic (ECG) monitoring.

Results

Out of the 323 subjects [mean age 63.5 ± 10.5 years, 221 males (68.4%)], 123 (38.0%) underwent testing due to suspected CAD symptoms, while the remaining subjects (200 / 62.0%) were tested to reassess known CAD (with or without previous intervention). Twenty-one (7.0%) subjects had a left ventricular ejection fraction (LVEF) ≤40% at rest. The maximum dose of dobutamine most commonly administered was 30 μg/kg/min [137 subjects, (43.0%)], and atropine was given in 51 subjects (16.0%). The target HR was achieved in 291 (90.0%) tests. Eighty-seven (27.0%) SEs utilized a contrast agent in all stages, while in 177 (55.0%) a contrast agent was administered only at rest and peak HR. Major complications, such as acute myocardial infarction or persistent ventricular tachycardia, occurred in 6 patients (1.8%). Specifically, 5 (1.5%) experienced transient ST-segment elevation during the test, and one patient had a lateral myocardial infarction with ST-segment elevation after the test. No allergic reactions were reported. In 226 (70.0%) tests, results were classified as "negative for ischemia up to the achieved HR". In the remaining tests, classified as "positive for ischemia" (97/30.0%), the mean wall motion score index (WMSI) at peak HR was 1.3 ± 0.2 with a mean peak-to-rest ΔWMSI of 0.1 ± 0.1 (Table 1).

Conclusion

Of all the SEs performed at our center with an indication for assessing myocardial ischemia, 30.0% were positive, while major complications occurred in 1.8% of the subjects.
Relationship between left ventricular contractile reserve and vector flow mapping analysis in chronic aortic regurgitation
Authors: Amano M , Kubota Y , Moriuchi K , Kurashima S , Irie Y , Sakamoto T , Amaki M , Kanzaki H , Kitai T , Nakatani S , Izumi C
Published: January 2025

Background

When determining the optimal timing of surgery for aortic regurgitation (AR), evaluation of left ventricular contractile reserve (LVCR) using exercise stress echocardiography (ESE) is helpful. However, no previous studies have identified the relationship between LVCR and low energy efficiency in the left ventricle during exercise.

Purpose

We assessed the relationship between LVCR and the intraventricular flow dynamic parameters using vector flow mapping (VFM) in patients with chronic AR.

Methods

We retrospectively enrolled 44 consecutive asymptomatic or equivocally symptomatic patients undergoing ESE with more than moderate to severe chronic AR and a left ventricular ejection fraction (LVEF) of ≥50%. The patients were classified into two groups: ΔLVEF (peak workload − baseline) of ≥5% (LVCR(+)) and ΔLVEF of <5% (LVCR(−)). In the VFM analysis, energy loss (EL) and wall shear stress (WSS) were evaluated at baseline, low workload, and peak workload during exercise.

Results

Among the 44 patients, 32 were LVCR(−) and 12 were LVCR(+). At baseline, no differences were revealed in interventricular EL and WSS between the two groups. During exercise, however, EL was higher in patients with LVCR(−) than LVCR(+) [16.2 (11.7–22.5) vs. 11.2 (9.3–15.6) mW/m, p=0.015 at low workload; 17.8 (15.4–22.3) vs. 13.3 (9.6–18.0) mW/m, p=0.027 at peak workload]. EL at low workload could predict patients with LVCR(−) (odds ratio: 1.18, 95% confidence interval: 1.02–1.37, p=0.025). No differences in WSS were shown between patients with LVCR(−) and LVCR(+) during exercise.

Conclusions

In patients with chronic AR and LVCR(−), EL during exercise increased, and evaluation of EL at low workload was useful for predicting impaired LVCR. Impaired LVCR may be attributed to not only a non-physiological regurgitant jet but also increased cardiac work due to subclinical LV damage.

Measurement of EL and WSS

Changes in EL and WSS
Influence of gender on the prognostic significance of the wall motion score index in Dobutama n stress echocardiography
Authors: Trninic D
Published: January 2025

Background/Aim

The dobutamine stress echocardiographic test (DSE) plays a significant role in the diagnosis of coronary artery disease (CAD). The aims of our stady were to examine the influence of gender on the prognostic significance of the wall motion score index (WMSI) in the dobutamine stress echocardiographic test for ischemia.

Methods

It is a prospective, observational study that was conducted at the Clinic for Cardiovascular Diseases of the University-Clinical Center of the Republic of Srpska. The study included 143 patients who, due to suspicion of coronary disease, underwent a dobutamine stress echocardiographic test in the period from 01.01. 2021. until 01.02.2022.

Results

Adverse cardiovascular events observed one year after DSE test were more frequent in men (43%) than in women (19%), this difference was statistically significant (p<0.01). WMSI in men had sensitivity (96 %) and specificity (824%) in detection of adverse cardiovascular events. In women, the WMSI in detection of adverse cardiovascular events, sensitivity (93.3%) and specificity (90.6%).

Conclusion

Our results identified WMSI as a prognostic factor for adverse cardiovascular events in both sexes, with sensitivity being higher in men and specificity in women.

Adverse cardiovascular events in women

Adverse cardiovascular events in men
Prognostic value of right ventricular ejection fraction using three-dimensional echocardiography in patients with ischemic cardiomyopathy and dilated cardiomyopathy
Authors: Kitano T , Nagata Y , Nabeshima Y , Dohi K , Takeuchi M
Published: January 2025

Background

Prognostic value of right ventricular (RV) ejection fraction (EF) using three-dimensional echocardiography (3DE) in a diverse group of patients has been demonstrated in several studies [1-3]. However, little is known about its potential utility in patients with ischaemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM).

Purpose

To investigate the prognostic value of 3DE-RVEF in ICM and DCM.

Methods

We retrospectively selected ICM and DCM patients who had undergone 3DE from December 2007 to December 2018. 3DE analysis was performed using 3DE speckle tracking software. The primary end point was a composite of cardiac events, including cardiac death, heart failure hospitalization, myocardial infarction, or ventricular tachyarrhythmia.

Results

268 ICM and 127 DCM patients were included in this analysis. During a median of 33 and 51 months of follow-up, 84 and 43 patients reached a primary end point in ICM and DCM, respectively. Univariable analysis showed RVEF was significantly associated with cardiac events in both groups [ICM, hazard ratio (HR): 0.92, 95% confidence interval (CI): 0.90 – 0.94; DCM, HR: 0.91, 95% CI: 0.88 – 0.94, respectively]. In multivariable analysis, RVEF (HR: 0.91, both for p<0.001) was significantly associated with cardiac events, after adjustment for age, chronic kidney disease, New York Heart Association function class (NYHA), Charlson comorbidity index (CCI), E/e', left ventricular (LV) EF or LV global longitudinal strain (GLS) in ICM. In DCM, RVEF (HR: 0.91 – 0.94, all for p<0.001) was significantly associated with outcome, after adjusting clinical factors (age and CCI or NYHA) and echocardiographic parameters (E/e' or LVEF or LVGLS). Kaplan-Meier survival curves, divided into four groups by RVEF ≥ 45% and < 45% and E/e' 14 ≥ and < 14, showed significant risk stratification for both ICM and DCM (Log-rank: p<0.0001, Fig 1). Crude Kaplan-Meyer survival analysis revealed there were no significant survival differences between ICM and DCM (p=0.36). However, ICM had a worse outcome than DCM after adjustment for age, NYHA, CCI, E/e', RVEF, LVEF or LVGLS (p=0.049 and p=0.028, respectively, Fig 2).

Conclusions

Our study confirmed the independent prognostic value of RVEF in patients with ICM and DCM and provided detailed risk stratification of cardiac events by E/e' and RVEF. In addition, ICM was associated with worse outcome than DCM after adjusting multiple covariates.
Dimensions and functional features of the mitral and tricuspid annuli in hemophilia - a three-dimensional speckle-tracking echocardiographic study
Authors: Nemes A , Racz G , Kormanyos A , Ambrus N , Marton I , Borbenyi Z
Published: January 2025

Introduction

Theoretically, heamophilia-related hypocoaguability and related changes in myocardial mechanics could affect valvular dimensions anf function.

Purpose

The present study aimed to determine mitral (MA) and tricuspid annular (TA) dimensions and functional properties by a three-dimensional speckle-tracking echocardiography (3DSTE)-based quantification method in hemophilia patients.

Methods

The study comprised 17 patients with hemophilia, all of them received treatment and were under regular care in a tertiary haematology center. Due to inferior image quality, 4 patients were excluded. The remaining group of patients consisted of 13 cases with hemophilia (mean age: 40.8±16.3 years, all males), from which 11 proved to be type A and 2 cases had type B disease. Their results were compared to 30 age- and gender-matched control subjects (mean age: 40.4±9.24 years, all males).

Results

Routine two-dimensional Doppler echocardiographic data proved to be similar between hemophilia patients and controls except for higher left ventricular ejection fraction and lower E/A values in hemophilia patients. Other echocardiographic parameters did not differ between the groups examined. None of the hemophilia patients and controls showed ≥ grade 1 valvular regurgitation or significant stenosis on any valves. Dilated end-diastolic and end-systolic MA diameters (2.47±0.35 cm vs. 2.79±0.25 cm, p=0.006 and 1.83±0.40 cm vs. 2.19±0.38 cm, p=0.01, respectively), areas (7.66±1.90 cm² vs. 10.70±2.55 cm², p<0.001 and 4.02±1.34 cm² vs. 6.91±2.31 cm², p<0.001, respectively), perimeters (10.46±1.22 cm vs. 11.30±3.33 cm, p<0.001 and 7.48±1.28 cm vs. 9.99±1.71 cm, p<0.001, respectively) and consequentially decreased MA fractional area change (47.17±15.91% vs. 35.57± 16.44%, p=0.042) were present in hemophilia patients compared to those of healthy controls. From tricuspid annular (TA) dimensions, only end-diastolic TA diameter (2.41±0.41 cm vs. 2.65±0.34 cm, p=0.071), area (7.68±1.94 cm² vs. 9.06±2.32 cm², p=0.050) and perimeter (10.68±1.25 cm vs. 11.54±1.32 cm, p=0.049) proved to be dilated with preserved end-systolic TA diameter (1.99±0.37 cm vs. 2.08±0.37 cm, p=0.438), area (5.92±0.78 cm² vs. 5.65±1.34 cm², p=0.628) and perimeter (9.34± 1.20 cm vs. 9.50±1.46 cm, p=0.709) in hemophilia patients. TA fractional area change proved to be reduced (23.75±9.42% vs. 36.57±12.01%, p=0.001).

Conclusion

Both MA and TA are dilated with functional deterioration in patients with hemophilia, although TA dilation seems to be less pronounced.
Left atrial function and left atrioventricular coupling indices for atrial fibrillation prediction in hypertrophic cardiomyopathy
Authors: Rella V , Delcea C , Clement A , Fisicaro S , Perelli F , Tomaselli M , Penso M , Parati G , Crotti L , Badano L , Muraru D
Published: January 2025

Background

In hypertrophic cardiomyopathy (HCM), atrial fibrillation (AF) is a marker of disease progression and worse outcome, increasing the risk of thromboembolic events. Identification of HCM patients (pts) at risk of AF is pivotal for their clinical management and follow-up.

Purpose

We aimed to explore whether a detailed echocardiographic evaluation of the left atrium (LA) remodeling and function in HCM pts might improve the predictive value for new AF compared to standard parameters.

Methods

In consecutive HCM pts referred to our Cardiomyopathy Clinic between 2020 and 2023, we assess left ventricular (LV) and LA volumes and strain by two-dimensional echocardiography (2DE), and LV and LA volumes and total LA emptying fraction (EF) by three-dimensional (3DE) echocardiography. 3DE left atrioventricular coupling index (LACI) was calculated as the ratio of respective LA to LV end-diastolic volumes and expressed as percentage %. Clinical, ECG, and 48h ECG Holter data were also collected.

Results

A total of 180 HCM pts (58±18 years, 55% men) were followed for 23±13 months. Twenty-seven patients experienced at least one episode of AF during follow-up. They were older and had more impaired LV global longitudinal strain (GLS) (-13±4% vs -15±4%, p=0.004), total LA EF (31±12 vs 42±11%, p=0.001) and LA reservoir strain (LASr, 10±6 vs 16 ±8%, p=0.001) compared to pts without AF. In addition, larger values of 3DE LACI (75±51% vs 43±25%p=0.009) were found in the HCM pts with new AF episode during follow-up.

At Cox univariable analysis, 3DE LACI, LA EF and LASr were associated with AF (AUC 0.68, 0.69 and 0.72, respectively, p<0.001 for all). The optimal cutoffs for predicting AF were > 59% for 3DE LACI and < 26% for LA EF with significant discriminative value in Kaplan-Meier analysis. The addition of 3DE LACI and LA EF to a model including LV GLS and 2DE LA volume had a significant incremental value for predicting the occurrence of AF (Figure 1).

Conclusions

In HCM patients, the advanced evaluation of LA function and left atrio-ventricular coupling by 3DE may improve the identification of patients at risk for subsequent AF episodes within 1 year follow-up.

Predictive Model
Would the addition of three more views to the standard echocardiographic examination add important non cardiac findings and change the management plan?
Authors: Farouk H , El-Chilali K , Schoene D , Witt C , Ronge R , Kloppe A
Published: January 2025

Background

Routine and rapid screening of the liver, pleura, and abdominal aorta during standard transthoracic echocardiographic (TTE) studies might result in better management of patients referred for echocardiographic assessment.

A total of 7000 cases referred from different departments between 2022 to 2024 were enrolled, non-cardiac findings were documented in 589 cases (8.4%). We screened rapidly the liver, pleura, and aorta in all these patients as a part of our policy in performing the standard echocardiographic examination. The most detected abnormalities were pleural effusion in context of heart failure (88%), left sided pleural effusion following cardiac surgeries (coronary bypass graft, valve replacement) in 20 cases (3%), and first diagnosis of malignancies (liver metastases, non-small cell lung carcinoma, suprarenal metastasis, renal carcinoma, and ascites in 3%). Most cases were referred from the cardiology ward (88%) and chest ward (10%). Patients were commonly admitted because of dyspnea, tachycardia, chest pain, or lower limbs edema. The most common referring diagnoses were heart failure (87%), pneumonia (5%), and lower limbs edema for further investigations (4%). In 3% of cases, echocardiography was the first clue to a malignancy with further work-up confirming the diagnosis while empyema was suggested by echocardiography in 1% of cases necessitating surgical intervention. Aortic abnormalities namely descending aortic aneurysms with superimposed thrombus were detected in 4 patients (0.6%).

Conclusion

Routine rapid screening of the liver, pleura, and aorta could add an important clinical piece of information, detect possible malignancy (mainly liver metastases), infected pleural effusion, and aortic dilatation necessitating further assessment and management in hospitalized patients with various cardiopulmonary symptoms.

Learning objectives: Spending few minutes more in standard echocardiography could change the plan, direct the treating physician to the problem, and spare performing unnecessary investigations.

Learning more skills makes the echocardiography a part of the clinical assessment of patients rather than a pure cardiac investigation.

Limitations: Screening should never replace a detailed abdominal sonography or further comprehensive studies (computed tomography or angiography in patients suspected having pleural or aortic diseases).

Accidental Findings