bluuebunny/crossref_metadata_2025 huggingface dataset:
Prognostic role of echocardiography to predict cardiovascular involvement in systemic sclerosis
Authors: Mazzola M , Bruni C , Pugliese NR , D"alto M , Argiento P , Moreo A , De Chiara B , Vriz O , Ferrara F , Bossone E , Matucci-Cerinic M , Gargani L
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Purpose. Cardiovascular involvement in systemic sclerosis (SSc) is frequent, often subtle, and is associated with poor prognosis. Our aim was to compare echocardiographic data of SSc patients to controls, and to assess parameters able to predict the development of cardiovascular involvement.

Methods. We enrolled 756 SSc patients  (Group 1) without a previous diagnosis of cardiac involvement nor pulmonary arterial hypertension (PAH), and 614 healthy controls (Group 2) matched for age (Group 1 54.9 ± 14.6 years vs Group 2 54.4 ± 12.1, p = 0.6), sex (7.3% vs 7.2%, p = 0.8), and prevalence of hypertension (17.8% vs 19.8%, p = 0.2). All subjects underwent a comprehensive transthoracic 2D and Doppler echocardiography, including tissue Doppler imaging analysis (TDI). Five hundred and two SSc patients were followed-up and the development of PAH, left-sided heart failure (LHF), right-sided heart failure (RHF), and need of implantable cardioverter defibrillator (ICD) were considered as events.

Results. Compared to controls, SSc patients showed worse left and right ventricular systolic and diastolic function, hemodynamics and right ventricle-arterial coupling (tricuspid annulus plane systolic excursion over systolic pulmonary artery pressure, TAPSE/sPAP) (Table).  After a median follow-up with of 35 moths, 45 composite events (PAH, LVH, RHF and ICD) occurred. In a multivariate model, only ejectioin fraction (EF) and TAPSE/sPAP had independent prognostic value (Table).

Conclusions. SSc patients without overt cardiovascular involvement and no PAH display subtle impairments in biventricular systo-diastolic function and right ventricle-arterial coupling. Left ventricular EF and TAPSE/sPAP can predict further cardiovascular events.

Descriptive analysis and Cox regression Descriptive Univariate Multivariate VARIABLE Group 1 (Ssc) n = 756 Group 2 (controls) n = 614 p HR (95 % CI) p HR (95% CI) p Ejection fraction (%) 63 ± 5.7 63.7 ± 5.9 0.038 0.94 (0.88 - 0.99) 0.024 0.91 (0.85 - 0.98) 0.017 E/A 1.0 ± 0.46 1.2 ± 0.51 <0.0001 1.41 (0.77 - 2.58) 0.26 e’ mean (mm) 10.7 ± 3 11.2 ± 3.4 0.034 0.87 (0.76 - 0.99) 0.038 1.0 (0.87 - 1.17) 0.902 Left atrial volume index (mL/m2) 26.5 ± 7.7 21.3 ± 6.7 <0.0001 1.03 (0.98 - 1.1) 0.24 TAPSE (mm) 22.1± 23.3± <0.0001 0.89 (0.81 - 0.97) 0.012 sPAP (mmHg) 24.7± 22.3± <0.0001 1.07 (1.04 - 1.1) < 0.0001 TAPSE/sPAP (mm/mmHg) 0.98 ± 0.96 1.1 ± 0.39 <0.0001 0.036 (0.009 - 0.141) < 0.0001 0.03 (0.004 - 0.19) < 0.0001 Pericardial effusion 57 (7.5%) 0 (0%) <0.0001 1.10 (0.38 - 3.15 ) 0.85
Non invasive ventilation and right ventricle function in cardiogenic pulmonary edema: an echocardiographic perspective to select the "right" ventilatory support
Authors: Pedicino D , Angelini A , Russo G , D"aiello A , Rocco E , Ciampi P , Ponzo M , Graziani F , Locorotondo G , Sanna T , Rebuzzi AG , Lombardo A , Massetti M , Liuzzo G , Crea F
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

High-flow nasal cannulae oxygen therapy (HFNCOT) represents a better tolerated alternative to non-invasive pressure support ventilation (NIPSV) for acute cardiogenic pulmonary edema (ACPE) treatment. However, there are still few data on the effect of HFNCOT on cardiac function and hemodynamic.

Purpose

To assess and compare the effects of NIPSV and HFNCOT in ACPE setting on right ventricular (RV) systolic function and on indices of cardiac filling and output, as measured by echocardiography. 

Methods

 This is a cross-over controlled study, enrolling 15 consecutive patients admitted to our Cardiovascular Intensive Care Unit for ACPE and hypoxaemic, normo/hypocapnic acute respiratory failure, with P/F ratio < 200. Each patient received NIPSV, followed by HFNCOT. Full echocardiographic assessment and blood gas analysis (BGA) were performed 40 minutes from onset of each ventilation modality, respectively before NIPSV to HFNCOT switch and before HFNCOT interruption. In particular, RV function parameters, together with RV and atrial strain, were prospectively collected.

Results

 In spite of not significant changes in BGA, RV function was significantly improved under HFNCOT, as compared to NIPSV, as assessed by the following parameters: tricuspid annular plane excursion (TAPSE) (P = 0.001), RV S’ wave (P = 0.007), RV fractional area change (RVFAC) (P = 0.006). Strain analysis confirmed the significant improvement in RV function, with free wall global longitudinal strain (GLS) and free wall and septum GLS significantly higher under HFNCOT, as compared to NIPSV (-21% vs -18% P < 0.001, and -15% vs -19% P = 0.008, respectively,), and a significant increase in right atrial positive longitudinal strain (P < 0.001). 

Conclusions

NIPSV significantly affect RV function making more complex the management of patients presenting with ACPE. In this setting, HFNCOT represents a valuable alternative, providing similar respiratory outcomes while preserving good right ventricle performance.
Bicuspid aortic valve flow dynamics using blood speckle tracking in children
Authors: Henry M , Fadnes S , Lovstakken L , Mawad W , Mertens L , Nyrnes S
Published: February 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Labatt Family Heart Centre

Background

Bicuspid aortic valves (BAV) are the most common form of congenital heart disease with a prevalence of up to 2%. Fusion of the aortic cusps result in complex flow patterns in the aortic root which may contribute to the risk of progressive dilation. Imaging these patterns with conventional echocardiography is challenging due to the angle dependency of colour Doppler. Blood speckle tracking (BST) is a novel method based on high-frame rate ultrasound that is less angle-independent and developed to evaluate complex flow.

Purpose

The aims of this study were to 1) describe and quantify flow patterns in the aortic root using blood speckle tracking and 2) quantitatively compare flow parameters (energy loss, vorticity, kinetic energy) between paediatric patients with BAVs and those with normal aortic valves.

Methods

Clinical and routine echocardiographic parameters were collected for children with normal and BAVs.  Children were imaged using a commercially available clinical scanner with research software enabling the acquisition of high-frame rate imaging and blood speckle tracking. Aortic root energy loss, vorticity and kinetic energy were measured in the parasternal long axis view.

Results

Data from 46 patients were analyzed (31 normal aortic valves, 15 BAVs) with no significant difference in age, height, weight or BSA between groups. Nine patients (60%) had right-left fusion; 6 (40%) had right-non fusion. Qualitative flow assessment in aortic root demonstrated disturbed flow in the BAV group (see figure) generally directed towards the non-fused cusp (i.e non coronary cusp in right-left fusion). Patients with a BAV had higher aortic valve peak velocity (2.1 m/s vs 0.9 m/s, p< 0.001);  aortic root systolic energy loss (4.29 mW/m vs 1.79 mW/m, p< 0. 001), vorticity (38.7 1/s vs 31.1 1/s, p< 0.01) and kinetic energy (34.5  mJ/m vs 24.5 mJ/m, p = 0.04) compared to those with normal aortic valves.

Conclusion(s)

Blood speckle tracking can demonstrate altered flow patterns in the aortic root in patients with BAV. These patients have increased energy losses, vorticity and kinetic energy when compared to age matched patients with normal aortic valves however the relationship of theses parameters to aortic root dilation remains to be demonstrated.

Abstract Figure. Flow patterns (A-C) and analysis (D-F)
Time to step up 4 flights of stairs gives relevant information on exercise testing performance and results
Authors: Peteiro Vazquez JC , Bouzas-Mosquera A , Rivadulla-Varela C , Barbeito-Caamano C , Vazquez-Rodriguez JM
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The achievement of a maximal workload of 10 metabolic equivalents (METs) is associated to good outcome with hard cardiac events of just around 1%/year. However, there is no much information on common daily exercises that can be quantitatively measured and give information about this exercise performance. We aimed to assess the capacity of stepping up stairs in patients submitted for an exercise testing (ExT).

Methods

A total of 165 consecutive ambulatory patients submitted for a clinically indicated ExT with ECG (ExT-ECG, n = 15) or echocardiography (ExT-E, n = 150) were included. At least 15 minutes after the test patients were asked to step up 4 flights of stairs (60 stairs) at fast pace without stopping but also without running and the time to do it was counted.

Results

Patients who achieved 10 METs during exercise (n = 69) made the stairs test in 46 ± 11 secs, those who achieved 8-10 METs (n = 37) in 58 ± 21 secs, and those who achieved <8 METs (n = 59) made it in 82 ± 41 secs (p < 0.001). Correlation between METs and stairs time test was 0.53 (Figure 1). The area under the curve ROC of stairs time for predicting an achievement of 10 METs was 0.79 (95% CI= 0.72-0.86, p < 0.001). A cut off value of 60 secs had high sensitivity (94%) and negative predictive value for 10 METs (93%) although specificity and positive predictive values were of 53% and 59%, respectively. A cut-off value of 90 secs had low sensitivity (34%) but high specificity (96%) and positive predictive value (83%) for predicting <8 METs. Abnormal results were seen in 58% of patients with limited exercise capacity, 30% with intermediate exercise capacity, and 29% with good exercise capacity (p = 0.002); and in 32% of patients that did the stairs test in at least 60 secs in comparison with 52% of those that lasted between 61-89 secs and 58% of those that lasted more (p = 0.018).

Conclusions

Most subjects able to step up 4 flights of stairs in 45 secs will perform well during exercise testing. On the contrary, those unable to make the stairs test in 1 and a half minutes are expected to have bad functional capacity and worse exercise test performance.

Abstract Figure.
The usefulness of dipyridamole stress echocardiography in high-risk patients before abdominal aneurism surgery
Authors: Binno S , Moderato L , Capelli P , Piepoli MF , Scabini M , Mosso F , Aschieri D
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 Coronary artery disease (CAD) and aortic aneurysm (AA) share commons risk factors,

such as hypertension, diabetes mellitus, hypercholesterolemia, and smoking. Cardiac

assessment before aortic abdominal aneurysm (AAA) surgery is indicated for patients with

symptomatic coronary artery disease (CAD). The usefulness of assessment of moderate/high-risk

patients is still debated. 

Purpose

the purpose of our study is to evaluate the safety and effectiveness of dipyridamole stress

echocardiography (DSE) for the detection of CAD in patients undergoing AAA surgery with high cardiovascular risk. 

Methods

From 2017th to 2019th 120 patients underwent surgery for aortic aneurysm (71 endovascular technique and 49 with open laparotomy). 

Of these, 74 asymptomatic patients with high cardiovascular risk underwent a pre-surgical contrast-enhanced dipyridamole stress echo (0,84 mg/kg over 6 minutes – protocol with LVO with sulfur hexafluoride), to exclude the presence of inducible myocardial ischemia, Mean follow-up was 6-24 months. 

Results

  Mean age was 77 years +/- 6.6, with male gender prevalent (83%).  No complication during DSE occurred; mean SCORE risk was 9.8% +/- 2.3%, with 63% patients with very high risk.  Only 1 patient showed inducible ischemia during stress echocardiography, with evidence of significant LAD stenosis; no myocardial infarction was reported at follow-up, while 1 ischemic stroke and 1 unplanned revascularization occurred. 

11% of patients died, of which 50% for Sars-Cov-2 disease and 12% due to post-surgery dissection while no cardiac deaths were found.

Conclusions

dipyridamole stress echo is safe in patients with surgical-class abdominal aortic aneurism; in patients with high cardiovascular risk but no symptoms reversible ischemia is rare. DSE should not be routinely performed before high-risk surgery but only in patients with cardiac symptoms.

Abstract Figure. Patients Diagram
Clinical, functional and prognostic correlates of blunted heart rate reserve during exercise stress echocardiography in hypertrophic cardiomyopathy
Authors: Palinkas ED , Varga A , Agoston G , Palinkas A , Sepp R
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Blunted heart rate reserve (HRR) during exercise is associated with cardiac autonomic dysfunction and poor outcome.

Purpose

To evaluate the anatomical, functional and prognostic correlates of HRR during exercise stress echocardiography (ESE) in hypertrophic cardiomyopathy (HCM).

Methods

We prospectively recruited a consecutive sample of 121 HCM patients [age 47 ± 13 years, 67 males; NYHA class 1.7 ± 0.7; left ventricular (LV) ejection fraction 71 ± 9 %; LV maximal wall thickness 24 ± 5 mm; 58 (48%) with LV outflow tract obstruction (LVOTO, gradient ≥ 50 mmHg) at rest] who underwent semi-supine bicycle ESE from January 2006 to September 2019. HRR was calculated as the peak/rest heart rate (HR) ratio. All patients were followed-up for a median of 7.5 years.

Results

HR was 68 ± 11 bpm at rest and 105 ± 19 bpm at peak stress. Receiver-operating characteristic analysis was used to determine the best cut-off value of HRR (≤ 1.48, blunted) to predict all-cause death. A blunted HRR was present in 52 patients (43 %, Group 1). Patients with blunted HRR had more frequently hypertension (Group 1= 41/52 vs Group 2= 40/69, 79 vs 58 %, p = 0.019), resting systolic anterior motion of the mitral valve [(SAM) , Group 1= 41/52 vs Group 2= 40/69, 79 vs 58 %, p = 0.019] and rest LVOTO (Group 1= 31/52 vs Group 2= 27/69, 60 vs 39 %, p = 0.029).  Patients in Group 1 had larger left atrial diameter (48.8 ± 6.5 vs 46.5 ± 7.6, p = 0.076), lower LV end-diastolic [(EDD) , 44.8 ± 4.6 vs 46.7 ± 4.6 mm p = 0.02] and LV end-systolic diameter [(ESD), 25.2 ± 5.3 vs 27.6 ± 5.5 mm p = 0.02] at rest. Patients in Group 1 had higher NYHA class (1.9 ± 0.6 vs 1.6 ± 0.7, p = 0.009), resting HR (71.5 ± 11.4 vs 64.6 ± 10.6 bpm p < 0.001), and shorter total exercise time (6.3 ± 3.1 vs 9.1 ± 2.8 min, p < 0.001) compared to patients in Group 2.

During the follow-up, 13 patients died. All-cause death was observed in 10/52 patients of Group 1 and 3/69 patients of Group 2 (19 vs 4 %, p < 0.05). Cox multivariate regression survival analysis revealed that HRR ≤ 1.48 (Hazard ratio 3.7, 95% CI 0.96-14.5, p = 0.048) and left atrial diameter (Hazard ratio 1.15, 95% CI 1.04-1.28, p = 0.003) were independent predictors of all-cause mortality, either on or off beta-blocker therapy.

Conclusion

HRR is a simple non-imaging biomarker of cardiac autonomic function and is frequently abnormal in HCM. The blunted increase in frequency is associated with NYHA functional class, exercise time, rest HR, rest LVOTO, SAM, LV EDD and ESD. HRR independently predicts survival in HCM. The lower the HRR, the worse the outcome.

Abstract Figure.
Global longitudinal strain and left ventricle dyssynchrony changes during stress echocardiography in response to antihypertensive treatment optimization
Authors: Karev E , Verbilo S , Malev E , Prokudina M , Suvorov A
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background. The positive effect of blood pressure (BP) lowering medications on global longitudinal strain (GLS) and left ventricle (LV) dyssynchrony even in patients with narrow QRS complexes at rest has been established at rest. The dynamic changes of GLS and dyssynchrony markers on exertion are still remain underinvestigated, especially in patients with hypertensive response to exercise (HRE).

Purpose. The aim of the study was to define if any changes in GLS and dyssynchrony markers assessed during exercise stress echocardiography (SE) can occur after the optimization of antihypertensive treatment.

Methods. 18 patients without coronary artery stenosis on coronary angiography, underwent exercise SE on treadmill. All patients had arterial hypertension and HRE, defined as elevation of systolic BP ≥190 mmHg in women and ≥210 mmHg in men or ≥180 mmHg from the second stage of standard Bruce protocol. After optimization of BP lowering medications (addition/dose correction of ACEI/ARB, CCB or diuretics) we repeated SE within 138.5 ± 85.1 days. GLS and dyssynchrony markers at rest and on exertion from both tests were subsequently analyzed with the QLab and 3D-Q Advanced software.

Results. The target systolic BP at rest was reached in all 18 patients (145.8 ± 21.8 mmHg vs. 126.1 ± 14.5 mmHg, p = 0.03), moreover exercise BP on exercise decreased significantly (209.4 ± 15.4 mmHg vs. 170.8 ± 14.4 mmHg, p = 0.003). We observed improvement in tolerance to exertion (7.2 ± 2.4 METs vs. 8.7 ± 3.0 METs, p = 0.0004), 2D and 3D-ejection fraction increase (4.7 ± 2.2% vs. 8.8 ± 2.1%, p = 0.0002 and 3.9 ± 4.9% vs. 10.8 ± 8.5, p = 0.03) and significant reduction of wall motion score index (1.21 ± 0.24 vs. 1.03 ± 0.11, p = 0.001). The speckle tracking analysis revealed increase in GLS on exertion (-20.4 ± 3.5 vs. -23.78 ± 3.2, p = 0.001) and its increment (-0.28 ± 2.1 vs. 3.17 ± 1.89, p = 0.0006), while the level of rest GLS remained unchanged (-20.61 ± 2.9 vs. -20.61 ± 2.6, p = 0.9) (Fig. 1). The dyssynchrony marker STE-TIME SD-IMPOST (standard deviation of time from QRS onset to peak segmental longitudinal strain on exertion) has also diminished (47.3 ± 18.4 vs. 33.8 ± 12.2, p = 0.005).

Conclusions. Stress-induced wall motion abnormalities and poor increase/decrease in GLS observed in patients with HRE even in absence of coronary artery stenosis can resolve or diminish after antihypertensive treatment optimization.

Speckle tracking LV-dyssynchrony markers in patients with narrow QRS complexes can also decrease in response to BP-lowering medications.

Abstract Figure 1.
Does number of volumes affect regional deformation measurements when using volume stitched 3D speckle tracking?
Authors: Hjertaas JJ , Einarsen E , Gerdts E , Kokorina M , Moen CA , Urheim S , Saeed S , Matre K
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Optimal 3D speckle tracking echocardiography (STE) requires volume stitching, a technique prone to errors, such as patient movements, respiration and arrhythmias. With different resolution at different depths (Figure 1A), such errors may cause stitching artefacts that affect STE derived deformation measurements at different levels of the left ventricle.

Methods

In this cross-sectional study, 62 patients with variable degree of aortic stenosis participated. 3D images were recorded using 3 different methods (2-, 4- and 6-beat volume stitching at 22 ± 2, 29 ± 4 and 36 ± 6 volumes per second, respectively). Strain, rotation and torsion were analyzed at 3 different levels (basal, mid and apical) (Figure 1B). Results were compared using one-way analysis of variance between methods. Inter-segmental variation was estimated using the coefficient of variation (CV) of the segments involved for each level. Results were interpreted as more accurate if low values of inter-segmental variation between segments in a level was present.

Results

Neither longitudinal strain (LS) nor circumferential strain (CS) showed any difference between methods in the basal level (Table 1). LS was higher in mid and apical level for 2-beat, while CS was higher only in apical level for 2-beat.

Inter-segmental CV showed no significant difference between methods for LS and CS. Between levels, both had higher CV in basal than apical level, but CS had much higher values, indicating lower accuracy in basal level.

Rotation measurements showed negative values in basal level and positive in apical level. None of the methods differed significantly. Torsion showed higher values for 2 beat images only.

Conclusion

3D STE from both 4- and 6 beat images have insignificant differences for strain, as well as low inter-segmental variability. LS is accurate in all levels while CS has high accuracy in apical, and poor in basal level. Both rotation and torsion differ insignificantly when using 4- and 6-beat images.

Table 1 Level Mean ± SD ANOVA P CV 2-beat 4-beat 6-beat 2-beat 4-beat 6-beat Longitudinal strain (%) Basal -17.82 ± 4.83 -16.81 ± 4.48 -17.05 ± 3.56 0.402 34.5 34.9 31.5 Mid -16.34 ± 4.30 -14.91 ± 3.62 -14.46 ± 3.53 0.019 31.4 29.9 29.9 Apical -16.80 ± 4.33 -15.06 ± 3.12 -15.09 ± 3.02 0.008 30.6 28.5 24.9 Circumferential strain (%) Basal -12.93 ± 4.42 -14.16 ± 4.21 -13.05 ± 3.24 0.168 106.7 71.7 74.4 Mid -17.59 ± 3.86 -16.73 ± 3.56 -16.98 ± 3.51 0.406 43.0 36.9 30.3 Apical -22.14 ± 6.20 -19.04 ± 4.81 -20.32 ± 5.40 0.008 26.8 29.4 23.4 Abstract Figure 1
Cardiac computed tomography for therapy targeting in surgical repair of anteroapical left ventricular aneurysms: assessment of aneurysm volume and of anticipated residual left ventricular volume
Authors: Solowjowa N , Nemchyna O , Hrytsyna Y , Meyer A , Pasic M , Falk V , Knosalla CH
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Surgical ventricular repair (SVR) is an established treatment option in patients with heart failure (HF) due to left ventricular (LV) aneurysms, whereby LV volume reduction is the principal therapeutic target. Precise planning therefore is essential for postoperative improvement of HF symptoms.

Purpose

In this study we evaluated the potential of cardiac computed tomography (CCT) to estimate the aneurysm volume and to predict the achievable residual LV volume.

Methods

 205 patients (11/2005-01/2016, m:w = 151:54, median 63.4 years; mean NYHA class 3.03) with anteroapical LV aneurysm underwent SVR combined with coronary artery bypass grafting (77%), mitral valve repair/replacement (19%), and LV thrombectomy (19%). CCT was performed before and 7 days after surgery. Volumetric assessment was made using dedicated software (syngo.via Cardiac Function, Siemens AG).  Preoperative CCT data of 48 consecutive patients were analyzed and then matched with effectively achieved postoperative volumes. To separate the aneurysm volume in the systole and diastole a plane determined by three landmarks on borders of scared to intact LV myocardium (antero-septal, lateral and inferior) was used. In this way ensued the retrospective estimation of the aneurysm volume (AnV/AnVI) and anticipated LV end diastolic and end systolic volume (LVEDVI, LVESVI).

Results

Mean diastolic and systolic estimated AnV were 92 ± 56.6 ml and 83.5 ± 61.6 ml respectively. Relation of AnV to LVEDV and to LVESV was 29.2% and 38.2%, correspondingly. There was significant correlation between anticipated and effectively achieved LVEDV and LVESV (r = 0.87 and r = 0.88, respectively, p < 0.0001), and their indexed values (r = 0.83 and r = 0.83, respectively, p < 0.0001). Anticipated LVEDVI was only 10.3 ± 22.5 ml/m2 greater than achieved LVEDVI (p = 0.003), and anticipated LVESVI was only 2.4 ± 20.3 ml/m2 greater than achieved LVESVI (p = 0.433).

Conclusions

Estimation of aneurysm volume and anticipated postoperative LV volume allows to predict if the therapeutic targets can be successfully achieved in individual patients. Based on the CCT assessment we propose an approach for surgical planning in anterior LV aneurysms.
Computed tomography for the prediction of structural valve deterioration in patients undergoing transcatheter aortic valve implantation
Authors: Guglielmo M , Fusini L , Muratori M , Tamborini G , Mantegazza V , Muscogiuri G , Baggiano A , Stefano S , Babbaro M , Mollace R , Mushtaq S , Conte E , Guaricci AI , Pepi M , Pontone G
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 Computed tomography (CT) provides excellent anatomy assessment of the aortic annulus (AoA) and is currently routinely utilized for pre-procedural planning of transcatheter aortic valve implantation (TAVI). This study sought to investigate if geometrical characteristics of the AoA determined by CT may represent predictors of structural valve deterioration (SVD) in patients undergoing transcatheter aortic implantation (TAVI) with balloon-expandable valves.

Methods

AoA maximum diameter (Dmax), minimum diameter (Dmin), and area were assessed using pre-procedural CT in patients undergoing TAVI in our Institution.  SVD was identified with transthoracic echocardiography at 5.9 ± 1.7 follow-up years.

Results

124 consecutive patients (mean age: 79 ± 7 years old; female: 61%) were retrospectively enrolled. AoA Dmax, Dmin and area were significantly smaller in patients with SVD compared to patients without SVD (27.1 ± 2.8 mm vs 25.6 ± 2.2 mm, p = 0.012; 21.8 ± 2.1 mm vs 20.5 ± 2.1 mm, p = 0.001 and 467 ± 88 mm2 vs 419 ± 77 mm2  p = 0.002 respectively). At univariate analysis, female sex, body surface area, the use of a -23 mm prosthetic valve a Dmax <27.1 mm and a Dmin < 19.9 mm were all variables independently associated with SVD whereas at multivariate analysis, only Dmin <19.9 mm (OR = 2.873, 95% CI: 1.191-6.929, p = 0.019) and female sex (OR = 2.659, 95% CI: 1.095-6.458, p = 0.031)  were independent predictors of SVD.

Conclusions

Female sex and AoA Dmin < 19.9 mm are associated to SVD in patients undergoing TAVI with balloon explandable valves.

Abstract Figure.
Myocardial fibrosis quantification by cardiac CT predicts outcome in severe aortic stenosis
Authors: Scully P , Patel KP , Augusto JB , Klotz E , Lloyd G , Kelion A , Kennon S , Ozkor M , Mullen M , Cavalcante JL , Menezes LJ , Hawkins PN , Moon JC , Pugliese F , Treibel TA
Published: February 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Background

Myocardial extracellular volume (ECV) increases with fibrosis, oedema or infiltration. ECV by CMR predicts all-cause and cardiovascular mortality in severe AS after valve intervention. Previous studies have shown that ECV can be reliably quantified by computed tomography (ECVCT), but these studies have not differentiated between ECV elevation due to fibrosis or cardiac amyloid deposition (13-16% of patients with severe AS). 

Purpose

We hypothesised that ECVCT quantification, performed as part of a transcatheter aortic valve implantation (TAVI) work-up CT, predicts survival in patients with severe AS without cardiac amyloid (lone AS).

Methods

Patients aged ≥75, with severe AS, referred for TAVI at Barts Heart Centre (as part of ATTRact-AS (NCT03029026)) underwent CT as part of their clinical work-up. All patients had 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (DPD) scintigraphy and those with a positive result were excluded.  CT was performed on a 128-slice dual-source 3rdgeneration scanner (Siemens Somatom FORCE) and ECVCT was acquired during the TAVI work-up CT using additional pre- and 3-minute post-contrast ‘axial shuttle mode’ acquisitions (no additional contrast).  ECVCT was calculated from the Hounsfield units (HU) and a venous haematocrit (HCT): ECVCT = (1-HCT) x (ΔHUmyo/ΔHUblood).

Results

Following exclusion of 16 patients with cardiac uptake on DPD, 93 patients (41% male, aged 85 ± 5 years) were included in the study.  All patients had severe AS (AV Vmax 4.12 ± 0.63m/s, mean AV gradient 42 ± 14mmHg, AVA 0.71 ± 0.23cm2). The mean HCT was 0.38 ± 0.04 and total dose-length product for additional research scans was 364 ± 41 mGy.cm. 76 patients (82%) underwent TAVI. ECVCT was 32 ± 3% in the entire cohort, which we then split into those with a ‘higher’ ECVCT (>34%, n = 23, representing the highest quartile) and those with a ‘lower’ ECVCT (≤34%, n = 70, representing the lower quartiles). Over a median follow-up of 25 months (IQR 17-34 months) there were 27 deaths (29%), of whom 11 did not undergo TAVI (41%). There were 10 deaths in the 23 patients (44%) with a higher ECVCT, compared to 17 in the 70 patients (24%) with a lower ECVCT (p = 0.03, figure 1). This mortality difference remained significant when those patients who did not undergo TAVI were excluded (p = 0.03).

Conclusions

Myocardial fibrosis quantified by ECVCT is associated with a significantly worse prognosis in lone AS, even after patients with AS-amyloid are excluded. ECVCT can be performed as a simple addition to the TAVI work-up CT and provides additional prognostic information.

Abstract Figure.
The association between early vascular aging and cyclothymic affective temperament
Authors: Vecsey-Nagy M , Szilveszter B , Kolossvary M , Gonda X , Rihmer Z , Merkely B , Maurovich-Horvat P , Nemcsik J
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

onbehalf

Cardiovascular Imaging Research Group

Background

Affective temperaments (depressive, anxious, irritable, hyperthymic, cyclothymic) are regarded as the biologically stable core of personality, and accumulating data implies their relationship with cardiovascular diseases. There are currently limited data on the association of affective temperaments and early vascular aging.

Purpose

The aim of our study was to assess the potential relationship of affective temperaments and vascular age, as assessed by coronary CT.

Methods

In our current cross-sectional study, 209 patients referred to coronary computed tomography angiography (CCTA) due to suspected coronary artery disease (CAD), were included. After the evaluation of medical history and demographic parameters, all patients completed the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego Autoquestionnaire (TEMPS-A) and the Beck Depression Inventory (BDI). Vascular age was estimated using coronary artery calcium (CAC) score and we calculated its difference from chronological age for each patient. Linear regression analysis was applied to identify predictors of early vascular aging in the entire cohort and in male and female sub-populations, separately.

Results

The independent predictors of early vascular aging were female sex (B = -10.82 [95%CI: -15.30 – -6.33]), diabetes mellitus (B = 7.16 [95%CI: 1.20 – 13.12]) and dyslipidemia (B = -8.28 [95%CI: 3.94 – 12.62]). Further assessing gender differences, cyclothymic temperament score proved to be an independent predictor of early vascular aging in women (B = 0.89 [95%CI: 0.04 – 1.75]), while this association was absent in men.

Conclusion

Our results suggest that cyclothymic affective temperament contribute to early vascular aging in women.
Objective evaluation of improved image quality with application of novel noise reduction filter in dynamic myocardial CT perfusion
Authors: Sliwicka O , Sechopoulos I , Habets J
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Dynamic myocardial CT perfusion (CTP) is a non-invasive imaging technique able to depict cardiac ischemia. It is expected that the application of a new dynamic perfusion image noise reducing filter, the similarity filter (4DSF) would improve the image quality of CTP, resulting in clear visualization of perfusion deficits and hypo-perfused tissue and allowing for a substantial reduction in the radiation dose in dynamic myocardial CTP.

Purpose

To evaluate image quality before and after the application of a novel noise reducing filter on dynamic myocardial CT perfusion images reconstructed with deep learning-based algorithm.

Methods

The image datasets of patients with stable chest pain at intermediate risk of cardiovascular disease, who underwent stress dynamic CTP scanning as clinically indicated were retrospectively collected. The images were acquired with a 320-slice CT system, reconstructed using a deep learning-based algorithm (8 mm slice thickness) and filtered with the 4DSF. For each case, the signal-to-noise ratio (SNR) and the contrast-to-noise ratio (CNR) in six regions-of-interest (ROIs, 33-38 mm2) were computed, before and after filtering. The signal ROIs were located midventricular, in both four-chamber and short-axis views in the left ventricle blood pool, and the background ROIs in the cardiac septum and lateral wall. Differences in the SNR and CNR values were compared using paired t-tests.

Results

As a part of an ongoing study, twenty five cases were analysed to date. The following results (means for AiCE and AiCE + 4DSF, and corresponding p-values) were obtained in short axis view: septum SNR: 3.46 vs 6.25 (p = 0.007), lateral wall SNR: 3.66 vs 6.52 (p = 0.000), septum CNR: 13.35 vs 23.85 (p = 0.005), lateral wall CNR: 13.16 vs 23.57 (p = 0.010); and in four-chamber view: septum SNR: 3.67 vs 7.44 (p = 0.003), lateral wall SNR: 3.97 vs 7.65 (p = 0.001) and septum CNR: 13.92 vs 29.97 (p = 0.016), lateral wall CNR: 13.63 vs 29.75 (p = 0.018). All results are statistically significant.

Conclusions

We confirmed that the similarity filter decreases noise and therefore improves the objective image quality in both short axis and four chamber views. Therefore, the improved tissue texture depiction and improved visualization of perfusion defects may facilitate detection of ischemia and lead to reduction in radiation dose necessary for dynamic CTP, maintaining image quality.

Abstract Figure. Region-of-interests (ROIs) location
T1 mapping-derived signature of myocardial involvement in idiopathic inflammatory myopathy compared to acute viral myocarditis: a texture-based analysis
Authors: Bollache E , Huber AT , Lamy J , Afari E , Bacoyannis TM , De Cesare A , Bravetti M , Giron A , Rigolet A , Allenbach Y , Cluzel P , Benveniste O , Kerneis M , Redheuil A , Kachenoura N
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background. Recent studies revealed the ability of MRI T1 mapping to characterize myocardial involvement in both idiopathic inflammatory myopathy (IIM) and acute viral myocarditis (AVM), as compared to healthy controls. However, neither myocardial T1 nor T2 maps were able to discriminate between IIM and AVM patients, when considering conventional myocardial mean values and derived indices such as lambda and extracellular volume.

Purpose. To investigate the ability of T1 mapping-derived texture analysis to differentiate IIM from AVM.

Methods. Forty patients, 20 with IIM (51 ± 17 years, 9 men) and 20 with AVM (34 ± 13 years, 16 men) underwent 1.5T MRI T1 mapping using a modified Look-Locker inversion-recovery sequence before and 15 minutes after injection of a gadolinium contrast agent. After manual delineation of endocardial and epicardial borders and co-registration of all inversion time images, native and post-contrast T1 maps were estimated. Myocardial texture analysis was performed on native T1 maps. Textural features such as: autocorrelation, contrast, dissimilarity, energy and sum entropy were used to build a least squares-based linear regression model. Finally, receiver operating characteristic (ROC) analysis was used to investigate the ability of such texture features score to classify IIM vs. AVM patients, compared to the performance of mean myocardial T1. A Wilcoxon rank-sum test was also used to test difference significance between groups.

Results. Both native and post-contrast mean myocardial T1 values were comparable between IIM (native: 1022 ± 43 ms; post-contrast: 319 ± 44 ms) and AVM (1056 ± 59 ms, p = 0.07; 318 ± 35 ms, p = 0.90, respectively) groups. Results of ROC analyses are provided in the Table, indicating that a better discrimination between IIM and AVM patients was obtained when using texture features, with higher AUC and accuracy than mean T1 values (Figure).

Conclusion. Texture analysis derived from MRI T1 maps without contrast agent injection was able to discriminate between IIM and AVM with higher accuracy, sensitivity and specificity than conventional T1 indices. Such analysis could provide a useful myocardial signature to help diagnose and manage cardiac alterations associated with IIM in patients presenting with myocarditis and primarily suspected of AVM.

Table Area under curve (AUC) Accuracy Sensitivity Specificity Native T1 0.67 0.70 0.65 0.75 Post-contrast T1 0.49 0.60 0.25 0.95 Texture features score 0.85 0.82 0.90 0.75 ROC analyses for classification between IIM and AVM patients Abstract Figure
Cardiac magnetic resonance imaging in differential diagnosis of cardiac masses
Authors: D"angelo EC , Paolisso P , Bergamaschi L , Foa A , Magnani I , Rinaldi A , Toniolo S , Angeli F , Bartoli L , Donati F , Renzulli M , Rucci P , Pacini D , Pizzi C , Galie N
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): S. Orsola Hospital

Background

 Differential diagnosis of cardiac masses represents a challenging issue with important implications for therapeutic management and patient’s prognosis. Cardiac Magnetic Resonance (CMR) is a non-invasive imaging technique used to characterize morphologic and functional features of masses. Integration of these information can lead an accurate diagnosis.

Purpose

 To evaluate the diagnostic role of CMR in defining the nature of cardiac masses.

Methods : Ninety-three patients with cardiac masses evaluated with CMR were enrolled. All masses had histological certainty. CMR sequences allowed a qualitative morphologic description as well as tissue characterization. Evaluation of masses morphology included localization, size and borders assessment, detection of potential multiple lesions and pericardial effusion. Tissue characterization resulted from an estimation of contrast enhancement - early gadolinium enhancement (EGE) and late gadolinium enhancement (LGE) sequences - and tissue homogeneity in T1 and T2 weighted acquisitions. The descriptive analysis was carried out by comparing benign vs malignant lesions as well as dividing patients into 4 subgroups: primitive benign tumours, primitive malignant tumours, metastatic tumours and pseudotumours. 

Results

 The descriptive analysis of the morphologic features showed that diameter > 50mm, invasion of surrounding planes, irregular margins and presence of pericardial effusion were able to predict malignancy (p < 0.001). As for tissue characteristics, heterogeneous signal intensity - independently from T1 and T2 weighted acquisitions - and EGE were more common in malignant lesions (p <0.001). When analysing the four subgroups, CMR features did not discriminate between primitive malignant masses and metastasis. Conversely, hyperintensity signal and EGE were able to distinguish benign primitive lesions from pseudotumors (p = 0.002). 

Furthermore, using classification and regression tree (CART) analysis, we developed an algorithm to differentiate masses: invasion of surrounding planes was a common characteristic of malignancy and identifies itself malignant tumors. In the absence of invasive features, gadolinium enhancement was evaluated: the lack of contrast uptake was able to exclude a pseudotumor diagnosis and reduced the probability of a primary benign tumor. 

Conclusions

Cardiac magnetic resonance is a very powerful diagnostic tool for differential diagnosis of cardiac masses as it correctly addresses malignancy. Furthermore, an accurate evaluation of the several CMR features, may discriminate primary benign masses and pseudotumours.

Abstract Figure. Benign and malignant cardiac masses
The use of mechanical dyssynchrony for predicting response to cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy
Authors: Saushkin V , Varlamova YV , Mishkina AI , Lebedev DI , Popov SV , Zavadovskiy KV
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Aim/Introduction: Assessment of mechanical dyssynchrony by myocardial perfusion gated-SPECT in patients with non-ischemic cardiomyopathy for predict response to cardiac resynchronization therapy (CRT).

Materials and Methods

 We examined 32 patients with non-ischemic cardiomyopathy before and six months after CRT.  Left ventricular mechanical dyssynchrony and contractility were assessed for all patients by myocardial perfusion gated-SPECT. The phase standard deviation (PSD), histogram bandwidth (HBW), phase histogram skewness (S) and phase histogram kurtosis (K) were used as an indicator of mechanical dyssynchrony for the both ventricles. 

Results

 Mechanical dyssynchrony of both ventricles before CRT was increased in all patients. Median value PSD 53°(41-61°), HBW 176°(136-202°), S 1,62(1,21-1,89), K 2,81(1,21-3,49). Six months after CRT 22(68%) respondents were identified. We divided the patients into two groups (responders and non-responders) and compared phase parameters. It was found that the PSD (44°(35-54°)) and HBW (158°(118-179°) in the responders were significantly lower than in the non-responders (PSD (68°(58-72°); HBW (205°(199-249°)). The value of phase histogram skewness and kurtosis in responders were significantly higher (Responders: S 1,77(1,62-2,02); K 3,03(2,60-3,58). Non-responders: S 1,21(0,93-1,31); K 1,21(0,19-1,46)).  We found that all four indicators of mechanical dyssynchrony can predict CRT response according to the results of univariate logistic regression analysis. Moreover, It was found that only phase histogram kurtosis (OR = 1.196, 95% CI 1.04-1.37) is an independent predictor of CRT response according to multivariate logistic regression.

Conclusion

 Radionuclide assessment of mechanical dyssynchrony may be the optimal diagnostic method for selecting patients with non-ischemic cardiomyopathy on CRT.
Prognostic significance of cardiac amyloidosis in patients with aortic stenosis: a systematic review and meta-analysis
Authors: Ricci F , Ceriello L , Khanji MY , Dangas G , Bucciarelli Ducci C , Di Mauro M , Fedorowski A , Zimarino M , Gallina S
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 Cardiac amyloidosis (CA) has been increasingly recognized in elderly patients with aortic stenosis (AS), but with uncertain prognostic significance.

Objectives

We performed a systematic review and meta-analysis to clarify whether concurrent CA portends excess mortality in patients with aortic stenosis AS.

Methods

Our systematic review of the literature published through June 2020, sought observational studies reporting summary-level outcome data of all-cause mortality in AS patients with or without concurrent CA. Pooled estimate of Mantel-Haenszel odds ratio (OR) and 95% confidence intervals (CIs) for all-cause death was assessed as the primary endpoint. We performed subgroup analysis stratified by severity of left ventricular hypertrophy (LVH) and study-level meta-regression analysis to explore the effect of covariates on summary effect size and to address statistical heterogeneity.

Results

We identified 4 studies including 609 AS patients (9% AS-CA; 69% men; age, 84 ± 5 years). The average follow-up was 20 ± 5 months. Compared with lone AS, AS-CA was associated with 2-fold increase in all-cause mortality (pooled OR: 2.30; 95% CI: 1.02-5.18; I2 = 62%). When analysed according to LVH severity, pooled ORs (95% CI) for all-cause mortality were 1.29 (0.65-2.22) for mild LVH (≤16 mm), and 4.81 (2.19-10.56) for moderate/severe LVH (>16 mm). Meta-regression analysis confirmed a stronger relationship proportional to the degree of LVH, regardless of age and aortic valve replacement, explaining between-study heterogeneity variance.

Conclusions

CA heralds significantly higher risk of all-cause death in elderly patients with AS. Severity of LVH appears to be a major prognostic determinant in patients with dual AS-CA pathology.

Abstract Figure.
Intermittent outpatient administration of levosimendan improves right ventricular-pulmonary arterial coupling in ambulatory patients with advanced heart failure
Authors: Melillo E , Masarone D , Valente F , Vastarella R , Gravino R , Ammendola E , Verrengia M , Caiazzo A , Petraio A , Pacileo G
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Intermittent infusions of levosimendan in an outpatient setting have been associated with improved symptoms and reduced hospitalizations in patients with advanced heart failure (HF). Little is known on the potential effect of intermittent levosimendan infusions on right ventricle (RV)-pulmonary arterial (PA) coupling in ambulatory patients with advanced HF.

Purpose Aim of the present study was to explore the effects of intermittent levosimendan infusions on the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PAPs), an echocardiographic measure of RV/PA coupling, in ambulatory patients with advanced HF, and on left ventricular arterial coupling (VAC), expressed as the relationship between arterial elastance (Ea) and ventricular elastance (Ees).

Methods 17 ambulatory patients with advanced HF treated with intermittent levosimendan (6-hour intravenous infusion, 0.2 ug/kg/min without bolus) received baseline clinical, biochemical and echocardiographic evaluation and changes in TAPSE/PAPs ratio were assessed from baseline to 48 hours after the infusion, based on the pharmacokinetic profile of levosimendan. VAC, expressed as Ea/Ees ratio, was obtained by a calculator (iElastance) designed for non-invasive single beat measure of end-systolic Ees  and Ea according to Chen"s method.

Results After 48 hours from levosimendan infusion, there was a significant improvement of TAPSE/PAPs  ratio (p = 0.04), stroke voume (SV) (p = 0.05) and cardiac output (CO)(p = 0.04). We observed a significant reduction of Ea (p = 0.007) and of Ees (p = 0.01) and a non significant improvement of VAC (p = 0.4)(Tab.1). 

Conclusion. Our results show that an intermittent 6-hour levosimendan infusion at 0.2 ug/kg/min improves after 48 hours RV-PA coupling, SV, CO, Ea and Ees in ambulatory patients with advanced HF. Further studies including more patients are necessary to confirm these preliminary findings.

Tab.1 Baseline 48h afterlevosimendan infusion p value NT-proBNP (pg/mL) 5607 ± 4300 3868 ± 3856 <0.001 LVEF (%) 24.1 ± 7.7 25.7 ± 7.3 0.5 SV (mL) 36.8 ± 12.4 46.1 ± 14.8 0.05 CO (L/min)36.8 ± 12.4 2.6 ± 0.7 3.2 ± 0.9 0.05 TAPSE/PAPs (mm/mmHg) 0.38 ± 0.13 0.49 ± 0.16 0.04 Ea (mmHg/mL/m2) 2.9 ± 0.9 2.1 ± 0.6 0.007 Ees (mmHg/mL/m2) 1.3 ± 0.4 1.0 ± 0.2 0.01 VAC 2.2 ± 0.6 2.0 ± 0.4 0.4