bluuebunny/crossref_metadata_2025 huggingface dataset:
3D trans-thoracic echocardiography in assessment and follow up of corrected tetralogy of Fallot patients : whether it is comparable to MRI or not ?
Authors: Nour A M I R A , El Sayed M A I Y
Published: November 2023

Background

Nowadays with the increasing number of repaired Fallot patients , and the chronicity of pulmonary regurgitation leading to severe right ventricle dilatation and impairment of ventricular functions , we need a method for regular follow up for the appropriate timing for intervention for pulmonary valve replacement either surgical or per-cutaneous. Cardiac MRI is the gold standard however time consuming and more expensive. 3D trans-thoracic echocardiography has recently been developed and applied for assessment of RV volumes and functions.

Aim

To evaluate right ventricle (RV) volume , ejection fraction (EF) and pulmonary valve (PV) regurgitant fraction in patients post tetralogy of Fallot (TOF) repair by 3D trans-thoracic echocardiography (3DE) in comparison with the gold standard cardiac MRI regarding its accuracy and variability and whether it can be used for annual follow up.

Methods

The study group composed of 100 patients post TOF repair with mean age group (11.66 ± 4.65) , mean BSA (1.18 ± 0.36) underwent both 3D echo. and CMR within 2 to 3 days . 3D echo assessment of Right ventricle end diastolic volume (RV EDV) , end systolic volume (RV ESV) , ejection fraction (EF) , severity of pulmonary regurgitant and regurgitant fraction were carried out by two different operators using 3D echo compared with the cardiac MRI results for the same parameters done by the standard protocol according to ESC working group of cardiovascular imaging guidelines.

Results

On comparing the two groups , 3DE was comparable to the CMR in assessment of EF (52.69 ± 6.44 % by 3DE vs 51.38 ± 6.86 % by CMR) with p value (0.165) by the paired test, while the RV EDVI and RV EDVI was slightly elevated by CMR vs 3 DE (RVEDVI: 147.85 ± 40.77 ml/m2, RVESVI: 72.69 ± 27.70 ml/m2) by CMR vs (RVEDVI: 136.51 ± 34.40 ml/m2 , RVESVI 65.12 ± 22.44 ml/m2) by 3 DE with p value (0.035). however there was statistical difference when comparing regurgitant fraction(RF) by CMR vs 3DE which was technically difficult and time consuming when calculating by 3DE as the RF was significantly higher by CMR (46.44 ± 11.27 %) vs 3DE (40.57 ± 10.50 %) with P value (0.000). our study also noted positive linear correlation between regurgitant fraction and RV EDVI (p value 0.000), and RV ESVI (p value = 0.010), and pulmonary valve annulus (p value = 0.000) respectively.

Conclusion

Three dimensional echo when compared to cardiac MRI as a method for assessment of patients with repaired TOF showed quite agreement in assessment of ejection fraction with slight difference in assessment of ventricular volumes as the accuracy of the 3DE decreases in larger volumes, however the significant difference in assessment of regurgitant fraction by 3DE makes it used as a method for serial follow up however CMR should be done as baseline.comparing RV volumes and RFcorrelation of RF and CMR paramters
Right atrial performance of adult patients with repaired tetralogy of fallot
Authors: Borrelli N , La Rocca F , Sorice D , Ciriello G D , Barracano R , Grimaldi N , Fusco F , Merola A , Correra A , Palma M , Scognamiglio G , Sarubbi B
Published: November 2023

Background

Patients with repaired Tetralogy of Fallot (rToF) present anatomic and hemodynamic sequelae which may impact the right heart mechanics. Right ventricular adaptation to prolonged loading conditions should not be considered in isolation from the right atrium, because the atrial function affects that of the ventricle.

Purpose

This study aims to describe the right atrial performance using the echocardiographic right atrial longitudinal strain in a population of adult patients with rToF.

Methods

Echocardiographic images of adult patients (>18 years old) with rToF were retrospectively reviewed, and atrial reservoir (rRAS), conduit (cRAS), and contractile (aRAS) right atrial longitudinal strain were calculated. A group of healthy subjects (CTR) with comparable sex, age, and body surface area was included for comparison. Invasive cardiac catheterization data were also collected for patients with rToF.

Results

Sixty patients were included in the study: 30 with rToF (age 34 ± 9 years old) and 30 healthy subjects (age 34 ± 11 years old). Patients with rToF presented a lower value of rRAS, cRAS, and aRAS when compared to CTR (rRAS: rToF 20.83 ± 8.44% vs CTR 36.22 ± 9.53%, p<0.0001; cRAS: rToF -11.22 ± 6.41% vs CTR -22.67% ± 8.88%, p<0.0001; aRAS: rToF 9.67 ± 5.94% vs CTR 14.28 ± 6.35%, p=0.03). rRAS presented a good positive correlation with systolic peak velocity at tissue doppler imaging (p=0.006) and a trend toward positive correlation with right ventricle global longitudinal strain (p=0.08) and with the tricuspid annular plane systolic excursion (p=0.07). No correlation was found between invasive right ventricle end-diastolic and -systolic pressure and echocardiographic right atrial longitudinal strain parameters.

Conclusion

Adult patients with rToF presented a lower value of right atrial longitudinal strain, indicating an impaired atrial performance. Right atrial longitudinal strain provides additional insight for the comprehensive evaluation of right heart mechanics and should be systematically evaluated during the follow-up of adult patients with rToF.
Assessment of left ventricular myocardial fibrosis in adult patients with Ebstein's anomaly: a retrospective cohort study based on cardiac magnetic resonance and histopathological samples
Authors: Antonio-Villa N E , Espinola-Zavaleta N , Fernandez-Badillo V , Serrano-Roman J , Aranda-Fraustro A , Espejel-Guzman A , Cabello-Ganem A , Meave-Gonzalez A , Guerra E C , Luna-Alcala S , Aparicio-Ortiz A D , Proano-Bernal L , Alexanderson-Rosas E
Published: November 2023

Background

The relationship between Ebstein's Anomaly (EA) and myocardial fibrosis in the left ventricle (LV) has been debated. This study aimed to determine the prevalence of replacement fibrosis in the LV using cardiac magnetic resonance (CMR) imaging and correlate it with histopathological findings. The study also investigated whether LV fibrosis is an independent risk factor for cardiovascular disease (CVD) mortality and developed a risk score for this purpose.

Methods

We performed a twelve-years (2009-2021) retrospective cohort study of adult patients with EA who underwent CMR. The CMR evaluation included a comprehensive assessment of myocardial fibrosis by late gadolinium enhancement (LGE). Four post-mortem samples were obtained from our cohort and stained using Masson trichrome to characterize LV-fibrosis. We used Cox-Regression analysis to identify and derive a prediction score that associates LV-fibrosis with CVD-mortality.

Results

We included 57 adults with EA (52% male, median age 29.52, IQR: 21.24-39.17 years). LGE prevalence by CMR was observed in 52.6% (95% CI: 39.9%-66.0%) in any chamber; LGE-LV in 29.8% (95% CI: 19.5%-42.7%). Histopathological findings revealed a mid-wall pattern with predominantly interstitial fibrosis and minimal replacement fibrosis. LV-fibrosis was associated with increased risk for CVD mortality (HR: 6.02, 95% CI: 1.22-19.91) attributable to lateral and mid-wall LV segment involvement. Our mortality score achieved an overall good prediction capacity (C-statistic: 0.93, Dxy= 0.86).

Conclusions

There is a high prevalence of replacement LV fibrosis in adults with EA, characterized by specific CMR and histological patterns. Furthermore, LV fibrosis is an independent predictor of CVD mortality, which could be integrated into a risk assessment in clinical management.Figure 1.CMR and pathological imagesFigure 1.Kaplan-Meier analysis
Balloon-expandable cheatham-platinum stents versus self-expandable nitinol stents in coarctation of aorta: 3-year outcome of a randomized clinical trial
Authors: Sadeghipour P , Pouraliakbar H R , Farrashi M , Habibi Khorasani S , Mohebbi B , Iranian M R , Babaei M R , Forouzannia S M , Afrooghe A , Firouzi A , Hoseini F , Khajali Z , Saedi S , Haulon S , Moosavi J
Published: November 2023

Introduction

Although stenting showed early promising results in the treatment of patients with coarctation of aorta (CoA), its long-term benefit it is scarcely studied. Previously, we have shown, balloon-expandable stents (BES) and self-expandable (SES) stents were both effective and safe during 12-month follow up in the treatment of native CoA.

Purpose

To report the 3-year outcomes of BES versus SES stents in patients with native CoA.

Methods

Adult patients with de novo native CoA were randomized into Cheatham-platinum BES and uncovered nitinol SES groups in this parallel-group, open-label, blinded endpoint randomized clinical trial. All randomized patients were assigned to the 3-year structural follow up, consisted of clinical examination (including blood pressure measurement), exercise test for detecting masked hypertension, aortic CT angiography and transthoracic echocardiography. The 3-year incidence of recoarctation of aorta, thoracic aortic aneurysm formation, and residual hypertension were reported as the main long-term outcomes.

Results

Of the 92 patients initially randomized, 71 patients were participated in 3-year structural follow-up (Figure 1). Residual hypertension, defined as a persistent need for antihypertensive drugs at 3-year were significantly higher in BES (25 (71.4%) versus 17 (47.2%) patients (risk ratio (RR), 1.51, 95% confidence interval (CI), [1.00 to 2.26], p= 0.03) (Figure 2). Apart from five patients diagnosed with recoarctation during the first year of follow-up, no new cases of recoarctation were detected between 1 to 3-year follow up. Of note 2 of 3 patients with recorctation in the BES group, needed a second reintervention during the long-term follow up. Thoracic aortic aneurysm formation was not different in both stent types (4 (11.4%) versus 2 (5.6%) patients (RR, 2.06, 95% CI, [0.40 to 10.52], p= 0.37). Three-year median differences of ascending aorta and aortic arch were not different between the two groups.

Conclusion

Overall, both BES and SES were safe and effective in the long-term follow up. The rate of recoarctation was low even in the long-term follow up, which were safely reintervene. A hypothesis-generating difference were detected between two types of stents on residual hypertension which needs to be verified in larger studies.Baseline Characteristics and Study Flow3-year Outcomes
Frailty phenotype and cognitive functioning in middle-aged and older adults with congenital heart disease: results of an international multicentric study
Authors: Daelman B , Van Bulck L , Luyckx K , Kovacs A H , Moons P , Goossens E
Published: November 2023

Background

The life expectancy of patients with congenital heart disease (CHD) has increased rapidly, resulting in a growing and aging population. Recent studies showed that older CHD patients have a higher morbidity, healthcare utilization, and mortality. Furthermore, many will encounter a state of frailty. To maintain longevity and quality of life, understanding the evolving medical and psychosocial challenges of older patients is important to enable the mapping of specific healthcare needs. There are indications that, independent of age and comorbidity, the frailty phenotype can guide risk prediction in chronically ill patients. However, current knowledge on frailty phenotype and cognitive function of older CHD patients is limited.

Purpose

This study aimed (i) to describe the frailty and cognitive profile of older adults with mild to complex CHD, and (ii) to investigate the relationship with patient-related factors (e.g., age, complexity of CHD and physiological stage).

Methods

Using a cross-sectional, multicentric design, we included 814 patients aged ≥ 40 years (median age: 52y [45.0-61.0]; 52% women; 13% mild, 70% moderate, 17% complex CHD) from 17 centers in 11 countries. The frailty phenotype was determined using the Fried method, which classifies patients as robust, prefrail and frail based on five criteria: weakness; slow walking speed; unintentional weight loss; exhaustion; and low physical activity. Cognitive function was evaluated using the Montréal Cognitive Assessment (MoCA). Comorbidities were assessed using the Charlson Comorbidity Index (CCI).

Results

In this sample, 52% of patients were assessed as robust, 42% prefrail, and 6% frail. Based on the MoCA, 39% had cognitive dysfunction. A weak negative correlation was found between frailty and cognitive functioning (rho=-0.210, p<0.001). Multinomial regression showed that prefrail and frail status was associated with older age, female sex, higher physiological class, and comorbidities (Table 1). Logistic regression demonstrated that cognitive dysfunction was related to older age and comorbidities.

Conclusion

Approximately half of the sample of CHD patients were (pre)frail and almost two out of five experienced cognitive impairment. These age-related problems were not related to the anatomical complexity of the heart condition, indicating that these issues are not limited to severe CHD. Future research is needed to determine the impact of these findings on healthcare use.
The effect of atrial morphology on atrial function in hypertrophic cardiomyopathy
Authors: Weerts J , Teis A , Junca G , Kasa G , Bisbal F , Arano J , Ruiz M , Domingo M , Codina P , Santiago-Vacas E , Borrellas A , Lupon J , Bayes-Genis A , Delgado V , Cediel G
Published: November 2023

Background

Atrial dysfunction is a relevant marker of disease progression in hypertrophic cardiomyopathy (HCM). Left atrial (LA) longitudinal functional parameters and volumes derived from cardiac magnetic resonance (CMR) are associated with new-onset atrial fibrillation (AF) and its complications. The asymmetrical shape of the LA and its morphological alterations may influence LA function and could provide new mechanistic insights into HCM.

Objective

To assess the association between CMR derived functional and morphological LA characteristics in HCM patients.

Methods

Patients with an established diagnosis of HCM were included. HCM patients with a history of AF or without available CMR were excluded. CMR acquisitions used for clinical indication of heart failure diagnosis and etiology were retrospectively analyzed to obtain LA reservoir (LAres), booster (LAboost), and conduit (LAcond) strain on 2-chamber views (Medis Suite v3.2). Strain measurements of the other cardiac chambers were also performed. Manual tracing of LA endocardial border at the LA orthogonal longitudinal and transverse diameters on 2-, 3-, and 4-chamber views was performed (Philips Portal v10.1). Univariable and multivariable forward linear regression was employed to assess associations between functional and morphological LA measures.

Results

A total of 81 HCM patients were included, mean age 52±16 years, 59 (73%) male, and left ventricular ejection fraction 72.0±8.3%. Mean LAres was 27.2±11.0%, LAboost -14.9%±6.4%, and LAcond -12.5%±7.5%. LA morphological parameters are summarized in Table 1. The strongest correlates in multivariable regression for LAres were longitudinal LA diameter on 2-chamber view (Figure 1) and transverse LA diameter ratio between 4- and 2-chamber view (R2 0.30, p<0.001). The strongest correlates in multivariable regression for LAboost were longitudinal LA diameter on 2- and 4-chamber view, antero-posterior LA diameter on 3-chamber view, and LA area on 4-chamber view (R2 0.29, p<0.001). Longitudinal 2-chamber LA diameter also correlated with LAcond, but the strongest correlates of LAcond in multivariable regression were longitudinal-transversal LA diameter ratio on 2-chamber view, LA area on 3-chamber view, and LA sphericity (R2 0.25, p<0.001).

Conclusions

CMR-derived LA functions in HCM patients differently correlated with LA morphology. LA longitudinal 2-chamber diameter had a strong influence on all LA functions.Left atrial measures in HCMLA function and diameter correlations
Left ventricular strain-volume loops in bicuspid aortic valve: new insights in hemodynamics and prognostic value
Authors: Keuning Z , Kerstens T P , Zwaan R R , Bowen D J , Van Dijk A P J , Roos-Hesselink J W , Thijssen D H J , Hirsch A , Van Den Bosch A E
Published: November 2023

Background

Bicuspid aortic valve (BAV) is a common congenital cardiac disease with a high risk of adverse outcomes. By combining left ventricular (LV) global longitudinal strain (GLS) with LV volume during the cardiac cycle, LV strain-volume loops (SV-loops) can be generated. This may be a valuable biomarker in early detection of LV deterioration. The aim of this study is to describe SV-loop characteristics in BAV patients and investigate its prognostic value.

Methods

BAV patients were compared with healthy controls, matched for age and sex on a group level. Apical 2, 3 and 4 chamber views were used to measure LV GLS and volume to construct SV-loops. The parameters measured from these SV-loops are depicted in Figure 1A. Associations with the composite endpoint of all-cause mortality, heart failure and supraventricular and ventricular arrhythmias were assessed by univariable Cox regression.

Results

113 BAV patients were included (median age 32 years, 40% female). The median aortic jet velocity was 2.3 m/s [IQR 1.6-3.3] and 21 patients (19%) had moderate aortic regurgitation. A clear rightward shift in average SV-loops was seen between BAV patients and healthy controls (figure 1B). Sslope was significantly lower in BAV patients (0.21%/mL, [IQR 0.17-0.28] vs. 0.27%/mL [0.24-0.34], p<0.001), as was ESslope (0.19%/mL [0.12-0.25] vs. 0.29%/mL [0.21-0.43], p<0.001). Moreover, greater uncoupling was seen in BAV patients, both early (0.48±1.29 vs. 0.05±1.21, p=0.018) and late diastolic (0.66±1.02 vs -0.07±1.07, p<0.001). During a median follow-up period of 9.9 years [9.3-10.4], 17 patients experienced a primary endpoint. Echocardiographic parameters associated with the primary endpoint were early diastolic uncoupling (HR 1.82, p=0.009), E/e’ ratio (HR 1.29, p<0.001), ESslope (HR 0.55, p=0.03) and LV end-systolic volume (HR 1.05, p=0.03).

Conclusion

Significant differences in SV-loop characteristics were observed between BAV patients and healthy controls, suggesting its capability to provide new insights in cardiac hemodynamics and detect LV remodelling at an early stage. Moreover, SV-loops can be promising new prognostic markers.
Three-year quality of life and its effect on functional limitation and anticoagulation adherence in patients with acute pulmonary emboli
Authors: Mohammadi M , Kalantari S , Mehdizadeh K , Farrashi M , Kaviani R , Naghshbandi M , Moosavi J , Mohebbi B , Bakhshandeh H , Pouraliakbar H R , Klok F A , Sadeghipour P
Published: November 2023

Introduction

Quality of life disturbance is among important consequences of acute pulmonary emboli (PE) which result in a long-standing mental burden affecting functional ability, social life and patients’ adherence to assigned treatment. However, the long-term effect of disturbed quality of life is poorly studied. Of note, many survivors are recommended to continue their antithrombotic regimen until "indefinite period" on which the effect of quality of life impairment is unknown.

Purpose

To report the 3-year changes in quality of life and its effect on functional limitation and anticoagulation adherence in patients with acute PE.

Methods

In our prospective registry, 170 consecutive patients with acute PE were recruited. Six-month clinical, imaging and functional status were previously published. In the current study, survivors were asked to participate in a 3-year structural follow up consisting of clinical examination, transthoracic echocardiography (including Pulmonary EmbolIsm THrOmbolysis (PEITHO) right ventricle (RV) functional recovery), 6-minute walk test and quality of life assessment based on Pulmonary Embolism Quality of Life Questionnaire (PEmb-QoL). The use of antithrombotic drugs was also evaluated.

Results

Of the 170 registered patients, during the 3-year follow-up time, 37 (21.8%) died and 16 (9.4%) were lost to follow-up. 117 patients were followed clinically, of whom 73 patients (median age 49 (37-61) years and 29 (39.7%) were female) accepted to participated in the all steps of the structural follow up. 45 (61.6%), 25 (34.3%) and 3 (4.1%) patients have complete, incomplete and no RV recovery in the 3-year echocardiogram exam, respectively. Three-year median 6MWT was 400 (320-460) meters. 33 (45%) patients did not adhere to the instructed antithrombotic regimen. In 51 patients 6-month and 3-year Pem-QoL questionnaires were available. The mean PEmb-QoL scores improved overall and in all dimensions (Figure 1). Better quality of life was not associated with RV function recovery, 6MWT results or antithrombotic adherence.

Conclusion

Our study showed a significant improvement in quality of life in PE survivors followed for 3 years. QoL was not associated with echocardiographic parameters or 6-minute walking test.PEmb-QoL in 6-month and 3-year Follow up
Phenotype and outcome correlates of high dose loop diuretics in type 1 pulmonary hypertension
Authors: Stolfo D , Barbisan D , Lo Giudice F , Lombardi C M , Airo' E , Driussi M , Gentile P , Howard L , Giannoni A , Collini V , Toma M , Garascia A , Metra M , Sinagra G , Ameri P
Published: November 2023

Background

Use of higher dose of loop diuretics has been associated with worse survival in acute and chronic heart failure. The use of loop diuretics in type 1 pulmonary hypertension (PAH) is generally less frequent compared to heart failure and required doses may be lower. the clinical and prognostic characteristics of patients requiring high dose of loop diuretics in PAH remain unexplored.

Purpose

We studied the characteristics of patients requiring different doses of loop diuretic and their association with survival in PAH.

Methods

Patients with a diagnosis of PAH according to 2015 European guidelines criteria enrolled from 2001 and 2021 at seven European centers for the management of PAH and with available information on loop diuretic use were retrospectively included in the study. High dose diuretic use was defined according to the median dose of furosemide in the overall cohort and patients were then divided into two subgroups: no/low dose and high dose diuretic use. Primary outcome was 5-year survival. Predictors of high dose diuretic use were assessed by multivariable logistic regression analysis. Multivariable Cox regression analysis was performed to test the association between high dose diuretic use and 5-year survival.

Results

Among the 402 patients included (median age 61 years, IQR 49-74; 67% females), 231 (57%) were treated with loop diuretics. Median furosemide dose was 25 mg (IQR 0-40 mg) and accordingly patients were divided in no/low dose (n. 260, 65%, median dose 0 mg, IQR 0-20) vs high dose (n. 142, 35%, median dose 40, 50-100) diuretic ones. Patients in the high dose group were older, had more comorbidities, including impaired renal function (Figure 1) and the characteristics of a more severe disease (41% vs 27% at intermediate-high risk and 42% vs 22% at high risk based on COMPERA 2.0 classification, p<0.001). Predictors of high dose loop diuretic use were obesity (OR 2.04, 95%CI 1.06-3.91, p=0.032), COMPERA 2.0 risk class (OR 1.66, 95%CI 1.19-2.31, p=0.003) and right atrial pressure risk class (OR 2.23, 95%CI 1.42-3.51, p=0.001). Rates of monotherapy, dual and triple combination therapy were similar in patients at no/low vs high dose. Crude 5-year survival was significantly lower in patients in the high dose group (log-rank p=0.002). However, after adjustment for age, sex and main risk factors (i.e. COMPERA 2.0 score, TAPSE/PASP, right atrial pressure and cardiac index), high loop diuretic dose was not significantly associated with higher 5-year mortality risk.

Conclusions

Use of high dose of loop diuretics in PAH characterizes patients with higher burden of comorbidities, more severe disease and worse survival. However, in PAH the need of high loop diuretic dose represents a marker of disease severity rather than an independent prognostic factor.Figure 1Figure 2.
Clinical impact of residual pulmonary hypertension based on revised criteria after balloon pulmonary angioplasty
Authors: Takano R , Aoki T , Asano R , Ueda J , Tsuji A , Ogo T
Published: November 2023

Background

Balloon pulmonary angioplasty (BPA) improves haemodynamics, exercise capacity, and prognosis in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). However, the treatment goal of BPA is not well established. The European Society of Cardiology guidelines published in 2022 revised the diagnosis of pulmonary hypertension from resting mean pulmonary arterial pressure (mPAP) ≥25 mmHg to mPAP >20 mmHg because mild elevation of pulmonary hypertension has decreased exercise capacity and worsened the prognosis. The clinical impact of normalization in resting pulmonary hypertension after balloon pulmonary angioplasty is not investigated.

Purpose

The purpose of this study is to clarify the clinical impact of mPAP normalization after BPA as a treatment goal in patients with CTEPH.

Methods

We retrospectively reviewed consecutive 236 CTEPH patients (68 [55,75] yrs., Male 52 (22%)) who completed BPA procedures from July 2009 to December 2020 and had haemodynamics evaluation after the procedures and had mPAP <30 mm Hg after BPA. We extracted two groups with mPAP <20 mmHg (Non-PH group) and 21≤ mPAP <30 mmHg (Residual-PH group) after BPA.

Results

The median follow-up period from the final BPA session was 38 [22,61] months. In both the Non-PH and Residual-PH groups, BPA significantly improved mPAP (37 [29,43] to 18 [16,19] mmHg, P<0.01 and 38 [34,45] to 23 [22,26], P<0.01, respectively) and cardiac index (CI) (2.15 [1.86,2.63] to 2.39 [2.11,2.80] L/min/m2, P<0.01 and 2.25 [1.87,2.63] to 2.50 [2.23,2.88] L/min/m2, P<0.01, respectively). There were no significant differences in CI after BPA between the Non-PH and Residual-PH groups. The 6-minute walk distance (6MWD) after BPA was shorter in the Residual-PH group than in the Non-PH group (435m and 480m, P<0.01). However, the estimated 5-year survival in the Non-PH and Residual-PH groups was comparable (96.3% and 99.1%, P=0.23, Figure 1). Patients in the Residual-PH group showed significantly shorter 6MWD and higher mPAP before BPA, and required more procedures (P<0.01, 0.02, 0.03, respectively). Additional multivariate logistic regression analysis revealed that shorter 6MWD before BPA was a significant predictor of residual PH (odds ratio=1.03, P=0.04).

Conclusions

The Residual-PH group had lower exercise capacity than the Non-PH group, although the prognosis in the Residual-PH group was similar to that in the Non-PH group.Figure 1
Cardiac magnetic resonance hemodynamic force patterns in patients with ST-segment elevation myocardial infarction and dilated cardiomyopathy as compared to healthy controls: an observational study
Authors: Beijnink C , Raafs A G , Rodwell L , Pedrizzetti G , Lapinskas T , Heymans S R B , Nijveldt R , Vos J L
Published: November 2023

Background

Intraventricular Pressure Gradients (IVPG) reflect the driving force behind blood motion in and out of the left ventricle (LV). IVPG can be computed non-invasively using Cardiac Magnetic Resonance (CMR) cine imaging. It is unknown how IVPG components change as a consequence of ST-segment Elevation Myocardial Infarction (STEMI) and in non-ischemic Dilated Cardiomyopathy (DCM).

Aims

We aimed to assess if LV dysfunction of an ischemic and non-ischemic origin translates into reduced IVPG. The IVPG values were compared to conventional CMR markers of LV systolic function, to evaluate potential future applications.

Methods

This analysis of prospectively included cohorts included patients with DCM (n=40), anterior (n=20) or inferior STEMI (n=19) with an LV ejection fraction (EF) ≤ 52%, and healthy control subjects (n=13). LV ejection fraction was measured on the short-axis cine images. LV global longitudinal strain (GLS) and IVPG were measured in the long-axis cine images, using feature tracking software. Contours were drawn manually and the mitral and aortic valve orifice areas were measured. The dimensionless IVPG were measured in the longitudinal direction, using feature tracking combined with valve orifice measurements. IVPG consisted of the A, B, C, and D-wave, see Figure 1. IVPG values were compared between controls and diseased cohorts by the Mann Whitney U test.

Results

LVEF and LV-GLS were significantly impaired in all diseased groups. DCM and anterior STEMI patients had lower overall IVPG (15.1 [IQR 12.6-17.9] vs 9.4 [IQR 7.8-13.4], p=0.001 for DCM and 11.1 [IQR 8.7-13.0], p=0.002 for anterior STEMI). DCM and anterior STEMI patients had a significantly reduced systolic ejection A-wave (21.8 [IQR 19.1-27.2] in controls vs. 13.5 [IQR 10.3-19.1] in DCM, p<0.001, and 16.9 [IQR 10.8-20.6] in anterior STEMI, p=0.004). Secondly, patients with DCM and inferior STEMI have significantly dampened E-wave decelerative C-waves (8.1 [IQR 6.5-12.3] in controls, vs. 3.7 [IQR 2.4-5.5], p<0.001 in DCM, and 6.4 [IQR 4.3-7.8], p=0.04 in inferior STEMI), due to impaired passive ventricular filling.

Conclusions

IVPG values are altered in patients with myocardial dysfunction due to anterior and inferior STEMI to a lesser extent than in DCM patients. Conventional measures for systolic function (i.e. LV-GLS and LV ejection fraction) were lower in all diseased groups as well. On the other hand, IVPG is a promising measure to quantify diastolic LV function on the ventricular level.
Diuretics versus volume expansion for acute pulmonary embolism: a systematic review and meta-analysis
Authors: Gibicoski T , Caetano L , Rivera A , Meldola P , Rygoll J
Published: November 2023

Background/Introduction

The potential benefit of diuretics over volume expansion in patients with acute submassive pulmonary embolism with right ventricle dysfunction is controversial.

Purpose

This study aims to compare the effects of diuretic therapy versus volume expansion in patients hospitalized for pulmonary embolism with right ventricle dysfunction.

Methods

We performed a systematic review and meta-analysis of studies comparing diuretics and volume expansion for acute submassive pulmonary embolism. PubMed, Embase, and Cochrane databases were searched up to January 20, 2023. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. Review Manager 5.1 was used for statistical analysis. A random-effects model was used to calculate a pooled effect size and 95% confidence interval.

Results

Three studies and 176 patients were included. Follow-up ranged from 2 to 30 days. The mean age was 67.5 ± 17.5 years and 52.3% were female. There were no differences between groups regarding the 24h-variation of heart rate (MD -5.98, 95% CI -14.41 to 2.46 beats/min, P = 0.17; Fig. 1A) and systolic blood pressure (MD 9.68, 95% CI -2.94 to 22.30 mmHg, P = 0.13; Fig. 1B). Diuretic therapy was associated with a faster normalisation of BNP (MD -38.38, 95% CI -60.51 to -16.24 hours, P = 0.0007; Fig. 2A). In the 24h-echocardiography parameters, no difference was found in the tricuspid annular plane systolic excursion (TAPSE) (MD -0.15, 95% CI -2.04 to 1.74 mm, P = 0.87; Fig. 2B). Similarly, no significant difference in oxygen requirement, troponin normalization, and inotropic support was seen.

Conclusions

Compared with the volume expansion strategy, diuretic therapy was not associated with improved hemodynamic and echocardiography parameters at 24h. Prospective and more extensive randomised trials are warranted to confirm the efficacy and safety of diuretics in acute submissive pulmonary embolism with right ventricle dysfunction.
Right ventricular global longitudinal strain on cardiovascular magnetic resonance imaging predicts outcome in patients undergoing transcatheter edge-to-edge mitral valve repair
Authors: Koschutnik M , Dona C , Nitsche C , Dannenberg V , Koschatko S , Mascherbauer K , Beitzke D , Loewe C , Huelsmann M , Schneider M , Bartko P , Goliasch G , Hengstenberg C , Kammerlander A , Mascherbauer J
Published: November 2023

Background

Right ventricular dysfunction (RVD) on echocardiography was shown to predict outcomes in patients undergoing transcatheter edge-to-edge mitral valve repair (M-TEER). However, the prognostic value of left and RV global longitudinal strain (LV- and RV-GLS) on cardiovascular magnetic resonance feature tracking (CMR-FT) is unknown.

Methods

Consecutive M-TEER patients underwent pre-procedural and follow-up CMR-FT analysis. Kaplan-Meier estimates and multivariable Cox-regression analyses were performed, using a composite endpoint of heart failure hospitalization (HFH) and death.

Results

62 patients (78.3±7.0y/o, 45% female, EuroSCORE-II: 9.6±7.1%) underwent CMR-FT prior to M-TEER, 24% had concomitant tricuspid edge-to-edge repair (T-TEER). On presentation, 23 (37%) patients suffered RVD, defined as RV-GLS >-20% on CMR-FT. RVD was associated with reduced LV and RV ejection fraction (LVEF: 39 vs. 49%, p=0.01, RVEF: 35 vs. 47%, p<0.01), as well as impaired LV-GLS (-14.0 vs. -19.5%, p=0.01).

Eighteen events (12 deaths, 6 HFH) occurred during follow-up (11.4±9.1months). On multivariable Cox-regression adjusted for baseline, procedural, imaging, and biomarker data, RV but not LV-GLS was significantly associated with outcome (adj.HR 2.50, 95% CI: 1.29-4.86, p=0.01 and 1.46, 95% CI: 0.50-4.28, p=0.49, respectively). Among various definitions of RVD on echocardiography and CMR, only RV-GLS on CMR-FT was significantly associated with outcome (RV-GLS >-20%: adj.HR 7.53, 95% CI: 2.07-27.42, p<0.01), but not RVEF on CMR or echo-indices of RV function.

Follow-up CMR-FT was performed in 21 (34%) patients and RV-GLS significantly improved after TMVR (-20.6 to -25.2%, p=0.02), irrespective of additional T-TEER.

Conclusions

RV-GLS, as determined on CMR-FT, rather than LV-GLS or RVEF, is an independent predictor of outcome in patients undergoing M-TEER.Central Illustration
Cardiopulmonary exercise testing and echocardiography in the follow-up after acute pulmonary embolism
Authors: Farmakis I , Valerio L , Barco S , Alsheimer E , Ewert R , Giannakoulas G , Hobohm L , Keller K , Mavromanoli A C , Rosenkranz S , Morris T A , Held M , Dumitrescu D , Konstantinides S
Published: November 2023

Background

Echocardiography and cardiopulmonary exercise testing (CPET) can both provide prognostically relevant information during the follow-up after pulmonary embolism (PE).

Objective

To investigate the association of cardiopulmonary exercise limitation, as assessed by CPET, with the tricuspid regurgitation velocity (TRV) and probability of pulmonary hypertension (PH) as estimated by echocardiography after PE.

Methods

In a prospective cohort study, consecutive unselected survivors of acute PE underwent 3-month and 12-month follow-up, including echocardiography and CPET. We defined cardiopulmonary exercise limitation from CPET as at least one of VE/VCO2-slope ≥ 30 (≥ 36 for severe), or VE/VCO2-nadir ≥ 30 (≥ 36 for severe), peak O2 pulse < 80% of the predicted value (< 70% for severe). Echocardiographic probability of PH was defined according to the 2022 ESC/ERS PH Guidelines.

Results

Overall, 395 patients were included in the analysis. On CPET performed at 3 months, cardiopulmonary exercise limitation was found in 180/360 patients (50.0%; 34.7% mild/moderate; 15.3% severe), and at 12 months in 119/267 patients (44.5%; 28.8% mild/moderate; 15.7% severe). On echocardiography at 3 months, high probability was found in 13/360 patients (3.6%) and intermediate in 60/360 patients (16.7%); at 12 months, it was 10/267 (3.8%) and 36/267 (13.5%), respectively. TRV >2.8 m/s (Figure 1A) and high echocardiographic probability of PH (Figure 1B) were both significantly more prevalent among patients with severe cardiopulmonary limitation (both p <0.001 ). For patients who had measurable and quantified TRV values (n = 246 patients), TRV was significantly weakly/moderately associated with VE/VCO2 slope and VE/VCO2 nadir, but not associated with O2 pulse (Figure 2).

Conclusion

Abnormal exercise capacity of cardiopulmonary origin is frequent after PE and was associated with high echocardiographic probability of PH. Still, 67% of patients with severe cardiopulmonary limitation after PE exhibit low echocardiographic probability PH, thus supporting the argument to upgrade the role of CPET in the follow-up of patients after acute PE.Figure 1Figure 2
Clinical features and long-term outcomes of venous thromboembolism in the warfarin era versus in the direct oral anticoagulant era
Authors: Kaneda K , Yamashita Y , Chatani R , Nishimoto Y , Ikeda N , Kobayashi Y , Ikeda S , Kim K , Takase T , Tsuji S , Oi M , Takada T , Otsui K , Sakamoto J , Ogihara Y
Published: November 2023

Background/Introduction

After the introduction of direct oral anticoagulant (DOAC) for venous thromboembolism (VTE), DOAC for VTE have prevailed all over the world, which could change the daily clinical practice and clinical outcomes. However, there have been still limited data on the issue in the real world.

Purpose

We aimed to investigate demographics, practice patterns and long-term clinical outcomes in patients with VTE comparing a large observational study in the warfarin era and that in the DOAC era.

Methods

The COMMAND VTE Registry-1 (enrolled 3,027 VTE patients among 29 center between January 2010 and August 2014 in the warfarin era) and Registry-2 (enrolled 5,197 VTE patients among 31 centers between January 2015 and August 2020 in the DOAC era) are the series of a multicenter observational study in Japan enrolling consecutive patients with acute symptomatic VTE.

Results

Patients characteristics were comparable in most of aspects between the groups, whereas prevalence of active cancer was higher in the Registry-2 (Registry-1: 23% vs. Registry-2: 29%, P<0.001). As for oral anticoagulation therapy, 88% (2,676/3,027) of patients were treated with warfarin in the Registry-1 and 79% (4,128/5,197) of patients were treated with DOAC in the Registry-2. The proportion of patients admitted to the hospital was lower in the Registry-2 (80% vs. 69%, P<0.001). The discontinuation rate of anticoagulation therapy was significantly higher in the Registry-2 (42.8% vs. 52.5% at 3-year, Log rank P<0.001). The cumulative 5-year incidence of recurrent VTE was lower in the Registry-2 (10.5% vs. 9.5%, Log rank P=0.02), which remained significant even after adjusting the confounders (adjusted hazard ratio [HR]: 0.78 (0.65-0.93), P=0.006). There was no significant difference in the cumulative incidence of major bleeding between the groups (12.1% vs. 13.7%, Log-rank P=0.26), which remained insignificant even after adjusting the confounders (adjusted HR: 1.03 (0.89-1.20), P=0.67). After stratifying a total cohort into sub-groups according to the risk classification of recurrent VTE in the current guidelines (major transient risk factors, minor transient risk factors, unprovoked, non-malignant persistent risk factors, and active cancer), the risks of recurrent VTE and major bleeding were significantly lower in the Registry-2 among active cancer group (recurrent VTE: 17.7% vs 10.1% at 5-year, Log rank P<0.001, major bleeding: 26.6% vs 20.4% at 5-year, Log rank P=0.04), while those were not significantly different between the groups among other sub-groups.

Conclusion

In the current series of large real-world VTE registries, there seemed to be a significant risk reduction of recurrent VTE in the DOAC era compared with in the warfarin era, while there was no sign of increased risk of major bleeding in the DOAC era.
The impact of surgical aortic valve replacement on myocardial deformation in patients with severe aortic stenosis: a comparison between echocardiography and CMR
Authors: Alfuhied A , Steadman C D , Parke K , Aslam S , Sian M , Marsh A M , Mccann G P , Singh A
Published: November 2023

Background

Aortic valve replacement (AVR) in patients with severe aortic stenosis (AS) leads to reverse remodelling, with reduction in left ventricle (LV) mass and volumes. However, the effect of AVR on left atrial (LA) and LV myocardial deformation using speckle tracking echocardiography (STE) and feature tracking cardiac magnetic resonance (FT-CMR) has not been extensively compared in the same cohort.

Methods

Patients with severe AS scheduled for AVR were recruited. Same-day TTE and CMR scans were performed pre- and post-AVR using a standard protocol. Myocardial deformation was assessed using STE and FT-CMR by a blinded single observer. LA strain (LAS) corresponding to reservoir, conduit and booster pump function were assessed on 4- and 2-chamber and average values calculated. For the LV, the three long-axis views were utilised for global longitudinal strain (GLS) and peak early diastolic strain rate (PEDSR). Mid circumferential strain (Mid-CS) and PEDSR were calculated from the mid short-axis view. Global circumferential strain (GCS) and PEDSR were derived by averaging values from the basal, mid and apical short axis cine slices by FT-CMR only.

Results

We recruited 78 patients with severe AS, 66 of whom (mean age 67.0±9.4 years; 75.8% males) had matched pre- and post-AVR CMR scans. Median follow-up period was 6 months. LV assessment by TTE was limited by image quality (>20% unanalysable images). STE demonstrated a significant increase in reservoir and conduit LAS, GLS and longitudinal PEDSR post-AVR (Table 1&2). FT-CMR demonstrated a significant increase in booster-pump LAS, GLS, GCS and longitudinal/ circumferential-PEDSR post-AVR.

Conclusion

In patients with severe AS, significant increase in LV GLS and longitudinal-PEDSR was seen using both FT-CMR and STE. GCS and circumferential-PEDSR were significantly increased using FT-CMR only, suggesting that CMR may be more sensitive to subtle changes in LV function at 6 months post-AVR. LAS assessment showed significant improvements post-AVR by both imaging modalities.Table 1Table 2
Aortic diastolic flow displacement from phase-contrast CMR is associated with exercise capacity in healthy adults
Authors: Zhao X , Garg P , Tan R S , Chai P , Yeo T J , Leng S , Bryant J , Teo L , Koh A S , Zhang S , Van Der Geest R J , Yip J , Tan J L , Plein S , Zhong L
Published: November 2023

Background

Blood flow eccentricity, as determined by phase contrast (PC) CMR-assessed peak systolic flow displacement, has been linked to future aortic enlargement in patients with bicuspid aortic valve and thoracic aortic aneurysm. Its presence, extent and functional consequence in healthy adults are unknown.

Purpose

We quantified aortic flow eccentricity and studied its association with exercise capacity in a cohort of healthy Asian subjects using 2-dimensional (2D) PC-CMR and cardiopulmonary exercise testing (CPET), respectively.

Method

169 community healthy volunteers (age 44±13 years, M:F 96:73) without cardiovascular diseases (the control group in a prospective observational study NCT03217240) underwent CMR, including 2D PC at an orthogonal plane just above the sinotubular junction, and CPET within one week. From 2D PC-CMR, we obtained the average flow displacements (FD) during systole (avFDSys), late systole (avFDLateSys) and diastole (avFDDias), as well as flow reversal ratios (FRR) during systole (FRRSys) and the whole cardiac cycle (FFRRR) (see Figure). Exercise capacity was determined by peak VO2 (PVO2) from CPET. Univariate analysis and multivariable regression using a model that included FD and FRR parameters as well as standard cine CMR-assessed left ventricular (LV) volumes and ejection fraction were performed to investigate the determinants of PVO2.

Results

Mean values of average flow displacements (avFDSys, avFDLateSys, avFDDias), and flow reverse ratios (FRRSys and FRRRR) were 17±6%, 19±8%, 29±7%, 5.9±5.1%, and 13.7±8.0%, respectively, which were positively correlated with age (R values of 0.623, 0.628, 0.353, 0.649, 0.708, respectively; all P <0.0001) and negatively correlated with PVO2 (R values of -0.302, -0.270, -0.253, -0.219, -0.205, respectively, all P <0.01). Women had higher avFDSys (18±7 vs. 15±6%, P=0.003) and avFDLateSys (21±9 vs. 18±8%, P=0.007), and lower PVO2 (median 21 vs. 26ml/kg/min, P <0.001) compared with men. On multivariable analysis, avFDDias (=-0.234, P=0.002) and LV end-diastolic volume (=0.116, P <0.001) were significantly associated with PVO2 after adjustment for age. For every 10-year increase in age, avFDDias increased by 1.4% in men and 2.6% in women; and for every 1% increase in avFDDias, PVO2 decreased by 0.2 ml/kg/min in men and 0.3 ml/kg/min in women.

Conclusion

Compared with men, women had more eccentric and less efficient aortic flow, and exhibited a higher ageing-related increase in avFDDias. The latter was independently associated with reduced PVO2, which lends support to its functional significance and potential application as a marker of cardiovascular health.Figure 1
Global molecular calcium score: is there a link between sodium fluoride uptake and cardiovascular risk burden?
Authors: Borges-Rosa J , Oliveira-Santos M , Silva R , Gomes A , Campos G O , Gomes A R , Abrunhosa A , Castelo-Branco M , Goncalves L , Ferreira M J
Published: November 2023

Background

Sodium fluoride (18F-NaF) uptake in positron emission tomography with computed tomography (PET-CT) identifies active microcalcification both in atherosclerotic plaques and the aortic valve.

Purpose

We aimed to evaluate global cardiac microcalcification activity with 18F-NaF, as a measure of the microcalcification burden, in high cardiovascular (CV) risk patients. Additionally, as an exploratory endpoint, we evaluated the association between global cardiac microcalcification and diastolic dysfunction.

Methods

High CV-risk individuals without previous CV events from a single centre were prospectively scanned with 18F-NaF PET-CT. Total cardiac 18F-NaF uptake was measured as global molecular calcium score (GMCS), which was calculated by summing the product of mean standardized uptake value and volume of the region of interest on every slice within the borders of the heart. The result was then divided by the number of slices to adjust for the volume.

Results

We included sixty-five patients with a mean age of 64.0 ± 9.0 years and 38.5% females. There was a high rate of CV risk factors, including hypertension (95.4%), diabetes (84.6%), dyslipidemia (78.5%), obesity (58.5%), smoking (26.2%) chronic kidney disease (18.5%), and family history of premature coronary disease (9.2%). The mean 10-year risk of fatal and nonfatal cardiovascular events predicted by ASCVD risk score was 30.54 ± 18.4. Median GMCS was 221.42 [IQR 144.55-317.58]. Individuals with > 5 CV risk factors (46.2%) had increased overall GMCS compared to those with a lower number of CV risk factors (295.29, IQR 159.37-356.87 vs 186.16, IQR 122.57-281.78; p=0.03). Thirty-three patients underwent diastolic dysfunction evaluation by echocardiography. All patients had normal left ventricle ejection fraction, mean of 62.86 ± 3.58%. Mean E/A was 0.88 ± 0.27, mean septal e’ velocity 0.07 ± 0.02 m/s, mean lateral e’ velocity 0.08 ± 0.02 m/s, and mean average E/e’ 10.7 ± 3.3. The mean peak tricuspid regurgitation velocity was 2.14 ± 0.59 m/s and the median indexed left atrium volume was 37, IQR 29-44mL/m2. After applying the algorithm for diagnosis of diastolic dysfunction in subjects with normal ejection fraction, 21.2% had diastolic dysfunction and 36.4% had a normal diastolic function, while 42.4% were indeterminate. There was no correlation between echocardiographic variables of diastolic function and GMCS, except for indexed left atrium volume (r = 0.83, p<0.01). There was no association between GMCS and diastolic function categories.

Conclusions

In a high CV risk cohort, the global cardiac microcalcification assessed by GMCS was associated with the burden of CV risk factors. Additionally, despite a strong positive correlation between GMCS and indexed left atrium volume, we found no association between GMCS and echocardiographic variables of diastolic function.