bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of valvular heart disease in patients referred for suspected coronary artery disease
Authors: Molenaar MA , Coerkamp CF , Man JP , Bouma BJ , Isgum I , Verouden NJ , Selder JL , Chamuleau SAJ , Schuuring MJ
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The most recent European Society of Cardiology guideline on coronary syndromes recommends echocardiography in all patients with suspected coronary artery disease (CAD). Whereas left ventricular function (LVF) is recognized as an important determinant of major adverse cardiovascular events (MACE) in these patients, little is known about the role of valvular heart disease (VHD).

Purpose

  The aim of this study was to evaluate the prevalence and impact on the prognosis of VHD in patients referred for suspected CAD.

Method

Baseline, treatment and event in follow-up data of patients with suspected CAD who underwent transthoracic echocardiography (TTE) in a tertiary center between 2014 and 2021 were collected. MACE were defined as all-cause death, nonfatal stroke and nonfatal myocardial infarction (MI). VHD was defined as moderate-or-severe aortic stenosis (AS) or mitral regurgitation (MR). LV dysfunction was defined an ejection fraction less than 50%. Time-to-first-event analysis was performed with Kaplan-Meier survival curves and Cox proportional hazard analysis adjusting for significant covariates and time-dependent interventions.

Results

A total of 845 patients (57% men) with mean age of 65 years were identified. The median follow-up time was 2.8 years (1.1 – 4.8). In total 144 MACE (108 all-cause death, 14  nonfatal stroke, 22 nonfatal MI) occurred. VHD was prevalent in 132 (16%) patients of which 95 patients had moderate or severe AS and 44 had moderate or severe MR, see Figure 1. Independent determinants of MACE in VHD patients included moderate or severe VHD (HR 1.5, p = 0,05), LV dysfunction (HR 2.1, p < 0.001), age older than 70 years (HR 1.7, p = 0.003) and diabetes (HR 2.0, p < 0.001).

Conclusion

There is a high prevalence of VHD in patients referred for suspected CAD. Moderate to severe VHD strongly determines the prognosis. Future studies are needed to determine whether valvular interventions can improve the long-term outcome. Abstract Figure.
Cardiac deformation imaging in differentiation between patients with ischemic versus non-ischemic dilated cardiomyopathy presented with Left bundle branch block
Authors: Badran H , Faheem N , Gaber H , Yacoub MY
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Differentiation between ischemic (IDCM) and non-ischemic(NIDCM) cardiomyopathy using non-invasive image modalities is a clinical dilemma. Left bundle branch block (LBBB) imparts additional challenges into the etiologic diagnosis of DCM. This study employed 2D-strain imaging to characterize myocardial deformation and extent of mechanical discoordination in IDCM and NIDCM in presence of LBBB and their possible value for etiologic diagnosis.

Methods

We examined myocardial longitudinal& circumferential strain at segmental & global levels and LV twist [derived from basal and apical rotation] and electromechanical dyssynchrony in 36 DCM patients with LBBB. Of these patients, 16 were diagnosed with IDCM and 20 with NIDCM using coronary angiography, they were compared to 30 healthy controls.

Results

NIDCM were younger in age (45.7 ± 14 versus 61.5 ± 7.5, P<.0001) had larger LV end systolic (P<.03), end diastolic (P<.02) dimensions, LAV (P<.003), more mitral regurgitation(P<.02) and lower EF (31% vs 39%, P<.04). Compared with IDCM, patients with NIDCM had lower longitudinal strain of septal, lateral, inferior walls and global longitudinal strain (GLS), P<.001 and lower LV twist (1.64 ± 1.4º vs. 3.25 ± 2.1º, p< 0.01). IDCM had prevalent typical contraction activation (38% versus 5%) and higher electromechanical delay compared with NIDCM (P<.01). However, there was no significant difference in circumferential strain between LBBB groups. Using ROC analysis value of GLS <3.4% predicted NIDCM with 87.5% sensitivity and 78.9% specificity, area under curve is 0.836 and p < 0.001.

Conclusion

In dilated cardiomyopathy with LBBB, deformation imaging is offering newer mechanistic insights and enables detailed characterization of ischemic and non-ischemic etiologies in heart failure patients.
Sex-specific echocardiographic phenotypes in left ventricular outflow tract obstruction
Authors: Hagen C , Lonnebakken MT , Davidsen ES
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Previous studies have reported major sex differences in prevalence, demographics, and timing of intervention in left ventricular outflow tract (LVOT) obstruction. Whether the observed differences are related to LVOT anatomy is less explored.

Purpose

The aim of this study was to assess the anatomic substrate for LVOT obstruction by echocardiography to identify sex-specific phenotypes.

Methods

We included 76 patients (37% women) with symptomatic LVOT obstruction referred to a tertiary care centre between 2005-2020 to be considered for septal ablation or myectomy. A standardized echocardiography was extended with systematic measurements of parasternal LVOT dimensions at 5, 10 and 15 mm below the aortic valve, proximal septal thickness at 10, 20 and 30 mm, subaortic septal bulge radius and aortoseptal angle in all patients prior to intervention (Image). Measurements were also adjusted for body surface area (BSA). A total of 3 patients had to be excluded from analysis due to poor image quality.

Results

Women were older (p < 0.001, Table), while there were no differences in body mass index (27.6 v.s. 27.5, p = ns), systolic and diastolic blood pressure (133 v.s 133 mmHg, p = ns and 75 v.s 80 mmHg, p = ns, respectively), or prevalence of hypertension (24% v.s. 29%, p = n.s). Left ventricular end-diastolic diameter, LVOT diameters and septum thickness measured 30 mm from the aortic valve were lower in women (Table). However, in all these measurements the differences disappeared after adjusting for BSA. There were no sex differences in posterior wall thickness. Furthermore, the aortoseptal angle was steeper among women, and the septum bulge radius smaller, remaining so even after adjustment for BSA(Table).

Conclusion

In women with LVOT obstruction, the septum bulge radius adjusted for BSA was smaller, and the aortoseptal angle steeper. Our findings suggest that there may be important sex differences in the echocardiographic phenotype in LVOT obstruction. Abstract Table  Abstract Figure. Image
Right ventricle-pulmonary artery coupling in repaired tetralogy of fallot with pulmonary regurgitation: clinical implications
Authors: Panaioli E , Birritella L , Graziani F , Lillo R , Grandinetti M , Di Molfetta A , Przybyleka B , Lombardo A , Lanza G , Secinaro A , Perri G , Amodeo A , Massetti M , Crea F , Delogu AB
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The right ventricle-pulmonary artery (RV-PA) coupling is a strong prognostic marker in

several clinical settings, but only few studies focused on its role in repaired Tetralogy of

Fallot (rToF) with pulmonary regurgitation (PR). Aim of this study was to assess

whether differences exist in RV-PA coupling, estimated as by echocardiography,

between patients with rToF and PR with (i-PVR) or without (ni-PVR) indication for

pulmonary valve replacement (PVR).

3

Materials and Methods

The study population included 40 rToF patients allocated to two groups: 20 i-PVR and

20 ni-PVR; 40 healthy controls were also included. All subjects underwent

echocardiogram, while Cardiac magnetic resonance (CMR) was available in 27/40

rToF patients. RV-PA coupling was assessed by echocardiographic TAPSE/PASP and

RV stroke volume/RV end systolic volume (RVSV/RVESV) by CMR.

Results

TAPSE was similar in i-PVR vs ni-PVR (19.0 ± 3.4 vs 18.8 ± 2.7 mm, p = 0.85) while RV-PA coupling

was significantly worse in i-PVR vs ni-PVR (TAPSE/PASP 0.8 ± 0.3 vs 1.1 ± 0.5

mm/mmHg, p = 0.009) as well as in i-PVR vs controls (p = 0.02) while there was no

difference between ni-PVR and controls (p = 0.29). CMR data confirmed the echo

results, with a significant difference in RV-PA coupling between i-PVR and ni-PVR

(RVSV/RVESV 0.9 ± 0.2 vs 1.2 ± 0.3 mL/min/mL, p = 0.01).

Conclusions

This study shows the presence of worse RV-PA uncoupling, despite normal RV systolic

function, in rToF patients with indication to PVR. RV-PA coupling could be a sensitive

marker of a progressive maladaptive RV response to long-standing volume overload in

rToF prior to the onset of clinical symptoms and RV systolic dysfunction. Abstract Figure. example of an i-PVR patient
Safety and reliability of dobutamine stress echocardiography in pediatric and young adult patients with coronary arteries abnormalities
Authors: Bianco F , Bucciarelli V , Colaneri M , Surace FC , Berton E , Baldoni M , Arcieri L , Baldinelli A , Gallina S , Pozzi M
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was conducted with the support of Regione Marche, Italy

Background

Risk stratification in coronary arteries abnormalities (CAA), both anomalous aortic origin of a coronary artery (AAOCA) and myocardial bridges (MBs), is still challenging. A reliable method to detect myocardial ischemia is missing in these anomalies. We studied the safety and feasibility of dobutamine stress echocardiography (DSE), compared with exercise stress echocardiography (ESE), in pediatric and young adult patients with CAA.

Methods

In 2019-21, N = 27 CAA [median age 16 years (Q1–Q3: 11, 22)] (n= 23 AAOCA, n = 4 MBs) were assessed. ESE was performed 1-2 days before the DSE examination, double-blinded for examiners and patients. Hemodynamic response and major (cardiac arrest, myocardial infarction, ventricular arrhythmia) and minor [hypertension (≥ 200/120 mmHg), paradoxical bradycardia, chest pain, nausea/vomiting, skin rash, anxiety, dizziness, dyspnea] events were recorded. Differences between rest/stress and DSE/ESE for wall motion abnormalities (WMA) and global longitudinal strain (GLS) were evaluated. Inter-observer agreement was also tested using the kappa (k) coefficient.

Results

Heart rate and blood pressure increased significantly from baseline (p < 0.001) in both DSE and ESE exams. Only DSE tests reached a heart rate ≥ 150 bpm (p < 0.001), while younger patients barely reached the heart rate target and frequently showed less compliance to the test. No patient had major events, while 5 (18.5%) had minor events, the majority during DSE. Inducible WMA were observed only at DSE examinations. Inter-observer agreement for WMA and GLS changes was good for both examinations (95%, k = 0.85, p < 0.001).

Conclusions

DSE is feasible in pediatric and young adult patients with AAOCA and MBs to assess inducible WMA and GLS rest/stress changes. It can be performed safely with a low incidence of major/minor events, with a better performance when compared to ESE. DSE is potentially a valuable test for detecting myocardial ischemia and probably helpful in managing CAA patients.
Dynamic myocardial response to exercise in children with transposition of the great arteries post arterial switch operation
Authors: Henry M , Grotenhuis H , Slorach C , Fan S , Grosse-Wortmann L , Mertens L , Cifra B
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The arterial switch operation (ASO) has improved outcomes for patients with transposition of the great arteries (TGA) however the long-term impact on myocardial function and functional reserve during exercise remains poorly described. The aim of this study was to evaluate left (LV), and right ventricular (RV) myocardial response to exercise in children post ASO using semi-supine cycle ergometry stress echocardiography (SSCE).

Methods

This is a single-center cross-sectional study. Participants prospectively underwent exercise stress echocardiography using a semi-supine bicycle and a stepwise exercise protocol. Systolic (s’) and diastolic (e’) tissue Doppler velocities, as well as myocardial acceleration during isovolumic contraction (IVA) were measured at rest and during exercise at incremental heart rates (HR) in the basal segments of the RV lateral wall, IVS and LV lateral wall. Systolic and diastolic reserve were evaluated by plotting s’ and e’ against HR while contractile reserve was assessed by plotting IVA values against HR which represents the force-frequency relationship (FFR).

Results

A total of 40 patients with TGA and 29 controls were included. There were no differences between groups in age (14.6 ± 2.9 vs 14.3 ± 3.1 years, p= 0.75), sex (male= 30/40 vs 20/29 p= 0.58), and resting HR (67 ± 12 vs. 71 ± 12 bpm, p = 0.31). Peak HR was lower in the ASO group (142.2 ±12.4 vs 157 ± 12.3 bpm, p< 0.01). At rest, the ASO group showed lower s’ in the RV and IVS (RV s’: 5.7 ± 1.4 vs. 10.2 ± 2.1 cm/s, p <0.001; IVS s’: 4.2 ± 1.3 vs. 6.2 ± 1.8 cm/s, p< 0.001); lower IVA in the IVS and LV (IVS: 1.01 ± 0.37 vs. 1.23 ± 0.4 m/s2, p= 0.03; LV: 0.86 ± 0.32 vs. 1.1 ± 0.4 m/s2, p =0.02), and reduced e’ in all segments. At peak exercise the ASO group showed reduced s’, e’, and IVA in all segments (table1). When plotted against HR, there was blunting of the s’ slope in RV and septal segments while the LV s’ slope was similar between groups. There were no differences in e’ slope when compared to controls (figure 1). The ASO group showed a blunted IVA response to HR in all measured segments compared to controls.

Conclusion(s):

Our data demonstrate patients post ASO have reduced RV and LV contractile reserve in response to exercise. The etiology and long-term implications of these abnormalities however remains to be described. Abstract Figure. Doppler velocities at baseline and peak  Abstract Figure. Dynamic response to exercise
Classical and myocardial deformation echocardiographic indices in chronic kidney disease patients; effects of aging and comparison to healthy controls
Authors: Lakkas L , Naka KK , Bechlioulis A , Girdis I , Duni A , Theodorou I , Koutlas V , Moustakli M , Katsouras CS , Dounousi E , Michalis LK
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background Patients with chronic kidney disease (CKD) are at high risk for cardiovascular disease compared to the general population. Classic echocardiographic indices of left ventricular (LV) function may not be sensitive enough in detecting early myocardial deterioration in CKD patients while LV speckle tracking (2DSTE) analysis has shown promising results. Dipyridamole stress echocardiography (DIPSE), mostly used to measure coronary flow reserve (CFR), assesses coronary macrovascular and/or microvascular dysfunction in a non-invasive way.

Purpose To investigate differences in classic, 2DSTE-related indices, CFR and other DIPSE-induced changes in various echocardiographic parameters between 1) healthy controls and age-matched (younger) CKD patients, 2) younger versus older CKD patients with similar clinical characteristics.

Methods We prospectively evaluated 30 healthy controls and 60 consecutive CKD patients 40-75 years old who were followed-up at the CKD outpatient clinic of a University Hospital in Western Greece. A standard echocardiographic analysis including 2DSTE analysis was performed in all subjects before and after dipyridamole infusion. CFR in left anterior descending artery was also assessed.

Results The median age of the CKD patients was 63 years and most of them were males (70%). Younger patients with CKD (i.e. <60 years old) had higher E/e" ratio (7.80 ± 2.71 vs 6.06 ± 1.37, p = 0.019), LVMI (114.7 ± 41.1 vs 89.6 ± 21.2, p = 0.017) and relative wall thickness (0.47 ± 0.08 vs 0.40 ± 0.06, p = 0.031) and lower E" (10.6 ± 2.6 vs 2.3 ± 2.9 cm/s, p = 0.045) compared to age and gender-matched healthy controls. Older CKD patients had lower E/A (0.80 ± 0.19 vs 1.03 ± 0.33, p = 0.007) and E" (8.5 ± 1.8 vs 10.6 ± 2.6 cm/s, p = 0.003) compared to younger CKD patients. CFR was higher in healthy controls compared to both younger (3.93 ± 1.25 versus 3.1 ± 0.75, p = 0.009) and older CKD patients (3.93 ± 1.25 versus 2.89 ± 0.88, p < 0.001); no significant difference in CFR was observed between younger and older CKD patients. Dipyridamole-induced changes in other studied echocardiographic indices did not differ significantly among groups. Conclusions In the current study, impaired coronary microcirculation, LV diastolic function and increased LV mass with concentric remodeling were shown to be the principal findings early in the process of CKD. These results may have pathophysiological implications for cardiorenal syndrome type 4 and targeted cardiac assessment in CKD patients. Future studies are needed to assess whether any therapeutic efforts aiming to delay or reverse these changes may have an impact on the cardiovascular prognosis in CKD patients.
Right ventriculoarterial coupling as a marker of subclinical myocardial damage in rheumatoid arthritis
Authors: Miranda Aquino T , Cepeda-Rocha M , Rosal-Arteaga CA , Perez-Topete SE , Cerpa-Cruz S , Hernandez-Del Rio JE
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The lung involvement in autoimmune diseases has been described previously. Currently the incidence of pulmonary hypertension in patients with rheumatoid arthritis (RA) ranges from 1-25%. Right ventriculoarterial coupling (RVAC) is altered early before presenting right ventricular dysfunction and pulmonary hypertension, its measurement in patients with RA has been barely studied.

Objectives

To determine if there is a difference in RVAC in patients with RA. Analyze if there are differences in patients with normal vs abnormal right RVAC. To investigate if there is an association in patients with RA to present abnormal RVAC.

Methods

A single-center, analytical, cross-sectional, observational study was performed. Patients with diagnosis of RA were included according to the ACR / EULAR 2010 classification criteria, without any other comorbidity. An ACUSON SC2000 echocardiogram was used. Patients were compared with healthy controls matched by age and gender. The clinical, laboratory and echocardiographic variables were contrasted. Among the echocardiographic variables, the left ventricular ejection fraction, the left ventricular volume index, the left atrial volume index, right ventricular diastolic area, right ventricular fractional area change (RV FAC), right atrial volume, pulmonary artery systolic pressure (PASP), right ventricular free wall longitudinal strain (RVFWLS) and right atrial global longitudinal strain (RAGLS). The RVAC was determined with the RVFWLS / PSAP ratio. A RVAC less than 0.8 was classified as abnormal. The quantitative variables were contrasted with Student"s t-test or Mann-Whitney"s u test, according to the normality of the variables; qualitative variables were compared with x2. The association with an abnormal RVAC was determined with univariate and multivariate analysis.

Results

Thirty-four patients were included in each group. Among the echocardiographic variables, it was found that patients with RA had a greater right ventricular diastolic area and the PASP; while the RV FAC, the RVFWLS and the RVAC were lower. 68% of the RA patients had an abnormal RVAC, and C-reactive protein (CRP) levels were higher in patients with an abnormal RVAC.  In the multivariate analysis, we found that patients with RA and CRP levels were independently associated to an abnormal RVAC.

Conclusion

The right ventricular subclinical myocardial damage, determined by the RVAC, is present in patients with rheumatoid arthritis. CRP levels and rheumatoid arthritis were associated with an abnormal ventriculoarterial coupling. Abstract Table 1  Abstract Table 2
Age- and sex-specific characteristics of right ventricular compacted and trabeculated myocardium by cardiac magnetic resonance
Authors: Szucs A , Kiss AR , Gregor ZS , Furak A , Szabo LE , Dohy ZS , Grebur K , Merkely B , Vago H
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry for Innovation and Technology in Hungary within the framework of the Therapeutic Development and Bioimaging Programs of Semmelweis University. National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme.

The sex-specific characteristics of right ventricular compacted (RV-CM) and RV-trabeculated myocardial mass (RV-TM) over time and the determinants of RV myocardium are less well studied; however, in different conditions, these might provide additional information to the diagnosis.

We aimed to describe the age- and sex-specific characteristics of RV-CMi, RV-TMi, and RV volumetric and functional parameters and investigate the determinants of RV myocardial mass with CMR.

Two hundred healthy Caucasian volunteers free of known cardiovascular or systemic diseases were enrolled in this study. Four different age groups were established with equal numbers of males and females: Group A (n = 50, 20-29 years, mean age: 24.3 ± 3.2 years), Group B (n = 50, 30-39 years, mean age: 33.6 ± 2.6 years), Group C (n = 50, 40-49 years, mean age: 44.7 ± 2.7 years), and Group D (n = 50, ≥ 50 years, mean age: 55.1 ± 3.9 years). RV volumetric and functional, RV-CMi and RV-TMi values were measured with a threshold-based postprocessing method for CMR.

The volumetric parameters, RV-CMi, and RV-TMi were larger in males, and the ejection fraction (EF) was higher in females. The RV-CMi did not correlate with age in either of the sexes, while the RV-TMi decreased with age in females but remained stable in males. The RV-TMi and RV-CMi correlated positively with RV volumetric parameters, the left ventricular (LV)-CMi, the LV-TMi, and each other in both sexes. LV-TMi, LV-CMi, RV end-systolic volume, and sex were independent predictors of RV-TMi.

Understanding the natural history of RV-trabeculated and RV-compacted myocardium might have additive value in diagnosing different conditions with RV hypertrophy or hypertrabeculation.
Layer-specific regional circumferential strain as prognostic marker of cardiovascular events
Authors: Pezel T , Bluemke D , Wu C , Lima J , Ambale Venkatesh B
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Left ventricular (LV) circumferential strain (Ecc) is an accurate indicator of regional myocardial function. Recent studies have emphasized the potential superiority of regional Ecc, particularly using the layer-specific strain. To date, no studies have assessed the prognostic value of layer-specific regional Ecc in the general population.

PURPOSE

This study aimed to investigate the prognostic value of the layer-specific regional Ecc for predicting the incident of heart failure (HF) and coronary heart disease (CHD) in a population without a history of cardiovascular disease at baseline.

METHODS

Data from participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent tagged magnetic resonance imaging for strain determination were analyzed. Using −17% and −10% as Ecc cut-offs, each segment was rated from 0–2 points according to the Ecc value of each layer. The endo-Ecc, mid-Ecc, and epi-Ecc values from the 16-segment model were used to calculate three indexes: Endo-MyoHealth, Mid-MyoHealth, and Epi-MyoHealth, respectively, which were defined as a percentage of good LV regional function. The Intramyocardial-MyoHealth index was the sum of these three MyoHealth indexes. Cox proportional hazard models were used to evaluate the association between each MyoHealth index and incident HF and hard CHD.

RESULTS

Among the 1,506 participants (63.3 ± 9.4 years, 54.6% men), 122 cases of hard CHD and 91 cases of HF were observed (median [IQR] follow-up 15.9 [12.9-16.6] years). After adjustment, Mid-, Epi-, and Intramyocardial-MyoHealth index values <50% were independently associated with HF (adjusted HR 1.43; 95% CI [1.08-2.87], p = 0.004; HR 1.80; 95% CI [1.12-3.07], p < 0.001; and HR 2.01; 95% CI [1.19-3.20], p < 0.001). After adjustment, Endo-, Mid-, Epi-, and Intramyocardial-MyoHealth <50% were also independently associated with hard CHD (adjusted HR 1.31; 95% CI [1.03-1.51], p = 0.04; HR 1.79; 95% CI [1.26-2.57], p < 0.001; HR 2.03; 95% CI [1.45-3.40], p < 0.001; and HR 2.28; 95% CI [1.51-3.53], p < 0.001).

CONCLUSIONS

Layer-specific regional Ecc, assessed via MyoHealth indexes, provides a robust, independent predictive value for incident HF and hard CHD in asymptomatic participants without any history of previous clinical cardiovascular disease.

Unique identifier Clinical.gov : NCT00005487. Abstract Figure.  Abstract Figure. Kaplan Meier curves
Mitral paravalvular leak 3D printing from 3D-transesophageal echocardiography - proof of concept
Authors: Jedrzejek M , Kozlowski M , Pysz P , Wojakowski W , Smolka G
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Higher Education

Background

Paravalvular leak (PVL) may occur  in almost 15% of patients undergoing surgical mitral valve replacement. This complication can cause congestive heart failure and hemolysis. Multimodal imaging including computed tomography (MSCT) and 3D-transesophageal echocardiography (3D-TEE) is essential for assessment of PVLs. 3D-TEE-based 3D-printing might be useful in preprocedural planning of PVL closure for the optimization of transcatether procedures. In contrast to 3D-printing based on MSCT, use of 3D-TEE for segmentation and printing is not standardized.

Purpose

A proof of concept study to evaluate 3D printing of mitral PVLs using 3D-TEE.

Methods

A case of a 64-year-old woman with 2 clinically significant PVLs around a mitral prosthetic valve is presented. In 3D-TEE (Philips Epiq) anteromedial defects were visualized (surgical view). Qlab Station was used to export the 3D recording of PVLs with surrounding tissue in cartesian DICOM format. Next Slicer, a free open-source software, was used for segmentation and preparation of a STL (stereolithography) file. The PVL model was printed with Starsys Objet 30 printer using Med620 material. Diameters PVLs were the same in 3D Echocardiography and 3D printed model (12mm and 9mm).

Results

Printed PVL model and corresponding 3D-TEE image are shown in Figure 1 and Figure 2, respectively.

Conclusion(s)

Proof of concept study confirms feasibility of using standard 3D-TEE and open source software for preparation of 3D models of anatomically complex mitral PVLs. Further studies to assess cost-effectiveness and clinical applicability of the presented methodology are ongoing. Abstract Figure 1.  Abstract Figure 2.
Evaluation of energy loss in patients with severe primary valvular heart disease before cardiac valve intervention
Authors: Pugliese NR , Del Punta L , Falcetta G , Besola L , De Biase N , Mazzola M , Giannini C , Petronio AS , Taddei S , Masi S , Colli A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. Valvular heart disease (VHD) determines non-physiological, inefficient blood flow within the left ventricle, resulting in abnormal vortex formation and energy loss (EL). EL evaluation could provide valuable insights in addition to more common parameters of left ventricle systolic and diastolic dysfunction. Vector flow mapping (VFM) is a novel, non-invasive echocardiographic technique that measures EL through the study of intraventricular flow.

Purpose. To assess EL throughout the whole cardiac cycle in patients with severe primary left-sided VHD before cardiac valve intervention.

Methods. VFM is based on the continuity equation applied to colour Doppler and speckle tracking echocardiography, acquired from the apical long-axis view. VFM estimates blood flow velocity and vortex characteristics to quantify energy dissipation (i.e., EL) due to blood viscosity in a turbulent flow. EL was calculated frame by frame and averaged over three beats.

Results. We enrolled 20 healthy controls (55 ± 19 years old, 65% male) and 73 patients (70 ± 17 years old, 59% male) with severe VHD before cardiac surgery: 30 with primary mitral regurgitation (MR), 8 with mitral stenosis (MS), 15 with aortic regurgitation (AR), 20 with aortic stenosis (AS). All patients had a left ventricle (LV) ejection fraction ≥50% and no wall motion abnormalities. We observed an increased number of vortexes in patients with VHD when compared to controls, especially in mid-diastole (p = 0.003). This is reflected in a significantly higher EL during the whole cardiac cycle in VHD patients than controls (p < 0.0001), with the highest values observed in MS and AR (post-hoc test: all p < 0.0.1; Figure 1 and Figure 2). The differences were driven by the diastolic EL (p < 0.0001), while the systolic EL values were similar between patients with VHD and controls (p = ns).

Conclusions. In addition to standard baseline echocardiography, VFM can quantitatively evaluate the energy dissipation in different subsets of VHD. EL is not uniform during the cardiac cycle, as diastole seems significantly more affected than systole. The assessment of EL after valve intervention is ongoing. VFM could provide further insights into the pathophysiology of heart valve disease and help to evaluate the efficacy of the procedure (repair/replacement) performed. Abstract Figure 1  Abstract Figure 2
Comparison of different software solutions for AVC quantification using contrast enhanced MDCT
Authors: Evertz R , Hub S , Backhaus S , Lange T , Toischer K , Kowallick J , Hasenfuss G , Schuster A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Aims

Estimating aortic valve calcification (AVC) derived from multi detector computed tomography (MDCT) scans in aortic stenosis (AS) patients has gained increasing interest for diagnostic and prognostic reasons. Little is known about the interchangeability of AVC obtained from different software solutions which, was systematically determined in consecutive patients undergoing contrast enhanced MDCT before TAVR.

Methods and results

50 randomly selected patients who underwent contrast enhanced MDCT for TAVR planning were included in the analysis. All MDCT data sets were analysed using three different software vendors (3 Mensio, CVI 42, Snygo.Via). AVC score was expressed as mm³. For analysing intra- and inter-observer variability a subset of 10 patients were analysed twice with at least 2 weeks in between the measurements. Intra- and inter-observer variability was quantified using the ICC reliability method, Bland-Altman analysis and coefficients of variation.

AVC scores were successfully obtained using all software solutions (3 Mensio 941 ± 623, CVI42 941 ± 637, Syngo.Via 948 mm³ ± 655) without significant differences (p = 0.455). There was excellent intra- (3 Mensio: ICC 0.999 [0.995 – 1.000], COV 3.86 %, mean difference -19.28 [± 45.07]; CVI 42: ICC 1.000 [0.999 – 1.000], COV 1.6 %, mean difference -10.28 [± 18.6]; Syngo.Via: ICC 0.998 [0.993 – 1.000], COV 4.13 %, mean difference -24.81 [± 48.52]) and inter-observer variability (3 Mensio: ICC 1.000 [0.999 – 1.000], COV 1.38 %, mean difference -7.14 [± 16.20]; CVI 42: ICC 1.000 [1.000 – 1.000], COV 1.01 %, mean difference -1.74 [± 11.83]; Syngo.Via: ICC 0.996 [0.985 – 0.999], COV 6.68 %, mean difference -0.65 [± 79.43]) for all software types. Best inter-vendor agreement was found between CVI 42 and Syngo.Via (ICC 0.997 [CI 0.995-0.998], COV 7.26 %, mean difference -7 [± 68.60]) followed by 3 Mensio / CVI 42 (ICC 0,996 [CI 0,922-0,998], COV 8.95 %, mean difference -0.06 [± 84.16]) and 3 Mensio / Syngo.Via (ICC 0,992 [CI 0,986-0,995], COV 12.19%, mean difference -7.06 [± 115.07]).

Conclusion

Contrast enhanced MDCT derived AVC scores are interchangeable between and reproducible within different commercially available software solutions. This is important since sufficient reproducibility, inter-changeability and valid results represent prerequisites for accurate TAVR planning and wide spread clinical use.
Cardiac magnetic resonance to asess aortic valve anatomy in doubtful cases. Case series from a cardiology clinic
Authors: Sanz Ortega I , Bravo Martinez I , Oca Penas R , Cacicedo Fernandez De Bobadilla A , Rodriguez Sanchez I , Velasco Del Castillo S , Capelastegi Alber A , Salcedo Arruti A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, affecting 1-2% of the population, and several types have been described, each one with different prevalence. Partial raphae have also been described and much rarer congenital affectations of aortic valve also exist (unicuspid, quadricuspid), with its own classification. Although echocardiogram is usually enough for diagnosis, sometimes other exams are needed to assess the anatomy of the valve. In these cases, due to lack of radiation, Magnetic Resonance (MRI) can be performed.

Methods

We reviewed cases from a single general cardiology clinic in which MRI was needed for asses aortic valve anatomy during a period of 9 non-consecutive (due to Covid-19 pandemic) months, Characteristics of the patients, as well as valvular and aortic characteristics, were reported.

Results

There 8 doubtful cases. 5 men. Mean Age 60 years old (range 21-77, 6 patients 58 or more). 6 cases were non-tricuspid aortic valve: 5 bicuspid, 1 quadricuspid. Except in rare anatomies (bicuspid with 2 cusps type lateral and quadricuspid), with age 21 and 38 respectively (both men), the mean age was 70, ranging from 58 to 77, with 3 cases (50%) women. Except 2 cases, MRI was performed after the first visit, without follow-up time. Taking into account all patients, mean time from first visit to perform MRI was 1,12 years (maximum 6 years in the quadricuspid case). 6 cases had valvular functional anomalies greater than mild (3 women). 5 cases presented aortic dilatation (3 men), 1 man without valvular functional anomalies, 1 woman with tricuspid aortic valve. BAV with 2 cusps type lateral and quadricuspid cases had no aortic dilatation. There were no extracardiac findings in the exams. Figure shows characteristics of patients. Figure 2 shows images from exams (in the superior left and inferior right part of the image are shown BAV with 2 cusps and quadricuspid valve repectively, in diastole and systole).

Conclusions

Clinicians usually think BAV is a problem of young people, but can be even diagnosed in the eighth decade of life. In these cases, senile changes with valvular degeneration make diagnosis more challenging with doubtful cases. Rare anatomies may be also challenging.  MRI seems useful to assess doubtful cases. Although usually performed in the first visit, in some cases it can take years before MRI is performed. In older cases, there may be no sex predominance for BAV. Abstract Table: Characteristics of patients  Abstract Figure. Images from exams
Myocardial work evaluation in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation
Authors: Sperlongano S , Renon F , Del Giudice C , Iannuzzi A , Bocchetti M , Liccardo B , Malvezzi Caracciolo D"aquino M , Scognamiglio G , Salerno G , Ciccarelli G , Bianchi R , Tartaglione D , Cappelli Bigazzi M , D"andrea A , Golino P
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

myocardial work (MW) is a novel echocardiographic technique which assesses left ventricular (LV) performance through LV pressure-strain loops. MW corrects speckle tracking echocardiography (STE)-derived parameters for afterload using non-invasive systolic blood pressure (SBP) as a surrogate for LV systolic pressure. In patients with severe aortic stenosis (AS), the corrected MW (cMW) has been proposed, consisting in adding the mean aortic gradient in SBP. This method revealed to be feasible and reliable, demonstrating good correlation with invasively measured LV systolic pressure.

Purpose

to evaluate myocardial performance of patients with severe AS, before and after transcatheter aortic valve implantation (TAVI), by MW indices.

Methods

patients with severe AS undergoing TAVI were included. Transthoracic, standard echocardiography and STE were performed the day before the procedure and within 2 days after. MW was calculated by combining STE-derived indices with non-invasively estimated LV systolic pressure.

Results

30 patients (79 ± 5 years old, 56% females) with severe AS (mean gradient 47 ± 14 mmHg, aortic valve area 0.6 ± 0.1 cm2), and eligible for TAVI were enrolled. Baseline global longitudinal strain was impaired (GLS -15 ± 4%), in presence of normal LV ejection fraction (LVEF 57 ± 10%). Corrected global work index and global constructive work were preserved at baseline and markedly decreased after TAVI (cGWI 2322 ± 791 vs 1710 ± 505 mmHg%, p = 0.001; cGCW 2774 ± 803 vs 2083 ± 536 mmHg%, p = 0.0007). Corrected global wasted work and global work efficiency were higher than reference values existing in literature, and no significant changes were observed after TAVI (cGWW 276 ± 174 vs 277 ± 165 mmHg%, p = 0.974; cGWE 89 ± 5 vs 87 ± 5%, p = 0.177). A significant inverse correlation was found between baseline cGWI and left atrial volume index (r=-0.5, p = 0.03).

Conclusions

patients with severe aortic stenosis and preserved LVEF show a good LV performance before and after TAVI, with a significant decrease in MW indices after TAVI, because of the reduced afterload due to AS treatment. The negative correlation between left atrial volume and cGWI may reflect the extent of myocardial damage in AS. However, further studies with larger sample size and appropriate follow-up are needed to evaluate the role of MW in prognosis and risk stratification of this subset of patients.
Impact of proportionality of tricuspid regurgitation on outcome after tricuspid annuloplasty
Authors: Stephanie YK , Li HL , Wu MZ , Ren QW , Yiu KH
Published: February 2022

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Sanming Project of Medicine in Shenzhen, China [No. SZSM201911020]; HKU-SZH Fund for Shenzhen Key Medical Discipline [No. SZXK2020081]

Background

 Patients with secondary tricuspid regurgitation (TR) benefit differentially from tricuspid annuloplasty. We hypothesized that TR severity may be proportional or disproportional to right ventricular (RV) remodeling and investigated the prognostic implication of this novel framework.

Methods

 The ratios of pre-procedural effective regurgitant orifice area (EROA) with right ventricular end-diastolic area (RVDA) and tricuspid annular plane systolic excursion (TAPSE) were retrospectively assessed in 307 patients undergoing tricuspid annuloplasty. Based on optimal thresholds derived from cubic splines and maximally selected rank statistics, patients were stratified into 3 groups: proportionate TR (Group 1: EROA/RVDA ≤1.70 and EROA/TAPSE ≤3.42), disproportionate TR to RV size (Group 2: EROA/RVDA >1.70 and EROA/TAPSE ≤3.42), and disproportionate TR to RV size and function (Group 3: EROA/RVDA >1.70 and EROA/TAPSE >3.42). 

Results

 Overall, 77 (25%), 126 (41%), and 104 (34%) patients were classified into Group 1, 2, and 3, respectively. Compared with those with proportionate TR (Group 1), patients with disproportionate TR (Group 2 and 3) had a higher prevalence of atrial fibrillation and smaller left ventricular end-diastolic and end-systolic volumes. During a median (interquartile range) follow-up of 4.1 (2.5-6.2) years, 81 adverse events (49 HF hospitalizations and 32 deaths) occurred. Patients with disproportionate TR (Group 2 and 3) had higher rates of adverse events than those with proportionate TR (22% and 44% versus 9%; P = 0.018 and P < 0.001, respectively) and were independently associated with poor outcomes on multivariate analysis. TR proportionality outperformed guideline-based prediction algorithm comprising EROA and RV assessment in outcome prediction (C-statistic 0.70 versus 0.62, p = 0.015; likelihood ratio test <0.001).

Conclusion

 Disproportionate TR is independently associated with poor prognosis in patients undergoing tricuspid annuloplasty. Characterization of TR severity to RV size and function may aid patient selection and risk stratification for tricuspid annuloplasty. Abstract Figure.
Lead dependent tricuspid dysfunction- diagnosis and management
Authors: Polewczyk A , Nowosielecka DN , Tomaszewski AT , Brzozowski WB , Szczesniak-Stanczyk DS , Kutarski AK
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Lead-dependent tricuspid dysfunction (LDTD) is one of complications related to cardiac implantable electronic devices.

Purpose

The aim of the study was to analyze transthoracic and transesophageal echocardiographic examinations with the assessment of tricuspid valve dysfunction before and after the procedure of transvenous lead extraction (TLE).

Methods

We analyzed data of  3343  patients undergoing TLE in years 2006-2021 in single center and separated 112 (3,35%) patients with  LDTD. The mechanism of LDTD and the effect of TLE on tricuspid valve function were assessed

Results are presented in the table

Conclusions

The most common mechanism of LDTD is to pull the leaflet down and propping the leaflet through the lead.  In about 40% of patients, an effective method of therapy is removal of the lead, with reimplantation under the control of TEE or bypassing the tricuspid valve (implantation into the coronary sinus). 65% of patients, despite the lack of improvement after TLE, do not require cardiac surgery (mean follow up- 5 years). Abstract Table  Abstract Figure. LDTD
The association between epicardial adipose tissue and prognosis in heart failure with preserved and reduced ejection fraction
Authors: Pugliese NR , De Biase N , Mazzola M , Paneni F , Del Punta L , Gargani L , Mengozzi A , Virdis A , Nesti L , Taddei S , Flammer A , Borlaug BA , Ruschitzka F , Masi S
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. Recent evidence shows that increased epicardial adipose tissue (EAT) thickness is associated with metabolic syndrome, microvascular dysfunction and enhanced pericardial restraint.

Purpose. We measured echocardiography-derived EAT thickness in a population of heart failure (HF) patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction to examine the relationship between EAT and prognosis at clinical follow-up.

Methods. We prospectively enrolled 393 consecutive HF outpatients  (205 HFrEF, 188 HFpEF) who had been referred to our hospital due to dyspnoea and/or effort intolerance. We performed a resting clinical and biohumoral evaluation, followed by combined cardiopulmonary-echocardiography exercise stress. We considered a composite endpoint of cardiovascular death and HF-related hospitalization during follow-up.

Results. Patients with HFpEF displayed greater EAT thickness (median 8 mm, interquartile range [IQR] 4–12 mm) than HFrEF (median 3 mm, IQR 2–6 mm; p < 0.0001).  During a median follow-up of 20.9 months (IQR 15-25 months), 34 cardiovascular deaths and 146 HF hospitalizations were reported, with no significant differences between the two HF phenotypes. EAT was shown to predict adverse events independently from body mass index, waist circumference and other well-established prognostic markers in HF (such as NT-proBNP and peak oxygen consumption). The risk of adverse events increased with increasing EAT thickness in HFpEF and with EAT thinning in HFrEF. Kaplan-Meier analyses for the composite endpoint showed that in HFpEF, the survival probability was significantly lower in patients with thicker EAT than those with thinner EAT. In HFrEF, conversely, patients with increased EAT thickness had a higher survival probability than those with reduced EAT thickness (Figure 1).

Conclusion. EAT accumulation is increased in HFpEF compared to HFrEF and carries different prognostic meanings in the two subsets. In HFpEF, EAT thickening portends adverse outcomes, which may be due to the secretion of pro-inflammatory and pro-atherogenic adipokines and increased mechanical restraint. In HFrEF, EAT thinning is associated with a worse prognosis, probably reflecting a more advanced catabolic state (e.g., cardiac cachexia). Larger studies are needed to determine whether or not EAT has a causal role in influencing progression and survival in the different HF phenotypes. Abstract Figure 1
Impact of cardiovascular therapy on left ventricular function in her2 positive breast cancer patients who were treated with trastuzumab
Authors: Krstic I , Deljanin Ilic M , Pejcic I , Vrbic S , Marinkovic D
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Trastuzumab  prolongs survival in women with HER2-positive breast cancer, but caries the risk of cardiotoxicity.  Cardiac function should be closely monitored, as well as identification of the patients (pts) with risk of  cardiotoxicity.

Purose

To assess the impact  of cardiovascular therapy on the echocardiografic parameters of left ventricular function in patients with HER2 positiv breast cancer  during trastuzumab therapy.

Methods

96 pts with HER2 positive breast cancer (mean age, 59.57 ± 9.6 years) were studied. All pts were on sequential therapy with anthracyclines (IV to VI cycles) within the FAC regimen (fluorouracil 500 mg/m2, doxorubicin 50 mg/m2, cyclophosphamide 500 mg/m2) on day 21, and after that trastuzumab therapy (6 mg/kg of body weight on day 21, for the period of one year).  The echocardiographic parameters: left ventricular ejection fraction (LVEF%), fractional shortening (FS%), end-diastolic diameter (EDD, mm); left ventricular mass (LVM, g) were assesed at the beginning and after the therapy with trastuzumab in all pts.

Out of 96 studied pts, 44 pts (45.85%) were treated with beta-blockers, 35 pts with ACE inhibitors (36.45%), 12 pts (12.5%) with calcium antagonists and 5 pts (5.2%) with sartans.

Results

At the end of trastuzumab therapy patients who were on beta-blockers therapy, showed the reduction of LVEF by 3.28% (p = 0.005), while patients on ACE inhibitors (by 2.80%; p = 0.016) and calcium antagonists (by 2.80%; p = 0.012) had the lowest decrease in LVEF. Patients on sartans therapy showed decreased of LVEF by 4,76% (p = 0.461) compared to baseline values.

Patients on beta-blockers had the lowest decrease of FS (0.68%; p = 0.448) while the highest decrease of FS had patients on calcium antagonist therapy (3.05%, p = 0.022). The highest increase in EDD (by 3.28 mm; p = 0.194) was detected in pts on sartans therapy. In patients on beta-blockers therapy, there was an increase in LVM by 16.36 g (p = 0.012). The highest increase in LVM (by 17.56 g, p = 0.141) was observed in patients on sartans therapy.

Conclusion

The results of our study showed that after trastuzumab treatment in patients with HER2  positive breast cancer, the least reduction of LVEF was in pts who were on therapy with ACE inhibitors or calcium antagonists, while the least decrease in FS was in pts on beta-blockers therapy. The highest increase in EDD and LVM was in patients who were on sartans therapy.