bluuebunny/crossref_metadata_2025 huggingface dataset:
Shear wave elastography: can we discover elevated diastolic filling pressures?
Authors: Werner AE , Bezy S , Orlowska M , Kubiak G , Duchenne J , Desmet W , Delcroix M , Van Cleemput J , Ince H , D"hooge J , Voigt JU
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): University Hospitals (Uz) Leuven

Background

 The assessment of the left ventricular diastolic function is complex, as there is no single invasive parameter that provides a direct measurement of myocardial relaxation, myocardial compliance, or – as a surrogate - LV filling pressure. Estimation of diastolic function is therefore based on the combination of several parameters.

Shear wave (SW) elastography is a novel method based on high frame rate echocardiography. SWs occur after mechanical excitation of the myocardium, e.g. after mitral valve closure (MVC), and their propagation velocity is directly related to myocardial stiffness (MS).

Purpose

The aim of this study was to investigate if velocities of natural shear waves are related to MS at end-diastole (ED) and, thus, could be used to estimate left ventricular end-diastolic pressures (LVEDP) as marker of diastolic function.

Methods

So far, we have prospectively enrolled 42 patients with a wide range of diastolic function, scheduled for heart catheterization so that LV filling pressures could be invasively measured. Patients with severe aortic stenosis, mitral stenosis of any degree and a more than moderate mitral regurgitation, as well as regional myocardial abnormalities or dysfunction in the anteroseptal wall were excluded.

Echocardiography was performed immediately after catheterization. SW elastography in parasternal long axis views of the left ventricle (LV) was performed using an experimental scanner (HD-PULSE) at 1100 ± 250 frames per second. Tissue acceleration maps were extracted from an anatomical M-mode line along the midline of the LV septum. The SW propagation velocity at MVC was measured as the slope on the M-mode acceleration map (Figure A). Standard echocardiographic parameters of diastolic function were obtained with a high end ultrasound machine.

Results

SW velocities at ED correlated well with the invasively measured LVEDP (r = 0.74, p < 0.001, Figure B). In comparison, classical echocardiographic parameters correlated only weakly with LVEDP (E/A: r = 0.398, p = 0.02, Figure C; E/E’: r = 0.204, p = 0.247, Figure D).

For the detection of an elevated LVEDP above 15 mmHg, a cut off value for the SW velocity at MVC of 4.395 m/s (Figure A) was associated with a sensitivity of 91.3% and a specificity of 90.9%.

Conclusions

End-diastolic shear wave velocities, measured by high frame rate shear wave elastography, showed a significant correlation with the end-diastolic filling pressure of the LV and allowed to differentiate normal from elevated filling pressure which indicates a potential clinical value of the new method for a non-invasive and direct assessment of LV diastolic function. More patients will be included to confirm these findings.

Abstract Figure.
Multivariate analysis of right ventricle echocardiographic function parameters for the prediction of outcomes in significant functional tricuspid regurgitation
Authors: Travieso Gonzalez A , Romero Delgado T , Luque Diaz TS , Islas F , Olmos C , Higueras Nafria J , Vivas D , Mahia Casado P , Vilacosta I
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Functional tricuspid regurgitation is a common disease that significantly impairs survival and quality of life. The role of echocardiographic right ventricular (RV) function parameters to detect patients with worse prognosis that may benefit from invasive treatment is still under debate.

Methods

121 consecutive patients with grade III and IV functional tricuspid regurgitation were evaluated. RV function parameters and clinical variables were assessed at baseline, and then patients were prospectively followed-up. The primary endpoint was the combination of death or heart failure (HF) admissions. Comparison of imaging parameters was done using receiver-operating characteristics (ROC) curves. Multivariate logistic regression analysis was preformed to establish independent predictors of outcomes.

Results

Median follow up was 27.3 months. 73.6% of the patients were female, and mean age was 80.4 years. 63.6% were grade IV tricuspid regurgitation.

In the univariate analysis using the area under the ROC curve (AUC), RV-free wall strain (RVS, AUC = 0.633) and pulmonary artery systolic pressure (PASP, AUC = 0.605) were the best predictors of death and HF admissions, showing better diagnostic performance than tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) and tricuspid S’ (p < 0.001 for each comparison) (graph 1A).

In the multivariate analysis including either clinical and echocardiographic variables, independent predictors of death and HF admissions were Age (OR 1.07, p = 0.029), RVS>-16 (OR 5.0, p = 0.001), Diabetes mellitus (OR 3.0, p = 0.011), eGFR (ml/min, OR 0.96, p = 0.001) and Hemoglobin (g/dL, OR = 0.74, p = 0.048) (table 1). The model including these variables was superior than RVS and PASP alone (AUC 0.884, p < 0.001) (graph 1B), showing high sensitivity (78.8%) and moderate specificity (67.3%).

Conclusions

In patients with significant functional tricuspid regurgitation, RVS and PASP show the best performance for the detection of death and HF admissions. A multivariate model including age, diabetes, eGFR, hemoglobin and RVS was superior than the individual imaging parameters.

Table 1 Variable OR 95% CI P value Age (years) 1.07 1.01-1.13 0.029 Diabetes Mellitus 3.00 1.29-7.00 0.011 RV free wall strain >-16 5.01 1.87-13.4 0.001 Hemoglobin (d/dL) 0.74 0.55-1.00 0.048 eGFR (ml/min) 0.96 0.94-0.98 0.001 OR odds ratio. CI: confidence interval. eGFR: estimated glomerular filtration rate (CKD-EPI formula). Abstract Figure. Graph 1
Assessment of no-reflow phenomenon by myocardial contrast echocardiography in patients with acute myocardial infarction with ST-segment elevation
Authors: Krinochkin D , Bessonov I , Yaroslavskaya E , Kuznetsov V
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

The noninvasive assessment of myocardial perfusion by echo contrast agents in patients with acute myocardial infarction with ST-segment elevation (STEMI) after successful revascularization is becoming a relevant clinical reality. Perfusion imaging techniques with myocardial contrast echocardiography (MCE) remains the least studied and most promising ultrasound technology for the diagnosis of no-reflow phenomenon.

Purpose

To study the echocardiographic and angiographic characteristics of the no-reflow phenomenon detected by MCE in patients with STEMI.

Methods

The study included 43 patients aged from 40 to 82 years in acute stage of myocardial infarction. Patients were divided into two groups: 32 patients characterized by sufficient myocardial reperfusion after revascularization according to MCE results and 11 patients were with the impaired perfusion.

Results

The patients with impaired perfusion demonstrated a greater size of the left ventricular (LV) asynergy (40.1 ± 2.2% vs 27.4 ± 8.5%, p < 0.001). LV dilatation (LV end-systolic volume 67.3 ± 20.3 ml vs 51.8 ± 17.2 ml, p = 0.015), impaired LV ejection fraction (39.5 ± 3.4% vs 47.2 ± 4.9%, p < 0.001), and significant mitral regurgitation (45.5% vs 3.1%, p = 0.011) with a decrease in DP/DT (979.9 ± 363.4 mmHg/s vs 1565.7 ± 502.8 mmHg/s, p < 0.001) was more often detected in this group. In more than a quarter of these patients, coronary angiography showed no perfusion disorders after revascularization. In the group with impaired perfusion by MCE, the single-vascular lesions (46.9% vs 9.1%, p = 0.033), the lesions of the anterior interventricular artery (90.9% vs 40.6%, p = 0.004), and acute occlusion (100% vs 68.8%, p = 0.043) were more often determined.

Conclusion

According to the results of MCE, the echo signs of LV dysfunction were more pronounced after successful revascularization in patients with STEMI and myocardial perfusion disorders. The SYNTAX score was twice higher in these patients compared to the patients with recovered perfusion. In addition, no-reflow phenomenon by MCE was observed in the most patients with anterior interventricular artery lesion.
Cyclic variation of integrated backscatter detects radiotherapy-induced changes better than global longitudinal strain, a three-year follow-up study in early-stage breast cancer patients
Authors: Tuohinen S , Skytta T , Virtanen V , Kellokumpu-Lehtinen P-L , Raatikainen P
Published: February 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Paavo and Eila Salonen Legacy The Finnish Foundation for Cardiovascular Research

onbehalf

-

Aims

To characterize the early phases of radiotherapy-induced changes in myocardial deformation echocardiography.

Methods

Ninety-nine breast cancer patients were studied prior adjuvant treatment, after chemotherapy (CT), after radiotherapy (RT) and three years after RT (3Y). Nineteen patients with left-sided breast cancer received adjuvant CTand RT (Group A). Sixty patients with left-sided (Group B) and 20 patients with right-sided breast cancer (Group C) were treated with RT only. Echocardiography with the analysis of cyclic variation of the integrated backscatter of the septum (sCV) and the posterior wall (pCV) and global longitudinal strain (GLS) were performed.

Results

Group A patients had a sCV decline from baseline to after CT, after RT and  at 3Y by 1.2 ± 3.4 dB (p = 0.146), 2.6 ± 3.9 dB (p = 0.010) and 4.1 ± 5.4 dB (p = 0.011), and GLS decline by 0.9 ± 1.7 % (p = 0.027), 0.1 ± 2.4 % (p = 0.848), and 0.9 ± 2.9 % (p = 0.124), respectively. Group B displayed sCV changes after RT by 1.4 ± 3.5 dB (p = 0.007) and at 3Y by 2.4 ± 3.2 dB (p < 0.001) and the respective GLS changes were 1.1 ± 2.7 % (p = 0.003) and 1.7 ± 3.5 % (p = 0.001). sCV changes in Group C were 1.3 ± 3.9 dB (p = 0.159) after RT and  2.0 ± 4.1 dB (p = 0.049) at 3Y whereas GLS remained stable. A late decline in pCV was observed in all groups. In the whole patient population, sCV decline was independently associated with the mean LAD dose (p = 0.023, β= -0.251), CT (p = 0.044, β= -0.240) and with the use of aromatase inhibitor (AI) (p = 0.027, β=0.251).  GLS impairment was independently associated with AI (p = 0.017, β= -0.281).

Conclusions

Radiation-exposed septal areas displayed a significant decline early after RT in Group A and B patients in contrast to posterior wall and patients with right-sided breast cancer. In addition, the changes were independently associated with the mean LAD radiation dose. GLS had no independent association with radiation dose . CV appears to be a more sensitive marker of radiotherapy-induced changes of the myocardial contractility than GLS.
Correlation of left atrial strain with left ventricular end-diastolic pressure in patients with coronary artery disease and preserved left ventricular ejection faction
Authors: Ohara Y , Yoshimura Y , Fukuoka Y , Tanioka K , Yamamoto K
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Elevated left ventricular (LV) filling pressures are the main physiologic consequence of LV diastolic dysfunction. Left atrial (LA) strain was recently found useful to predict elevated LV filling pressures noninvasively. However, there are few reports on the role of LA strain when predicting LV filling pressure in patients with coronary artery disease (CAD). The aim of this study was to explore the correlation between LA strain and LV end-diastolic pressure (LVEDP) in patients with CAD and preserved LV ejection fraction.

Methods

Fifty-four patients with stable CAD were enrolled. Global atrial longitudinal strain was measured by averaging all atrial segments. Resorvoir (S-LAs), conduit (S-LAe), and contractile (S-LAa) phase strain were obtained. LVEDP was invasively obtained by left heart catheterization.

Results

Patients were divided into two groups: elevated LVEDP group (LVEDP > 15mmHg group: n = 23) and normal LVEDP group (LVEDP ≤ 15mmHg group: n = 31). Elevated LVEDP group showed significantly decreased S-LAs and S-LAa (S-LAs: 21.3 ± 7.2% vs. 27.5 ± 7.8%, p < 0.005; S-LAa: 9.7 ± 3.3% vs. 14.6 ± 3.4%, p < 0.0001). However, E/Ea and S-LAe were not significantly different between the two groups. LVEDP significantly correlated with S-LAa (r=-0.596, p < 0.0001) and S-LAs (r=-0.431, p < 0.001). Receiver operating characteristics curve analysis showed that S-LAa could predict elevated LVEDP (AUC = 0.84) and a cut-off value of S-LAa < 11.6% was able to most accurately identify patients with elevated LVEDP.

Conclusions

LA strain, especially S-LAa, provided additional diagnostic value for the noninvasive assessment of LV filling pressure in CAD patients with preserved LV ejection fraction.
2D-echocardiography vs cardiac MRI strain using deep learning: a prospective cohort study in patients with HER2-positive breast cancer undergoing trastuzumab
Authors: Bouwer NI , Liesting C , Kofflard MJM , Brugts JJ , Kock MCJ , Kitzen JJEM , Levin M-D , Boersma E
Published: February 2021

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): Promotiefonds Albert Schweitzer Hospital

Background

Subclinical cardiotoxicity due to trastuzumab could be recognized by repeated measurements of global longitudinal/radial strain (GLS/GRS) which could be performed with cardiac magnetic resonance (CMR) or two-dimensional speckle tracking echocardiography (2DE-ST). Although CMR is the gold standard for cardiac function evaluation, it is not used for cardiac monitoring. 2DE-ST might be a reasonable alternative. 

Purpose

To study the predictive value of early 2DE-ST for left ventricular ejection fraction (LVEF) changes during trastuzumab for HER2-positive breast cancer.

Methods

HER2-positive breast cancer patients receiving trastuzumab, with or without anthracycline, underwent 2DE-ST at baseline and after 3 and 6 months (m) trastuzumab. Cardiac magnetic resonance (CMR) imaging (with ST) was performed at baseline and 6m. We studied the correlation between 2DE-ST- and CMR-derived GLS and GRS. We then associated baseline and 3m 2DE-ST with later CMR-LVEF, and with cardiotoxicity, defined as CMR-LVEF <45% and/or absolute decline >10% during trastuzumab.

Results

47 patients were included. GLS measurements based on 2DE-ST and CMR showed weak correlation (Pearson’s r = 0.33; P = 0.041); GRS measurements were uncorrelated (r = 0.09; P = 0.979). 2DE-LVEF at baseline and 3m, and 2DE-STE-GLS at 3m were predictive of CMR-LVEF at 6m (Table 1). In contrast, the change in 2DE-ST-GLS at 3m was predictive of the change in CMR-LVEF at 6m, whereas the change in 2DE-LVEF was not. Importantly, the 11 patients (28%) who developed cardiotoxicity had larger 2DE-ST-GLS change at 3m than those who did not (median 5.2% versus 1.7%; odds ratio 1.81, 95% confidence interval 1.11–2.93; P = 0.016).

Conclusion

Although correlations between 2DE-ST and CMR are weak, ST-measurements appeared useful to improve the performance of 2DE in predicting LVEF changes after 6m of trastuzumab.

Table 1 2DE CMR-LVEF after 6m TZT Mean difference (95% CI) Change in CMR-LVEF after 6m TZT Mean difference (95% CI) Cardiotoxicity OR (95% CI) Before TZT LVEF, % 0.85 (0.42, 1.27)* 0.32 (-0.16, 0.80) 0.88 (0.75, 1.02) ST-GLS, % -0.42 (-1.31, 0.46) -0.28 (-1.14, 0.58) 1.13 (0.87, 1.46) 3 Months TZT LVEF, % 0.59 (0.30, 0.88)* 0.29 (-0.04, 0.61) 0.85 (0.74, 0.98)* ST-GLS, % -1.14 (-2.07, -0.19)* -0.62 (-1.54, 0.30) 1.36 (0.94, 1.84) Change at 3 months TZT LVEF, % 0.30 (-0.11, -0.71) 0.21 (-0.19, 0.61) 0.90 (0.80, 1.01) ST-GLS, % -1.17 (-2.14, -0.20)* -1.10 (-2.02, -0.18)* 1.81 (1.11, 2.93)* * P-value <0.05
Changes in mechanics of septal and lateral walls in patients with left bundle-branch block are related to extent of systolic dysfunction
Authors: Kupczynska K , Nguyen KA , Surkova E , Palermo CH , Sambugaro F , Previtero M , Muraru D , Badano L
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Karolina Kupczynska was supported by research grant awarded by the Club 30 of the Polish Cardiac Society

Background

Left bundle branch block (LBBB) affects left ventricular (LV) mechanics and promotes systolic dysfunction.

Purpose

To analyse myocardial work (MW) and myocardial work efficiency (MWE) of the septal and LV lateral wall in healthy controls and LBBB patients with various degrees of LV dysfunction using non-invasive method.

Methods

Our study involved 102 healthy controls (mean age 41.5 ± 15.7 years, 45% male) and 58 LBBB patients without coronary artery disease (mean age 65 ± 13 years, 60% male) divided into 3 groups based on their LVEF: preserved (n= 27), mid-range (n= 16) and reduced (n= 15). Myocardial work parameters were estimated in septal and lateral wall by LV pressure-strain loop obtained by echocardiography.

Results

There were no differences between septal and lateral MW and MWE in healthy controls (p = NS). We found lower septal MW in comparison to lateral MW (p < 0.0001), but there were no differences in MWE (p = NS) in LBBB patients with preserved LVEF. Patients with LBBB and mid-range or reduced LVEF had lower MW (p < 0.0001 in both subgroups) and lower MWE (p = 0.002 and p = 0.0001, respectively) in septum compared with lateral wall. There was a progressive decrease in septal MW and MWE with the occurring of LBBB and the worsening of LVEF (figure A). Interestingly in healthy controls there was significantly lower lateral MW but higher MWE in comparison to group with LBBB and preserved LVEF. We did not detect differences between LBBB groups with preserved and mid-range LVEF, but patients with reduced LVEF had significant reduction in terms of lateral MW and MWE (figure B).

Conclusions

Impairment in septal myocardial work escalated according to the appearance of LBBB and LVEF loss. Septal dysfunction was compensated by the effective myocardial work of the lateral wall in LBBB patients with preserved and mid-range LVEF. Mechanical dysfunction of the lateral wall was associated with severely reduced LVEF.

Abstract Figure.
Improvement in left atrial reservoir strain following hematopoietic stem cell transplant in patients with systemic sclerosis
Authors: Chen C , Nishtala A , Groenendyk JW , Schultz W , Li E , Shah SJ , Burt RK , Freed BH
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction

Systemic sclerosis (SSc) can cause cardiac complications as a result of multi-organ fibrosis. The study of left atrial (LA) mechanics can offer insights into the pathophysiology of cardiac involvement in SSc. LA strain measured by speckle-tracking echocardiography (STE) has been shown to be a sensitive marker of LA function. The impact of a disease modifying treatment like hematopoietic stem cell transplant (HSCT) on LA mechanics is not known.

Aim

To study the effect of HSCT on LA mechanics using both conventional echocardiography and STE.

Methods

Patients with SSc who underwent comprehensive 2D echo evaluation pre- and post-HSCT were identified. Patients with pulmonary hypertension on right heart catheterization (RHC) were excluded. The modified Rodnan skin score (mRSS) was evaluated for each patient pre- and post-HSCT. Speckle tracking software was utilized to measure myocardial strain (TomTec, Unterschleissheim, Germany). LA reservoir strain was measured from the apical 2-, and 4-chamber views. The ratio of E/e’ to LA reservoir strain was used to non-invasively estimate LA stiffness. Paired student’s t-test and Pearson"s correlation were used in data analysis.

Results

Among 89 patients with SSc (average age 46 ± 11 years, 75% female) who underwent HSCT, the mRSS significantly improved after HSCT. The mean pulmonary capillary wedge pressure (PCWP) measured by RHC prior to HSCT was 9.6 ± 4.1 mmHg. LA reservoir strain was abnormal at baseline and significantly improved following HSCT. Although LA volume index and E/e’ remained unchanged, LA stiffness index decreased significantly post-HSCT. There was no correlation between LA reservoir strain and PCWP at baseline or between change in LA reservoir strain and change in LA volume index or E/e’.

Conclusions

Patients undergoing HSCT for SSc show significant improvement in LA reservoir strain and LA stiffness despite no significant change in LA volumes or estimates of LV filling pressures. This improvement in LA mechanics following HSCT thus appears to be independent of loading conditions and could represent an improvement in intrinsic LA performance.

Key clinical and echo characteristics Pre-HSCT Post-HSCT P value Median mRSS (25th - 75th percentile) 20 (13-34) 9 (4-20) <0.01 LA volume index (ml/m2) 24.6 ± 8.3 24.1 ± 7.1 0.66 E/e’ 8.0 ± 2.4 8.3 ± 2.6 0.30 LA stiffness index 0.24 ± 0.12 0.18 ± 0.08 <0.01 LA reservoir strain (%)* 35.8 ± 8.6 47.7 ± 11.2 <0.01 All values are presented as mean ± SD unless indicated otherwise. *Normal LA reservoir strain is defined in this study as being greater than 39%.
Myocardial work index better reflects contractility than longitudinal strain in rat models of pressure- and volume overload-induced heart failure
Authors: Lakatos BK , Ruppert M , Tokodi M , Olah A , Braun S , Karime C , Ladanyi Z , Sayour AA , Barta BA , Merkely B , Kovacs A , Radovits T
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Speckle-tracking echocardiography (STE)-derived global longitudinal strain (GLS) is considered to be a sensitive marker of left ventricular (LV) function in a wide variety of cardiovascular diseases. Still, evidence suggests that GLS is significantly influenced by loading conditions. Myocardial work index (MWI) evaluates myocardial deformation in the context of afterload through the interpretation of strain in relation to instantaneous LV pressure. MWI may potentially overcome the limitations of mere strain calculation, and may better reflect cardiac contractility in hemodynamic overload states.

Accordingly, our aim was to examine the relationship of GLS and MWI with load-independent markers of LV contractility in rat models of pressure- and volume overload-induced heart failure.

Male Wistar rats underwent transverse aortic constriction (TAC; n = 12) to generate LV pressure overload, or aortocaval fistula (ACF; n = 12) was established to induce severe LV volume overload. In case of the control groups, sham procedures were performed (n = 12/12). Echocardiography loops were obtained to determine STE-derived GLS and global MWI. Pressure-volume analysis with transient occlusion of the inferior vena cava was carried out to calculate preload recruitable stroke work (PRSW), as a load-independent „gold-standard" parameter of LV contractility.

GLS was mildly reduced in the ACF group (-13.2 ± 2.4 vs. -15.4 ± 2.0%, p < 0.05), while it was significantly lower in TAC group compared to controls (-7.0 ± 2.8 vs. -14.5 ± 2.5%; p < 0.001). In contrast with these findings, PRSW and also MWI were significantly reduced in ACF (58 ± 14 vs. 111 ± 40 mmHg; 1328 ± 411 vs. 1934 ± 308 mmHg%, both p < 0.01), however, they were comparable between TAC and the corresponding sham group (110 ± 26 vs. 116 ± 68 mmHg; 1687 ± 275 Hgmm% vs. 1537 ± 662 Hgmm%; both p = NS). In the pooled population, GLS did not show relationship with PRSW (r=-0.23; p = 0.12), while MWI showed significant correlation with it (r = 0.70; p < 0.001).

GLS is significantly influenced by loading conditions, therefore, in case of severe pressure- or volume overload it may not be a reliable marker of LV contractility. In our rat model of pressure overload induced heart failure, contractility was maintained despite decreased GLS, while in the model of volume overload induced heart failure, GLS was maintained despite decreased contractility. MWI reflects contractility in hemodynamic overload states, therefore, it may be a more suitable marker of systolic function.

Abstract Figure. Pressure-strain loops of the groups
Exercise induced worsening of mechanical heterogeneity and diastolic impairment in Long QT syndrome
Authors: Charisopoulou D , Koulaouzidis G , Rydberg A , Henein MY
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Left ventricular (LV)  mechanical dispersion and prolonged myocardial contraction are associated with symptoms in long QT syndrome (LQTS) mutation carriers. Sub-clinical LV diastolic impairment has also been reported in this group.

Purpose

To investigate at rest and during exercise the combined effect of prolonged myocardial contraction and increased mechanical dispersion on myocardial diastolic function and symptoms in LQTS subjects.

Methods

47 LQTS patients (36 LQT1, 11 LQT2) underwent a bicycle exercise test in semi-supine position. ECG and echo parameters were recorded at rest, peak exercise (p.e) and were compared with 35 healthy individuals.

Results

  No difference was seen between LQTS and control subjects for age (45 ± 15 vs 47 ± 13 years, p = 0.2), gender (53 vs 54% females, p = 0.3) or LV Ejection Fraction (65 ± 6 vs 67 ± 7%, p = 0.3). LQTS subjects, compared to controls, had not only prolonged QTc interval, but also longer contraction duration (tGLS), total isovolumic time (t-IVT), delayed early relaxation phase (tESR) and markedly decreased filling time (FT) at rest and p.e. Unlike controls, these electromechanical disturbances deteriorated further with exercise, during which additional decrease of  the LV systolic (GLS) and diastolic myocardial function (ESR)  and attenuated LV stroke volume response (Δ SV: +2 ± 0.5 vs +4 ± 1 vs +32 ± 4%, p< 0.0001) were noted. Such abnormal response to exercise was of greater degree in symptomatic patients and in the LQT1  subgroup and appeared to be amplified by b-blocker therapy (p < 0.05). Worsening myocardial contraction dispersion (SD-tGLS) at p.e was the strongest discriminator for previous clinical events (AUC 0.960, 95% CI 0.020 - 0.995, p < 0.0001)  and its discriminating power excelled further by adding early relaxation delay.

Conclusions

  Our findings suggest that in LQTS  subjects prolonged and dyssynchronous mechanical contraction during  exercise may be associated with inadequate cardiac output increase and symptoms.

Table 1. REST PEAK LQT CONTROL p- LQT CONTROL p- QTc (ms) 453 ± 42 413 ± 17 < 0.0001 455 ± 44 390 ± 19 < 0.0001 GLS (%) 17.3 ± 4.3 18.7 ± 1.3 0.05 19.1 ± 32.6 23.5 ± 11.6 0.0001 tGLS (%) 47 ± 7.2 42 ± 6.3 0.0001 58.7 ± 10 40.1 ± 5.8 < 0.0001 ESR (%) 1 ± 0.3 2 ± 0.3 < 0.0001 1.1 ± 0.4 2.8 ± 0.4 < 0.0001 tESR (%) 61.4 ± 6.8 58.7 ± 4.1 0.03 69.7 ± 5.9 56.1 ± 2.9 < 0.0001 SD TGLS (ms) 58 ± 8 31 ± 8 < 0.0001 61 ± 8 24 ± 10 < 0.0001 Exercise response in long QT syndrome patients and controls
Utility of 3-dimensional transoesophageal echocardiography for mitral annular sizing in transcatheter mitral valve replacement procedures: a cardiac computed tomography comparative study
Authors: Coisne A , Pontana F , Aghezzaf S , Mouton S , Ridon H , Richardson M , Polge AS , Longere B , Silvestri V , Pagniez J , Rousse N , Modine T , Montaigne D
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background.  3-dimensional transoesophageal echocardiography (3D-TEE) is frequently used as an initial screening tool in the evaluation of patients who are candidates to Transcatheter Mitral Valve Replacement (TMVR). However, little is known about the imaging correlation with the gold-standard computed tomography (CT) imaging. We aimed at testing the quantitative differences between these two modalities and finding the best 3D-TEE parameters for TMVR screening.

Methods. We included 57 patients referred to our Heart Valve Clinic for TMVR with prostheses specifically designed for the mitral valve. Mitral annulus (MA) analyses were performed using commercially available software in 3D-TEE and CT.

Results. 3D-TEE was feasible in 52 patients (91%). Although 3D-TEE measurements were slightly lower than in CT, both measurements of projected MA area and perimeter showed excellent correlation with small differences between the two modalities (r = 0.88 and r = 0.92 respectively, p < 0.0001). Correlations were significant but lower for MA diameters (r = 0.68 to 0.72, p < 0.0001) and mitro-aortic angle (r = 0.53, p = 0.0001). ROC curve analyses showed that 3D-TEE had a good ability to predict TMVR screening success defined by constructors based on CT measurements with a range of 12.9 to 15cm² for MA area (AUC = 0.88-0.91, p < 0.0001), 128 to 139mm for MA perimeter (AUC = 0.85-0.91, p < 0.0001), 35 to 39mm for anteroposterior diameter (AUC = 0.79-0.84 p < 0.0001) and 37 to 42mm for posteromedial-anterolateral diameter (AUC = 0.81-0.89, p < 0.0001) (Figure 1). Conclusion. 3D-TEE measurements of MA dimensions display strong correlation with CT measurements in patients undergoing TMVR screening process. 3D-TEE should be proposed as a reasonable alternative to CT in this vulnerable population.

Abstract Figure.
Correlations between left atrial volumes and strains in healthy adults - a three-dimensional speckle-tracking echocardiographic study
Authors: Nemes A , Kormanyos A , Domsik P , Kalapos A , Gyenes N , Lengyel C
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Introduction. Left atrium (LA) is a dynamic structure, which can be characterized by several volumetric and functional properties. Not only volumetric changes could be detected during cardiac cycle, but contractility of its walls have also special quantitative properties. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is a new imaging technique with capability of featuring changes in both LA volume and function by several parameters based on a virtual 3D LA model respecting cardiac cycle at the same time. This ability of 3DSTE makes an opportunity to examine correlations between LA volumes and contractility features. Due to the limited number of studies assessing these physiologic relationships, the present study aimed to test correlations between LA volumes, volume-based functional properties and strains respecting cardiac cycle in healthy adults by 3DSTE. 

Methods. The present study comprised 217 healthy adult volunteers (mean age: 33.4 ± 12.7 years, 112 males) without any symptoms, known diseases or other states, which could affect results. None of them received any medication at the time of examination. Complete two-dimensional (2D) Doppler echocardiography and 3DSTE have been performed in all cases. 

Results. LA stroke volumes increased with maximum LA volume (Vmax) in reservoir, conduit and booster pump phases of LA function. LA emptying fraction (EF) remained unchanged in LA reservoir phase (total atrial EF, TAEF) with the increase in Vmax (TAEF at Vmax < 30 ml = 51.9 ± 13.7% vs. TAEF at Vmax > 50 ml = 50.9 ± 10.9%, p = ns). Significant reduction in LA-EF could be detected in LA conduit phase (passive atrial EF, PAEF), if Vmax proved to be larger than 50 ml (PAEF at Vmax < 30 ml = 34.0 ± 13.2% vs. PAEF at Vmax > 50 ml = 27.5 ± 12.6%, p < 0.05). In booster pump function LA-EF (active atrial EF, AAEF)  did not show significant alterations with the increase of Vmax (AAEF at Vmax < 30 ml = 26.9 ± 14.7% vs. PAEF at Vmax > 50 ml = 31.7 ± 11.7%, p = ns). Global peak LA radial strain (RS) (at Vmax < 30 ml = -11.7 ± 8.9% vs. at 30 ml ≤ Vmax ≤ 50 ml = -15.4 ± 7.7% and at Vmax > 50 ml = -14.7 ± 6.8%, p <0.05 and p < 0.05, respectively) and 3D strain (3DS) (at Vmax < 30 ml = -5.5 ± 5.7% vs. at 30 ml ≤ Vmax ≤ 50 ml = -7.5 ± 5.6% and at Vmax > 50 ml = -8.0 ± 5.0%, p < 0.05 and p < 0.05, respectively) increased with Vmax only until a point. LA-RS and LA-3DS at atrial contraction similarly increased with Vmax. The other strain parameters did not show any changes.

Conclusions. LA-RS and LA-3DS, objective features of LA contractility do not increase beyond a point in parallel with an increase in maximum LA volume in healthy subjects.
Functional DSCT assessment of tricuspid regurgitation: AROA reproducibility and comparison with 3D TEE
Authors: Cunha Lopes B , Hashimoto G , Fukui M , Du Y , Bae R , Stanberry L , S Schwartz R , R Lesser J , Sorajja P , L Cavalcante J
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

onbehalf

Minneapolis Heart Institute Foundation

Background

Tricuspid regurgitation (TR) assessment by echocardiography is often challenging. Functional dual-source CT (DSCT) with third-generation scanners allows accurate evaluation of leaflet anatomy and mobility.

Purpose

Investigate the reproducibility of tricuspid anatomical regurgitant orifice area (AROA) by DSCT, and its correlation with TR quantification by 3D TEE.

Methods

We evaluated patients with symptomatic TR referred for transcatheter tricuspid repair. DSCT (SOMATOM Force [Siemens, Erlangen, Germany]) and 3D TEE was performed on the same day as part of our institutional registry. DSCT scans were retrospective and ECG-gated, with a contrast protocol to enhance the right heart. The reproducibility of tricuspid AROA was assessed in 20 patients. The tricuspid AROA was compared with the TR severity (5-grade classification) and the 3D VCA by TEE (Panel 1).

Results

We included 60 patients (Table). The AROA had excellent intra and interobserver reliability (ICC 0.99 [0.97, 0.99] and 0.99 [0.96, 0.99]). We found a stepwise increase in tricuspid AROA from moderate to torrential TR (Panel 2A). Of 60 patients, 3D VCA was feasible in 39; in those, we found an excellent linear correlation of AROA and 3D VCA (Panel 2B).

Conclusions

Tricuspid AROA by DSCT was reproducible, showed a stepwise increase from moderate to massive TR and correlated with 3D VCA by TEE.

Baseline Patient Characteristics All (n = 60) Age, years 82 ± 7 BSA, m2 1.8 ± 0.2 NYHA III-IV, n(%) 42 (70) Atrial Fibrilation 55 (91) Hypertension 44 (73) Pulmonary Hypertension 34 (56) Chronic Kidney Disease 25 (44) Coronary Artery Disease 17 (28) Chronic Lung Disease 14 (23) Permanent Pacemaker 13 (21) Diabetes Mellitus 10 (17) Mitral Valve Repair (MitraClip) 9 (15) Mitral Valve Replacement 7 (12) Mitral Valve Repair 3 (5) Aortic Valve Replacement 5 (8) Values are mean ± SD and n (%). BSA = body surface area. Abstract Figure. Panels
Non-invasive assessment of cardiac percutaneous occluders healing process using computed tomography imaging: a proof of concept study
Authors: Perdreau E , Jalal Z , Walton R , Sigler M , Cochet H , Naulin J , Quesson B , Bernus O , Thambo JB
Published: February 2021

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): National Research Agency (ANR) French Federation of Cardiology : “Aide à la recherche par équipe 2018, Cardiopathies de l’enfant”

Introduction

After percutaneous implantation of an atrial septal defect (ASD) occluder device, a complex healing process leads to the device coverage within several months. However, an unexplained incomplete device coverage is at risk of complications such as thrombosis or infectious endocarditis.

Purpose

The aim of the study was to assess the device coverage process of ASD occluder devices in a chronic sheep model using micro-CT technology.

Methods

After percutaneous creation of an ASD by catheterization, 8 ewes (mean age 5.4 ± 0.7 yo and mean weight 55.6 ± 7.9 kg) were implanted with a 16-mm Nit-Occlud ASD-R occluder (PFM medical, Cologne, Germany) and were followed for 1 month (N = 3) and 3 months (N =5). After heart explantation, a iodine contrast agent was used to enhance the tissue signal. The device coverage was then assessed by micro-CT and the results were compared to histology, used as the gold standard for healing evaluation. The micro-CT image resolution was 41.7 µm. Reconstruction was performed in 2D and 3D with Amira® software, allowing to obtain images that were exploited by a code to measure the surface for each disk of the analyzed devices. Histological study was performed after resin embedding and Richardson blue staining was used.  The pathologist was blinded to the duration of animals’ follow-up and micro-CT results.

Results

ASD creation and device closure was successful in 100% animals without complications. Following heart explantation, macroscopic assessment of devices showed that the coverage was complete for the left-side disk regardless of the duration of the follow-up and variable for the right-side disk, depending of the protrusion of this disk. 2D and 3D micro-CT analysis allowed an accurate evaluation of device coverage of each disk and was overall well correlated to histology slices (cf Figure). Surface calculation from micro-CT images showed that the median surface of coverage was 93 ± 8% for the left-side disk and 55 ± 31% for the right-side disk.

Conclusion

This preliminary study made the proof of concept that micro-CT is a reliable tool to assess the coverage of intra-cardiac occluders in vitro. The translation to clinical practice is challenging but would allow an individual follow-up, to avoid thrombotic or infective complications.

Abstract Figure.
Computed tomography characteristics of patients with functional MR receiving MitraClip
Authors: Hashimoto G , Lopes B , Fukui M , Sarano M , Garcia S , Goessl M , Sorajja P , Lesser J , Cavalcante J
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Percutaneous leaflet repair with the MitraClip device (Abbott Vascular, Menlo Park, CA) is safe and effective in patients with severe functional mitral regurgitation (FMR). Residual or recurrent MR may occur in up to 40% of patients and is associated with persistent symptoms and impaired survival. The anatomical characteristics associated with residual or recurrent MR after MitraClip are not well defined by computed tomography angiography (CTA) in FMR population.

Methods

A retrospective analysis of patients with significant FMR, who underwent retrospective-gated CTA at Minneapolis Heart Institute between July 2015 to January 2020, identified those who underwent percutaneous leaflet repair with MitraClip. Anatomical and functional parameters were assessed by pre-procedure CTA and compared between those with and without residual (≥2) MR.

Results

  A total of 25 patients were included (median[Q1, Q3]; age, 80[75, 85]; 44% men) and classified into ventricular FMR (V-FMR, n = 12) and atrial FMR (A-FMR, n = 13) according to anatomical and functional characteristics by CTA. 50% of V-FMR and 38% of A-FMR had residual/worsening MR. Among V-FMR patients with residual/worsening MR, shorter coaptation length was observed (2.2[2, 2.3] mm vs. 3.5[3, 4], p = 0.006) (Figure). No differences in anatomical or functional characteristics were seen in A-FMR patients.

Conclusion

Longer coaptation length in V-FMR is predictive of successful MitraClip procedure, whereas mitral annulus size and cardiac volumes are not.

 Total (N = 12) No residual/no worsening MR (N = 6) Residual/worsening MR (N = 6) P value Septal-lateral diameter, mm 31.9 (30.5, 37.9) 32.2 (30.1, 39.8) 31.9 (29.5, 35) 0.749 Annulus area, cm² 11.2 (10.4, 13.6) 11.3 (10.1, 14.6) 11.1 (9.6, 12.6) 0.631 Tenting area, cm² 1.6 (1.3, 2.1) 1.6 (1.2, 2.2) 1.7 (1.2, 2.3) 0.873 Tenting height, mm 8.5 (6.5, 9.7) 8.5 (6.6, 9.3) 8.3 (6.3, 10.1) 0.749 Coaptation length, mm 2.6 (2.1, 3.5) 3.5 (3.0, 4.0) 2.2 (2.0, 2.3) 0.006  Total (N = 13) No residual/no worsening MR (N = 8) Residual/worsening MR (N = 5) P value Septal-lateral diameter, mm 32.3 (29.5, 39.0) 32.0 (29.2, 39.9) 34.3 (30.8, 39.02) 0.464 Annulus area, cm² 10.3 (9.2, 14.7) 10.2 (9.0, 14.6) 12.4 (9.4, 14.7) 0.661 Tenting area, cm² 1.2 (0.8, 1.8) 1.1 (0.7, 2.2) 1.3 (0.7, 1.8) 0.884 Tenting height, mm 5.5 (4.1, 6.9) 6.3 (4.1, 8.7) 4.6 (3.7, 5.8) 0.213 Coaptation length, mm 2.3 (1.5, 2.8) 2.5 (1.4, 3.5) 1.9 (1.5, 2.6) 0.464 Comparison of baseline CT parameters between no residual/ no worsening MR and residual/ worsening MR Abstract Figure.
Best approach in d-dimer algorithm to exclude pulmonary thromboembolism: a comparative study
Authors: Silva BV , Rigueira J , Aguiar Ricardo I , Mendonca C , Alves Da Silva P , Brito J , Rodrigues T , Santos R , Cunha N , Placido R , Jorge C , Pinto FJ
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

 Ruling out pulmonary embolism (PE) through a combination of clinical assessment and Ddimer is crucial to avoid excessive computed tomography pulmonary angiography (CTPA), and different algorithms should be considered as an alternative to the fixed cutoff to achieve that goal.

Purpose

 To compare sensitivity, specificity, and reduction in CTPA requests of 4 algorithms to rule out PE: fixed Ddimer cutoff, age-adjusted, YEARS and PEGeD.

Methods

 Retrospective study of consecutive outpatients who presented to the emergency department and underwent CTPA for PE suspicion from April 2019 to February 2020. The clinical-decision algorithms were retrospectively applied. 

In fixed and age-adjusted cutoffs, high probability patients are directly selected for CTPA and the others perform CTPA if Ddimer ≥500µg/L or age x10 µg/L within patients over 50 years, respectively. YEARS includes 3 items (signs of deep vein thrombosis, haemoptysis and whether PE is the most likely diagnosis): patients without any YEARS items and Ddimer ≥1000ng/mL or with ≥1 items and Ddimer 500ng/mL perform CTPA. In the PEGeD, patients with high clinical probability or with intermediate and Ddimers >500µg/L or low probability and Ddimer >1000 µg/L are selected for CTPA.

Results

We enrolled 409 patients and PE was confirmed by CTPA in 125 patients. Compared with a fixed Ddimer cutoff, age-adjusted was associated with a significant increased of specificity (p < 0.001), correctly avoiding 29 CTPAs, without losing sensitivity. YEARS resulted in a marked increase in specificity, compared to the fixed cutoff, but with an impairment of sensitivity(p = 0.002). PEGeD had the worst sensitivity, associated with 11 more false negatives (FN) than the fixed cutoff. Despite the lack of difference between PEGed and YEARS strategies regarding sensitivity, YEARS had a significantly higher specificity (p < 0.001) and allowed to correctly avoid a higher number of CTPA(55 vs 63), compared to the fixed cutoff. Results are summarized in table 1.

Conclusion

 Compared to fixed d-dimer cutoff, all algorithms were associated with an increased specificity. Age-adjusted cutoff was the only that is not associated with a significant decrease in sensitivity when compared to fixed cutoff, allowing to safely reduce the need to perform CTPA.

Sens(%) Spec(%) Correctly avoid CTPAs(n) FN(n) Fixed cutoff 95 29 85 6 Age-adjusted 93 40 114 9 YEARS 87 52 148 16 PEGeD 86 49 140 17
Fully automated cardiac assessment for diagnostic and prognostic stratification following myocardial infarction
Authors: Schuster A , Lange T , Backhaus SJ , Strohmeyer C , Boom P , Matz J , Kowallick JT , Steinmetz M , Kutty S , Bigalke B , Desch S , Hasenfuss G , Thiele H , Stiermaier T , Eitel I
Published: February 2021

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiovascular magnetic resonance (CMR) imaging is considered the reference methodology for cardiac morphology and function but requires manual post-processing. Whether novel artificial intelligence (AI) -based automated analyses deliver similar information for risk stratification is unknown. Therefore, this study aimed to investigate feasibility and prognostic implications of AI-based analyses.

Methods

CMR data (n = 1017 patients) from two myocardial infarction multi-center trials were included. Analyses of biventricular parameters including ejection fraction (EF) were manually and automatically assessed using conventional and AI-based software. Obtained parameters entered regression analyses for prediction of major adverse clinical events (MACE) defined as death, reinfarction or congestive heart failure within one-year after the acute event.

Results

Both manual and uncorrected automated volumetric assessments showed similar impact on outcome on univariate (LVEF HR 0.93, [95% CI 0.91-0.95]; p < 0.001 for manual and HR 0.94 [0.92-0.96]; p < 0.001 for automated) and multivariable analyses (LVEF HR 0.95, [0.92-0.98]; p = 0.001 for manual and HR 0.95 [CI 0.92-0.98]; p = 0.001 for automated). Manual correction of the automated contours did not lead to improved risk prediction (LVEF AUC 0.67 automated vs. 0.68 automated corrected, p = 0.49). There was acceptable agreement (bias: 2.6%, 95% limits of agreement [LOA] -9.1-14.2%, intraclass correlation coefficient [ICC] 0.88 [0.77-0.93] for LVEF) of manual and automated volumetric assessments.

Conclusions

User independent volumetric analyses performed by fully automated software are feasible and results are equally predictive of MACE compared with conventional analyses in patients following myocardial infarction.
Cardiovascular magnetic resonance deformation imaging: method comparison and considerations regarding reproducibility
Authors: Backhaus SJ , Metschies G , Zieschang V , Erley J , Zamani SM , Kowallick JT , Lapinskas T , Pieske B , Lotz J , Kutty S , Hasenfus G , Kelle S , Schuster A
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Centre for Cardiovascular Research

Purpose

Myocardial Feature-Tracking (FT) deformation imaging is superior for risk-stratification compared to volumetric approaches. Since there is no clear recommendation regarding FT post-processing, we compared different FT-strain analyses with reference standard techniques, including tagging and strain encoded (SENC) magnetic resonance imaging.

Methods

FT software from 4 different vendors (TomTec/Medis/Circle(CVI)/Neosoft), tagging (Segment), and fastSENC (MyoStrain) were used to determine left ventricular global circumferential and longitudinal strains (GCS/GLS) in 12 healthy volunteers and 12 heart failure patients. Variability and agreements were assessed using intraclass correlation coefficients for absolute agreement (ICCa) and consistency (ICCc) as well as pearson correlation coefficients.

Results

For FT-GCS, consistency was excellent comparing different FT-vendors (ICCc = 0.84-0.97, r = 0.86-0.95) and compared to fSENC (ICCc = 0.78-0.89, r = 0.73-0.81). FT-GCS consistency was excellent compared to tagging (ICCc = 0.79-0.85, r = 0.74-0.77) except for TomTec (ICCc = 0.68, r = 0.72). Absolute FT-GCS agreements between FT-vendors were highest for CVI and Medis (ICCa = 0.96) and lowest for TomTec and Neosoft (ICCa = 0.32). Similarly, absolute FT-GCS agreements were excellent for CVI and Medis compared to both tagging and fSENC (ICCa = 0.84-0.88), good to excellent for Neosoft (ICCa = 0.77 and 0.64) and lowest for TomTec (ICCa = 0.41 and 0.47).

For FT-GLS, consistency was excellent (ICCc≥0.86, r≥0.76). Absolute agreements between FT-vendors were excellent (ICCa = 0.91-0.93) or good to excellent for TomTec (ICCa = 0.69-0.85). Absolute agreements (ICCa) were good (CVI 0.70, Medis 0.60) and fair (TomTec 0.41, Neosoft 0.59) compared to tagging but excellent compared to fSENC (ICCa = 0.77-0.90).

Conclusion

Although absolute agreements differ depending on deformation assessment approaches, consistency and correlation are consistently high irrespective of the method chosen, thus indicating reliable strain assessment. Further standardisation and introduction of uniform references is warranted for routine clinical implementation.