bluuebunny/crossref_metadata_2025 huggingface dataset:
Abnormal left ventricular and left atrial mechanics in patients with resistant hypertension
Authors: Akhmimi A , Sprung V S , Lip G Y H , Oxborough D , Shantsila A
Published: January 2025

Introduction

Patients with resistant hypertension (RH) suffer from a high rate of cardiovascular (CV) complications and have poor prognosis. Given the poor prognosis in RH patients, early identification of subclinical myocardial abnormalities is of clinical importance to allow for timely preventive therapeutic interventions. Speckle tracking echocardiography (STE) is a valuable technique to detect subclinical myocardial dysfunction in hypertensive patients and, therefore, could assist in clinical risk stratification and provide important therapeutic implications.

Purpose

The study aimed to investigate whether left ventricular (LV) and left atrial (LA) myocardial mechanics are impaired in patients with RH compared to controlled hypertension (CH) patients and normotensive controls (NC).

Methods

This was a prospective cross-sectional study in which 54 age and sex-matched participants: 17 with RH (mean age 60.5±12.4 years), 18 with CH (57.7±12.2 years), and 19 NC (54.7±11.9 years) were consecutively recruited. Clinical and conventional echocardiographic measurements were obtained, followed by a two-dimensional STE analysis to assess LV and LA strain. Stepwise multivariable linear regression analysis was performed to identify independent predictors of LV and LA strain indices.

Results

The demographical characteristics were similar across the three groups (Table 1). Patients with RH had elevated BP readings and pronounced cardiac remodelling compared to CH and NC (p<0.001). Peak systolic global longitudinal strain (GLS) was lower in RH and CH groups compared to NC (RH: -16.7±1.9% and CH: -19.8±1.4% vs NC: -21.4±1.3%; p<0.001 and p=0.005, respectively), and being lower in RH compared to CH (p<0.001). Peak systolic global circumferential strain (GCS) was lower between RH and NC (RH: -18.3±3.6% vs NC: -21.7±2.2%, p=0.004) but not between RH and CH (RH: -18.3±3.6% vs CH: -20.3±2.9%, p=0.13). Peak systolic global radial strain (GRS) was lower in RH than in CH and NC (RH: 32.8±8.1% vs CH: 45.0±8.9% and NC: 49.1±5.2%, p<0.001 for all). LV twist was similar amongst the three groups (p>0.05). For the LA longitudinal strain indices, patients with RH had significantly lower reservoir, conduit, and pump strains than NC (p<0.001, p<0.001 and p=0.04, respectively) and CH (p=0.01, p=0.02 and p=0.02, respectively). Of note, the presence of RH remained independently associated with worse GLS (β=3.1, p<0.001), GRS (β= -8.6, p<0.001), LA reservoir (β= -6.0, p=0.005) and pump strains (β=3.5, p=0.007) after adjusting for demographical and clinical variables (Table 2).

Conclusion

Patients with RH show evidence of greater cardiac remodelling with subclinical impairment of their LV and LA mechanics when compared to CH and NC. The subclinical identification of myocardial abnormalities in patients with RH may provide a therapeutic window of opportunity for their reversal and potentially mitigate the occurrence of accompanied CV complications.
Utility of left atrial strain to volume relationship during passive leg lift to identify elevated left ventricular filling pressure - a proof-of-concept study
Authors: Venkateshvaran A , Wiklund U , Lindqvist P , Lindow T
Published: January 2025

Background

Assessment of left ventricular (LV) filling pressure in heart failure (HF) poses a diagnostic challenge, particularly when patients display normal LV filling pressures at rest but elevated LV filling pressures during exercise. Rapid preload increase during passive leg lift (PLL) has displayed promise to unmask HF in such challenging scenarios. Novel echocardiographic variables that identify patients with elevated LV filling pressures during PLL are of important clinical value. We explored the dynamic interplay between left atrial (LA) function and volume using LA strain/volume loops during PLL and compared their diagnostic performance to detect elevated LV filling pressure with conventional echocardiographic surrogates.

Methods

We retrospectively reviewed 39 patients with a clinical HF that underwent simultaneous echocardiography and right heart catheterization before and immediately after PLL. Patients with atrial fibrillation (n=4) were excluded. LA-strain volume dynamics at rest and at PLL were also evaluated in 20 age-matched, healthy controls. LA reservoir strain (LASr) was analyzed using speckle-tracking echocardiography. LA strain-volume loops were generated including the best-fit linear regression line employing simultaneous LASr and LA volume.

Results

LA strain-volume slope was lower for HF patients when compared with controls (0.71 vs. 1.22 %/mL, p<0.001). During PLL, LA strain-volume slope displayed a moderately strong negative correlation with invasive pulmonary arterial wedge pressure (PAWP) (r = -0.71, p<0.001) (Fig. 1). At a 0.74 %/mL cut-off, LA strain-volume slope displayed 88% sensitivity and 86% specificity to identify elevated PAWP (AUC 0.89 [0.76–1.00]). In comparison, LASr displayed strong but numerically lower diagnostic performance (AUC 0.83 [0.67–1.00]) and mitral E/e’ demonstrated poor performance (AUC 0.68 [0.40–0.96]) to identify elevated PAWP either at rest or at PLL (Fig 2).

Conclusions

In this proof-of-concept study, LA strain-volume characteristics display potential to provide incremental diagnostic value compared to conventional echocardiographic measures at rest in identification of elevated LV filling pressure. Our preliminary findings need validation in larger cohorts.

Figure 1

Figure 2
Left atrial stiffness index estimated by echocardiography is an independent predictor of mortality in non-ischemic dilated cardiomyopathy
Authors: Sanchez Sanchez I , Islas F , Zulet P , Gil-Abizanda S , Ferrandez-Escarabajal M , Davila C , Poveda V , Restrepo A , Goirigolzarri J , De Agustin J A , Olmos C
Published: January 2025

Introduction and Objectives

Left atrial function parameters have been shown to be important prognostic markers in different clinical settings. Our objective was to evaluate the prognostic role of a non-invasive estimation of left atrial stiffness index using echocardiography in patients with non-ischemic dilated cardiomyopathy (NIDCM).

Methods

Prospective cohort study of patients with NIDCM evaluated at a tertiary Spanish hospital between 2017 and 2022. Clinical and cardiac imaging variables were collected in a multipurpose registry, and the incidence of clinical events was recorded during follow-up. Left atrial stiffness index was estimated non-invasively as the ratio between E/e' and left atrial strain in the reservoir phase.

Results

Mean age of patients in our cohort (n=200) was 61 (14) years, and 68 (34%) were women. During a mean follow-up of 3.6 years, 33 (16.5%) patients died, and 54 (27%) were hospitalized for heart failure.

Mean left ventricular ejection fraction (LVEF) was 31% (9.5), and mean left atrial stiffness index was 1.3 (0.9), with significant differences between patients with and without events (1.68 (1.1) vs 1.21 (0.8); p=0.005) (Figure).

In a logistic regression analysis, the variables significantly associated with all-cause mortality during follow-up were LVEF, E/e' ratio, and left atrial stiffness index (Table). In a multivariable analysis, left atrial stiffness index emerged as an independent predictor of mortality (OR 1.79, 95% CI 1.19-2.69; p=0.005).

Conclusions

In our cohort of patients with NIDCM, the left atrial stiffness index, which combines information related to filling pressures with left atrial function, was an independent predictor of mortality and could be useful as an additional tool for risk stratification in this setting.

Differences in LA stiffness index

Logistic regression analysis (mortality)
Echocardiographic predictors of atrial fibrillation recurrence after catheter ablation in patients with heart failure.
Authors: Uzieblo-Zyczkowska B , Kiliszek Marek M K , Maciorowska Malgorzata M M , Krzyzanowski Krystian K K , Potapowicz Krysztofiak Magdalena M P K , Krzesinski Pawel P K
Published: January 2025

Background

Atrial fibrillation (AF) and heart failure (HF) often occur together. Restoring and maintaining sinus rhythm in these patients appears to be beneficial, however difficult.

Purpose

The aim of the study was to assess AF recurrence after catheter ablation and its predictors in patients with diagnosed HF.

Methods

Consecutive patients with AF undergoing first-time AF ablation in 2019-2022 were enrolled. Comprehensive echocardiography was performed in all patients on the day of ablation. AF recurrence was assessed during a follow-up consisting of outpatient visits/televisits and 7-day Holter monitoring (at 6 and 12 months after ablation and annually thereafter).

Results

Out of total 293 patients enrolled in the study (7 of whom were excluded due to poor image quality), 27.6% (n=81) were diagnosed with HF (12.3% with reduced ejection fraction – HFrEF; 27.2% with mildly reduced EF – HFmrEF, and 60.5% with preserved EF – HFpEF). Median follow-up was at 12 months (IQR 6–16). The incidence of AF recurrence did not differ between the group with and without HF (33.3% vs. 30.7%, p=0.67). There were no differences in AF recurrence rate between the different types of HF (30% AF recurrence rate in HFrEF, 31.8% in HFmrEF and 34.7% in HFpEF, p=0.75). The AF recurrence rate did not vary between patients with AF during echocardiography and those with sinus rhythm (p=0.24), so therefore a combined analysis of them was performed. The groups of HF patients with and without AF recurrence did not differ in terms of demographic data, comorbidities, or results of baseline laboratory tests. In a univariable Cox regression analysis only echocardiographic parameters (left atrial (LA) volume index, LA reservoir strain, LA emptying fraction - LAEF, E wave, e’average, E/e’ average ratio, LA appendage velocity) correlated significantly with AF recurrence in the group of patients with HF. In a multivariable Cox regression analysis, after exclusion of interdependent values, only LAEF (determined automatically using automated functional imaging of the LA) remained significant predictor of the AF recurrence (hazard ratio (HR) 0.962, 95% confidence interval (CI) 0.926-0.998, p=0.043). An LAEF threshold of 35% presented with 62% sensitivity and 85% specificity in predicting AF recurrence (with area under curve 0.733).

Conclusions

AF recurrence rate after ablation was similar in AF patients with and without diagnosed HF as well as in the different types of HF. LAEF was found to be the best predictor of AF recurrence in patients with AF and HF undergoing catheter ablation.
Left atrial strain as the predictor of subclinical atrial fibrillation using speckle-tracking echocardiography: a systematic review and meta-analysis
Authors: Jain H , Singh J , Jain J , Goyal A , Odat R M , Yadav A , Patel N , Passey S , Scott I , Ahmed R
Published: January 2025

Background

Subclinical atrial fibrillation (AF) is defined as an episode of clinically undetected AF that is associated with adverse cardiovascular outcomes. The pathophysiological mechanisms underlying subclinical AF are poorly understood. Estimates of clinical AF risk have previously been based on the left atrial (LA) structure, which can be assessed using echocardiography. Newer echocardiographic parameters, such as LA strain obtained using two-dimensional speckle-tracking echocardiography (STE), have shown promising results. However, the current data are limited, which prompted this study.

Purpose

This meta-analysis aimed to evaluate whether LA strain measured using STE can independently predict subclinical AF.

Methods

A comprehensive systematic literature search was conducted using PubMed/MEDLINE, Embase, and Cochrane Library from their inception until June 10, 2024. The search aimed to retrieve studies assessing LA strain using STE to predict subclinical AF. We pooled multivariate regression log-transformed hazard ratios (HR) with 95% confidence intervals (CIs) using the inverse variance random-effects model. A forest plot was generated to depict the effect estimates visually. Statistical significance was set at p<0.05.

Results

Thirteen studies with 12,388 participants were included in this meta-analysis. The pooled analysis demonstrated that LA strain was an independent predictor of subclinical AF after multivariate adjustments [pooled HR: 1.55; 95% CI: 1.33, 1.80; p<0.00001].

Conclusion

LA strain obtained by STE was an independent predictor of subclinical AF. Assessment of LA strain can aid in prognostication and risk stratification for future AF. Further large-scale prospective studies are required to validate the findings of this meta-analysis.

Figure 1
Effects of mavacamten on left atrial function in hypertrophic obstructive cardiomyopathy
Authors: Ozbay B , Venkatesan N , Wong T C , Sade L E
Published: January 2025

Background

Mavacamten, a cardiac myosin inhibitor, reduces actin–myosin cross-bridge formation in hypertrophic obstructive cardiomyopathy (HOCM). Mavacamten has been shown to reduce left ventricular (LV) systolic performance. However, scarce data exist about its impact on left atrial (LA) function.

Aim

This study aimed to investigate the effects of mavacamten on LA function.

Method

We consecutively reviewed 32 patients’ echocardiograms before and 2-12 months after mavacamten treatment. LA function was assessed by using speckle tracking echocardiography. Patients were monitored for atrial fibrillation (AF) development.

Results

Among 32 patients (mean age 60.5 ± 13.5 years, 11 female) maintenance mavacamten dose was 5 mg/day in 91%, 2.5 mg/day in 9% of the subjects. Mavacamten treatment reduced the LV outflow tract gradient from 71 (44-125) mmHg to 10 (7-24) mmHg (p<0.001). However, some impairment was observed in LV ejection fraction (LVEF) and global longitudinal strain (GLS) after Mavacamten treatment (LVEF; from 66±4% to 59±5%, p<0.001 and in GLS; from -14.3±3.2% to -12.5±2.9%, p=0.038). Also, LA reservoir strain (LASr) and LA contraction strain (LASct) reduced significantly (LASr, from 21.0±6.8% to 16.5±5.6%, p=0.012 and LASct; from 10.2±4.0% to 7.4±3.9%, p=0.011), whereas maximal LA volume index did not change (38.8±10.0 ml/m² vs 36.1±9.2 ml/m², p=0.360). During follow-up (median 8, range 2-21 months), 2 patients developed AF. In patient 1; LASct decreased from 10% to 6%, in patient 2; LASct decreased from 7% to 1% with mavacamten treatment.

Conclusion

Mavacamten appears to have a negative effect on LA function in patients with HOCM. Further studies are needed to investigate its impact on AF development.
Low myocardial work assessed by echocardiography is associated with prolonged ICU-Stay in CABG patients
Authors: Politz C , Hedwig F , Nymchena O , Stein J , Abd El Al A , Hagendorff A , Schoenrath F , Falk F , Knierim J , Merke N
Published: January 2025

Objectives

The aim of this study was to investigate whether echocardiographic assessment of myocardial work is a predictor of outcome in patients undergoing operative revascularization.

Background

Global work index (GWI) is calculated by means of speckle tracking, blood pressure measurement at the moment of strain analysis, and a normalized reference curve. The prognostic value of GWI in patients who are scheduled for bypass surgery is unknown.

Methods

In this retrospective analysis, 193 patients scheduled for a bypass operation were tracked using echocardiographic strain measurement and calculation of the Global Longitudinal Strain (GLS), the GWI and ejection fraction concerning outcome parameters. The primary endpoint was the occurrence of intrahospital major cardiac events (MACE). As secondary endpoints, prolonged ICU stay (more than 24 hours), requirement for catecholamines (more than 12 hours) and duration of mechanical ventilation (mora than 12 hours) were defined as well as all-cause mortality within a year. Both GWI, EF, and Strain were examined for their validity with respect to the primary and secondary endpoints.

Results

The mean patient age was 63.41 years (SD 8.67). The median left ventricular ejection fraction was 53.78 % [IQR 48.30, 57.46] and the median global longitudinal strain -14.73 % [IQR-17.20, -11.87]. The median GWI was 1428.00mmHg% [IQR 1074.00, 1725.00]. Regarding the primary endpoint, no statistically significant differences were found between patients with a GWI of over 1000 mmHg% and those with a GWI of under 1000 mmHg% (p=0.281), which can be attributed to the low number of MACE events (n=13). For the secondary endpoints, there was no significant difference in terms of the duration of mechanical ventilation between patients with a GWI of under or over 1000 mmHg% (p= 0.879). However, there was a significantly higher risk for a longer stay in the ICU (OR 3.44, 95%CI [1.54, 8.33], p=0.004) among patients with a GWI of under 1000 mmHg%, and furthermore, a higher requirement for catecholamines was observed (p= 0.007).

Conclusion

GWI is associated with prolonged ICU Stay above 24 hours and requirement for catecholamines, but not for mace or ventilation time.
Speckle tracking parameters in the two genders in chronic heart failure: a multicentric italian study
Authors: Mandoli G E , Martini L , Spaccaterra L , Pastore M C , Benfari G , Santoro C , De Giovanni A , Patti G , Giannoni A , Emdin M , Malagoli A , Lisi M , Cameli M
Published: January 2025

Introduction

the incidence of heart failure (HF) with reduced ejection fraction (EF, HFrEF) and with mildly reduced EF (HFmrEF) is globally lower worldwide and women are underrepresented in clinical trials. A deeper knowledge of possible gender differences in HF is needed to guarantee a better management.

Purpose

to evaluate left (LV) and right ventricular (RV) and left atrial (LA) longitudinal deformation by speckle tracking echocardiography (STE) in a population of patients with HF and ejection fraction (EF) <50%, to describe possible gender differences.

Methods

we retrospectively enrolled patients from 7 different Italian centers, referred to a high experience echocardiographic laboratory for stable chronic HF follow up. We excluded patients with preserved LV ejection fraction, recent admission for acute HF, previous cardiac surgery, and absent informed consent. All patients underwent complete standard and advanced echocardiography, including STE-derived LV, RV and LA strain. Kolmogorov-Smirnov test was used to verify normal distribution of variables. Continuous variables were compared using the unpaired t test for normally distributed variables and the nonparametric Mann-Whitney U test for non-normally distributed variables.

Results

a multicentric population of 644 patients (mean age 66.8±11.4, 237 female, 37%) was finally included in the study. The population had a globally reduced systolic function (mean LVEF 33.4±9.7%, mean LV global longitudinal strain (GLS) -9.7±3.5%) with abnormal RV longitudinal deformation (mean free wall RVLS -17.6±6.1%), increased pulmonary pressures (sPAP 35.1±12 mmHg) and diastolic disfunction (LA strain (PALS) was 16.3±8%, mean E/e’ ratio 12.2±3.6). Analyzing the female population with HF (see Table 1), women had lower LV and RV mass and diameters. The LA was smaller, but they had similar diastolic indices compared to man. Interestingly, deformation analysis revealed comparable LV, LA, and RV longitudinal strain in the two genders.

Conclusion

female HF population seems to have similar cardiac longitudinal dysfunction compared to men. It could be then credible to expect similar therapeutic response to HF drugs in the two genders. Further studies are needed to evaluate different echocardiographic prognostic parameters across gender in HFrEF and HFmrEF.
Association of left atrial strain with hypertension in pregnancy: a prospective observational study.
Authors: Alegre M , Bundalian I , Katimbang-Lazaro K
Published: January 2025

Introduction

Maternal hypertension, be it gestational or pre-existing, has been a health concern throughout the modern world. Although advances in healthcare have drastically improved the outcome of pregnancies in the past decade or so, the increasing age of expectant mothers, as well as the prevalence of hypertension in the general population and its associated complications, have dealt a different dilemma for current medical practitioners. Hypertension was documented as the 3rd third leading cause of maternal mortality in the Philippines. Studies also showed that Filipinos, when compared to their other Asian counterparts, have a higher incidence of maternal hypertension and its complications. Left atrial strain, a non-invasive, early marker of diastolic dysfunction, has been studied as predictor of chronicity of cases of gestational hypertension. As of writing of this paper, no local study using left atrial strain has been conducted on Filipino people, less so for pregnant women. Hence, further investigation to determine the baseline values and the effect of hypertension in left atrial strain in this population is warranted.

Objectives

This study aims to determine the relationship between left atrial strain using 2D echocardiogram and the presence of hypertension in pregnant Filipino women.

Methods

This was a single center, prospective, cross-sectional observational study involving pregnant patients seen at a tertiary hospital. The primary endpoint was the difference in left atrial strain and compliance between hypertensive and non-hypertensive subjects. For comparison, demographics and other systolic and diastolic echocardiographic parameters were evaluated. A sub-analysis between gestational and chronic hypertensive patients was also done.

Results

Twenty-six pregnant patients between 20 to 38 weeks age of gestation were divided into hypertensive (n=7) and normotensive (n=19) groups. Age (p=0.938), gestational age (p=0.909), and other co-morbidities were comparable between both groups. The left atrial reservoir strain (LASr) was significantly lower in hypertensive patients (32.15 ± 6.17%) compared to normotensive patients (43.85 ± 4.50%), indicating impaired left atrial function in hypertensive individuals (p<0.001). Left atrial compliance was also significantly lower in the hypertensive group (p=0.006), suggestive of elevated filling pressure. Comparison between gestational (n=2) and chronic hypertensive patients (n=5) yielded minimal difference in strain values.

Conclusion

Aside from the physiologic decrease in left atrial strain in pregnancy, the presence of hypertension further decreases left atrial function, specifically, the left atrial reservoir strain and compliance, despite normal standard echo parameters. Its implication on the future cardiac complication requires further investigation.

LA strain: Normotensive pregnant woman

LA strain: Hypertensive pregnant woman
Variation of left atrium strain after TAVI implantation
Authors: Santiago Setien I , Perez Barquin R , Ruisanchez Villar C , Veiga Fernandez G , Serrano Lozano D , Carreiro Da Cunha E , Coroas Pascual C , Cuesta Cosgaya J M , Lerena Saenz P , Llano Cardenal M F , Gil Ongay A , Zarauza Navarro M J , Garcia Camarero T , Sainz Laso F , De La Torre Hernandez J M
Published: January 2025

Introduction

Left atrium strain (LAS) is a marker of left atrium function, which has been shown to have diagnostic and prognostic value in various cardiovascular pathologies, serving as an indirect marker of left atrium fibrosis. On the other hand, the implantation of TAVI is currently a therapeutic alternative indicated in an increasingly broad cohort of patients with aortic stenosis (AS). Our objective was to analyze the variation in LAS values after TAVI implantation.

Methods

Patients with a diagnosis of severe symptomatic AS who received a TAVI (Edwards-Sapien) between October 2018 and February 2020 were included. Baseline echocardiographic studies conducted on the day of implantation, prior to the intervention, were analyzed and compared with examinations at a medium-term follow-up, established at six months. Variables of left atrium strain (LAS) in its three phases: reservoir, conduit, and contractile phases were detailed.

Results

A total of 129 patients (mean age 80.2 years, SD 9.02) were included, with 72 (55.8%) being women and the majority (76%) in functional class II. LAS could be analyzed in 99 cases. The baseline echocardiogram showed a global decrease in LAS values in its three phases compared to normal values (reservoir phase 20.4%, conduit phase -9.2%, contractile phase -10.9%). At follow-up, we observed a statistically significant improvement in LAS values in the reservoir phase (24.7%, SD±2.2; p 0.02) and in the contractile phase (-13.9%, SD 1.5; p 0.018). No significant differences were found in LAS values in the conduit phase (-10.4%, SD 0.9; p 0.21).

Conclusions

According to our data, the implantation of TAVI in patients with severe symptomatic AS is associated with a significant improvement in LAS values, both in the reservoir and contractile phases. Although the net improvement in values is modest, in relative terms the LAS value in the conduit phase improves by 23% compared to baseline and in the contractile phase by 27%. Additionally, it is noteworthy that in this cohort of elderly patients with established heart disease, the LAS (which is an indirect marker of fibrosis at the left atrium level) experiences a significant improvement after a relatively short follow-up (6 months). It would be of interest to analyze the variation of LAS over a longer term in the future and what clinical role it might play (development of atrial fibrillation, heart failure decompensation, etc.).
Is rotational mechanics the link between strain and ejection fraction in patients with ventricular hypertrophy?
Authors: Geraldo Martinez J , Galiana Talavera E , Gil Llopis C , Contreras Tornero M B , Hidalgo Mateos A , Gramage Sanchis P , Queipo Rodriguez A , Garcia Marin G , Rodriguez Gutierrez C , Gomon Dobrochynska T , Callizo Gallego R , Valls Serral A , Roldan Torres I , Mora Llabata V
Published: January 2025

Introduction

The reduction of global longitudinal strain (GLS) is an early marker of myocardial dysfunction. However, low GLS values do not provide information about the left ventricular ejection fraction (LVEF) because they can be decreased in patients with both reduced and preserved LVEF.

Purpose

To analyze the impact of rotational mechanics on the LVEF of patients with left ventricular hypertrophy and myocardial dysfunction.

Methods

We analyzed 248 patients with left ventricular hypertrophy, and divided them in two groups. Group 1 (n=104) with normal GLS (≥ 17%), and Group 2 (n=144) with decreased GLS (< 17%) due to myocardial dysfunction. We analyzed a) the rotational model ["twist" when the base and apex of the LV rotate in opposite directions, vs "rigid rotation" when the base and apex rotate in the same direction], and b) the rotational gradient (in degrees), as a result, in the case of twist, of the sum of basal and apical rotations (coded positive), and in the case of rigid rotation as a result of the difference between basal and apical rotations (coded negative).

Results

The 104 patients (Group 1) with normal GLS (≥ 17%), and therefore LVEF ≥ 50%, presented twist as the rotational model. Among the 144 pts (Group 2) with myocardial dysfunction (GLS < 17%), LVEF was < 50% in 34.7%. Twist was present in 83.3% of cases, and the remaining 16.7% exhibited rigid rotation. In this Group 2 of patients with myocardial dysfunction, the rotational gradient showed a good correlation with LVEF (r = 0.73; p < 0.001), such that in patients with twist, the values of the rotational gradient were progressively lower as LVEF decreased, until adopting negative values (pattern of rigid rotation) in those with more severe depression of LVEF as shown in Figure 2.

Conclusion

In patients with LVH and GLS impairment, the reduction of the rotational gradient translates into a deterioration of LVEF, providing additional information in the stratification of patients with myocardial dysfunction.

Figure 1

Figure 2
Effects of SGLT2i on right ventricule function in HFpEF: an echocardiographic study
Authors: Novo G , Guerra F , Benfari G , Pastore M C , Giannone A , Mazzeo P , Santoro C , Citro R , Inciardi R , Correale M , Carluccio E , Degiovanni A , Lisi M , Pasquini A , Cameli M C
Published: January 2025

Background

several studies have demonstrated the cardioprotective effects of Sodium-glucose co-transporter 2 inhibitors (SGLT-2i) in patients with heart failure (HF), irrespective of the presence of diabetes. These findings have culminated in new recommendations for SGLT2i in the treatment of HF, either with reduced or preserved ejection fraction (EF).

Purpose

the purpose of this study was to analyze the effect of Gliflozin on right ventricular function, in patients with HFpEF, using speckle tracking echocardiography and new echocardiographic surrogates of right ventricular-pulmonary artery (RV-PA) coupling.

Methods

we enrolled 105 symptomatic HF patients (aged 71,143 ± 9,913 years) with EF > 40% (47,9 ± 7,26) into a multicentric prospective observational study; main anamnestic information, NT-proBNP values and complete echocardiographic data were collected in an ambulatory setting, at time of enrolment and after 6 months of therapy with SGLT-2i.

The echocardiographic analysis included conventional, tissue-derived imaging, and myocardial deformation speckle tracking echocardiography of left and right sections. TAPSE/PASP (tricuspid annular plane systolic excursion/pulmonary artery systolic pressure) and RVFWLS/PASP (Right ventricle free wall longitudinal strain) were also collected as surrogates of RV-PA coupling such as

Results

after 6 months of SGLT-2i therapy echocardiographic evaluation revealed improvement of LVEF (47,909 ± 7,260; 49,562 ± 8,784; p value 0.003) LVGLS (-13,312 ± 3,555; -14,894 ± 3,970; p value < 0.001), RVFWLS (-18,324 ± 6,430; -20,705 ± 6,469; p value 0.002). Echocardiographic parameters of diastolic function such as E/E’m (11,270 ± 6,282; 9,782 ± 6,622; p value 0.003) and PASP (36,580 ± 14,879; 31,757 ± 10,740; p value 0.036) were also ameliorated. Both TAPSE/PASP (0,567 ± 0,267; 0,762±0,536; p value 0.036) and RV FWLS/PASP (-0,588 ± 0,299; -0,785 ± 0,663 p value 0.003) showed higher values.

Conclusions

our study has demonstrated a significant impact of SGLT-2i on echocardiographic parameters of LV diastolic function and on both left and right ventricle systolic function in patients with HFpEF in a 6 months follow up. Moreover, our findings of RV-PA coupling echocardiographic surrogates improvement, after SGLT-2I use, could underscore the potential of SGLT-2i in managing RV dysfunction in HFpEF.
Right atrial remodelling in middle- aged patients with atrial fibrillation and without overt heart disease
Authors: Borizanova-Petkova A , Kinova E , Goudev A
Published: January 2025

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia, where the focus of echocardiographic evaluation is the left atrium (LA), as a substrate for the arrhythmia(1). But AF is not only a disease of the LA, it also affects the right atrium (RA) (2). Available data on structural changes of RA in AF are scarce, and even more in relatively young patients without overt heart disease.

Aim

To assess RA structure and function with volumetric and speckle-tracking analysis in middle-aged symptomatic AF patients without overt heart disease , where conventional 2D echocardiography (2DE) demonstrated structurally normal hearts.

Methods

Prospective consecutive patients with AF (n=936), who had been admitted for sinus rhythm restoriation in our hospital for the period January 2016- December 2018, were screened for participation in the study. A total of 70 patients met the inclusion criteria- stable sinus rhythm, age between 40-60 years, without overt heart disease. They were separated in two groups:with new onset AF(n=33) and reccurent episode of AF(n=37); 30 healthy subjects were enrolled in the control group. All patients underwent 2DE assessment of RA structure and function with volumetric and speckle tracking analyses.

Results

There were significant differences between all groups in RA volumes- table 1. Furthermore, patients with AF had reduced reservoir strain and increased RA stiffness index in comparison to healthy controls. There were no differences between groups in emptying fractions, as well as in expansion index of RA.

Conclusion

In middle- aged AF patients without overt heart disease early structural and functional changes in RA were found. These findings supports the concept of bi-atrial remodelling in AF, where subclinical atrial disease progress to clinical one with first manifestation- AF (3,4)
Distinguishing athletic heart adaptations from cardiomyopathy using myocardial work: new kid on the block
Authors: Baptista Carvalho A , Mendes L
Published: January 2025

Background

Studying the athlete's heart is challenging due to the overlap between physiological adaptations from exercise and cardiomyopathies. Initially, deformation analysis was promising for differentiation, but it became clear that larger ventricular volumes in athletes result in low strain due to chamber geometry. Recently, a non-invasive myocardial work study tool has emerged, integrating load and deformation.

Aim

to determine the additional value of the Myocardial Work (MW) indices determined by echocardiography in the study of the athlete's heart.

Methods

A retrospective analysis of echocardiographic parameters was carried out, measuring myocardial work non-invasively among a group of male athletes (football players - class IC of Mitchell classification), compared with a control group composed of healthy young men. A GE Vivid E95 echocardiographic ultrasound system and EchoPAC V.206 software (GE Vingmed Ultrasound AS, Horten, Norway) were used.

Results

The athletes' group consisted of 121 males with a median age of 24 years (range 21-31), while the control group included 77 healthy individuals with a median age of 26 years (range 23-31). Refer to Table 1 for the descriptive analysis. Compared to the control group, the athletes had significantly lower blood pressure (p = 0.001), larger left ventricular volumes (p < 0.001), and higher left ventricular ejection fractions (p <0.001). Although there was a trend toward lower GLS in the athletes' group, it was not statistically significant (p = 0.203). GWI, GCW, and GWE were similar between the two groups, with GCW being significantly higher in the athletes (p = 0.01).

Conclusion

In our study, myocardial work indices in athletes were comparable to those in healthy individuals. Myocardial work is an intuitive and comprehensive variable that shows promise as a tool to differentiate between normal physiological adaptations to exercise and pathology in athletes.

Descriptive analysis

MW example
Left atrial strain is impaired in pediatric patients with mitral annular disjunction
Authors: Norton D M , Iturralde-Chavez A , Pignatelli R H , Doan T T
Published: January 2025

Background

Mitral annular disjunction (MAD) is characterized by separation of the posterior mitral valve (MV) annulus and left ventricular (LV) myocardium. MAD is reported to have a strong association with ventricular tachyarrhythmia and sudden cardiac arrest (SCA) though the mechanism is not well understood.

Purpose

We aimed to study left atrial strain (LAS) in pediatric patients with MAD, compared with healthy controls. We hypothesized that patients with MAD will demonstrate decreased LAS compared to controls, suggestive of impaired ventricular diastolic function.

Methods

We included consecutive patients <21 years old diagnosed with MAD from January to December 2023 at a tertiary pediatric care center, excluding patients with Marfan or Loeys-Dietz syndrome. All available echocardiographic images were reviewed to determine the earliest presence of MAD, defined as a distance between the LV myocardial crest and posterior MV hinge point at end-systole in the parasternal long axis view ≥2 mm. Demographic and clinical data were collected via retrospective chart review. Patients with MAD were matched by age and sex with healthy controls. We compared LV ejection fraction (EF), degree of mitral regurgitation (MR), biplane LA volume and LAS (reservoir, conduit, and contraction) between groups. Mann-Whitney U and Chi-Square tests were used to compare continuous and nominal variables between groups, respectively.

Results

We included 26 patients with MAD (81% female) diagnosed at a median age of 13.8 years (Q1-Q3: 10.5-17.1). During a median time of 3.8 years (Q1-Q3: 1.1-11.5), 19% (n=5) patients were diagnosed with SCA due to ventricular tachyarrhythmia and an additional 15% (n=4) patients had ventricular tachyarrhythmia without SCA. Patients with MAD more frequently had MR graded mild or greater (p < 0.001) than controls. LAS was significantly decreased in all phases of the cardiac cycle in patients with MAD, including conduit (-28.4% v -37.7% p = 0.003), contraction (-8.1% v -13.8%, p = 0.004) and reservoir (37.0% v 51.9%, p = < 0.001). Mean MAD distance was higher (5.24 v 3.66 mm, p = 0.004) and LVEF was lower (56% v 62%, p=0.032) in patients with MAD and SCA compared to those without SCA. There was a trend toward impaired LAS-contraction (-4.8% v –10.9%, p = 0.091) for patients with MAD and SCA, but this did not reach significance.

Conclusions

All phases of LAS are impaired in pediatric patients with MAD compared to age- and sex-matched controls, suggesting an underlying diastolic impairment. Patients with MAD and SCA had lower LVEF, greater MAD distance, and a trend of lower LAS-contraction. Future studies are needed to better understand the true prevalence of MAD in the pediatric population, its natural history, and its association with arrhythmia and other cardiovascular outcomes.
Mechanical dispersion as a marker of the risk of ventricular arrhythmias in patients who have suffered a left ventricular myocardial infarction
Authors: Doniyorov S H , Bekmetova F M , Ilkhomova L T , Bekmetova S I , Abdullayeva S Y , Valiyeva B S H , Tursunova N B , Usmonova N A , Khotamova M N , Karimov B S
Published: January 2025

Introduction

Purpose. To study the relationship between the indices of mechanical dispersion (MD) of the left ventricle and ventricular arrhythmias (VA) by classification Lown and Wolf in patients who have suffered a left ventricular myocardial infarction

Methods

The study included 80 patients with chronic CAD aged between 38 and 84 years. All patients underwent the following examinations: physical examination, general clinical and laboratory blood tests, 12-lead ECG, 24-hour holter monitoring; standart transthoracic echocardiography, assessment of left ventricular systolic function, speckle-tracking echocardiography with assessment of global longitudinal strain (GLS) and mechanical dispersion (MD) using the auto CMQ program on the Phillips Affinity 70 ultrasound machine. All patients divided into 5 groups: Group I - 22 patients without VA; Group II – 15 patients without ventricular arrhythmias.

Conclusion

The study shows that mechanical dispersion of the left ventricle is a marker of the risk of ventricular arrhythmias in patients who have suffered acute myocardial infarction of the left ventricle and the higher the gradation of arrhythmias, the longer the duration of MD
Enhancing myocardial function assessment in hypertension patients through the integration of exercise stress echocardiography and pressure-strain loop technique.
Authors: Zhang Q , Wang Y I , Yin L I X U E
Published: January 2025

Objective

This study aims to investigate the characteristics of myocardial work(MW) and reserve function in left ventricular remodeling hypertension (LVRH) patients through exercise stress echocardiography (ESE) and pressure-strain loop (PSL) technique,and further to investigate the associations of MW parameters with the exercise capacity in this observational study.

Methods

One hundred and five hypertensive patients with left ventricular remodeling{Left ventricular mass index (LVMI) ≥115 g/m2 (male) and LVMI ≥95 g/m2 (female)} underwent ESE examination according to established guidelines, the test was terminated at 85% of the target heart rate. Additionally, 59 healthy subjects were included as a control group. Speckle tracking software was utilized for analysis, the myocardial work parameters were calculated by combining the longitudinal strain with the noninvasive left ventricular pressure curve.Exercise capacity and reserve function,global and segment work index were evaluated and analysed.

Results

Global work index (GWI) , global constructive work (GCW) and global wasted work (GWW) were significantly increased both at rest and peak in LVRH group, while global work efficincy(GWE) were decreased. The GWI from basal to apiex both at rest and peak showed increasing trend in the order of the control group. GWI-rest showed prominent relation with exercise metabolic equivalent(METs)(r=-0.502,p＜0.001),E/e-peak ( (r=0.612,p＜0.001), ΔGobal longitudinal strain (GLS) (r=0.421,p＜0.001).Further GWI-rest and ΔGWI as well as E/e-peak add increased predictive utility of exercise capacity, superior to the change in GLS .The myocardial work reserve function can be available for predicting patients with LVRH{ΔGWI，AUC: 0.869 (95%CI,0.815−0.924), providing incremental value for LVRH diagnostic performance.

Conclusion

MW parameters can reflect the contractile force under hemodynamic overload,provide a more comprehensive and compelling perspective for evaluating cardiac function. GWI is an important predictor of systolic and diastolic function and a variable closely related to exercise endurance in patients with LVRH.

comparison rest and peak parameters

ROC for identify LVH patients
Assessment of blood pressure response to physical activity: influence on the results of five-step stress echocardiography
Authors: Safarova N , Safarova A , Timofeeva T , Kobalava Z H
Published: January 2025

Introduction

Due to the high prevalence of hypertensive blood pressure response to exercise (HER) during stress echocardiography (SE), the unclear prognostic significance, and the possible impact on SE results, it seems appropriate to analyze the prevalence of HER in outpatients and inpatients. Additionally, it is essential to identify the influence of HER on the results of the modern SE protocol.

Aim

To evaluate the incidence of HER during SE with physical activity on a treadmill or horizontal bicycle ergometer in patients and the impact of HER on the results of five-step SE.

Materials and methods

This single-center study included 193 patients who underwent five-step SE according to clinical indications. The steps in the protocol are as follows: Step A: Evaluates local contractility abnormalities; Step B: Assesses B-lines/diastolic function; Step C: Measures the contractile reserve of the left ventricle; Step D: Assesses the reserve coronary blood flow velocity in the anterior interventricular branch; Step E: Evaluates heart rate reserve. The blood pressure (BP) response to exercise was assessed as hypertensive with a systolic blood pressure (SBP) ≥190 mm Hg on the treadmill and 200 mm Hg on a bicycle ergometer in women, and ≥210 mm Hg and 220 mm Hg, respectively, in men. Alternatively, HER was defined as an increase in SBP ≥180 mm Hg from the second stage of the test or when SBP rises relative to the baseline by ≥60 mm Hg in men and ≥50 mm Hg in women. The incidence of HER during the SE study and the relationship of HER with positive outcomes of the study protocol steps were examined.

Results

The prevalence of HER in patients undergoing SE was 36.3% (70 patients). Patients with HER were significantly more likely to have low exercise tolerance (p=0.013). Blood flow velocity in the coronary artery, both at rest and under load, and the amount of contractile reserve were significantly higher in patients with HER (p=0.009, p=0.008, and p=0.002, respectively). There was a trend towards a greater value of relative LV wall thickness in patients with HER (p=0.070). Among patients with HER, a decrease in contractile reserve was less common than among patients with an adequate blood pressure response: 45 (64.3%) versus 99 (80.5%) (p=0.013).

Conclusion

An excessive increase in blood pressure may be a limiting factor, leading to premature termination of testing. Patients with HER are significantly more likely to have poorer exercise tolerance and require more careful monitoring and control of risk factors. There is a relationship between the response of blood pressure to exercise and the results of SE, particularly the effect of peak blood pressure on contractile reserve. The relationship between BP response to exercise and SE steps, as well as its prognostic significance, requires further study.
Additive value of simultaneous exercise echocardiography to cardiopulmonary exercise testing in unexplained dyspnea
Authors: Verelst F , De Schutter S , Nasser R , Hens W , De Bliek E , Van De Heyning C , Van Craenenbroeck E , Meems L G M , Gevaert A B
Published: January 2025

Background/Introduction

Exertional dyspnea is a nonspecific symptom and frequently serves as the initial sign of numerous cardiac and non-cardiac illnesses. Cardiopulmonary exercise testing (CPET) is often used in the workup of dyspnea, but specific markers for cardiac and peripheral causes of dyspnea are lacking. Combining CPET with exercise echocardiography (CPETecho) can non-invasively identify all pathophysiological mechanisms limiting exercise capacity, including cardiac, pulmonary, and peripheral disorders.

Purpose

To evaluate the use of CPETecho in patients with unexplained exertional dyspnea compared to CPET alone.

Methods

In this retrospective observational study, we evaluated patients with unexplained dyspnea (normal resting echocardiography and normal lung function) who underwent CPETecho at two university hospitals between July 2021 and November 2023. CPETecho was conducted on a semi-supine bicycle ergometer. At rest, submaximal exercise (heart rate ±100 bpm) and peak exercise echocardiography was performed. Respiratory gases, heart rate, and electrocardiogram were recorded continuously. We evaluated limitations to exercise according to cutoffs in published literature and compared them to diagnoses obtained via CPET alone, with exercise echo values being blinded. CPET reports were interpreted by 3 independent reviewers with expertise in cardiac rehabilitation and consensus was obtained.

Results

We enrolled 123 patients (63% women, mean age 67 ± 12 years). CPETecho identified a cause for dyspnea in 101 patients (81%), compared to 87 patients (71%) with CPET alone. However, only 36 patients (29%) had a ‘certain and complete’ diagnosis using CPET alone. CPET alone missed a diagnosis in 48% of patients, most commonly missing heart failure with preserved ejection fraction (HFpEF 27%), exercise pulmonary hypertension (20%) and LV or RV systolic dysfunction (20 and 20% respectively). Twenty eight patients were deemed to have a normal test by CPET, however CPETecho identified a cause for dyspnea in 89% of these patients, mainly cardiac disorders.

Conclusion

In summary, our study emphasizes the value of CPETecho in assessing patients with exertional dyspnea. CPETecho offers superior diagnostic accuracy compared to CPET alone, specifically aiding in the identification of cardiac disorders.