bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating the influence of physical activity composition on arterial stiffness in youth
Authors: Marshall Zoë A. , Mackintosh Kelly A. , McNarry Melitta A.
Published: February 2022

Physical activity is beneficial for arterial health in children but less is known about how all daily movement behaviours influence arterial stiffening. Compositional analysis can account for the co‐dependent nature of these behaviours and therefore was employed to explore how the movement composition influences arterial health. Augmentation index (AIx) and pulse wave velocity were measured cross‐sectionally in healthy children (n = 129; 12.4 ± 1.6 years). Time spent in sedentary, light physical activity (LPA), moderate‐to‐vigorous physical activity (MVPA) and asleep were derived from seven‐day hip‐worn accelerometry. The relative effects of individual behaviours and the overall movement composition on arterial stiffness were explored utilising compositional analysis, with predictive modelling used to predict effects of the substituting time between behaviours. Girls (n = 45, 12.1 ± 1.5yrs, 20.5 ± 3.6kg·m−2) had a higher AIx (+ 3.94; p < 0.05) and accrued physical activity predominantly in LPA, whereas boys (n = 56, 12.6 ± 1.7yrs, 20.6 ± 4.0kg·m‐2) accrued physical activity predominantly in MVPA. Individual behaviours and the movement composition were not significant predictors of any measure of arterial stiffness (P > 0.05), and the reallocation of 20‐minutes between behaviours did not elicit significant change in arterial stiffness, irrespective of sex (P > 0.05). The reallocation of time to MVPA from any other behaviour did not predict an improvement in arterial stiffness. This highlights the high potential dose of MVPA required to improve arterial health and the complex nature of the determinants of arterial stiffness.

Highlights

Movement behaviours in isolation nor combination predicted arterial stiffness in youth.

The reallocation of behaviours from any other behaviour to MVPA did not affect arterial stiffness in youth.

Arterial stiffness is a complex, multidimensional health parameter that does not appear to be primarily determined by physical activity levels or intensity.
An algorithm for identifying eigenvectors exhibiting strong spatial localization
Authors: Ovall Jeffrey , Reid Robyn
Published: February 2022

We introduce an approach for exploring eigenvector localization phenomena for a class of (unbounded) selfadjoint operators. More specifically, given a target region and a tolerance, the algorithm identifies candidate eigenpairs for which the eigenvector is expected to be localized in the target region to within that tolerance. Theoretical results, together with detailed numerical illustrations of them, are provided that support our algorithm. A partial realization of the algorithm is described and tested, providing a proof of concept for the approach.
Criticism’s Contexts
Authors: Kindley Evan
Published: February 2022

Professional book reviewing in the US dates to the “golden age of periodicals” in the mid-nineteenth century, but it has recently been in decline, along with the newspaper and magazine publishing industry in general. This has transformed the microdynamics of critical culture in the US, altering relationships between professional book critics, freelance reviewers, amateur consumer-reviewers online, and academic experts. In a review of two books, the author argues that the work of criticism involves not only distinctions about works of art and the forms they take, but distinctions about other forms of criticism as well.

The work of criticism involves not only distinctions about works of art and the forms they take but distinctions about other forms of criticism as well. One way or another, critics are always marking the boundaries.
Are chromosome number and genome size associated with habit and environmental niche variables? Insights from the Neotropical orchids
Authors: Moraes Ana Paula , Engel Thaissa Brogliato Junqueira , Forni-Martins Eliana R , de Barros Fábio , Felix Leonardo P , Cabral Juliano Sarmento
Published: February 2022

Background and Aims

The entangled relationship of chromosome number and genome size with species distribution has been the subject of study for almost a century, but remains an open question due to previous ecological and phylogenetic knowledge constraints. To better address this subject, we used the clade Maxillariinae, a widely distributed and karyotypically known orchid group, as a model system to infer such relationships in a robust methodological framework.

Methods

Based on the literature and new data, we gathered the chromosome number and genome size for 93 and 64 species, respectively. We built a phylogenetic hypothesis and assessed the best macroevolutionary model for both genomic traits. Additionally, we collected together ecological data (preferences for bioclimatic variables, elevation and habit) used as explanatory variables in multivariate phylogenetic models explaining genomic traits. Finally, the impact of polyploidy was estimated by running the analyses with and without polyploids in the sample.

Key Results

The association between genomic and ecological data varied depending on whether polyploids were considered or not. Without polyploids, chromosome number failed to present consistent associations with ecological variables. With polyploids, there was a tendency to waive epiphytism and colonize new habitats outside humid forests. The genome size showed association with ecological variables: without polyploids, genome increase was associated with flexible habits, with higher elevation and with drier summers; with polyploids, genome size increase was associated with colonizing drier environments.

Conclusions

The chromosome number and genome size variations, essential but neglected traits in the ecological niche, are shaped in the Maxillariinae by both neutral and adaptive evolution. Both genomic traits are partially correlated to bioclimatic variables and elevation, even when controlling for phylogenetic constraints. While polyploidy was associated with shifts in the environmental niche, the genome size emerges as a central trait in orchid evolution by the association between small genome size and epiphytism, a key innovation to Neotropical orchid diversification.
Safety and Effectiveness of Single Session Mega Volume Fat Grafting for Breast Augmentation: A Space-Creating Concept and Clinical Experiences
Authors: Hsiao Cheng-Wei , Zavala Abraham , Shiau Jun-Ping , Hsiao Kae-Yi , Hsiao Ya-Wen , Hsieh Hsi-Yen
Published: February 2022

Background

The main drawback of fat transfer breast augmentation is the need for multiple sessions of fat injection. For approximately 15 years, stem cells and the Brava device for breast expansion have been discussed and extensively investigated to address relevant challenges. However, the safety and effectiveness of autologous fat transfer as a single-session primary breast augmentation technique has not yet been standardized.

Objectives

The aim of this study was to achieve mega volume fat breast augmentation in a single session by developing a “space-creating” approach that emphasizes the use of highly purified fat to achieve an optimized surgical outcome with large-volume breast augmentation.

Methods

Female patients who underwent aesthetic breast augmentation (October 2013-October 2020) involving the application of this space-creating technique for mega volume autologous fat transfer were retrospectively enrolled. Inclusion criteria were patients with hypomastia, breast asymmetry, and volume replacement following implant removal with BMI ≥18.5 kg/m2. After macrospace creation, highly purified fat was injected in several rounds during the procedure. A breast massage was performed between each stage (microspace creation). Breast circumference, nipple–inframammary fold distance, and cup size were recorded during 6 months of follow-up.

Results

Three hundred fifty-eight patients met the inclusion criteria. Average fat injection volumes of 510.9 mL in the right breast and 490.8 mL in the left breast resulted in at least a 2 cup size increase. The significant outcome remained stable at 6 months after surgery.

Conclusions

The space-creating technique and the injection of highly purified fat achieves stable cosmetic outcomes of mega volume breast augmentation in a single session.

Level of Evidence: 4
Validation of a deep learning algorithm identifying diagnostic quality cardiac ultrasound reference views during search phase
Authors: Moal O , Roger E , Reant P , Dezellus A , Tavernier M , Moal B , Lafitte S
Published: February 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): DESKi

Background

Transthoracic echocardiography requires long and demanding training. The use of deep learning algorithms for the identification of diagnostic quality reference views opens the way for assisting low-experienced operators.

However, such algorithms have only been trained and validated on retrospective data extracted from daily hospital practice. Those retrospective data are the best clips selected by experts during each exam. Thus, the performance of those algorithms has not been evaluated on complete acquisitions, including the search phase, i.e. when the operator is moving the probe to reach the optimal position. Those search phases are not recorded in clinical practice.

Purpose

The objective of this study was to evaluate the performance of a deep learning algorithm that identifies diagnostic quality images for 7 echocardiographic reference views on a prospective dataset including search phases.

Methods

A retrospective dataset containing acquisitions extracted from daily hospital practice was created. The retrospective dataset was manually annotated by experts following quality criteria that were defined for 7 main reference views: parasternal long and short axis, apical 4, 2, and 3-chamber, subcostal 4-chamber and inferior vena cava. Each frame of the acquisitions was annotated by an expert and reviewed by a second expert. A deep learning model was trained on the retrospective dataset and evaluated with 5-fold cross-validation.

In a prospective dataset, for each included patient and each reference view, operators recorded the entire acquisition, including the search phase. Acquisitions were manually annotated by 2 experts following the same quality criteria. The model trained on retrospective data was evaluated on this prospective dataset against manual experts’ annotations. Additionally, 3 experts annotated a subset of the prospective dataset to evaluate the inter-observer variability.

Results

481,111 frames from 1,325 patients were annotated for the retrospective dataset. On the 5-fold cross-validation, the algorithm reached an average accuracy of 89.2 ± 0.7% per frame and an average F1-score of 87.9 ± 0.9% per frame.

For the prospective dataset, 70 patients were included and 143,804 frames annotated. The average accuracy was 84.8 ± 5.0% per patient, and the average F1-score was 83.1 ± 8.7% per patient. The average inter-observer agreement rates, performed on 10 patients (23,390 frames), were between 82.8 ± 4.9% and 86.3 ± 6.2%.

Conclusions

We propose a deep learning algorithm that automatically identifies 7 of the most common reference views with diagnostic quality while achieving performance within the range of the inter-observer variability in acquisitions including search phases.
Explainable deep neural network for echocardiography view classification
Authors: Huang M , Lin WC , Chen YD , Hsiao TA , Liu PY , Tsai WC
Published: February 2022

Funding Acknowledgements

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

Background

Deep neural network may assist echocardiography interpretation in several tasks; however, the lack of expandability hindered its broader application since physicians couldn’t realize the rationale of interpretation clearly and comfortably.

Method

Retrospectively, we manually annotated 26,465 transthoracic echocardiography images into 29 classes for model development in 4:1 ratio as training and validation datasets. We added an autoencoder component into our model, adapted from capsule net, for view-classifying to deconvolute the feature maps of last layer as decoder for human interpretation. The performance of view classification was measured in accuracy and confusion matrix, and the interpretability of model were assessed by cardiologist.

Result

After appropriate model training, the accuracy of our model achieved averaged 98.2% for echocardiography view classification, ranged from lowest 80.0% in suprasternal view to 100% of several more common view in validation dataset. The successful deconvolution of feature map to reconstruct images showed essential independent components of echocardiography view and could be interpretated by cardiologist and clinical physicians.

Conclusion

With the use of autoencoder in model for echocardiography view classification showed maintainable good performance in accuracy and facilitated clinical interpretation to enhance its reliability. Abstract Figure. Model architecture and performance  Abstract Figure. Example of explaniable deconvolution
Left atrial appendage structure predicts thromboembolic risk in 185 patients with crytogenic stroke/TIA without history of AF
Authors: Saberniak J , Skrebelyte-Strom L , Orstad EB , Solberg MG , Hilde JM , Ronning OM , Kjekshus H , Steine K
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Akerhus University Hospital Dept. of Cardiology

Background

Cryptogenic stroke/TIA (CS) is supposed to be associated with intracardiac thrombus formation and left atrial (LA) structure, in particular thrombus formation in left atrial appendage (LAA). However, there is little evidence if thromboembolic risk is associated with LAA morphology in patients with CS.

Purpose

We aimed to investigate, if different LAA morphology types may predict thromboembolic risk in patients with CS.

Methods

In this prospective study (mean follow-up 859 ± 226 days), 185 patients with CS (mean age 68 ±13 years, 33% female) without history of AF were included. All patients underwent complete transesophageal echocardiography in sinus rhythm after index CS (mean 5 ± 3days). Occurrence of LAA thrombus, sludge or spontaneous echo contrast (SEC) were defined as thromboembolic risk and LAA structure was evaluated by 2D and 3D transesophageal echocardiography. Multilobate LAA was defined as LAA with  > 1 lobes.

Results

Of the 185 included patients, LAA type chicken wing was found in 79 (43%), type windsock in 64 (35%), type cactus in 35 (19%) and type cauliflower in 7 (4%). Thrombus formation occurred in 29/185 (16%), LAA sludge in 112/185 (61%), and LAA SEC in 74/185 (40%), which is increased compared to data in the general population. We found SEC in sludge in 65/112 (58%), SEC in thrombus in 18/29 (62%) and sludge in thrombus in 27/29 (93%). SEC and sludge were significantly associated with thrombus formation, (p < 0.001 and p < 0.01, respectively). Finally, thromboembolic risk occurred in 123 (67%) of all patients with CS. Moreover, LAA type chicken wing was significantly associated with thromboembolic risk (p < 0.01), while all other LAA types were not. Multilobate LAA occurred in 115 (62%) of all patients and predicted thromboembolic risk vs. non-lobated LAA (p= 0.04). In a multivariate analysis LAA type chicken wing and multilobate LAA were independently predictors of thromboembolic risk, figure 1.

Conclusions

Patients with cryptogenic stroke/TIA without history of AF showed increased thromboembolic risk, and SEC and sludge were significantly associated with LAA thrombus formation. Only LAA type chicken wing and multilobate LAA predicted independently thromboembolic risk in this study. Abstract Figure.
Association of 24-hour ambulatory central aortic pressure and left atrium-ventriculo-arterial interactions
Authors: Georgieva N , Kinova E , Krustev B , Borizanova A , Ilieva R , Goudev A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

INTRODUCTION

Arterial stiffness is an independent risk factor in arterial hypertension, but little is known about the association between  left –heart side remodeling and arterial stiffness in middle – aged hypertensive patients.

AIM

The aim of our study was to assess the independence between the parameters of arterial stiffness and their relation with left atrium – ventriculo – arterial coupling in hypertensive patients, without any target-organ damage (TOD).

METHODS

A total 110 patients (56 ± 14 years) with hypertension, were separated in two groups: 32 patients with normal EA/Ees ratio (Arterial elastance (AE) and ventricular elastance (Ees)) and 78 hypertensive patients with decrease EA/Ees ratio, marker for ventriculo – arterial coupling. All patients underwent standard two - dimentional echocardiography with Speckle tracking analysis for LA – reservoir (LARs), conduit (LAScd) and contractile (LASct) and LV global longitudinal strain ( LV - GLS). End – systolic pressure was determined from the brachial pulse wave. Arterial elastance (AE) and ventricular elastance (Ees) were calculated as and – systolic pressure/stroke volume and end – systolic pressure/end – systolic volume. Parameters for arterial stiffness – 24 - hour central systolic pressure (cSys24h), central pulse pressure (cPP24h) and 24 - hour pulse wave velocity (PWV24h) were measured non – invasively with oscillometric method by Mobil-O-graph PWA.

RESULTS

Statistically significant differences in parameters of vascular stiffness were found in patients with normal ventriculo – arterial coupling in comparison with disturbed EA/Ees: cSys24h (106.78 ± 9.33 vs. 114.59 ± 16.1 mm Hg, p = 0.02), cPP24h (39.89 ± 11.78 vs. 48.56 ± 10.21 mm Hg, p= 0.04). There were statistically significant differences in echocardiography parameters between patients with disturbed VAC in comparison to other group: LAScd (16.66 ± 1.67 vs. 19.57 ± 1.34 %, p< 0.001), LASr (31.76 ± 5.14 vs. 30.56 ± 3.28 %, p= 0.007) and LAVI (30.15 ± 9.20 vs. 36.78 ± 8.80 ml/m², p= 0.007). There was positive correlation between LAScd with EA/Ees (r = -0.285, p< 0.008) and negative E/Em (r = -0.278, p< 0.01). LAVI correlated moderate positively with E/Em ratio (r = 0.416, p< 0.0001) and negatively with LAScd (r = - 0.418, p < 0.0001). cSys24h correlated negatively with LV – GLS (r = - 0.218, p < 0.03) and with EA/Ees (r = - 0.253, p = 0.013).

CONCLUSION

In well-controlled hypertension, 24 - hour ambulatory central aortic pressure played a part in LV remodeling. High LV filling pressures determined LA remodeling and dysfunction in middle–aged patients. These results could be used for a new direction of central aortic pressure-guided therapy.
Speckle tracking analysis of left ventricular function in patients with type 1 diabetes mellitus and kidney failure
Authors: Lehner LJ , Haag K , Zhang K
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Speckle tracking echocardiography (STE) is an excellent tool to detect early myocardial dysfunction when conventional parameters such as left ventricular ejection fraction are still unaltered. Reduced left ventricular strain has been described in patients with chronic kidney disease as well as in patients with diabetes mellitus. However, diabetes mellitus as a systemic microvascular disease can affect renal and cardiac function, potentially leading to kidney failure and diabetic cardiomyopathy.

Purpose

Aim of this study was to assess left ventricular function by speckle tracking analysis to delineate cardiac function in patients with diabetes mellitus type 1 and kidney failure (DM1 + KF) from patients with kidney failure without diabetes mellitus (KF).

Methods

We conducted a retrospective study and included 16 patients with DM1 + KF who were listed for a simultaneous pancreas-kidney-transplantation and received an echocardiogram between 2013 to 2016 in our clinic. They were compared to a sex- and age-matched group of kidney failure patients without diabetes mellitus (n= 20) and a healthy control group (n= 48).

Results

Subjects in all groups were young in age and had normal BMI. In the DM1 + KF group, 62.5% of patients were on dialysis as compared to 95% of patients in the KF group. As to be expected, only patients in the DM1 + KF group had elevated HbA1c plasma levels (Table 1).

Left ventricular ejection fraction was not significantly different between all three groups. Hypertrophy was present in the DM1 + KF group and even more in the KF group, as indicated by left ventricular mass index. Diastolic function was impaired in both patient groups compared to healthy controls. STE analysis revealed reduced global longitudinal strain (GLS) in the DM1 + KF (-13.07 ± 2.67 %) as well as KF group (-14.68 ± 4.87 %) to a similar extent in comparison to healthy control (-19.78 ± 1.89 %, p < 0.001). Interestingly, DM1 + KF patients had significantly worse global radial strain (GRS) and global circumferential strain (GCS) than KF patients, as shown in Table 2.

Conclusions

DM1 + KF and KF patients displayed comparable impairment in left ventricular function when using conventional echocardiography. STE analysis provided more differentiated results, showing significantly worse GRS and GCS in patients with DM1 + KF, even though hypertrophy was more pronounced in KF patients. These parameters seem to capture the detrimental effects of diabetic microvasculopathy on the myocardium, in addition to the interdependency of the reno-cardiac axis. Abstract Figure. Patient characteristics  Abstract Figure. Echocardiographic estimates
Quantification of mitral papillary muscle function using speckle tracking echocardiography in apparently healthy population
Authors: Kallala MY , Bouchahda N , Bettaieb SK , Mechri N , Lamine S , Hmidi M , Memmi K , Bnouni A , Hassan H , Boussaada M , B Messaoud M , Hassine M , Mahjoub M , Gamra H
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiac mitral papillary muscle is a structure that has been long ignored. Recently, growing evidence from case reports showed an important role in the pathophysiology of many cardiac pathologies such as hypertrophic cardiomyopathy and dilated cardiomyopathy.

To our knowledge, there isn’t any approved standard technique nor any methodological descriptive study of papillary muscle function in the apparently healthy population.

Purpose

To investigate mitral papillary muscle function in apparently healthy population by speckle tracking echocardiography (STE) using a proposed standard method.

Methods

We prospectively performed standard transthoracic echocardiography(TTE) in an apparently healthy cohort. Posterior mitral papillary muscle(PPM) was visualized on a modified three chamber view. The anterior papillary muscle(APM) was visualized on a modified 4 chamber view. To measure the value of the papillary muscles longitudinal strain, tracing of PPM and APM was done by a drag and click technique using an ECHOPAC software. Good quality tracing was ensured before approving the measurements. Each papillary muscle was divided into three segments by the software.

2D longitudinal strain curves of each papillary muscle consisted in 3 solid lines of the three segments and a dashed line that represented the mean longitudinal strain of the whole papillary muscle. This latter line was used to derive peak values, post systolic shortening (PSS) and systolic stretch (SS). Time of aortic valve closure was determined on the LV outflow pulsed doppler.

Results

Our study included 57 apparently healthy individuals between May 2021 and August 2021. Two patients were excluded due to lack of echogenicity. 71.19% (n = 44) were male. Mean age was 36 ± 14 yrs. 15.7% (n = 9) had history of hypertension and 7% (n = 4) were diabetic. 3.5% (n = 2) had history of stroke. 91.2% (n= 52) had functional status NYHA class I, 12.2% (n = 7) had functional status class II.

All of our cohort had a left ventricular ejection fraction (LVEF) above 55%, did not have diastolic dysfunction and were on sinus rhythm.

PPM peak strain value was -15.49 ±4.69 %. PSS was present in 98.2% (n = 56) and SS in 62.5%(n = 36) of cases.

Anterior papillary muscle (APM) had a peak strain value of -15.61 ± 3.66, PSS was present in 78.5% (n = 45) and SS in 51.7% (n = 29).

Conclusion

Mitral papillary muscles echocardiographic study is feasible in routine scans with modified apical views.

Post systolic shortening and systolic stretch are present in the majority of individuals. Abstract Figure. posterior papillary muscle strain curve  Abstract Figure. anterior papillary muscle strain curve
Subclinical left and right ventricular dysfunction in COVID-19 recovered patients using speckle tracking echocardiography
Authors: Kunal S , Gupta M , Shah B , Palleda G , Bansal A , Batra V , Yusuf J , Mukhopadhyay S , Tyagi S
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Myocardial injury during acute COVID-19 infection is well characterised however, its persistence during recovery is unclear.

Purpose

We assessed left ventricle (LV) global longitudinal strain (GLS) and right ventricular (RV) free wall longitudinal strain and RV global longitudinal strain (RV-GLS) using speckle tracking echocardiography (STE) in COVID-19 recovered patients (30-45 days post recovery) and studied its correlation with various parameters.

Methods

Of the 245 subjects screened, a total of 53 subjects recovered from COVID-19 infection and normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers (on admission) and comprehensive echocardiography including STE were done for all.

Results

All the 53 subjects were symptomatic during COVID-19 illness and were categorized as mild: 27 (50.9%), moderate: 20 (37.7%) and severe: 6 (11.4%) COVID-19 illness. Reduced LV GLS was reported in 22 (41.5%), reduced RV-GLS in 23 (43.4%) and reduced RVFWS in 22 (41.5%) patients respectively. LVGLS was significantly lower in patients recovered from severe illness (mild: -20.3 ± 1.7%; moderate: -15.3 ± 3.4%; severe: -10.7 ± 5.1%; P < 0.0001). Similarly, RVGLS (mild: -21.8 ± 2.8%; moderate: -16.8 ± 4.8%; severe: -9.7 ± 4.6%; P < 0.0001) and RVFWS (mild: -23.0 ± 4.1%; moderate: -18.1 ± 5.5%; severe: -9.3 ± 4.4%; P < 0.0001) were significantly lower in subjects with severe COVID-19. Subjects with reduced LVGLS as well as RVGLS and RVFWS had significantly higher interleukin-6, C-reactive protein, lactate dehydrogenase and serum ferritin levels during index admission.

Conclusions

Subclinical LV and RV dysfunction was seen in majority of  COVID-19 recovered patients. Patients with severe disease during index admission had far lower LV and RVGLS as compared to mild and moderate cases. Our study highlights the need for close follow-up of COVID-19 recovered subjects in order to determine the long-term cardiovascular outcomes.
Segmental speckle tracking strain and strain rate in stable coronary artery disease
Authors: Akay Caglayan H , Kjonas D , Jazbani M , Kornev M , Rosner A
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Northern Norway Regional Health Authority

Background

It is known that patients with coronary artery disease (CAD) display reduced

global and regional strain and strain rate (SR). However, knowledge about segmental strain

and SR in stable CAD patients is still limited.

Purpose

The purpose of this study was to explore whether segmental strain and SR analyses

are different between patients with normal and stenotic coronary arteries among individuals

with chest-pain.

Methods

A total of 510 patients with chest pain, referred to coronary computed

tomography angiography (CCTA) and additional 102 patients with myocardial infarction (MI)

were prospectively included. All patients underwent transthoracic echocardiography (TTE)

with strain-rate analysis. All patients with CCTA-suspected CAD subsequently underwent

invasive CAG, as well as in all MI patients. Global longitudinal strain (GLS) and average for

segmental peak longitudinal strain during systole (PLS), peak systolic strain rate (PLSR S),

peak early diastolic strain rate (PLSR E), post systolic shortening (PSS) measurements were analysed. Further, different cut-off values for reduced strain and SR

were used to define the percentage of functionally reduced segments between patients

with normal CAD (no CAD), MI, and stable CAD patients who were further treated by

percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG).

Results

As shown in the table 1,  all average segmental strain and SR parameters differed

significantly between no CAD and MI groups. However, only PLSR E showed significant differences

between no CAD and PCI groups .  PLSR E, PLS and GLS showed significant differences between no CAD and CABG groups. The percentage of reduced segmental strain and SR

showed similar results. Regarding the percentage of pathological segments at different cut-off values, PLSR E showed the most significant difference between these four groups at a cut-off value 1.5 (p < 0.001) (Figure 1).

Conclusion

Patients with MI or CABG display clearly reduced segmental strain and SR

values. However, in patients with chest-pain, segmental PLSR E seemed to be the only

indicator revealing subtle differences between patients with no CAD or those assigned to

PCI. The diagnostic value of PLSR E needs to be investigated in further studies. Abstract Table 1  Abstract Figure 1
Three-dimensional myocardial deformation parameters are associated with functional capacity assessed by cardiopulmonary exercise testing in patients with hypertrophic cardiomyopathy
Authors: Cardoso I , Garcia Bras P , Aguiar Rosa S , Moura Branco L , Galrinho A , Rio P , Fiarresga A , Lopes L , Mota Carmo M , Cruz Ferreira R
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Myocardial deformation parameters, derived from three-dimensional (3D) speckle-tracking echocardiography (3DSTE) are useful tools to determine left ventricular (LV) systolic function, and are often abnormal before a decline in ejection fraction (EF).

Aims

To study the correlation between systolic function evaluated by myocardial deformation parameters obtained by 3DSTE and functional capacity in patients with HCM.

Methods

HCM patients seen prospectively at outpatient cardiomyopathy clinic at a tertiary centre were included. Systolic function was assessed by strain measures – global longitudinal, circumferential and radial strain - obtain by 3DSTE, LVEF by 2D and 3D echocardiography were also assessed.  Functional capacity was evaluated by CPET.

Results

Of 67 P with HCM (mean age 57 ± 14 years, 41 males), 38 P (56.7%) were in New York Heart Association (NYHA) functional class I, 24 (35.8%) in class II and 5 (7.5%) in class III. 46P (68.7%) had obstructive (HCM), with a maximum LV wall thickness (MWT) of 20 (7) mm. 3DSTE and CPET parameters are reported in Table 1.

Absolute values of 3D global radial strain showed correlation with pVO2 (r=-0.336, p = 0.006), as well as longitudinal strain (r=-0.280, p= 0.024). No association was found between LVEF and pVO2. MWT did not correlate with 3DSTE strain measures.

Conclusion

Impaired myocardial deformation was associated with worse functional capacity assessed by peak oxygen consumption.
Impaired left atrial reservoir strain in patients with ischaemic stroke is associated with atrial fibrillation development
Authors: Miaris N , Vassaki M , Grigoraki E , Linardakis S , Karakosta M , Mpoukis D , Ntiloudi D , Kastis I , Michelongona A , Zachos P , Yiangou K , Destounis A , Theodosis-Georgilas A , Pisimisis E , Kasinos N
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

The investigation of patients with ischaemic stroke includes undoubtedly their evaluation for atrial fibrillation (AF). On the other hand, the role of left atrial (LA) function in cardiovascular disease is increasingly researched, while echocardiography strain analysis is a novel attractive technique.

Purpose

In this retrospective study, we investigated the association between LA function assessed with reservoir strain and the follow-up development of AF.

Methods

The study population consisted of consecutive ischaemic stroke patients with preserved left ventricular ejection fraction who were on sinus rhythm at the moment of enrollment and had no history of AF. Baseline LA reservoir strain was assessed with 2-dimensional transthoracic echocardiography (apical 4-chamber view) using longitudinal speckle-tracking technique. Afterwards, patients were investigated for AF with ambulatory electrocardiography during one-year follow-up. Differences in the distribution of LA reservoir strain values within the groups of patients with and without AF development were examined with Mann-Whitney U test (new procedure). The level of statistical significance was set to a p value of <0.05.

Results

Sixty-three patients (41 males, 22 females) of a mean age of 50.94 years [minimum = 20, maximum = 65, standard deviation (SD)=10,02] were enrolled in the study. Eight (12.7%) patients developed atrial fibrillation on follow-up. Overall, the mean LA reservoir strain was 32.75% (minimum = 5.62%, maximum = 71.88%, SD=%) and the median value was 32.91%. The values were shown to be lower in the group with later AF development (mean rank = 13.94, Mann-Whitney U = 75.5, p = 0.003) than in those without this finding (mean rank = 13.94). Neither the gender nor the age was associated with AF diagnosis.

Conclusion

Lower LA reservoir strain values were found to be associated with AF development in ischaemic stroke patients of our study. Pending more research data from large studies, this novel technique appears to be promising in identifying AF risk in stroke patients.

Figure

Non parametric assessment with Mann-Whitney U test (new procedure) of left atrial reservoir strain analysis with 2-dimensional transthoracic echocardiography in the groups of ischaemic stroke patients with and without atrial fibrillation development. Abstract Figure.
Impairment of LA strain and LV myocardial work in Ph+ Chronic myeloid leukaemia patients treated with TKis
Authors: Parlavecchio A , Caminiti R , Vetta G , Pelaggi G , Lofrumento F , Vinciguerra P , Parisi F , Demurtas E , Licordari R , Cusma M , Manganaro R , Micari A , Di Bella G , Carerj S , Zito C
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Worsening of cardiac function with increased arrhythmic risk is common in cancer patients undergoing chemotherapy. Impaired LV Global Longitudinal Strain (GLS) in these patients despite preserved ejection fraction is a common issue. Recently, myocardial work by speckle-tracking echocardiography has been used to overcome GLS limitations in various conditions, but little is known about its usefulness in the detection of cardiac toxicity. Moreover, left atrial (LA) toxicity may occur early in the course of cancer therapy. The main aim of the study was to assess the cardiotoxic effects of tyrosine kinase inhibitors (TKIs) on patients with Philadelphia chromosome-positive chronic myeloid leukaemia (Ph+ CML) by using novel echocardiographic tools as myocardial work and atrial strain analysis.

Methods

We retrospectively enrolled Ph+ CML patients treated with TKIs followed at the cardio-oncology outpatient clinic of our hospital from December 2018 to March 2019 who underwent clinical evaluation with ECG and echocardiogram (TTE) before and after one year of treatment with TKIs. Healthy subjects were enrolled in the control group matched for gender, age and cardiovascular risk factors. Myocardial work was derived from the strain-pressure relation, integrating in its calculation the non-invasive arterial pressure. LA longitudinal strain (reservoir, conduit and booster) was obtained from an optimized apical 4-chamber view of the LA.

Results

The study recruited 32 patients in Ph+ CML group and 32 healthy controls. 39% of patients were treated with Imatinib, 29.3% with Nilotinib, 4.9% with Dasatinib and 4.9% with Ponatinib. Main results are detailed in the Table 1. At one-year follow-up there was a significant reduction compared to baseline in Global Constructive Work (2555.22 ± 564.33 vs 2119.31 ± 700.19; p = 0.0001), Global Work Efficiency (96.13 ± 1.90 vs 94.00 ± 2.96; p = 0.002) and Global Work Index (2340.75 ± 579.57 vs 1938.46 ± 680.23; p = 0.001), and a non-significant reduction in Global Wasted Work (p = 0.393). Regarding left atrial strain analysis at the one-year follow-up there was a statistically significant reduction in LA contractile strain (booster= 14.63 ± 1.408 vs 12.38 ± 1.581; p= 0.018). LA contractile strain reduction was also observed in the comparison with controls (12.38 ± 2.99 vs 14.91 ± 3.09; p = 0.009). Any other significant difference was detected between baseline and FU TTE data in the Ph+ CML group.

Conclusions

New imaging methods for the study of cardiotoxicity provide an additional tool for early prediction of potential adverse effects of antineoplastic drugs. TKIs therapy leads to an impairment of atrial contractility, which can be detected by atrial strain e myocardial work analysis. Abstract table 1  Abstract figure 1
Wasted myocardial work may affect left ventricular remodelling occurrence after primary percutaneous coronary revascularization
Authors: Caminiti R , Vetta G , Parlavecchio A , Pelaggi G , Lofrumento F , Licordari R , Cusma M , Manganaro R , Pucci M , Radano I , Citro R , Carerj S , Di Bella G , Zito C
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Left ventricular function recovery (LV-REC) or left ventricular adverse remodelling (LV-REM) after acute myocardial infarction (AMI) play an important role for identifying patients at risk of heart failure.

Purpose

In this study we aim to evaluate the usefulness of non-invasive myocardial work (MW), a new index of global and regional myocardial performance, to predict LV-REC or LV-REM after AMI.

Methods

Fifty patients with AMI (mean age, 63,8 ±13,4 years), treated by primary percutaneous coronary intervention (PCI), were prospectively enrolled.  They underwent a baseline transthoracic Doppler echocardiography (TTE) within 48 hours after PCI and a second TTE after a median of 31 days during the follow-up. MW was derived from the strain-pressure loops, integrating in its calculation the non-invasive arterial pressure, according to standard speckle tracking echocardiography recommendations. LV-REC was defined as an absolute improvement of left ventricular ejection fraction (LVEF) ≥ 5% from LVEF at baseline, whereas LV-REM was defined as an increase of ≥ 20% of the LV end diastolic volume (LVEDV) at 1 month follow up.

Results

We overall found a significant improvement from baseline to one-month follow-up for values of LVEF (49,8 ± 9,5 % vs 52,8 ± 9,3 %, p = 0.001), Global Longitudinal Strain (GLS) (-13,4 ± 3,9 % vs -18,7 ± 5,4 %, p = 0.016), Global Work Index (GWI) (1368,6 ±435,2 vs 1788 ±493 mmHg/%, p = 0.0001), Global Work Efficiency (GWE) (89,96 ± 9,3 % vs 91,3 ± 6,4 %,  p = 0.001), Global Constructive Work (GCW) (1619,16 ± 497,9 mmHg/% vs 2008,6 ± 535,3 mmHg/%, p = 0.0001), Global Wasted Work (GWW) (188,8 ± 19,8 mmHg/% vs 149,2 ± 16,5 mmHg/%). However, LV-REC at 1 month of follow-up was observed only in 36 % of the population enrolled, whereas LV-REM was described in 18% of cases. Using ROC curve analysis, we identified a cut off value of 202 mmHg/% for baseline GWW (Sensitivity 75%, Specificity 62%, AUC 0.6667, CI 95%: 0,51618 - 0,81715, p =0.0001) to identify patients with LV-REM at 1 month. With regards to conventional echo parameters, patients with LV-REC showed lower baseline Wall Motion Score Index (WMSI) than those without LV-REC (1,73 vs 1,38, p = 0.007).

Conclusions

Among standard and advanced TTE parameters, only baseline GWW is able to predict early LV-REM at 1 month after primary PCI. Therefore, it could be used during baseline evaluation of AMI patients for a more accurate stratification of those at higher risk of heart failure. However, further larger scale studies are needed to validate these findings. Abstract table 1  Abstract table 2
Assessment of anthracycline-induced cardiotoxicity in patients with childhood cancer survivor for long-term follow-up
Authors: Hosono Y , Takahashi K , Shigemitsu S , Akatsuka Y , Akiya A , Akimoto S , Ifuku M , Yazaki K , Yaguchi A , Tomita O , Fujimura J , Saito M , Yoneoka D , Shimizu T
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

 Anthracycline cardiotoxicity is an important prognostic determinant in childhood cancer survivors (CCSs). That has been reported to improve with early therapeutic intervention, and because it is dose-dependent and progressive, early diagnosis and long-term follow-up are important. In adult survivors of cancer, the longitudinal strain (LS) is useful as a sensitive index of cardiac function. In childhood cancer survivors, strain abnormalities are also observed at both short-term and long-term follow-up. Global longitudinal strain (GLS) abnormalities are common during or early after chemotherapy, whereas changes in global circumferential strain (GCS) are more significant and consistent on long-term follow-up.

Purpose

 In this study, we aimed to conduct a cross-sectional study using strain analysis in childhood cancer survivors of a wide age range to clarify the mode of progression of anthracycline-induced cardiotoxicity and to identify useful indicators for long-term follow-up.

Methods

 In total, 116 patients (median age: 15.5 [range: 4.7-40.2] years) with childhood cancer who had passed at least 1 year after chemotherapy with anthracycline, and 116 control patients of similar age. Strain measurements were assessed for longitudinal strain (LS) and circumferential strain at the apical, papillary and basal levels using speckle tracking imaging. Estimated value at 5, 15, 25 and 35 years old were mathematically calculated.

Results

 Results were shown in tables and figures. Most of conventional echocardiographic parameters were not significantly different between CCCs and controls. LS, papillary CS and basal CS in CCCs decreased compared to normal controls at all age. The difference of estimated value between CCCs and normal controls in LS at all age were relatively constant. However, those in basal CS tended to increase with aging. Furthermore, basal CS in CCCs decreased with aging (r = 0.212, p < 0.001) and the duration after completion of anthracycline treatment (r = -0.244, p < 0.008).

Conclusions

 In childhood cancer survivors, strain analysis is a more sensitive indicators of cardiac function than conventional parameters. In addition, basal CS may decrease most markedly over time and could be useful indicator in long-term follow-up. Longitudinal studies should be conducted in the future to improve the accuracy of predicting anthracycline cardiotoxicity. These are new findings regarding the decline in cardiac function in childhood cancer survivors. Abstract Figure. Relationship between age and strains  Abstract Figure. Estimated values for each age group
Predicting maintenance of sinus rhythm after cardioversion - novel versus conventional left atrial parameters
Authors: Kupczynska K , Michalski B , Miskowiec D , Lipiec P , Kasprzak JD
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

 The successful electrical cardioversion (EC) in patients with atrial fibrillation (AF) improves cardiac mechanical function and enables early assessment of atrial activity by echocardiography.

Purpose

 To analyze conventional and novel parameters characterizing left atrium (LA) within 24 hours after the restoration of sinus rhythm (SR) and their prognostic value during 2-years follow-up.

Methods

 Prospective study involved 71 patients with nonvalvular AF (mean age 64 ± 13 years, 61% male). All patients underwent echo 24 hours after conversion to SR. In addition, standard echocardiographic and Doppler parameters were assessed. Using speckle-tracking method we analysed LA longitudinal strain in reservoir and contractile phase. The clinical endpoint was predefined as AF recurrence.

Results

 During a 24-months follow-up we noticed AF recurrence in 48 (68%) patients. The median time-to-event was 2.4 months (IQR 1 to 6.9). Standard echo measurements revealed a median of LV ejection fraction 55% (IQR 45-58) and median of LA volume indexed to body surface area 42 ml/m2 (IQR 34-51). Median mitral A wave was 0.46 m/s (IQR 0.39-0.5) vs 0.35 m/s (IQR 0.28-0.5) in patients without and with AF recurrence, respectively (p = 0.04). Patients without AF recurrence had also higher mitral annular A’ velocity obtained by tissue Doppler imaging (7.4 ± 2.8 cm/s vs 3.5 cm/s, IQR 2.8-4.8; p < 0.0001), LA reservoir strain (19.4 ± 7.3% vs 11%, IQR 9.6-15.3; p = 0.0003) and LA contractile strain (9.4 ± 4.1% vs 2.8%, IQR 1.2-4.4; p < 0.0001). The table presents results derived from univariate Cox regression analysis.

Conclusion

 LA activity assessed early after the restoration of sinus rhythm is the predictor of AF recurrence. The strongest association was proven for LA contractile strain. Abstract Figure. Univariate Cox regression analysis
The ischemic cascades in contemporary patients: five distinct phenotypes assessed by ABCDE stress echocardiography
Authors: Zagatina A , Ciampi Q , Cortigiani L , Wierzbowska-Drabik K , Haberka M , Djordjevic-Dikic A , Boshchenko A , Rigo F , Simova I , Dodi C , Gaibazzi N , Morrone D , Barbieri A , Pellikka PA , Picano E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)

Background

The classical pathophysiological cornerstone of stress cardiac imaging is the ischemic cascade: alterations in coronary flow velocity reserve (CFVR) come first, regional wall motion abnormalities (RWMA) second, and global alterations of left ventricular diastolic and systolic function last.

Aim

To evaluate the ischemic cascade with stress echo (SE) assessed with ABCDE protocol.

Methods

We analyzed 1616 patients (age 66 ± 10 years, 1156, 72% males) with chest pain and angiographically documented coronary artery disease (CAD): 928 (57.4%) with previous myocardial infarction and 1451 (89.8%) with previous coronary revascularization. CAD patients were studied with ABCDE-SE protocol by 13 certified laboratories of 5 countries. Stress modality was exercise in 427 (26.4%) dobutamine in 173 (10.7%) and vasodilator stress in 1016 (62.9%) patients (dipyridamole in 982 – 60.8% and adenosine in 34 – 2.1% patients). Step A assessed RWMA; step B, B-lines (diastolic function); step C, left ventricular contractile reserve based on force; step D, CFVR in left anterior descending artery; step E, heart rate reserve. SE response ranged from score 0 (all steps normal) to score 5 (all steps abnormal). Follow up was obtained in all patients.

Results

Results were abnormal in 350 (21.7) % for step A, 572 (35.4%) for B, 666 (41.2%) for C, 546 (33.5%) for D and 643 (39.8%) for E. The distribution of positivity is shown in figure. The dominant "solitary phenotype" (only one biomarker abnormal during the test) was step A in 10 (0.6%), step B in 124 (7.7%) step C in 100 (6.2%), step D in 64 (4.0%) and step E in 157 (9.7%) patients. The overall sensitivity for CAD detection including each step of ABCDE score (≥1) was 95.7%. During median follow-up of 22 months [IQ range: 13-37 months] 279 coronary revascularizations occurred. ABCDE score predicted coronary revascularization with score 1: HR: 3.182, 95% CI: 1.699-6.067; score 2: HR: 4.921, 95% CI: 2.571-9.420; score 3: HR: 7.234, 95% CI: 3.743-13.979; score 4: HR: 24.570, 95% CI: 13.390-45.086; and score 5: HR: 38.720, 95% CI: 20.975-71.478

Conclusion

Inducible ischemia with CAD is characterized by the complexity and multiplicity of diagnostic phenotypes. The overall ABCDE score predicts clinically driven revascularization. Abstract Figure. The 5 circles of ischemia biomarkers