bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of COVID-19 with impaired endothelial glycocalyx, coronary flow and longitudinal strain four months after infection
Authors: Ikonomidis I , Katogiannis K , Mitrakou A , Kountouri A , Thymis J , Korakas E , Varlamos C , Andreadou I , Tsoumani M , Bamias A , Kazakou P , Grigoropoulou S , Kavatha D , Dimopoulos MA , Lambadiari V
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Aims

SARS-CoV-2 infection may lead to endothelial and vascular dysfunction. We

investigated alterations of arterial stiffness, endothelial coronary and myocardial

function markers four months after COVID-19 infection.

Methods

In a case-control prospective study, we included 100 patients four months after COVID-19 infection, 50 age- and sex-matched healthy individuals. We measured a) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), b) flow-mediated dilation (FMD), c) coronary Flow Reserve (CFR) by Doppler echocardiography d) pulse wave velocity (PWV) e) global left (LV) and right (RV) ventricular longitudinal strain (GLS), f) malondialdehyde (MDA), an oxidative stress marker, von-Willenbrand factor and thrombomodulin as endothelial biomarkers.

Results

COVID-19 patients had lower CFR and FMD values than controls (2.39 ± 0.39 vs 3.31 ± 0.59, p = 0.0122, 5.12 ± 2.95% vs 8.12 ± 2.23%, p = 0.006 respectively). Compared to controls, COVID-19 had greater PBR5-25 (2.11 ± 0.14μm vs 1.87 ± 0.16μm, p = 0.002), higher PWV (PWVc-f 12.32 ± 2.44 vs 10.11 ± 1.85 m/sec, p = 0.033) and impaired LV and RV GLS (-19.11 ± 2.14% vs -20.41 ± 1.61%, p = 0.001 and -16.45 ± 3.33% vs -20.11 ± 2.48%, p < 0.001). MDA and thrombomodulin were higher in COVID-19 patients than controls (10.55 ± 2.45 vs 1.01 ± 0.50 nmole/L, p = 0.001 and 3716.63 ± 188.36 vs 2590.02 ± 156.51pg/ml, p < 0.001). Residual cardiovascular symptoms at 4 months were associated with oxidative stress and endothelial dysfunction markers.

Conclusions

SARS-CoV-2 may cause endothelial and vascular dysfunction linked to

impaired cardiac performance four months after infection.
Long term non-invasive endothelial function assessment in patients with paediatric inflammatory multisystem syndrome temporarily associated with Covid 19 (PIMS TS)
Authors: Spanaki A , Miller O , Wong J , Pushparajah K , Theocharis P
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Patients with PIMS-TS present with features of vasculitis (bright coronary arteries and diffuse coronary ectasia on transthoracic echocardiography) and prothrombotic features (e.g. elevated D Dimers) indicating involvement of the endothelial layer in the inflammatory process. Impairment in endothelial function may contribute to the acute but also to possible long-term consequences in patients with PIMS-TS. The aim of this pilot study is to assess non-invasively the endothelial (dys)function using reactive hyperemic peripheral arterial tonometry (RH-PAT) 6 months after the acute inflammatory phase. 

Methods

Ten patients with previous diagnosis of PIMS-TS were compared to  age-matched controls. The endothelial function was assessed using the EndoPAT device which provides the reactive hyperemic index (RHI) of endothelial function in a 15-min test. Cardiac function indices by means of LV fractional shortening (FS) was also assessed.

Results

There were no significant differences regarding age (11.2 ± 3.0 vs 13.6 ± 2.4, p = 0.063), height, weight and body surface area, (BSA: 1.49 ± 0.36 vs 1.52 ± 0.25, p = 0.856) in patients with previous diagnosis of PIMS-TS and controls respectively. The two groups also had similar LV systolic function assessed by FS (36.3 ± 9.1% vs 36.7 ± 7.1%, p = 0.922). The RHI in the PIMS TS group was similar to the control group (1.65 ± 0.43 vs 1.81 ± 0.60, p = 0.533 respectively).

Conclusions.  Patients with PIMS-TS who may present with features of vasculitis during the acute phase, do not show evidence of endothelial dysfunction during the long term follow-up, suggesting resolution. Further studies are required to accurately determine the endothelial (dys)function during the acute phase of the inflammatory syndrome and course.
Left ventricle structure and function relations with the levels of plasma markers of fibrosis in hypertensive patients with NonSTEMI
Authors: Krestjyaninov M , Gimaev RH , Buharaeva AI , Bakshutova AA , Mirina MP
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction. The myocardial fibrosis lies in the basis of left ventricle remodelling in patients with hypertension. Cardiomyocites hypertrophy, fibroblasts proliferation, enlargement of interstitial collagen volume and their ratio disorders may increase severity of stroke and myocardial infarction.

Purpose. The purpose of the study is to evaluate relations between the plasma levels of myocardium fibrosis markers and left ventricle remodelling, systolic and diastolic function in hypertensive patients with NonSTEMI.

Methods. Were examined 138 hypertensive patients (both men and women) with NonSTEMI.

The mean age of patients was 51.2 (11.2) years. Patients with arrhythmias and conduction abnormalities, diabetes mellitus and autoimmune diseases were excluded form the study.

In all patients was performed

ECG in 12 standard leads; EchoCG (according to ASE/EACVI 2015 recommendations); evaluation plasma levels of tissue inhibitor of metalloproteinases-1 (TIMP-1) and insulin-like growth factor 1 (IGF-1). HF NYHA functional class was determined by performing 6MWT.

Statistical significance was defined at the level of methods for p < 0,05.

Results. The averaged levels for plasma markers of myocardium fibrosis were: TIMP-1 - 322.0 (250.0; 483.5) ng/mL; IGF-1 - 160.0 (141.0; 175.0) ng/mL.

Results of correlative analysis revealed relations between IGF-1 and ILV mass (R=-0.59; p < 0.001), and weak correlation between IGF-1 and E/e" averaged (R=-0.19; p = 0.027) (Picture 1). These negative correlations may be explained by the growth in both fibroblasts and collagen production in myocardium. Also there were positive correlations between TIMP-1 and ILV mass (R = 0.63; p < 0.001) and TIMP-1 and E/e" average (R = 0.37; p < 0.001) (Picture 1) which may be due to an increase of myocardial stiffness as the result of fibrosis activity.

The results of the comparison of TIMP-1 and ICF-1 plasma levels, structural and functional parameters of the LV in groups of patients with different types of LV geometry can be seen in Table 1.

Conclusion. Thus, the results of the study show that plasma markers of fibrosis  was significantly higher in patients with concentric and eccentric LV hypertrophy which may reflects the higher levels of myocardium stiffness. Abstract Table 1.  Abstract Figure. Picture 1.
Left ventricular systolic function parameters are increased in patients with primary biliary cholangitis without cirrhosis
Authors: Bidiuk J , Styczynski G , Szmigielski CA , Lewandowski J , Sinski M
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Primary biliary cholangitis (PBC) is a chronic, autoimmune liver disease causing destruction of the small intralobular bile ducts in the liver. PBC patients can also develop extrahepatic manifestations, mostly related to skin, nervous system and laboratory abnormalities. Cardiac involvement is inconsistent in PBC studies despite high levels of serum lipids. Cardiac abnormalities are especially important because with the treatment many patients with early-stage PBC may have a normal life expectancy and therefore the cardiovascular complications can develop. Additionally, in recent years new echocardiographic modalities emerged letting for more precise analysis of cardiac morphology and function.

Purpose

The purpose of the study was to compare novel and classic echocardiographic indices in patients with confirmed PBC without cirrhosis and in control subjects.

Methods

22 female patients with PBC and without cirrhosis and 44 healthy females, matched for age, (53.3 ± 9 years and 50.9 ± 8 years respectively, p = 0.065) were investigated. TTE study was performed and analysis of left ventricular (LV) global longitudinal strain (GLS) and myocardial work was performed.

Results

Systolic blood pressure (SBP) differed between PBC and control group  (128 ± 17 mmHg and 116 ± 11 mmHg respectively, p = 0.006),  while diastolic blood pressure (DBP) (78 ± 10 mmHg and 76 ± 10 mmHg, p = 0.2) and heart rate (HR) (73 ± 12 bpm and 70 ± 8 bpm , p = 0.32) did not. PBC group had increased diameter of cardiac chambers when adjusted for body surface area (BSA), including left atrium (LA/BSA) and right ventricle (RV/BSA), as well as left ventricular mass (LWMI) and relative wall thickness (RWT) (Table) with no difference in left ventricular end diastolic diameter (LVEDD/BSA). LV ejection fraction (EF) measured by Simpson method was increased in PBC group (Table).  LV diastolic function parameters (E/A, E/e’) were impaired in patients with PBC when compared with controls (Table 1). LV GLS indices (GLSAVG, GLSLAX, GLS4C, GLS2C) were significantly higher in PBC group, as well as global myocardial work indexes : global myocardial work (GWI) and global constructive work (GCW).  Global work efficiency (GWE) and global wasted work (GWW)  indexes were not different (Table).

Conclusion

Our study shows that in patients with PBC without cirrhosis LV systolic function is increased. That implies hyperkinetic circulation in that group of patients even before the development of  cirrhosis. Abstract Table
Echocardiographic assessment of pulse wave velocity in psoriatic patients with and without psoriatic arthritis
Authors: Wierzbowska-Drabik K , Gruchala-Cislak A , Skibinska M , Lesiak A , Niedzwiedz M , Kasprzak JD , Narbutt J
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Psoriasis (PSO) is an inflammatory disorder which in its more severe form affects cardiovascular system (CVS) leading to more rapid atherosclerosis progression. Moreover, some data suggested that the presence of psoriatic arthritis (PSA) may further increase CVS deterioration.

Purpose

Our aim was to compare the pulse wave velocity (PWV) between psoriatic patients without and with psoriatic arthritis (PSA 0 and 1 group, respectively).

Methods

We examined 31 consecutive patients (20 males and 11 females) with moderate to severe PSO taking systemic anti-inflammatory medications (TNF-alpha inhibitor, IL-17 inhibitor, IL-23 inhibitor or IL12/23 inhibitor) with transthoracic echocardiography with the evaluation of PWV

The group was divided into two

17 patients without PSA (PSA 0) and 14 with concomitant PSA (PSA 1). To achieve PWV value the time from R wave in ECG to the onset of arterial flow was measured respectively in carotid (T1) and femoral artery (T2) with further calculation of time difference (delta T). The distance between supraclavicular area and groin was measured during physical examination of patient. PVW was expressed as the ratio between assessed distance (in meters) and time difference (in seconds).

Results

Patients with psoriatic arthritis (PSA 1) had more frequently hypertension and higher BMI but did not differ significantly from the group without joints involvement regarding other demographics, risk factors and basic echocardiographic data. They also showed similar PSO severity as assessed with PASI score, see Table. The PWV assessment was feasible in all patients and the respective mean values achieved 9.2 ± 3.7 m/s in PSA 0 vs 10 ± 2.8 m/s in PSA 1 group, p = ns.

Both T1 and T2 correlated significantly with duration of PSO, see Figure, and even better with patient’s age r = -0.61, p = 0.0003 for T1 and r = -0.77, p < 0.0001 for T2, whereas PWV correlated significantly only with patient’s age.

In the model of 12 variables only older age was the independent predictor of PWV >10 m/s in multivariate logistic analysis, OR 1.08 95% CI 1.003- 1.165.

Conclusions

Patients with PSA showed tendency to the higher prevalence of obesity and hypertension when compared with patients with skin PSO only. Measurement of PWV during echocardiography or even more simple times to flow spectrum onset in carotid or femoral arteries provided quantitative parameters reflecting cardiovascular impairment in PSO and PSA. Abstract Table. Group comparison.  Abstract Figure. PSO duration, T1, T2 and PVW.
Echocardiographic evaluation of patients with diastolic dysfunction of the left ventricle treated with external counterpulsation
Authors: Alakbarov R , Jahangirov T , Dadashova G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The influence of the external counterpulsation (ECP, EECP) on patients with diastolic dysfunction of the left ventricle (LV) is unclear. We aim to determine whether external counterpulsation therapy improves echocardiographic parameters in these patients.

Methods

We studied 57 patients with stable coronary artery disease undergoing one course of external counterpulsation therapy. The average age of the patients was 63.07 ± 7.44 years (there were 43 (75.4%) male and 14 (24.6%) women). All patients divided into two groups: patients with diastolic dysfunction of the left ventricle (E/e" ratio > 14, total 15 patients, main group) and control group (E/e"< =14, total 42 patients). The mean age of the patients included in the main and control groups was 64.20 ± 5.93 and 62.67 ± 7.93 years (p = 0.36). All patients treated with one course of ECP (EECP) treatment (33,26 ± 3,60 and 32,85 ± 4,56 sessions, p = 0,38). Results from echocardiographic examinations after the treatment in these groups were compared. Echocardiographic assessment included evaluation of the chamber size, chamber volume, ejection fraction of the left ventricle (LV) by 2D and Doppler measurements.

Results

Echocardiographic parameters for main and control groups before treatment: the diastolic diameter of the LV (cm): 5,65 ± 0,97 and 5,20 ± 0,62 (p = 0,0913); the end-diastolic volume of the LV (ml): 93.53 ± 28.38 and 75.45 ± 25.13 (p = 0.0163); LV stroke volume (ml): 48,57 ± 11,47 and 43,02 ± 10,64 (p = 0,1471); LV ejection fraction (%): 52.83 ± 10.12 and 59.11 ± 9.53 (p = 0.0340); the volume of the left atrium (ml): 73.25 ± 22.79 and 57.86 ± 20.60 (p = 0.0229); tissue Doppler velocity of the mitral annulus (e ", cm/s): 5,89 ± 1,18 and 7,43 ± 1,50 (p = 0,0006); E/e" ratio: 18,85 ± 3,40 and 9,69 ± 1,95 (p < 0,0001). Echocardiographic parameters for the main and control groups after treatment: the diastolic diameter of the LV (cm): 5.53 ± 0.85 and 5.15 ± 0.57 (p = 0.1879); the end diastolic volume of the LV (ml): 92.91 ± 31.29 and 75.15 ± 22.78 (p = 0.0536); LV stroke volume (ml): 50,77 ± 11,49 and 47,01 ± 11,24 (p = 0,2612); LV ejection fraction (%): 56.81 ± 10.50 and 64.06 ± 7.67 (p = 0.0088); the volume of the left atrium (ml): 60.84 ± 16.20 and 55.77 ± 17.53 (p = 0.2388); tissue Doppler velocity of the mitral annulus (e", cm/s): 6,15 ± 1,11 and 7,73 ± 1,90 (p = 0,0037); E/e" ratio: 15.97 ± 5.39 and 10.08 ± 2.81 (p < 0.0001). Statistically significant changes between two groups noted for the left atrium volume: decrease in 12,41 ± 16,33 ml and 2,09 ± 13,72 ml (p = 0,0124) in both groups, and for E/e" ratio: decrease in -2,87 ± 3,94 in the main group and increase in 0,39 ± 2,12 in the control group (p = 0,0003).

Conclusion

ECP treatment was associated with a decrease in the left atrium volume and E/e’ ratio in patients with diastolic dysfunction of the left ventricle.
Impact of regurgitant orifice ellipticity on quantitation of tricuspid regurgitation using the proximal isovelocity surface area method
Authors: Tat E , Hamid N , Khalique O , Lehenbauer K , Sitticharoenchai P , Nazif T , Vahl T , Ng V , George I , Cahill T , Blusztein D , Mihatov N , Leon M , Kodali SK , Hahn RT
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The proximal isovelocity surface area (PISA) method to quantify tricuspid regurgitation (TR) severity relies on the geometric assumption of a circular, planar regurgitant orifice.  However, the TR orifice is often non-circular resulting in underestimation of TR severity when calculating the effective regurgitant orifice area (EROA) and regurgitant volume (RegVol).

Purpose

To evaluate the effect of ellipticity of the tricuspid annulus on EROA-PISA correlation with quantitative Doppler (EROA-Dopp), and three-dimensional vena contracta area (VCA-3D).

Methods

Patients undergoing both transthoracic (TTE) and transesophageal (TEE) echo evaluation of TR severity were included in this study. Regurgitant orifice ellipticity was calculated as the ratio of the vena contracta maximum and minimum widths (VC-Ratio). Quantification of EROA and RegVol were performed on TTE for EROA-PISA and EROA-Dopp. Vena contract area was measured on TEE (VCA-3D).

Results

Of 44 total pts, the median age was 80 ± 9, 61% were female, 89% had atrial fibrillation, (86%) had functional TR, 32% were graded as severe, and 71% had a EROA-PISA ≥ 0.4 cm2. Median VC-Ratio was 1.3 (IQR 1.1-1.8) and was used to differentiate more circular orifices (VC-Ratio <1.3) from more elliptical orifices (VC-Ratio ≥1.3) (Table). EROA-PISA was significantly smaller compared to EROA-Dopp and VCA-3D in the whole group as well as elliptical subgroups (p < 0.0001 for all).  There was no significant difference between EROA-Dopp and 3D-VCA for the whole group, or in circular or elliptical orifice subgroups (p > 0.5 for all). EROA-PISA correlated better with both EROA-Dopp and VCA-3D in circular compared to elliptical orifices (Table). EROA-Dopp and VCA-3D demonstrated high correlation for both circular and elliptical orifices (r = 0.76, p < 0.0001 and r = 0.77, p < 0.0001 respectively).

Conclusion

Our study demonstrated that there is a significant difference in quantitative measurements of tricuspid regurgitant orifice area, with EROA-PISA significantly underestimating both EROA-Dopp and VCA-3D.  In more circular orifices, the EROA-PISA correlation was higher, however EROA-Dopp and VCA-3D were still significantly larger. Whether EROA-Dopp and VCA-3D are more predictive of outcomes requires further study. Abstract Table 1  Abstract Figure 1
The relationship of epicardial adipose tissue with hemodynamics and cardiopulmonary fitness in heart failure with preserved and reduced ejection fraction
Authors: Pugliese NR , De Biase N , Mazzola M , Paneni F , Del Punta L , Gargani L , Mengozzi A , Virdis A , Nesti L , Taddei S , Flammer A , Borlaug BA , Ruschitzka F , Masi S
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. Recent evidence shows epicardial adipose tissue (EAT) acts as a paracrine organ and may directly alter myocardial function by exerting mechanical compression.

Purpose. We evaluated EAT thickness through transthoracic echocardiography and investigated its relationship with cardiopulmonary fitness and cardiovascular haemodynamics at rest and during exercise in a population of heart failure (HF) patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction.

Methods. We prospectively enrolled 393 consecutive HF outpatients (205 HFrEF, 188 HFpEF) who had been referred to our hospital due to dyspnoea and/or effort intolerance, together with 44 healthy controls. We performed a resting state-of-the-art echocardiographic evaluation, followed by combined cardiopulmonary-echocardiography exercise stress.

Results. EAT thickness was higher in HFpEF (median 8 mm, interquartile range [IQR] 4–12 mm) and progressively reduced in controls (median 5 mm, IQR 3–7 mm; p < 0.0001) and HFrEF (median 3 mm, IQR 2–6 mm).  In HFpEF, EAT thickness was inversely correlated with peak oxygen consumption (VO2) and peripheral oxygen extraction (AVO2diff), while a direct association was observed for the same parameters in HFrEF (Figure 1). Furthermore, EAT independently predicted peak VO2 and AVO2diff in HFrEF and HFpEF regardless of body mass index and waist circumference. These relationships were direct in HFrEF (standard regression coefficient [SRC] for peak VO2: 0.18, p = 0.02; SRC for peak AVO2diff: 0.17, p = 0.03) and indirect in HFpEF (SRC for peak VO2: -0.33, p < 0.0001; SRC for peak AVO2diff: -0.25, p < 0.0001).

As there are no definite cut-off values to define increased EAT, patients were divided based on the median EAT value (5 mm) of the overall population. Thinner EAT (≤5 mm) was associated with worse LV systolic dysfunction (peak average S’) and remodeling (3D LV mass index) in HFrEF. In HFpEF, on the other hand, increased EAT (>5 mm) was related to worse right ventricular systolic dysfunction (3D right ventricular ejection fraction) and more severe left atrio-ventricular (left atrium reservoir strain/left ventricle global longitudinal strain) and right ventriculo-arterial (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) coupling (Figure 2).

Conclusion. In HFpEF, increased EAT thickness is associated with a worse hemodynamic profile and functional capacity. Conversely, in HFrEF, EAT thinning portends more advanced LV dysfunction and impaired cardiopulmonary fitness. Abstract Figure 1  Abstract Figure 2
Right ventricle function improvement after six month of therapy with Sacubitril/Valsartan in a real-life population of patients with chronic heart failure with reduced ejection fraction
Authors: Mazzeo P , Correale M , Magnesa M , Fortunato M , Mallardi A , Leopizzi A , Tricarico L , Mennella R , Iacoviello M , Brunetti ND
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

 Observational studies have demonstrated that treatment with sacubitril/valsartan may improve left ventricular (LV) systolic and diastolic function in subjects with reduced LV ejection fraction (LVEF) in real-world studies. Subjects with heart failure and reduced EF (HFrEF), however, are also characterized by an impaired right ventricular (RV) function. We therefore aimed to evaluate whether also RV function may improve after S/V therapy and possible predictors of RV improvement could be identified at echocardiography and tissue Doppler imaging. 

Methods

 Fifty consecutive patients (67 ± 8 years, LVEF 28 ± 6%, male 86%) with chronic HFrEF and NYHA class II-III were followed up for 6 months after therapy with S/V. L&RV function was assessed at baseline and after 6 months of therapy. 

Results

 After 6-month therapy with S/V a significant improvement was shown in the following echocardiography  parameters  assessing RV function: PAsP(31 ± 11vs 35 ± 10mmHg,p < 0.001),

TAPSE(19 ± 3vs18 ± 3mm,p < 0.001),RVFAC(38 ± 7 vs 34 ± 6 mm,p < 0.001), RVS’(12 ± 2vs10 ± 2cm/sec,p < 0.001), RVFWGLS(-20 ± 5vs-18 ± 5%,p < 0.001), RV4ChGLS (-16 ± 5vs-14 ± 5%,p < 0.001). At multivariable analysis improvement in RVFWGLS was associated to baseline levels of RV S’ (r 0.75, p < 0.01) and RAV (r–0.32,p < 0.05). 

Conclusions

 In a real-world scenario, 6-month therapy with S/V was associated with an improved RV function in HFrEF. RV function improvement may be predicted by assessing baseline RV S’ and right atrial volume values.
Association between early changes in left atrial strain and global left ventricular function in patients with heart failure with preserved EF ( HFpEF)
Authors: Hristova K , Tselov N , Tsonev SV , Slavchev B , Velikov T , Zlatancheva G , Marinov R
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial (LA) maximal volume and index (LAVI) had a prognostic value in patients  with  heart failure and incidence of atrial fibrilation(AF) . Recently, LA mechanical function and LA strain have been introduced as alternative methods to assess LA performance more accuratly.

Aim

To evaluate the relation between early changes in LA function and strain ( PALS) and correlate the association with global left ventricular (LV)  function and longitudinal strain (GLS) in patients  with HFpEF.

Methods

We evaluated 132 subjects in sinus rhythm: 22 normals (31y ± 5), and 70 pts with  HFpEF (65y ± 12), 60 pts HFrEF ( 64 y ± 10). Echocardiography was performed in all patients and follow  up after 12 monts and analyzed offline in order to extract the global and segmental strain values of the LV and LA and LA volume and LAVI.

Results

The two groups of patients were comparable for most of clinical variables. LV volumes, ejection fraction, stroke volume, and mitral valve effective regurgitant orifice were similar between the two groups. The LA diameter and maximal volume were higher  in HFrEF group.  The GLS is significantly reduced in HFrEF group.  LV GLS is the main parameter for myocardial dysfunction, which changed significantly in the HFrEF (p < 0,001) at  12mFU. Reduced PALS in HFrEF was associated with impairment of all measures of LV systolic and diastolic function and events of atrial fibrilation / 33 % in HFrEF and 12 % in HFpEF/  and the correlation between global longitudinal strain and PALS was highly significant (p < 0.001; r=-0.71). At 12mFU, PALS was significantly associated with lower global longitudinal strain in group with HFrEF (p < 0.001, r = 0.61 ), LAVI > 28 ml/m2 (p < 0.01,r = 0.57)  and slightly decreased  in HFpEF  /p <0.5, r =0.34/. ROC analysis  shows the cut –of value of 29 % for PALS which correlated with AF events. Conclusions: PALS and GLS are significantly reduced in HFpEF patients and decreased in HFpEF. PALS provides additional ,prognostic value beyond LA volume and LAVI. Severe LV myocardial dysfunction and reduced GLS  and decreased PALS, even still normal LAVI is a prognostic  index for AF.
Right ventricular longitudinal systolic strain can predict new onset heart failure with preserved ejection fraction in hypertensive patients
Authors: Marketou M , Danelatos C , Maragkoudakis S , Patrianakos A , Zervakis S , Plevritaki A , Savva E , Fragkiadakis K , Kladou E , Kampanieris E , Kochiadakis G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Purpose

Accurate assessment of right ventricular (RV) systolic function is important, as it is an established prognostic marker in cardiac diseases. Speckle-tracking echocardiography is a sensitive tool for detection of subclinical left ventricular impairment in essential hypertension. We associated RV function using longitudinal peak systolic strain (GLS) in patients with essential hypertension with the risk of future development of heart failure with preserved ejection fraction (HFpEF).

Methods

 We performed a retrospective observational study that included 458 patients with essential hypertension (266 males, aged 63 ± 18 years) and 179 normotensives (100 males, aged 66 ± 15 years). Standard echocardiography was performed at the initial visit. 2D speckle tracking echocardiography with evaluation of longitudinal strain in each segment of the RV (basal:  RVLS-B; mid: RVLS-M, apical: RVLS-A) and global RV free-wall strain (RVLS-G) were also performed. We studied the cases of new onset HFpEF in hypertensive patients. 

Results

The median follow up was 85 months (22–122). RVLS-G, RVLS-B and RVLS-M were significantly impaired in hypertensives compared to controls (RVLS-G: -16.1 ± 9.7 vs -20.0 ± 5.1, RVLS-B: -11.7 ± 3.7 vs -20.6 ± 3.3, RVLS-M:-16.3 ± 5.4 vs -20.7 ± 4.9, p < 0.05 for all). No significant difference was detected for the RVLS-A (-20.1 ± 3.8 for hypertensives vs -21.31 ± 6.5 for controls, p = NS). Thirty two hypertensive patients developed HFpEF (7 %). A cut-off RVLS-G worse than -17 % was significantly associated with new onset HFpEF (p< 0.001) in those patients. A multivariate Cox regression analysis showed that RVLS-G had independent significant prognostic value for the risk of HFpEF (HR: 10.5, 95% confidence interval (CI): 7.3-25.4). 

Conclusions

Essential hypertension leads to a decrease of RVLS which is strong predictor of a new onset HFpEF. Future studies are needed to assess the significance of these findings and the effects of treatment.
Evaluation of RV-arterial coupling in advanced heart failure
Authors: Dias Ferreira Reis JP , Bras P , Ferreira V , Goncalves A , Pereira Da Silva T , Soares R , Timoteo AT , Galrinho A , Branco L , Ferreira R
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The ratio of echocardiography-derived tricuspid annular plane systolic excursion (TAPSE) and pulmonary arterial systolic pressure (PASP) - TAPSE/PASP ratio - is a noninvasive measure of RV-arterial coupling. TAPSE/PASP ratio is a potent independent predictor of prognosis in heart failure and pulmonary arterial hypertension, with a prognostic cutoff value of 0.36 mm/mmHg.

Objective

To assess the prognostic impact of TAPSE/PASP ratio in a population of advanced HF patients.

Methods

Prospective evaluation of adult patients with advanced HFrEF referred to our Institution for evaluation with HF team and possible indication for urgent heart transplantation (HT) or MCS. Patients were followed up for 2 years for the primary endpoint of cardiac death and HT. Echocardiographically determined TAPSE/PASP ratio was used to assess RV-arterial coupling and a survival analysis was performed to evaluate the prognostic impact of the suggested cutoff of 0.36 mm/mmHg.

Results

A total of 450 Heart Failure with Reduced Ejection Fraction (HFrEF) patients with a mean age of 56 ± 12 years, of which 80% are male, and with a mean LVEF of 29 ± 4%, mean TAPSE of 19 ± 3 mm and PASP of 38 ± 11mmHg. The mean TAPSE/PASP was 0.80 ± 0.28. Fifty-four patients (12%) met the primary endpoint. Patients with RV-arterial uncoupling (TAPSE/PASP < 0.36 mm/mmHg) were more likely to have a non-ischaemic etiology for HF (66.7% vs 40%, p = 0.047), had a lower prevalence of diabetes (53.3% vs 77.9%, p = 0.041), a higher prevalence of moderate-to-severe mitral regurgitation (33.3% vs 13.0%, p = 0.035), a lower LVEF (26.2 ± 6.1 vs 29.9 ± 5.9, p = 0.038), a higher prevalence of RV dysfunction (73.3% vs 26.7%, p < 0.001) and worse cardiopulmonary fitness (pVO2: 12.7 ± 5.1 vs 15.8 ± 6.0 ml/kg/min, p = 0.047; VE/VCO2 slope: 49.5 ± 17.2 vs 37.6 ± 9.7, p < 0.001; cardiorespiratory optimal point: 36.9 ± 11.3 vs 29.0 ± 6.4, p < 0.001). More patients in the group of TAPSE/PASP < 0.36 mm/mmHg met the primary endpoint (33.3% vs 9.6%, p = 0.034) and more patients underwent urgent HT (13.3% vs 1.4%, p = 0.44). RV-arterial coupling was associated with a lower survival free of events during follow-up (log-rank p = 0.010).

Conclusion

RV-arterial coupling predicts a worse prognosis in advanced HF patients, with those below a cutoff of 0.36 mm/mmHg having lower survival. This variable may improve risk stratification in this setting. Abstract Figure.
Echocardiographic assessment of mechanical dyssynchrony: are the new parameters better?
Authors: Puvrez A , Mirea O , Duchenne J , Bezy S , Wouters L , Beela AS , Donal E , Voigt J-U
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction - The high cost and important non-response rate are preventing optimal use of cardiac resynchronization therapy (CRT). Assessing mechanical dyssynchrony on echocardiography in candidates for CRT could remove these barriers by improving patient selection. In 2008 the PROSPECT study compared several old parameters of dyssynchrony in search of a reproducible parameter capable of better predicting response to CRT. Unfortunately, the results were disappointing and the assessment of dyssynchrony became discredited. Promising new parameters have been developed but a comparison with the old parameters is currently missing.

Purpose - To compare the old and new parameters of mechanical dyssynchrony for (1) their effect on response to CRT as additional selection criteria, (2) predicting favourable long-term outcome after CRT and (3) their reproducibility.

Methods - 146 CRT patients were analysed retrospectively in a multicentre setting. Mechanical dyssynchrony was assessed using three old parameters: septal-to-posterior wall motion delay (SPWMD), left ventricular filling time/cardiac cycle ratio (LVFT/RR), and intraventricular mechanical delay (IVMD); and three new parameters: systolic stretch index (SSI), myocardial work index (MWI), and visual presence of septal flash or apical rocking (SFoAR). Response to CRT was defined as a ≥15% decrease in LV end-systolic volume 1 year after CRT. For each parameter patients were categorized using previously published cut-offs as ‘eligible’ or ‘non-eligible’. The ‘non-eligible’ were considered untreated. Results were compared to the guidelines (Fig. 1). The hazard ratio (HR) for cardiac death within 5 years after implantation was computed for all patients (Fig. 2), and intra- and interrater agreement was determined.

Results - 73% (n= 107) of patients showed response to CRT. The old parameters maintained less than 75% of the original responders. SFoAR preserved the highest proportion of responders (93%), while reducing the number of non-responders by 39% (Fig. 1). The prediction of cardiac death was significant for SFoAR (HR = 0.29; 95% CI: 0.12-0.74; P = 0.009) and IVMD (HR = 0.32; 95% CI: 0.13-0.79; P = 0.014) (Fig. 2). Intra- and interrater agreement was best for SFoAR (κ = 0.89; 95% CI: 0.67-1.0 and κ = 0.78; 95% CI: 0.50-1.0 respectively). Interrater agreement was poor for all old parameters (κ < 0.6).

Conclusion - The new parameters for dyssynchrony are performing better. The visual presence of apical rocking or septal flash provided the most responders to CRT, predicted favourable long-term outcome and was highly reproducible. Our results show that future research should focus on the new parameters. Abstract Figure.  Abstract Figure.
Incremental prognostic value of vasodilator stress cardiovascular magnetic resonance over coronary computed tomography angiography in symptomatic patients
Authors: Pezel T , Hovasse T , Lefevre T , Sanguineti F , Unterseeh T , Champagne S , Benamer H , Neylon A , Toupin S , Garot P , Chevalier B , Garot J
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Current guidelines recommend to perform noninvasive functional imaging in patients with obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CCTA). However, the prognostic value of stress cardiovascular magnetic resonance (CMR) over traditional risk factors and CCTA is not known.

PURPOSE

To assess the incremental prognostic value of stress CMR beyond traditional risk factors and CCTA in patients with obstructive CAD on CCTA.

METHODS

Between 2008 and 2020, consecutive symptomatic patients without known CAD referred for CCTA were screened. Among those, patients with obstructive CAD (at least 1 ≥50% stenosis on CCTA) and referred for functional stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. Univariable and multivariable Cox regressions were performed to determine the prognostic value of CCTA and CMR findings.

RESULTS

Of 2,210 patients who completed the CMR protocol, 2,038 patients (46.5% male, mean age 69.8 ± 12.2 years) completed the follow-up (median 6.8 [IQR 5.9-9.2] years); 281 experienced a MACE (13.8%). Stress CMR was well tolerated without severe adverse events. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 4.51, [95%CI: 3.55-5.74]; and HR: 3.32, [95%CI: 2.55-4.32], respectively; both p < 0.001). In multivariable Cox regression, the presence of inducible ischemia and LGE were independent predictors of a higher incidence of MACE (HR: 3.97, [95%CI: 3.43-5.13]; HR: 2.30, [95%CI: 1.52-3.33]; respectively, both p < 0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors and CCTA findings (C statistic improvement: 0.08; NRI = 0.421; IDI = 0.047).

CONCLUSIONS

In symptomatic patients with obstructive CAD of unknown significance on CCTA, stress CMR has an incremental prognostic value to predict MACE over traditional risk factors and CCTA findings. Abstract Figure. Kaplan-Meier curves for MACE  Abstract Figure. Competitive risk analysis
Epicardial fat volume improves prediction of adverse clinical events
Authors: Viegas JM , Mano TB , Reis JP , Ramos R , Fiarresga A , Cacela D , Marques H , Figueiredo L , Ferreira RC
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Recent studies have demonstrated the potential of epicardial fat volume (EFV) to predict obstructive coronary artery disease (CAD), however its impact in clinical outcomes remains elusive.

Objectives

To assess the association between EFV and demo­graphic and morphometric data, coronary atherosclerotic burden and adverse events in a population of patients (pts) referred for coronary computed tomography angiography (CTA).

­Methods: Retrospective analysis of pts without known CAD referred for coronary CTA in a single tertiary care centre. A standardized protocol for quantification of EFV, thoracic fat volume (TFV), coronary artery calcification (CAC) and coronary angiography was performed. Endpoint was composite of cardiovascular death, nonfatal myocardial infarction and urgent hospitalization leading to revascularization at 12 months.

Results

72 pts were included, 58% male, mean age 67 ± 9 years. The prevalence of hypertension, dyslipidemia and diabetes was 75%, 82% and 24%, respectively. Median EFV was 101 (68) ml and total TFV 1504 (694) ml. EFV was directly related with age (rs= 0.42, p <0.001), male sex (135 ± 50 vs 78 ± 30, p <0.001), body mass index (rs= 0.32, p= 0.008) and TFV (rs= 0.27, p= 0.025). A positive correlation with CAC (rs= 0.47, p <0.001) and a significant association with CAD (116 ± 50 vs 90 ± 37, p= 0.029) and obstructive CAD (141 ± 60 vs 97 ± 39, p= 0.031) were demonstrated. Composite endpoint was observed in 13 pts (18%). After adjusting for all considered confounders, EFV remained an independent predictor of adverse events (OR: 1.015, 95%CI: 1.003-1.027, p= 0.041). ROC analysis of EFV (AUC 0.751, p = 0.005) allowed to estimate that EFV >124 ml had a sensibility and specificity to predict clinical outcomes of 69% and 71%, respectively.

Conclusion

EFV positively relates to coronary atherosclerotic burden. This study also advocates that EFV may improve risk stratification for clinical outcomes. Larger studies are required to evaluate these results. Abstract Figure 1
Right ventricular diastolic dysfunction in patients with coronary artery disease: frequency and associated factors
Authors: Sumin A , Korok EV , Sergeeva TYU
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. The prognostic value of right ventricle (RV) systolic dysfunction is known. Nearly all data on the importance of right ventricle function is notably focused on its systolic dysfunction, while right ventricle filling is far less studied, perhaps because of challenges in diastolic dysfunction assessment [1]. Independent prognostic value of RV diastolic dysfunction (RVDD) has been identified in certain clinical situations [2], but these studies are few in number. Therefore it is important to continue investigating the right ventricle diastolic function and clarify its possible clinical and prognostic significance in various groups of patients [3]. Thus, the purpose of this study was to assess the incidence of RVDD in patients with coronary artery disease (CAD) and to identify factors associated with its presence.

Material and Methods

200 patients with stable CAD (153 men) were enrolled in the study. Echocardiography was performed on a Vivid S5 ultrasound scanner (GE). We studied clinical data, left ventricular indices, RV systolic and diastolic parameters (Et, At, et", a"t, s"t, TAPSE, and RV Tei index). Depending on the presence or absence of RVDD, all patients were divided into 2 groups: Group 1 - patients with RVDD (n = 92; 64 [61; 69] years; 73 (79.4%) men) and Group 2 - patients without RVDD (n = 108; 63 [60; 67] years; 80 (74.0%) men).

Results. The RV diastolic dysfunction is much more common than its systolic dysfunction in patients with stable CAD (46% and 7.5%, respectively, Fig. 1). Old myocardial infarction (MI) (p = 0.007), anterior MI (p = 0.001), congestive heart failure (p = 0.030) and peripheral arterial disease (p = 0.030) were more prevalent in patients with RVDD. The end-systolic dimension were higher (p = 0.010), while left ventricular (LV) ejection fraction (EF) (p = 0.044) and the mitral E/A ratio (p < 0.001) were lower in this group. No significant differences were found between groups in the coronary artery stenosis. Independent predictors of the RVDD presence were increased age, old MI, hyperlipidemia, moderate chronic heart failure, peripheral arterial disease, and decreased LVEF. ROC-curves of studied left ventricular variables (LVEF, ratio E/A and E/e’) association with RVDD is presented in Fig. 2. The areas under the curves were less than 0.7 for all variables, which indicated an unacceptable ability to distinguish.

Conclusions. The RV diastolic dysfunction is much more common than its systolic dysfunction in patients with stable CAD. The RVDD presence was predominantly associated with an increase in age and LV systolic dysfunction, but not with coronary artery lesions. The predictive value of RVDD requires further research. Abstract Figure.  Abstract Figure.
Accidental diagnosis of significant coronary artery disease by cardiac CT scan to rule out left atrial appendage thrombus in patients with atrial fibrillation during COVID19 pandemic
Authors: Szedlacsek Z , Herczku F , Kozma I , Vertesaljai M , Andreka P
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The exclusion of left atrial appendage (LAA) thrombus prior to urgent electrical cardioversion (DCCV) for atrial fibrillation (AF) is traditionally performed by transesophageal echocardiography (TEE). During the COVID19 pandemic, TEE was replaced by cardiac CT (CCT) due to its high aerosol generating property, which in addition to assessing the anatomy of the heart, can also be used to evaluate the coronary arteries at the same time.

Methods

In our retrospective study, we evaluated the cardiac CT scans of patients undergoing DCCV in our institution between January 1, 2020 and February 28, 2021 for coronary artery disease (CAD). The scans were performed by a GE Revolution 256-slice CT scanner.

Results

CCT scans were performed in 32 patients to rule out LAA thrombus (24 male; 8 female; age: 61.8 ± 11.2 years; BMI: 29.2 ± 4.4; heart rate: 79.2 ± 24.4 1/min; CHA2DS2VASc score: 2.4 ± 1.5). The mean radiation exposure of the scans was DLP: 356.3 ± 130.1 mGy-cm; effective dose: 5.0 ±1.8 mSv, Ca-score: 361.4 ± 883.0. In 4 equivocal cases TEE was also performed with negative results. No CAD was confirmed in 7 cases, mild CAD in 14 patients. CCT was not diagnostic only in 4 cases. Significant (moderate or severe) CAD was detected in 7 cases, invasive coronary angiography (ICA) was also performed in 5 cases. In 2 cases significant one-vessel disease, in 2 other cases borderline (FFR: 0.81 and 0.84) stenosis and in 1 case only mild CAD was diagnosed by ICA.

Conclusions

CCT scans performed by our 256-slice CT scanner for AF can identify patients,

who require further invasive or invasive and functional coronary artery assessment with

satisfactory accuracy. In terms of coronary artery disease, the non-diagnostic scan rate was

low, despite the presence of arrhythmia, suboptimal heart rate and higher than usual Ca-score.
Prognostic value of coronary artery calcium score in hospitalized COVID - 19 patients
Authors: Motoc A , Luchian ML , Lochy S , Belsack D , Magne J , Roosens B , De Mey J , Boeckstaens S , Van Den Bussche K , Geers J , Galloo X , Francois C , Weytjens C , Droogmans S , Cosyns B
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The association of known cardiovascular risk factors with poor prognosis of coronavirus disease 2019 (COVID-19) has been recently emphasized (1). Coronary artery calcium (CAC) score is considered a risk modifier in primary prevention of cardiovascular disease and has shown to improve cardiovascular risk prediction in addition to classical risk factors (2). 

Purpose

We hypothesized that the absence of CAC might have an additional predictive value for an improved cardiovascular outcome of hospitalized COVID-19 patients.

Methods

We prospectively included 310 consecutive hospitalized patients with COVID-19. Thirty patients with a history of coronary artery disease were excluded. Low dose non - contrast chest computed tomography (CT) was performed in all patients at admission. Visual assessment of CAC in every coronary artery was obtained by using an ordinal scoring of 0, 1, 2 or 3 corresponding to absent, mild, moderate or severe CAC score. A total score was calculated by summing the score of each vessel, which was further categorized as 0 (undetectable), 1-3 (mild), 4-5 (moderate) and ≥ 6 (severe). (Figure 1). Demographics, medical history, clinical characteristics, laboratory findings, imaging data, in-hospital treatment, and outcomes were retrospectively analyzed. A composite endpoint of major adverse cardiovascular events (MACE) was defined as all - cause mortality, heart failure, acute coronary syndrome, atrial fibrillation and stroke.

Results

Two hundred eighty patients (63.2 ± 16.7 years old, 57.5% male) were included in the analysis. One hundred thirty one (46.7%) patients had a CAC score of 0. MACE rate was 21.8% (61 patients). Multivariable logistic regression showed that the absence of CAC was inversely associated with MACE (OR 0.209, 95% CI 0.052–0.833, p = 0.027), with a negative predictive value of 84.5% (sensitivity 72%, specificity 55%), independent of age, risk factors or disease severity (Figure 2).

Conclusion

The absence of CAC had a high negative predictive value for MACE in patients hospitalized with COVID-19, independent of the presence of cardiac risk factors or disease severity. These findings reinforce the idea that the assessment of CAC could be a useful marker for risk stratification and management of COVID - 19 patients. Future directions should focus on the implementation of CAC score into mid - term and long - term follow - up of this particular population, to provide a more precise and earlier estimation of cardiovascular risk. Abstract Figure.  Abstract Figure.