bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of diastolic function parameters in transthoracic and transoesophageal echocardiography in patients under mechanical ventilation
Authors: Trauzeddel R , Sieber V , Adamsen A , Greiner A , Berger C , Treskatsch S
Published: January 2025

Background

Hemodynamically focused echocardiography in the perioperative setting allows for the evaluation of cardiovascular function and hemodynamic optimisation in heart failure, especially in heart failure with preserved ejection fraction (HFpEF). However, little is known about the comparability of the Doppler methods for the assessment of left ventricular diastolic function in transoesophageal (TEE) and transthoracic echocardiography (TTE) in intubated patients.

Purpose

The aim of the study was to investigate the comparability of Doppler parameters for the assessment of left ventricular diastolic function in mechanically ventilated patients.

Methods

This study was approved by the institutional ethics committee (Charité – Universitätsmedizin Berlin, EA 4/134/21) and registered at the German Clinical Trials Register (DRKS, DRKS-ID DRKS00027554). A hemodynamically focused TTE and TEE examination was conducted directly one after the other by an experienced examiner under consistent and equal cardiopulmonary conditions in invasively ventilated patients following the induction of general anaesthesia and prior to the commencement of non-cardiac surgery. Diastolic parameters were measured either directly by the examiner or subsequently using the workstation TomTec-Arena version 2.51.04 without Doppler angle corrections. The parameters compared included peak E-wave velocity, peak A-wave velocity, E/A ratio, pulsed-wave tissue Doppler e' average velocity and E/e' average ratio. For quantitative data mean ± standard deviation (SD) are presented. For comparability analyses relative differences (RD) and intraclass correlation coefficients (ICC) as well as Bland-Altman plots assessing the bias and 95% limits of agreement are presented which were calculated using SPSS version 29 and GraphPad PRISM version 9.

Results

17 female and 36 male patients were examined with an age of 66.3 ± 11 years. There was moderate to excellent agreement between the two image modalities (E-wave: RD=3.6±26.5%, ICC=0,816; A-wave: RD=5.3±27.3%, ICC=0.749; E/A: RD=-1.6±32.2%, ICC=0.716; e’ septal: RD=3.9±28.2%, ICC=0.633; e’ lateral: RD=2.6±32.6%, ICC=0.521; e´ average: RD=2.1±22.4%, ICC=0.762; E/e’ septal: RD=-0.8±28.3%, ICC=0.888; E/e’ lateral: RD=0.5±37.4%, ICC=0.817; E/e’ average: RD=0.2±27.2%, ICC=0.920). Bland-Altman plots showing the comparability are displayed in Figure 1.

Conclusion

In the perioperative setting TEE may be used for the evaluation of diastolic function in intubated patients under general anesthesia.
Phenotyping atrial and ventricular secondary tricuspid regurgitation based on aetiologies: insights from the CARE-TR registry
Authors: Lupi L , Antonioli E , Praderio A , Saccani N , Stanskowski K , Cocciani D , Pagliaro B , Tomasoni D , Pagnesi M , Mangieri A , Stolfo D , Sinagra G , Adamo M , Metra M
Published: January 2025

Purpose

To report prevalence and clinical outcomes of different phenotypes of atrial and ventricular secondary tricuspid regurgitation (ASTR; VSTR) enrolled in a prospective observational registry.

Methods and Results

The Consecutive pAtients with seveRE Tricuspid Regurgitation evaluated in Heart Failure (HF) and Valve Clinics (CARE-TR) registry collected data from patients with at least severe tricuspid regurgitation (TR) enrolled at 3 Italian Centres between January 2020 and December 2022. The present analysis includes 648 patients with secondary TR (STR), 143 (22.1%) with ASTR and 505 (77.9%) with VSTR. Patients with ASTR were further stratified in those with atrial fibrillation (AF, 25.1%), HF with preserved ejection fraction (HFpEF, 37.8%), and both (37%). Patients with VSTR were subdivided into those with severe left-sided valvular heart disease (LS-VHD, 28.5%), HF with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF, 29.1%), HFpEF (35.5%), precapillary pulmonary hypertension (PH, 4.0%) and isolated right ventricular (RV) dysfunction (2.9%). After a median follow-up of 498 days (IQR 379-676) 118 (18.2%) patients died and 153 (23.6%) were hospitalized for HF. Two-year survival free from death or HF hospitalization was higher in the patients with ASTR compared with those with VSTR (73.5% vs 54.4%; p<0.001). After adjustment for variables related with HF severity, VSTR remained independently associated with an increased risk of events (adjusted HR 2.00; CI 95% 1.36-2.95; p<0.001). Among ASTR patients, combined AF and HFpEF was associated with a poorer outcome compared with AF or HFpEF alone (60.2% vs 80.5% vs 83.6%, p=0.022). Among patients with VSTR, overall survival free from the composite outcome was 85%, 65%, 54%, 39% and 38% for RVD, HFpEF, HFrEF/HFmrEF, severe LS-VHD, and pre-capillary PH, respectively (p<0.001).

Conclusions

In a real-world population with at least severe STR, 22% had ASTR and showed better outcomes as compared to VSTR. Among patients with ASTR, combination of AF and HFpEF was common and associated with the worst prognosis. Among patients with VSTR, those with pre-capillary PH had the poorest outcomes, followed by those with LS-VHD.
Identification of risk phenogroups among patients with moderate-to-severe tricuspid regurgitation by unsupervised cluster analysis
Authors: Radu D N , Badano L P , Penso M , Tomaselli M , Clement A , Gavazzoni M , Hadareanu D R , Delcea C , Fisicaro S , Parati G , Muraru D
Published: January 2025

Background

Assessing the individual risk of patients with secondary tricuspid regurgitation (STR) is challenging as it requires integrating disease severity and mechanism with different clinical and imaging characteristics. Several scores and cluster analysis have recently been proposed, almost all of them using visual estimation or conventional echocardiography for the evaluation of right ventricle (RV) size and function. However, advanced echocardiography has been scarcely used so far in this context.

Purpose

We sought to identify the different phenogroups of STR using unsupervised cluster analysis and assess their association with clinical outcomes.

Methods

We included 558 consecutive patients (mean age 74±14 years, 54.7% women) with moderate and severe STR who underwent comprehensive two-, three-dimensional, and speckle-tracking echocardiography. The primary endpoint was a composite of heart failure hospitalization and all-cause mortality. Four unsupervised algorithms were used to cluster STR patients based on 16 variables recruited from demographics or echocardiographic domains, routinely obtained for the assessment of STR or having prognostic value.

Results

Over a median follow-up of 16.5 months, 215 patients reached the composite endpoint. A cluster analysis divided the patients into three phenogroups with distinct characteristics: Phenogroup 1 "lowest-risk STR" (rate of event-free survival at two years: 80±3%) with moderate STR, preserved RV size and function, and moderately dilated but normofunctional RA; Phenogroup 2 "intermediate-risk STR (hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.14-4.92, p=0.02) characterized by older age, severe STR, mildly dilated but uncoupled RV; and Phenogroup 3 "highest-risk STR" (HR 3.83, 95% CI 1.94-7.54, p<0.001), characterized by younger age, massive-torrential TR, severely dilated and overtly dysfunctional RV, and dysfunctional RA. After adjusting for multiple variables, the clustering analysis remained independently associated with the composite endpoint (HR 1.40, 95% CI 1.13–1.70, p=0.002, for each increased-risk phenogroup). Additionally, a supervised machine learning model was developed to assist clinicians to assign patients to one of the three phenogroups. The model successfully matched each patient with an accuracy of 0.91, precision 0.91, recall 0.91, and F1 score of 0.91.

Conclusions

The unsupervised cluster analysis has identified three risk phenogroups with distinct characteristics and different risk of experience death or hospitalization for HF which could potentially assist clinicians in developing more personalized treatment and follow-up strategies for STR patients.

Figure 1

Figure 2
Challenging sacred cows: does left ventricle end-systolic and end-diastolic diameter change significantly in long term follow up of patients with severe aortic regurgitation ?
Authors: Schwartzenberg S , Bental T B , Vaturi M V , Shapira Y S
Published: January 2025

Background

American and European valvular heart disease guidelines suggest considering aortic valve surgery in patients with severe aortic regurgitation (AR) and progressive increase in left ventricle (LV) end diastolic diameter (LVEDD) into the severe range or progressive decrease in LV function. Surprisingly, there are almost no studies that actually examined systematically the rate of change over time in these widely used parameters in clinical practice in patients with severe AR.

Purpose

determine the rate of change in LVEDD, left ventricular end systolic diameter (LVESD) and fractional shortening (FS) in patients with significant AR over a long period of time.

Methods

we considered all consecutive patients with at least moderate to severe AR on index transthoracic echo study and at least four subsequent echo studies over a follow-up period longer than 1.5 years in a large tertiary hospital registry between April 1994 and April 2024. Exclusion criteria were concomitant greater than mild to moderate aortic stenosis or mitral valve disease, aortic dissection, previous aortic or mitral surgery, hypertrophic cardiomyopathy or complex congenital heart disease on index study. Aortic valve replacement (AVR) or death terminated follow-up in this study. Partial correlation corrected for repeated measures was determined for LVEDD/LVESD/FS and interval period (in days) between repeat studies.

Results

We included a cohort of 140 patients meeting the inclusion criteria study after excluding 31 patients as per above criteria. Aortic valve was bicuspid in 39 (27.9%) of the patients, and unicuspid in 4 (2.9%) patients. Median follow-up was 4.4 years (interquartile range (IQR) 1.9 to 8.8 years), median interval between consecutive studies was 255 days (IQR 172 to 367 days), 35 (25%) patients died and 61 (43.6%) patients underwent AVR. Partial correlation coefficients and p values for LVEDD, LVESD, and FS were respectively -0.3 (p<0.0001), -0.032 (p=0.24), and -0.18 (p<0.001).

Conclusions

Contrary to conventional wisdom, we didn’t find a significant trend of dilatation in left ventricular end diastolic and end-systolic LV diameter in patients with ≥ moderate to severe AR over a long follow-up, but a weak trend of fractional shortening decrease over time was noted. These findings cast doubt on the utility attributed to change in these parameters as part of the routine clinical follow up of patients with significant AR.

LVEDD and LVESD change over time
Cardiac biomarkers in patients with systemic lupus erythematosus: association with valvular heart disease and utility for routine screening
Authors: Cocolea S , Delcea C , Badea-Lupasteanu I , Buzea C A , Dima A , Soium E , Badila E , Dan G A
Published: January 2025

Background

Valvular heart disease (VHD) is more prevalent in patients with systemic lupus erythematosus (SLE) compared to the general population, determined by direct autoimmune involvement as well as early valvular degeneration, and is associated with higher morbidity and mortality.

Purpose

We aimed to assess the utility of cardiac biomarkers in screening SLE patients for the early detection of VHD.

Methods

This observational prospective cohort study included consecutive adult SLE patients evaluated in our Cardiology Department between August 2021 and May 2024. Clinical data, echocardiography and laboratory parameters including NT-proBNP and high-sensitivity cardiac troponin T (hsTnT) were obtained. Patients with left ventricular ejection fraction ≤50% were excluded. Echocardiographic diastolic dysfunction (DD) was defined according to the 2016 ASE/EACVI guidelines.

Results

Our cohort included 86 SLE patients (mean age 53±12 years, 96% female, 30% with moderate VHD, 41% DD). Median disease duration was 13[IQR 4-21] years.

NTproBNP was associated with DD, mitral regurgitation (MR), aortic regurgitation (AR), and mitral stenosis (MS) (Table 1), but not with ischemic heart disease (IHD) (AUC 0.560, p=0.61), arterial hypertension (HTN) (AUC 0.553, p=0.43), or diabetes mellitus (DM) (AUC 0.637, p=0.29).

hsTnT was associated with DD, MR, AR, MS (Table 1), with IHD (AUC 0.749, p=0.004) and pericardial disease (PD)(AUC 0.736, p=0.002), but not with HTN (AUC 0.612, p=0.12), DM (AUC 0.524, p=0.86).

Association of NTproBNP and hsTnT and VHD was documented for patients with and without DD (Table 1).

In multiple linear regression models adjusted for age and DD, MR (p=0.038), MS (p<0.001), AR (p=0.017) were independent predictors of NTproBNP levels.

In multiple linear regression models adjusted for age, DD, PD, and IHD, MS (p<0.001) and AR (p=0.032) were independent predictors of hsTnT levels.

Conclusions

Increased levels of NTproBNP and hsTnT in SLE patients should prompt echocardiographic evaluation and screening for VHD and DD.
infective endocarditis - what contributes to a bad outcome?
Authors: Milic G , Mladenovic Z M , Ciric N C , Djuric P D J , Jovic Z J , Djuric I D J
Published: January 2025

Introduction

The diagnosis and treatment of infective endocarditis is a major challenge. The clinical course depends on the causative agent, the presence or absence of previous cardiac disease, artificial valves or implantable intracardiac devices, and the mode of presentation.

Purpose

To determine the 30-day mortality rate in patients with infective endocarditis.

Determine the mortality rate of patients after one year from the diagnosis of infective endocarditis.

Statistical analysis is used to assess the correlation between the characteristics of patients determined at admission and 30-day, i.e. mortality one year after diagnosis.

Determine the clinical significance of the results obtained in the diagnosis and treatment of patients with infective endocarditis.

Method

A prospective study analyzed patients with infective endocarditis treated between 2017 and 2023. The study included 59 patients with infective endocarditis with an average age of 62.4 ± 16.0 years, the representation of the male sex was twice as high. A total of 18 patients had artificial valves, of which 18 had an aortic valve, and two had an aortic and mitral prosthetic valve, 10 patients had a previously implanted pacemaker.

Results

In 19 patients, there was a fatal outcome after one month, with a mortality rate of 32%, and after one year, the fatal outcome occurred in 32 patients, with a mortality rate of 59%.

Predisposing factors independently associated with a higher probability of death after the one-month period were heart failure as a complication of infective endocarditis (OR = 0.025, 95% CI OR = 0.01-0.26, p = 0.002) and a higher number of days of hospitalization (OR = 1.160, 95% CI OR = 1.05-1.28, p = 0.003).

Predictors of death one year after diagnosis were the age of the patient, the presence of a congenital bicuspid aortic valve, uncontrolled infection and heart failure as complications of infective endocarditis, as well as a number of days until the ventilator. Independent predictors of one-year mortality were the presence of bicuspid aortic valve (OR = 33,500.95% CI OR = 1.26-887.90, p = 0.036) and a higher number of days to ventilator (OR = 0.536.95% CI OR = 0.32-0.90, p = 0.018).

Conclusion

An increased mortality rate in patients with infective endocarditis was present in those who had previously been highly febrile for a long period of time due to untimely diagnosis and subsequent treatment, in the elderly population, most likely due to a large number of comorbidities, then in patients with congenital heart defects, in those with previously implanted artificial valves or intracardiac electronic devices.

Factors associated with one-month death

Factors associated with one-year death f
TRIVO score: a new tool for predicting outcome in patients with secondary tricuspid regurgitation.
Authors: Tomaselli M , Penso M , Badano L , Clement A , Radu N , Heilbron F , Oliverio G , Baratto C , Caravita S , Springhetti P , Ciambellotti F , Fisicaro S , Pece C , Parati G , Muraru D
Published: January 2025

Background

Predicting outcomes in patients with significant secondary tricuspid regurgitation (STR) is extremely challenging.

Purpose

This study sought to develop and validate the TRIVO-SCORE, utilizing advanced echocardiographic parameters, for predicting hospitalization for heart failure (HF) and mortality in moderate and severe STR patients.

Methods

We retrospectively studied 504 consecutive STR outpatients (mean age 74 ± 13 years, 44% men), randomly divided into derivation (49%) and validation (51%) cohorts. The primary endpoint included all-cause death and/or heart failure HF hospitalization, whereas the secondary endpoint focused on HF hospitalization or all-cause death. Score discrimination was assessed using time-dependent area under the receiver operating characteristic curve (AUROC), and calibration was evaluated via the Hosmer-Lemeshow goodness-of-fit test. In a subset of patients (162/504, 29%) with severe STR and comprehensive clinical, laboratory, and echocardiographic data, we compared TRIVO-SCORE with TRI-SCORE and TRIO-SCORE.

Results

After Multivariable Cox Regression Analysis, four variables were incorporated into the final model: moderate to severe chronic kidney disease (CKD, GFR <30 mL/min), effective Right Ventricular Ejection Fraction (eRVEF <20%), right Ventricular free wall longitudinal strain/pulmonary artery systolic pressure (RVFWLS/PASP) <0.48, and effective regurgitant orifice area (EROA) >0.41cm². The final score ranged from 0 to a maximum of 5 points.

The TRIVO-SCORE demonstrated satisfactory performance in both the derivation cohort (AUROC 0.78, 95% CI 0.73-0.84) and the validation cohort (AUROC 0.71, 95% CI: 0.65-0.77) at 2-year. TRIVO-SCORE accurately predicted separate endpoints for HF hospitalization or mortality. Per each point of TRIVO-SCORE, the risk of experiencing the composite endpoint increased by 1.5 times (HR 1.55 [95% CI 1.35–1.80], p<0.001, for each stage increase). This progressive increase in risk persisted when stratifying the population into atrial and ventricular STR. The discrimination and calibration for mortality prediction were superior to those of TRI-SCORE (1) (AUROC 0.61) and TRIO-SCORE (2) (AUROC 0.57).

Conclusions

The TRIVO-SCORE, integrating both clinical and advanced echocardiographic variables, proved to be a robust tool for enhancing risk stratification in patients with moderate to severe STR, providing a stronger association with outcomes than previously validated risk scores.
The change of mean transmitral pressure gradient and mitral valve area after transcatheter edge-to-edge repair by G4 clips in japanese patients
Authors: Miyoshi T , Soejima N , Yoshida A , Matsuzoe H , Yamada N , Fujita K , Kawamura T , Nakazawa G
Published: January 2025

Background

Transcatheter Edge-to-edge repair (TEER) using the MitraClip is widely used to treat mitral regurgitation (MR). The evaluation of postprocedural mitral stenosis is important in addition to the reduction of MR. Some papers showed the effect of TEER on mitral valve area (MVA) and mean transmitral pressure gradient (tmPG), but those studies were performed in hospitals in Europe or the United States in the G2 clip era. In addition, the data on the relationship between MVA and mean tmPG is limited. Moreover, the study on the changes of those parameters by TEER in patients other than Europe and the United States is scarce. The current study aims to seek the changes in MVA and mean tmPG by TEER using the MitraClip and the relationship between those parameters in Japanese patients.

Methods

The patients with significant MR receiving TEER treatment between June 2023 and May 2024 in our hospital were included. The three-dimensional images of mitral valve and mean tmPG were acquired by transesophageal echocardiography (TEE) during the TEER procedure. The MVA before and after clip implantations (MVApre and MVApost) were retrospectively measured using dedicated software (Qlab, Philips). The reduction rate of MVA (change ratio between MVApre and MVApost) compared between degenerative (DMR) and functional MR (FMR), and also examined the relationship between MVApost and mean tmPG after TEER.

Results

Thirty patients received TEER using the MitraClip in our hospital between June 2023 and May 2024. One patient had two procedures on separate days because of worsening MR and another patient had cardiac surgery during the procedure because of an intraoperative complication. The images during the procedure were inadequate for MVA analysis in one patient. Accordingly, this study included 28 patients who have completed TEER treatment as a first session. Eight and 20 patients were classified as degenerative (DMR) and functional MR (FMR). The MVApre, MVApost, and the reduction rate of MVA were 4.51±1.53cm2, 1.96±0.78cm2, and 55±15%, respectively. The reduction rate of MVApost between DMR and FMR was similar (53±21% and 56±12%, respectively). There was no significant correlation between MVApost and tmPG after TEER even if dividing into two MR groups. However, DMR had a better correlation than FMR.

Conclusions

The reduction rate of MVA was similar between DMR and FMR. MVApost had no significant association with mean tmPG after TEER. Our study included a small number of patients. Further study is needed to deepen the insight into the relationship between MVA and tmPG.
Regional left ventricle strain outperforms global longitudinal strain in predicting late gadolinium enhancement in arrhythmogenic cardiomyopathy
Authors: Martini M , Cozac D A , Amato F , Savo M T , Lassandro E , Mattesi G , Rigato I , Perazzolo Marra M , Bauce B , Pergola V
Published: January 2025

Background

Arrhythmogenic cardiomyopathy (AC) is a genetically determined heart muscle disease characterized by myocyte necrosis and consequent fibro-fatty replacement. The recognition of fibrosis is a relevant finding with important diagnostic and prognostic implications. Speckle tracking echocardiography (STE) may be more accurate than conventional echocardiography in detecting early myocardial alterations that need to be confirmed with the gold standard technique, cardiac magnetic resonance (CMR).

Purpose

The aim of our study is to evaluate if STE-derived strain analysis can predict the presence of fibrosis on CMR in the corresponding segment.

Methods

86 patients with AC (including right/left dominant and biventricular forms) underwent advanced echocardiography with STE-derived strain analysis and CMR. Using a 17-segment Bull's-eye model, the cut-off value that best predicts the presence of gadolinium enhancement on CMR was determined for each wall segment using ROC curve analysis.

Results

The medium age was 45 (32-58) years, male gender was prevalent 71%. Among our patients, 44.1% had a biventricular form, 26.7% had a right-dominant form, 26.7% had a left-dominant form, and 2.3% had a borderline diagnosis. Regarding cardiovascular risk factors, 11.6% of patients had arterial hypertension, 15.1% had dyslipidemia, 2% had diabetes, 1% were smokers and 1% had coronary artery disease with previous percutaneous revascularization. The mean left ventricle (LV) ejection fraction (EF) was preserved 59% (54-64), while the medium LV global longitudinal strain (GLS) was slightly reduced, -18.2% (-20.1 to -15.2). A detailed analysis of regional wall strain was performed, and ROC curve analysis was used to determine a cut-off value for each segment to predict the presence of fibrosis on CMR in the corresponding segment, as shown in Table 1. Lower-than-average values demonstrated good accuracy in predicting the presence of fibrosis on CMR.

Conclusions

STE-strain analysis is a clinically accessible tool that enhances the sensitivity of echocardiography in detecting myocardial tissue alterations in AC, which would otherwise be identifiable only through CMR. Notably, even when GLS is within normal limits, regional strain sub-analysis can additionally reveal myocardial involvement.

Table 1
Prognostic value of noninvasive coronary flow reserve during dobutamine provocation in patients with myocardial bridging in long-term follow-up
Authors: Aleksandric S , Djordjevic-Dikic A , Djordjevic-Dikic A , Giga V , Tesic M , Banovic M , Juricic S , Boskovic N , Vukcevic V , Tomasevic M , Stojkovic S , Orlic D , Nedeljkovic M , Stankovic G , Beleslin B
Published: January 2025

Background

Recent studies showed that noninvasive coronary flow velocity reserve (CFR) measurement during inotropic stimulation with dobutamine (DOB) provides more reliable functional evaluation of myocardial bridging (MB). Additionally, a CFR cut-off value <2.1 during DOB was found to be the most reliable for the identification of MB associated with stress-induced myocardial ischemia. However, studies of clinical outcomes during long-term follow-up associated with the use of noninvasive CFR are lacking. The aim of the study was to evaluate major adverse cardiac events (MACE: unstable angina [UA] that required hospitalization, non-fatal myocardial infarction [MI], and all-cause mortality) associated with established CFR ischemic threshold during long-term follow-up.

Methods

This study included 79 patients (54 males, mean age 55±10 years) with angiographic evidence of isolated MB on the left anterior descending artery and systolic compression ≥50% diameter stenosis assessed by quantitative coronary angiography. CFR at peak DOB (30-40 μg/kg/min) was measured in the distal segment of LAD, and patients were divided into two groups according to previously validated CFR threshold of <2.1. Patients were monitored (ambulatory, hospital, and by telephone) for the occurrence of MACE over a median follow-up 8.2 years (interquartile range: 4.4 to 9.2 years) after enrollment.

Results

A total of 22 events were occurred in 20 patients: UA that required hospitalization in 20 patients (25%), nonfatal-MI in 1 patient (1.2%), and death in 1 patient (1.2%). The group of MB-patients with CFR <2.1 had 3.9 times higher rate of MACE during long-term follow-up in comparison to the group of MB-patients with CFR >2.1 (HR 3.90; 95% CI: 1.673-9.072; p=0.002). This was mainly driven by a 4-fold higher rate of UA that required hospitalization (HR 4.33; 95%CI: 1.773-10.589; p<0.001).

Conclusion

In MB-patients, CFR <2,1 during DOB provocation is associated with a significantly higher rate of UA that required hospitalization, whereas long-term prognosis with respect to death and nonfatal-MI was similar in both groups.
Prognostic value of right ventricular myocardial work in patients with pulmonary arterial hypertension
Authors: Pace N P , Selton-Suty C S , Filippetti L F , Fraix A F , Huttin O H , Mandry D M , Odille F O , Chabot F C , Chaouat A C , Valentin S V
Published: January 2025

Background

Right ventricular function is a key determinant of survival in patients with pulmonary arterial hypertension, with right heart failure being the leading cause of death. ESC/ERS guidelines recommend evaluating RV function at diagnosis and at first reevaluation under treatment to estimate the one-year mortality risk (1). However, few RV function markers address both systolic function and afterload. Noninvasive myocardial work is a promising new tool that incorporates both systolic function and its afterload by creating pressure-strain loops (2). The study aims to evaluate the association of RV myocardial work parameters with the estimated one-year mortality in patients with PAH.

Methods

This retrospective study included patients diagnosed with PAH who had transthoracic echocardiography and right heart catheterization within 48 hours at diagnosis and first reevaluation. Patients with unanalyzable echocardiography data were excluded.

Results

The study included 30 PAH patients and 28 healthy subjects for comparison. Myocardial work parameters (global work index, global constructive work, global wasted work and global work efficiency) were significantly different between PAH patient and healthy subjects. Between diagnosis and first reevaluation, myocardial work parameters showed improvement in most patients. However, patients without global wasted work improvement had a higher risk of estimated one-year mortality and a poorer transplantation-free survival.

Conclusions

Evaluating RV myocardial work at diagnosis and first reevaluation via TTE is feasible and can detect subclinical systolic dysfunction. Myocardial work parameters, and especially global wasted work appear to correlate with the prognosis of PAH patients, justifying larger-scale studies to confirm these findings and determine their prognostic value relative to other markers.
The value of global longitudinal strain and myocardial work indices in the early detection of left ventricular systolic dysfunction in patients with acute myocarditis
Authors: Kalesi A , Kasinos N , Gardikioti V , Karakosta M , Ntiloudi D , Zampelis D , Ntalekou K , Arnas N , Plaitis A , Skantzikas P , Archontikis A , Konstantara A , Destounis A , Patsourakos N , Theodosis - Georgilas A
Published: January 2025

Background/introduction

Conventional transthoracic echocardiography (TTE) is found to have limited sensitivity in detecting myocardial damage in patients with acute myocarditis and preserved left ventricular ejection fraction (LVEF).

Purpose

This study aimed to investigate the role of global longitudinal strain (GLS) and myocardial work (MW) echocardiographic indices in the identification of subclinical left ventricular systolic dysfunction in patients with acute myocarditis.

Methods

The study retrospectively included all patients admitted to the cardiology clinic of a tertiary hospital between December 2019 and May 2024, with suspected myocarditis, preserved ejection fraction, negative findings for coronary artery disease on coronary angiography or coronary computed tomography angiography, and whose diagnosis of myocarditis was confirmed by cardiac magnetic resonance imaging (CMR) using the Lake-Louise criteria. Gender and age-matched healthy individuals were also enrolled. The echocardiographic parameters assessed included global longitudinal strain (GLS) and myocardial work indices, specifically Global Work Efficiency (GWE), Global Work Index (GWI), Global Wasted Work (GWW), and Global Constructive Work (GCW). Statistical analysis was performed using non-parametric tests (Mann-Whitney test) and the predetermined level of statistical significance was set at p<0.05.

Results

A total of 41 patients (34 males – 82.9%) and 32 healthy controls (25 males – 78%) were included in the study. The median age in the patient group was 28 years (range 16-46 years), and in the healthy controls group, it was 29 years (range 17-48 years). In the patient group, the median values were as follows: GLS -18%, GWE 96%, GWI 1636 mmHg%, GWW 66 mmHg%, and GCW 1842 mmHg%. In the healthy controls group, the median values were GLS -19.6%, GWE 96%, GWI 1856 mmHg%, GWW 76 mmHg%, and GCW 2095 mmHg%. Patients showed significantly lower absolute values of GLS (p=0.014), GWI (p=0.023), and GCW (p=0.005) compared to healthy individuals. There were no statistically significant differences found for GWE and GWW values between the two groups.

Conclusion

Our study suggests that GLS, GWI, and GCW indices may be valuable in the early detection of left ventricular dysfunction in patients with myocarditis and preserved ejection fraction. Larger epidemiological studies are needed to further validate these findings.
Left atrial stiffness difference between beta thalassemia major and sickle cell disease patients
Authors: Gialeli F , Patsourakos D , Dimitroglou Y , Delicou S , Xydaki K , Aggeli C
Published: January 2025

Introduction

Diastolic dysfunction emerges as the earliest cardiac abnormality in individuals with hemoglobinopathies including sickle cell disease (SCD) and β-thalassemia major (β-ΤΜ). In symptomatic patients with hemoglobinopathies, Heart Failure with preserved Ejection Fraction (HFpEF) stands out as the predominant cardiac phenotype. Left Atrial Stiffness Index (LASI) has been established as a prognostic indicator in HFpEF patients.

Purpose

To investigate potential LASI differences between SCD and β-ΤΜ patients.

Methods

In this cross-sectional study, thirty-four SCD patients (mean age 46.6 ± 15.6 years, 44.2% males), sixty, age- and sex-matched, patients with β -ΤΜ, and twenty-nine, age- and sex-matched, controls were enrolled. Various echocardiographic parameters, including left ventricular ejection fraction (LVEF), early mitral inflow velocity to basal septal early diastolic velocity ratio (E/e’), left atrial volume index (LAVI), tricuspid valve regurgitation velocity (TVR), and left atrial deformation at reservoir phase (LASr), were calculated. LASI was derived as the [E/e’]/[LASr] ratio. Patients with LVEF <50% were systematically excluded. Diastolic dysfunction was established based on 2016 ASE/EACVI Guidelines and Standards.

Results

LASI was greater in β-ΤΜ patients compared to both SCD patients (0.30 ± 0.22 vs 0.22 ± 0.11, p = 0.006) and controls (0.30 ± 0.22 vs 0.18 ± 0.06, p = 0.002). No statistically significant difference was observed between SCD patients and controls. Among SCD patients, those with diastolic dysfunction (n = 12) demonstrated elevated LASI (0.31 ± 0.10 vs 0.16 ± 0.04, p = 0.001) and reduced LASr (24.50 ± 3.20 vs 51.50 ± 11.20, p = 0.001) compared to those without diastolic dysfunction. Moreover, SCD patients with diastolic dysfunction had a higher LASI value (0.31 ± 0.10 vs 0.16 ± 0.06, p = 0.001) compared to controls.

Conclusions

There is significant difference in terms of left atrial stiffness between β-ΤΜ and SCD. A possible explanation could be the regular blood transfusions in β-ΤΜ patient group that could contribute to the increased left atrial stiffness in these patients.
Evaluation and comparison of strain and myocardial work parameters in patients undergoing percutaneous edge-to-edge mitral valve repair with mitraclip system
Authors: Guarino L , Mega S , Annunziata M V , Carpenito M , Cocchia F , Mule' M T , Cammalleri V , Coletti F , Ussia G P , Grigioni F
Published: January 2025

Introduction

Myocardial Work (MW) is an advanced echocardiographic technique that assesses left ventricular performance, considering the hemodynamic load on the ventricle. Unlike traditional measures such as ejection fraction (EF) and global longitudinal strain (GLS), MW provides a comprehensive evaluation throughout the cardiac cycle.

Purpose

This study evaluates and compares echocardiographic parameters, specifically GLS and MW, before and after percutaneous edge-to-edge repair with the Mitraclip system, to highlight post-procedural improvements in ventricular performance.

Methods

A total of 59 patients with severe symptomatic mitral regurgitation, candidates for Mitraclip, were enrolled from March 2023 to April 2024. Parameters included GLS, Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), and Global Work Efficiency (GWE). Pre- and post-procedure measurements were analyzed using paired t-tests, considering patient comorbidities. The chi-square test and logistic regression were used to evaluate associations and predictive capacities.

Results

Significant improvements were observed in post-procedural GLS (-9.17±5.95 to -13.41±5.22, p=0.0001), GWI (p < 0.005), and GWE (p < 0.005), with a reduction in GWW (p = 0.0001). In hypertensive and non-hypertensive patients there was a significant increases in GWI and GWE, and reduction in GWW. In diabetic and dyslipidemic patients there was a significant improvements in GWI, GWE, GLS and reduction in GWW. In patients with atrial fibrillation there was a significant improvements in GWI, GWE, GLS and reduction in GWW. In patients with coronary artery disease patients there was a significant increases in GWI and GWE. No significant changes in GCW were observed in any group. For degenerative mitral regurgitation (DMR), leaflet fibrosis was associated with residual mitral regurgitation post-procedure (more than mild). In functional mitral regurgitation (FMR), ischemic etiology was not significantly associated with residual regurgitation (more than mild). Logistic regression indicated that reduced GWI and increased GLS were linked to adverse outcomes, though not statistically significant.

Conclusions

GLS and MW are highly sensitive and useful non-invasive diagnostic parameters compared to ejection fraction, demonstrating improvements in myocardial work efficiency and ventricular performance post-Mitraclip. Long-term follow-up studies are needed to confirm the durability and clinical outcomes of these benefits.
Left and right atrial strain in patients with heart failure with preserved ejection fraction
Authors: Tatsis E , Papadopoulos C , Oikonomidis D , Tasoulis A , Kouloulias I , Floropoulou C , Tsiafoutis I , Michalis L , Naka K
Published: January 2025

Background/Introduction

Left Atrial (LA) End Systolic Diameter (ESD) and Left atrial Volume index (LAVi) are used for the evaluation of dystolic dysfunction and the diagnosis of patients with Heart Failure with preserved Ejection Fraction (HFpEF). Recent studies imply that left atrial strain rate is an index of atrial myopathy . Also other studies imply a relationship between right atrial function and clinical status in HFpEF patients.

Purpose

The aim of our study is the evaluation of these echocardiography indexes in HFpEF patients.

Methods

We enrolled 50 subjects in our study (25 patients with HFpEF and 25 control subjects). All patients undergone in clinical evaluation, electrocardiography (All subjects were in sinus rhythm) and transthoracic echocardiography, applying Speckle Tracking Imaging techniques.

Results

Statistical analysis revealed a significant difference within patients with HFpEF and control group concerning LA ESD (median ESD LA (mm) 42.5 vs. 36, Wilcoxon rank-sum p-value=<0.001 ) , LAVi (cm2 ) (median 34.5 vs. 26, Wilcoxon rank-sum p-value = <0.001 ), LA median Strain (%) (23 vs. 32, Wilcoxon rank-sum p-value= <0.001) and RA median Strain (26 vs 32, Wilcoxon rank-sum p-value = <0.001)

Conclusion(s)

The current study demonstrates that patients with HFpEF have a significantly impaired left and right atrial strain, indexes that can be of important value in the further evaluation of these patients.

Table 1. Echocardiography Parameters
Myocardial work and left ventricular function in patients with heart failure with preserved ejection fraction
Authors: Tatsis E , Papadopoulos C , Oikonomidis D , Tasoulis A , Kouloulias I , Floropoulou C , Tsiafoutis I , Michalis L , Naka K
Published: January 2025

Background/Introduction

Patients with Heart Failure with preserved Ejection Fraction (HFpEF) have impaired diastolic function that plays a major role in the syndrome΄s pathophysiology . Several studies imply that these patients also suffer from left ventricular systolic dysfunction as assessed by Global Longitudinal Strain (GLS) estimation . Other studies show that the estimation of General Myocardial Work (GMW) is associated with left ventricular systolic function.

Purpose

The aim of our study is the evaluation of these echocardiography indexes in HFpEF patients.

Methods

We enrolled 50 subjects in our study (25 patients with HFpEF and 25 control subjects). All patients undergone in clinical evaluation, electrocardiography (All subjects were in sinus rhythm) and transthoracic echocardiography, applying modern techniques (GLS , Global Work Index – GWI and Global Work Efficiency – GWE).

Results

Statistical analysis revealed a significant difference within patients with HFpEF and control group concerning GLS (median GLS LV (%) - 18.0 vs – 19.7, Wilcoxon rank-sum p-value = 0.001). In addition , HFpEF group had significant lower GWE (median GWE (%) 91 vs 95, Wilcoxon rank-sum p-value = 0.001) . There was no significant difference in GWI (median GWI (mmHg) 1806.0 vs 2006.0 , Wilcoxon rank-sum p-value = 0.16) within groups. (Table 1)

Conclusion(s)

The current study shows that patients with HFpEF have a significant impaired GLS and GWE, revealing primary underlying myocardial damage in these patients.

Table1. Echocardiographic parameters
Insights into left ventricular deformation characteristics in sarcoidosis using multilayer strain imaging
Authors: Bal E , Okcun B , Barman H A , Cetinkaya E , Boyuk F , Yavuz Y E
Published: January 2025

Background

Sarcoidosis is a systemic inflammatory disease that can affect different layers of the myocardium. However, there is limited knowledge about layer-specific contraction in this clinical setting.

Purpose

To investigate multi-layer longitudinal strain in patients with sarcoidosis, in comparison to a control group of healthy individuals.

Methods

30 patients diagnosed with stage I-II pulmonary sarcoidosis (confirmed through non-cardiac biopsy , asymptomatic and routinely followed) and 30 healthy volunteers without known cardiac or systemic diseases were included in this case-control study. Conventional echocardiographic parameters were assessed, including Left Ventricular Ejection Fraction (LVEF), Endocardial Global Longitudinal Strain (Endo.GLS), Midmyocardial Global Longitudinal Strain (Mid.GLS), Epicardial Global Longitudinal Strain (Epi.GLS), Right Ventricular (RV) deformation (RV free-wall longitudinal strain (RVFWSL) and four-chamber longitudinal strain (RV4CSL)), and left atrial reservoir phase deformation (LASr).

Results

Sarcoidosis patients had similar age, blood pressure, heart rate, ejection fraction, left ventricular diameters, and diastolic parameters compared to healthy controls. Strain analysis using the speckle tracking method showed significantly lower Endo.GLS(-17.8(±1.6)vs-19(±2.3), p:0.018) Mid.GLS(-15.6(±1.7)vs-17.6(±2), p<0.001) and Epi.GLS(-14.2(±1.7)vs-16.2(±1.9) p<0.001) values in the sarcoidosis group compared to the control group.No statistically significant difference was found in right ventricul strain values between the groups (RVFWSL-24.3(±5.3)vs-26.9(±5.9), p: 0.077 and RV4CSL -19.98-+3,6vs-21.48-+5.3 p: 0.204) LASr was significantly lower in the sarcoidosis group compared to the control group (39.9(±11.8) vs47.8(±11.3) p value of 0.011).

Discussion: The strain values of the left ventricle and left atrial reservoir phase deformation were found to be lower in sarcoidosis patients compared to the healthy control group. These results suggest that layer-specific speckle tracking strain analysis may enable early detection of myocardial dysfunction in sarcoidosis, even in asymptomatic patients.
Left atrial strain and risk of atrial fibrillation post-aortic valve replacement surgery
Authors: Sulemane S , Youssef H , Aziz R , Rahman-Haley S , Silverman B
Published: January 2025

Background

Post-operative atrial fibrillation (POAF) occurs in approximately 30% of patients following aortic valve replacement (AVR) surgery. Left atrial dilatation has been proposed as a predictor of POAF. However, very little is known about the predictive value of left atrial strain analysis, which is a surrogate of left atrial mechanical function. This study evaluates the strength of association between left atrial function, assessed using strain echocardiography, and the occurrence of POAF after AVR.

Methods and materials

Perioperative data was collected retrospectively for patients undergoing surgical aortic valve replacement (n=100) who had appropriate pre-operative echocardiographic characterization, including echocardiography measures of LA strain (Fig. 1). Patients with pre-operative AF (n=3) were excluded. Patients were categorised according to the development of POAF.

Results

28 (29%) of 97 patients developed POAF. Initial univariate analysis suggested an association between POAF and increased age, larger LA and LV volumes, diastolic dysfunction, mitral valve E and A values, and lower LA and LV strain. Univariate analysis suggested post-operative associations between POAF and longer durations of intubation, longer durations of noradrenaline requirement, and longer stays in ICU and hospital. Multivariate analysis demonstrated that lower pre-operative left atrial reservoir function had a very strong independent association (mean 12.0% vs 41.5%, odds ratio 0.007, 95% CI 0.0001-0.33, p=0.01) with POAF. Longer post-operative duration of intubation also had a strong association (mean 10hr vs 8hr, odds ratio 67.5, 95% CI 1.1-41.5, p=0.04) with POAF.

Conclusion

Left atrial reservoir function, a surrogate of left atrial compliance, has a strong independent association with POAF post-AVR. This suggests that patients with underlying mechanical atrial dysfunction are at increased risk of developing POAF. This study supports the inclusion of left atrial reservoir function in any predictive tool for POAF post-AVR. The longer duration of post-operative intubation in the AF group supports the negative impact of POAF.

Figure 1. Example of speckle tracking analysis and strain measurements during the three phases of left atrial (LA) cycle using R-R ECG gating with the zero-baseline strain reference. Reservoir strain (yellow line) is the peak strain before mitral valve opening (positive value). Conduit strain (red line) is calculated as difference of the strain value at the onset of atrial contraction minus the peak strain value (negative value). Contraction strain is calculated as difference of the strain value at baseline (0) minus the strain value at onset of atrial contraction (negative value).