bluuebunny/crossref_metadata_2025 huggingface dataset:
Initial single-center experience with transapical beating heart mitral valve chordal repair of primary mitral regurgitation
Authors: Zadori A , Szolnoky J , Andreka P
Published: January 2025

Introduction

Ten patients underwent off-pump transapical mitral valve repair with chordal implantation for the treatment of primary mitral valve regurgitation (MR) between 01.2023 and 03.2024 in our tertiary referral center.

Purpose

Our aim was to examine the safety, feasibility and effectivity of the surgical method.

Methods

We fulfilled the retrospective analysis of the patients’ preoperative, operative and postoperative data.

Results

Median age was 75.5 years [IQR: 74; 80], Euroscore II 2.8 [IQR: 2; 3], and STS Score 3.8 [IQR: 2; 4]. Three patients were in NYHA II, four patients in NYHA III and three patients in NYHA IV functional stage. The patients had severe co-morbidities as congestive heart failure (n=9), pulmonary hypertension (n=10), chronic renal failure (n=4), more than mild coronary artery disease (n=4), peripheral arterial disease (n=4), previous pulmonary embolism (n=4), atrial fibrillation (n=3), chronic obstructive pulmonary disease (n=2), previous stroke (n=1).

All the patients had posterior mitral leaflet prolapse ± chordal rupture, causing severe mitral regurgitation. Six patients had isolated P2 disease and four had more complex pathology. Median MR PISA radius was 14 mm [12-15.8], 3-dimension vena contracta area 0.56 cm2 [IQR: 0.56-0.57], effective regurgitant orifice 0.61 cm2 [IQR: 0.5-0.84], regurgitant volume 83 ml [IQR: 65-111], leaflet-to-annulus index 1.23 [IQR: 1.2-1.3] and coaptation index 5 mm [IQR: 4.5-5].

All the surgeries were successful, with median 90 minutes [IQR: 75; 100] surgery time, 2-5 chordal implantations. The intra-operative echocardiography showed trace or mild MR in seven cases, and mild-to-moderate MR in three cases. There was no operative/early postoperative mortality, or early valvular/chordal failure. One case of postoperative bleeding occurred with successful surgical revision. There was one case of 30-days-mortality in a critically ill patient with severe heart failure. Mild left-sided pleural effusions and postoperative atrial arrhythmias were detected in five and three patients, respectively. Median ICU stay was 27 hours [IQR: 23.5; 27.8], and postoperative in-hospital stay was 8 days [IQR: 7; 9].

Predischarge transthoracic echocardiography showed trace-to-mild MR in eight patients, and mild-to-moderate MR in two patients, while three months postoperatively we detected four cases of mild, four cases of mild-moderate or moderate and one case of moderate-to-severe MR. In comparison to the baseline values, five patients were in NYHA I, two in NYHA II and two in NYHA III functional stage three months after surgery.

Conclusion

In summary, transapical beating heart mitral valve chordal repair seems a relatively safe and effective option for high-risk patients, however, we emphasize the significance of judicious preoperative risk and echocardiographic eligibility assessment and the need for further studies to examine the durability and long-time efficacy of the method.
The influence of left-heart myopathy on the diagnosis and treatment of mitral valve stenosis: an in silico trial
Authors: Van Den Acker G , Dhont S , Van Loon T , Churchill T W , Timmermans F , Delhaas T , Bertrand P B , Lumens J
Published: January 2025

Background

The shift in mitral stenosis (MS) aetiology from rheumatic to calcific valve disease, commonly seen in elderly patients with cardiomyopathy, challenges the differentiation between valve- or tissue-related causes of haemodynamic abnormalities.

Purpose

This study examines the impact of left-heart myopathy on the echocardiographic assessment of MS severity and acute haemodynamic effects following mitral valve (MV) intervention.

Methods

The CircAdapt model of the human cardiovascular system was used to evaluate the effect of MS on cardiac haemodynamics in a virtual patient cohort with broad ranges of impaired left atrial (LA) function and reduced left ventricular (LV) compliance. Mean gradient (MG) and pressure half-time (PHT) were derived for MS severity assessment, alongside LV and LA pressure traces to quantify the haemodynamic consequence of MV intervention.

Results

Depending on myocardial abnormalities, the MG varied by only 10%, 5% and 5% for mild, moderate and severe MS, respectively. Reduced LV compliance resulted in disproportionately lower PHT causing overestimation of the PHT-derived MV area up to 1.43 cm2. Following virtual MV intervention for moderate to severe MS, mean left atrial pressure (mLAP) decreased by 50% in presence of healthy myocardium but only 4% for combined LV and LA dysfunction. In patients with reduced LV compliance, LV end-diastolic pressure remained elevated despite MV intervention.

Conclusions

The virtual patient cohorts indicate that the MG is a robust metric for MS severity regardless of left-heart myopathy, whereas PHT may reveal underlying impaired LV compliance. However, neither MG nor PHT predict changes in mLAP following intervention. Recognizing the significance of distinguishing between increased left-heart pressures driven by valvular or tissue factors is therefore crucial for clinical decision-making.

graphical abstract

methods
Left ventricular impairment in aortic stenosis and clinical and neurohormonal improvement after TAVI
Authors: Rychlewski J , Golanski G , Kubisz K , Aleksandrowicz K , Protasiewicz M , Kubler P , Kosowski M , Przewlocka-Kosmala M , Ponikowski P , Kosmala W
Published: January 2025

In view of the increasing prevalence of aortic stenosis (AS) in ageing populations, identifying predictors of favorable clinical response to transcatheter aortic valve implantation (TAVI) is of particular importance. Typically, more severe LV function impairment is believed to indicate less potential for improvement after eliminating the cause of disease. However in AS, the reversibility of myocardial damage and its correlation with the regression of symptoms after valve replacement are less explored. It is suggested that myocardial work (MW) indices correcting global longitudinal strain (GLS) for LV afterload may offer greater diagnostic insight in AS than traditional load dependent echo markers.

Aim

To investigate the associations of post-TAVI improvements in 6 min walk test (6MWT) and NT-proBNP with baseline values and changes after valve replacement in LV systolic and diastolic function parameters in patients with AS.

Methods

We evaluated 162 patients (77±9 years) with severe AS who underwent TAVI. Transthoracic echocardiography, blood sampling and 6MWT were performed before and 3 months after treatment. The following indices of MW were assessed: global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE). Changes from pre- to post-TAVI (deltas) were calculated as the follow-up (3-months) value minus the baseline value.

Results

Based on the post-TAVI improvements in 6MWT and NT-proBNP, the population was divided into 3 subsets: high benefit group (HB): (delta 6MWT>median [49 m] and delta NT-proBNPmedian), and intermediate benefit group (IB): (the remainder patients). Participants from the HB group were characterized by the most severe LV function impairment, highest BNP and shortest 6MWT at baseline, as well as the greatest improvements in cardiac function after TAVI. On the other hand, the LB subgroup did not demonstrate the most impaired LV function at baseline compared to the other subgroups (Table). Post-TAVI improvements in 6MWT and NT-proBNP were larger in patients with baseline GLS below 9% than above 9% (85 ± 76 m vs. 43 ± 75 m, p=0.011, and -8848 ± 9096 pg/ml vs. -1384 ± 2740 pg/ml, p=<0.001, respectively), as well as in patients with baseline GCW below 1500 mmHg% than above 1500 mmHg% (83 ± 77 m vs. 43 ± 75 m, p=0.025, and -9245 ± 8798 pg/ml vs. -1447 ± 3038 pg/ml, p=<0.001, respectively).

Conclusions

Post-TAVI improvements in 6MWT and NT-proBNP can be expected even in AS patients with severely impaired myocardial function. GLS, MW, and diastolic parameters do not effectively identify patients with more irreversible LV impairment who benefit less from TAVI. MW indices are not superior to GLS in tracking LV responses to TAVI.

Table
Incremental clinical value of the regurgitant fraction assessed by three-dimensional echocardiography in patients with secondary tricuspid regurgitation
Authors: Buta A , Gavazzoni M , Tomaselli M , Radu N , Heilbron F , Fisicaro S , Clement A , Delcea C , Rella V , Kawada Y , Badano L P , Muraru D
Published: January 2025

Background

Differently from the effective regurgitant orifice area (EROA) and regurgitant volume (RegVol), RegFr directly accounts for the size and the function of the right ventricle (RV).

Objectives

To assess the relationship between regurgitant fraction (RegFr) evaluated using three-dimensional echocardiography (3DE) and the outcome in patients with secondary tricuspid regurgitation (STR).

Methods

331 patients with at least mild STR were enrolled. RegFr was computed as ratio between the RegVol, calculated using the proximal isovolumic surface area (PISA) method by Doppler and the total stroke volume (SV) of the RV computed as difference between 3DE RV end-diastolic (RVEDV) and end-systolic (RVESV) volumes. To compare the association of EROA, RegFr and RegVol with outcome, we used a composite endpoint of heart failure hospitalization (HFH) and death for any cause.

Results

After a median follow-up of 20 months, 133 patients (40%) reached the combined endpoint. Among the quantitative parameters of STR severity, RegFr had the highest area under the curve at ROC analysis (AUC= 0.65, 95%CI: 0.59-0.71). At Cox regression, RegFr was associated with outcome both in the univariate analysis (HR 1.012, CI 1.003-1.020, p=0.006) and in multivariate, adjusted for several clinical and echocardiography correlates. By testing each single quantitative parameter of STR severity, only RegFr significantly increased the prediction of the basal model (p=0.007) and improved the risk-stratification of the patients on top of EROA (Net Reclassification Index: 0.2833, p=0.011). In the subgroup of patients with non-severe STR (i.e., EROA<0.4 cm²), the RegFr identified the patients with significantly higher risk of events (cumulative incidence of the combined endpoint of 73% in patients with EROA<0.4 cm2 but RegFr≥50% vs 51 % in patients with RegFr<50%, p= 0.02).

Conclusions

Compared to EROA and RegVol obtained by PISA method, RegFr obtained by 3DE was more strongly associated with the outcome of patients with STR.
Aortic dP/dt as a new tool for prediction of aortic stenosis progression: a validation in a single-center cohort
Authors: Bello A , Paiva M , Freitas P , Gomes D A , Lopes P , Gama F , Guerreiro S , Ferreira A , Abecasis J , Trabulo M , Andrade M J , Ribeiras R
Published: January 2025

Introduction

Aortic pressure increase per time unit (dP/dt) has been recently shown to predict the risk of progression of aortic stenosis (AS), with a proposed cut-off of 600 mmHg/s (Panel A). Whether it applies to other populations remains to be elucidated.

Methods

In this single-center retrospective study, we included patients with isolated moderate AS who had performed a complete transthoracic echocardiography (TTE) assessment in our center between 2014 and 2022. The primary endpoint was progression to severe AS, as documented by follow-up TTE. Uni- and multivariate analysis with Cox regression was used to assess the predictive value of dP/dt.

Results

A total of 103 patients were included, with a median age of 78 years (IQR 71 - 83), of which 58 (56%) were male. Median follow-up was 2.2 years (QR 1.1-3.7) and mean left ventricular ejection fraction (LVEF) was 54 ± 7%. We identified a total of 75 (73%) patients with a dP/dt ≥ 600mmHg/s; the mean value for dP/dt 737 ± 269 mmHg/s.

Aortic dP/dt was independent of flow conditions, showing no correlation with stroke indexed volume (rho = 0.182; p = 0.08; r2 = 0.02) or LVEF (rho = 0.102; p = 0.31; r2 = 0.04).

After adjustment for aortic maximum velocity (aHR 2.46 [1.08 - 5.5; p = 0.033]) and baseline creatinine (aHR 1.21 [1.06 - 1.37; p = 0.04]), dP/dt remained an independent predictor of progression to severe AS (aHR per 100 mmHg/s: 1.18 [1.03 - 1.34; p = 0.017]).

The median time to AS progression was considerably shorter in patients with a dP/dt ≥ 600mmHg/s when compared with patients with a dP/dt < 600 mmHg/s (2.6 years [95%CI 2.0 – 3.3] vs. 5.3 years [95%CI 4.1-6.5]; Log-Rank p value < 0.001) (Panel B).

The dP/dt cut-off of 600 mmHg/s had a sensitivity of 81% (95%CI: 69-90%), a specificity of 44% (95%CI: 30-60) a positive predictive value of 67% (95%CI 60-73%) and negative predictive value of 63% (95%IC: 48-75%).

Conclusions

Aortic dP/dt was validated in a single-center cohort of moderate aortic stenosis patients as an independent predictor of accelerated disease progression. This finding may help tailor individualized follow-up strategies.
Prevalence of heart valve disease and left ventricular systolic dysfunction in a multi-ethnic, migrant community
Authors: Laskar N , Bhattacharyya S , Lloyd G
Published: January 2025

Introduction

Clinically significant valvular heart disease (VHD) affects 13.3% of individuals aged 75 and older, while left ventricular systolic dysfunction (LVSD) is seen in 2% of those aged 85 and older, and 3.5% of those aged 65 and older but most data comes from rural/suburban areas with predominantly Caucasian populations. Data on these diseases in urban, ethnically diverse areas with high migrant populations is lacking.

Purpose

This quality improvement project aimed to establish the prevalence of left-sided valve disease and LVSD by conducting community-based handheld echocardiography detection in an urban, multi-ethnic community.

Methods

Patients over 65 without known left-sided heart valve disease or heart failure, across four GP practices and one vaccination centre using handheld ultrasound device (Vscan Extend). The protocol included an abbreviated dataset with colour flow and three standard echocardiography views. All studies were reviewed and adjudicated by an independent expert. Those patients adjudicated to have important disease on handheld detection underwent subsequent comprehensive echocardiography.

Results

518 patients were evaluated. Ethnic distribution: 14.4% Caucasian, 51.6% Indian, 0.2% Chinese, 14% Pakistani, 9.7% African, 9.1% other. New diagnoses of left-sided HVD or LVSD were identified in (n=166 ) 32% and (n=10) 2% respectively. Mitral Regurgitation (MR) was most common (n =100, 19.3%), followed by aortic regurgitation (AR) (n =30, 5.8%), aortic stenosis (AS) (n =13, 2.5%), and mitral stenosis (MS) (n =2, 0.4%). LVSD was found in (n=10, 2%).

Comprehensive confirmatory echocardiograms were done in 73 patients. Of these mild VHD was observed in n =57 (78%), (mild AR n =27, 37%, mild MR n =31, 45%, and mild AS/aortic sclerosis n =12, 16%). Calcified mitral valve was found in n =3, (4%). Mild LVSD was in n =6, 8%.

Moderate to severe HVD was found in n= 12 (16.4%), (MR in 8%, AR in 5% and AS in 2.7%) and moderate to severe LVSD in n =3, 4%. Age predicted HVD (OR 1.09, 95% CI 1.06-1.13, p <0.001) and LVSD (OR 1.07, 95% CI 1.01-1.13, p <0.05) while Type 2 diabetes (OR 3.47, 95% CI 0.13-0.83, p <0.05) and ischemic heart disease (IHD) (OR 5.41, 95% CI 2.26-13.11, p <0.001) were predictors for LVSD. There was no relationship between ethnic group and the presence of HVD or LVSD (p values >0.05).

Conclusion(s)

HVD and LVSD is common in this urban, multi-ethnic community. A Vscan based detection program found a prevalence of any VHD of 32% and LVSD of 2% . Of these 2.3% and 0.6% were moderate to severe (HVD and LVSD). Age was associated with both HVD and LVSD, while T2DM and IHD are associated with LVSD. There was no relationship between ethnicity and either HVD or LVSD.

Severity of HVD

Ethnicity Distribution
Differential genetic impact on the occurrence of atrial fibrillation in hypertrophic cardiomyopathy according to age
Authors: Chung H , Ryu S K , Rim S J , Choi E Y
Published: January 2025

Background

Atrial fibrillation (AF) is a common arrhythmia associated with adverse events in patients with hypertrophic cardiomyopathy (HCM).

Purpose

The objective of this study was to investigate whether genetic characteristics were associated with AF in HCM patients.

Methods

Of the 212 prospectively enrolled patients in the HCM genetic registry, 33 had initial AF, and the remaining 179 (126 males, 58 ± 13 years) were followed up for the development of new-onset AF.

Results

Of the 212 patients, 45 were diagnosed with AF before the final follow-up visit. Pathogenic and likely pathogenic sarcomere gene mutations were detected in 29.3% (49/167) of patients without AF and 40.0% (18/45) of patients with AF, without significant differences. MYH6 was more prevalent in the AF group (2/45, 4.4%) than in the non-AF group (0/167, p = 0.044), and TNNI3 tended to be more prevalent in the AF group (6/45, 13.3%) than in the non-AF group (8/167, 4.8%) (p = 0.051). Among patients younger than 65 years (n = 128), those with any sarcomere variants (pathogenic and variants of uncertain significance, n = 77) had a higher prevalence of overall AF (initial and new-onset, p = 0.045). The mutation-positive group had a higher left atrial volume index, lower a’, and higher prevalence of non-apical HCM in patients <65 years. However, in patients ≥65 years, no significant difference was found between mutation-positive and -negative groups.

Conclusions

In younger HCM patients, the presence of sarcomere variants, including variants of uncertain significance, is related to a higher prevalence of AF.
Dapagliflozin prevents ejection fraction and fractional shortening reduction, reduces myocardial NF-KB expression and systemic pro-inflammatory biomarkers in models of doxorubicin cardiotoxicity
Authors: Quagliariello V , Paccone A , Maurea F , Palma G , Luciano A , Bruzzese F , Zito Marino F , Franco R , Montella M , Barbato M , Izzo F , Giacobbe I , Giordano V , Arianna R , Maurea N I C O L A
Published: January 2025

Background

Anthracycline-mediated adverse cardiovascular events are among the leading causes of morbidity and mortality in patients with cancer. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) exert multiple cardiometabolic benefits in patients with/without type 2 diabetes, chronic kidney disease, and heart failure with reduced and preserved ejection fraction. We hypothesized that the SGLT2i dapagliflozin administered before and during doxorubicin (DOXO) therapy could prevent cardiac dysfunction and reduce pro-inflammatory pathways in preclinical models.

Methods

Female C57Bl/6 mice were treated for 10 days with a saline solution or DOXO (2.17 mg/kg), DAPA (10 mg/kg), or DOXO combined with DAPA. ). Cardiac function studies, including EF, FS and radial/longitudinal strain were analysed through transthoracic echocardiography (Vevo 2100) . Systemic levels of ferroptosis-related biomarkers, galectin-3, high-sensitivity C-reactive protein (hs-CRP), and pro-inflammatory chemokines (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12, IL17-α, IL-18, IFN-γ, TNF-α, G-CSF, and GM-CSF) were quantified. After treatments, immunohistochemical staining of myocardial and renal p65/NF-kB was performed.

Results

DAPA exerts cytoprotective, antioxidant, and anti-inflammatory properties in human cardiomyocytes exposed to DOXO by reducing iATP and iCa++ levels, lipid peroxidation, NLRP-3, and MyD88 expression. Pro-inflammatory intracellular cytokines were also reduced. In preclinical models, DAPA prevented the reduction of radial and longitudinal strain and ejection fraction after 10 days of treatment with DOXO. A reduced myocardial expression of NLRP-3 and MyD-88 was seen in the DOXO-DAPA group compared to DOXO mice. Systemic levels of IL-1β, IL-6, TNF-α, G-CSF, and GM-CSF were significantly reduced after treatment with DAPA. Serum levels of galectine-3 and hs-CRP were strongly enhanced in the DOXO group; on the other hand, their expression was reduced in the DAPA-DOXO group. Troponin-T, B-type natriuretic peptide (BNP), and N-Terminal Pro-BNP (NT-pro-BNP) were strongly reduced in the DOXO-DAPA group, revealing cardioprotective properties of SGLT2i. Mice treated with DOXO and DAPA exhibited reduced myocardial and renal NF-kB expression.

Conclusion

The overall picture of the study encourages the use of DAPA in the primary prevention of cardiomyopathies induced by anthracyclines in patients with cancer.
Incidence, predictors and outcomes associated with pacemaker implantation in transthyretin cardiac amyloidosis
Authors: Istratoaie S , Bourg C , Marut B , L'official G , Lacout M , Serrano E , Fargeaud D , Donal E
Published: January 2025

Background

Arrhythmias are poorly tolerated by patients with transthyretin cardiac amyloidosis (ATTR). The occurrence rate of pacemaker (PM) implantation among ATTR, along with its predictors and impact on outcomes has not been extensively investigated. Our objective was to analyze the patterns of permanent PM implantation and to identify predictors for future PM placement in ATTR patients.

Methods

Consecutive patients with wild-type ATTR diagnosed in one single center between 2016-2022 were included. The primary outcome of the study was PM implantation. Patients with pre-existing PM (n = 31) were excluded. The study population included 160 patients, 88% male, median age 82 (76, 85) years. Clinical, laboratory, electrocardiography (ECG) and comprehensive echocardiography data were analysed.

Results

During a median follow-up of 30.5 months, 37 (23.1%) patients underwent PM implantation. The main indications for PM implantation were complete atrioventricular (AV) block (9 patients, 24.3%) and advanced conduction impairment (9 patients, 24.3%). ECG demonstrated a more prolonged PR interval and increased QRS duration (both p<0.001) with higher rate of first-degree AV block and right bundle branch block (both p=0.003) in patients requiring PM implantation. The echocardiogram showed greater wall thickness, a more dilated left atrium, along with biventricular dysfunction in the PM group. At multivariable analysis, first-degree AV block (HR=2.96, p=0.012), interventricular septum (IVS) thickness (HR=1.27, p=0.001) and biomarker-based staging system (HR= 2.43, p=0.008) were independently associated with PM implantation. PM implantation was associated with increased mortality or HF hospitalization.

Conclusions

In our cohort of ATTR patients, 23.1% required a pacemaker, primarily due to conduction system disease. Independent predictors for new pacemaker implantation included first-degree AV block, increased IVS thickness, and the biomarker-based staging system.
Systemic sclerosis is associated with coronary microvascular dysfunction assessed using echocardiographic coronary flow parameters: a meta-analysis
Authors: Jain H , Jain J , Alderhalli R , Singh J , Khaled K , Goyal A , Odat R M , Patel N , Scott I , Ahmed R
Published: January 2025

Background

Systemic sclerosis (SSc) is a connective tissue disease that is characterized by vascular dysfunction and extensive fibrosis. The current literature suggests a 15-35% prevalence of cardiac manifestations in patients with SSc, the majority of which remains subclinical. Patients with SSc often demonstrate angiographically normal epicardial coronary arteries despite underlying dysregulation in the coronary microvasculature. Coronary flow reserve (CFR) is a noninvasive marker of coronary microvascular circulation.

Purpose

This meta-analysis aimed to compare CFR between patients with SSc and healthy controls.

Methods

A comprehensive literature search of the major bibliographic databases, including PubMed/MEDLINE, Embase, and the Cochrane Library was conducted. The aim was to identify studies comparing CFR between patients with SSc and healthy controls. The standardized mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using an inverse-variance random-effects model. Statistical significance was set at p < 0.05. Heterogeneity was assessed using the Higgins I2 metric.

Results

Four studies were included in this meta-analysis, with a total of 210 participants (129 patients with SSc; 81 healthy controls). In the SSc and control groups, 88.3% and 70.3% of the patients, respectively, were female. The mean ages of the SSc and control group were 52.2 ± 13.2 and 47.77 ± 9.8, respectively. The pooled analysis demonstrated a statistically significant reduction in CFR associated with SSc [SMD: -1.44; 95% CI: -1.76, -1.13; p<0.00001] compared to healthy controls. No heterogeneity was observed in the effect estimates [I2 = 0%].

Conclusion

SSc is associated with a higher risk of coronary microvascular dysfunction, as indicated by the reduced CFR. The results of this meta-analysis demonstrate the importance of a comprehensive cardiac evaluation in patients with SSc. Early aggressive targeted interventions for impaired CFR in SSc patients may lead to improved clinical outcomes. Further prospective studies are required to elucidate the prognostic impact of a blunted CFR.

Figure 1
Right atrial strain in Anderson-Fabry disease
Authors: Lillo R , Cianci A , Meucci M C , Iannaccone G , Tusa F , Di Brango C , Marsilia M , Lanza G A , Lombardo A , Burzotta F , Graziani F
Published: January 2025

Background

Nowadays limited data are available on right atrium (RA) morpho-functional remodelling and mechanics in Fabry disease (FD).

Purpose

To investigate RA structural and functional remodelling in FD using 2D speckle tracking echocardiography (STE) and to explore if differences exist in FD patients with and without left ventricular hypertrophy (LVH) compared to controls.

Methods

In this prospective study we enrolled FD patients and controls matched for age, sex and cardiovascular risk factors. FD patients were divided in two groups, according to the presence/absence of LVH (LVH+: left ventricular wall thickness > 12 mm). All patients underwent standard echocardiography and STE analysis investigating the mechanics of all cardiac chambers, including RA reservoir, contractile and conduit strain.

Results

A total of 64 patients with FD (50% males; mean age 50 ± 17 years; 51.5 % LVH+) and 64 controls were included. Focusing on right chambers, RA and RV dimensions were similar between FD and controls; 25 FD patients (39%) had RV hypertrophy and RV TDI systolic velocity was lower in FD vs controls (p=0.041) while TAPSE and RVFAC did not significantly differ between the 2 groups. STE revealed impaired values of all cardiac chambers strains in FD vs controls: LV-GLS (p<0.001), LA reservoir (p=0.001), conduit (p=0.012) and contractile strains (p<0.001), RV-GLS and RV free wall strain (p<0.001). All RA strains were significantly reduced in FD vs controls (RA reservoir 27.4 ± 11.1 vs 41.9 ± 8.3%, p<0.001; RA contractile 9.9 ± 5.1 vs 18.0 ± 4.9%, p<0.001; RA conduit 19.1 ± 8.1 vs 24.1 ± 8.1%, p=0.001) and in 27 FD patients (42.1%) RA reservoir strain was <25%. When comparing FD LVH- vs controls, RA reservoir and contractile strains were significantly reduced in the formers (p<0.001). In multivariable linear regression analyses, LA reservoir (p=0.010) and LV-GLS (p=0.044) emerged as independent correlates of RA mechanics, after adjustment for RA dimensions, RV systolic function parameters and hypertrophy, maximal LV wall thickness.

Conclusions

In FD impaired RA strain is a common finding. RA reservoir and contractile strains are reduced in FD patients before LVH as compared to controls. LA reservoir strain and LV-GLS showed an independent correlation with RA reservoir strain.
Characteristic of adult patients with cyanosis due to congenital heart disease: special focus on endothelial damage.
Authors: Nartowicz A , Marcin G , Janus M , Cieslewicz A , Malesza K , Bartczak-Rutkowska A , Lesiak M , Trojnarska O
Published: January 2025

Background

Patients with cyanosis secondary to congenital heart disease (CHD) are characterized by erythrocytosis and increased blood viscosity, which contributes to endothelial dysfunction that is associated with an increased risk of atherosclerosis. Flow-mediated dilatation (FMD) is a phenomenon associated with NO release that indirectly assesses endothelium function. The intima-media complex measured in the carotid artery indicates the severity of atherosclerosis.

Aim

The aim of this study is to evaluate the intima-media complex and flow mediated dilation and demonstrate their potential relationship with the clinical presentation in cyanotic population.

Methods

A cross-sectional study including 36 adult CHD cyanotic patients [(12 males)(39 median, 19-73 years)] with arterial blood oxygen saturation less than 92% and 30 healthy controls [(11 males)(38.5 median, 26-59 years)] was performed. All patients underwent clinical examination, blood testing, and echocardiography. Endothelial function was assessed using intima-media thickness and flow-mediated dilatation during ultrasonography. Lipid profile, erythrocytosis indicators, as well as inflammatory and vascular markers, including sphingosine-1-phosphate, were measured.

Results

We did not demonstrate any difference between CHD patients and the control group in the intima-media complex, flow-mediated dilatation, and the size of the brachial artery after ischemia. Among the laboratory indicators of erythrocytosis, atherosclerosis, and inflammation, the size of the brachial artery after ischemia correlated positively with the level of erythrocytes (p=0.008), hemoglobin (p=0.02), hematocrit (p=0.03), LDL cholesterol (p=0.01), and negatively with d-dimer (p=0.003). Flow-mediated dilation correlated positively only with HDL cholesterol (p=0.02) concentration. The intima-media complex correlates positively only with body mass index (p=0.04).

Conclusions

Endothelial function assessed by FMD and the severity of atherosclerosis assessed by IMT do not appear to be abnormal in patients with cyanosis secondary to CHD.

Endothelial dysfunction

Logistic regression for FMD<7%
Increased myocardial stiffness as assessed by echocardiographic shear wave imaging is associated with Fontan circulatory failure
Authors: Youssef A , Van Belle H , Dhooge J , Voigt J U , Van De Bruaene A
Published: January 2025

Background

Diastolic dysfunction with elevated end-diastolic pressures is a key component of Fontan circulatory failure. However, conventional echocardiographic parameters of diastolic function do not correlate with invasive pressures in Fontan patients. Natural shear waves (SW) are emerging as a novel echocardiographic parameter of myocardial stiffness, a key determinant of diastolic function.

Purpose

We investigated the relationship between natural SW velocities and Fontan circulatory failure.

Methods

Fontan patients were prospectively recruited from a single center. They underwent a blood sampling for NT-proBNP and cardiopulmonary exercise testing on a supine bicycle combined with echocardiography and with peripheral venous pressure (PVP) measurement. PVP correlates with mean pulmonary arterial pressure in Fontan patients, and a PVP/cardiac output (CO) slope > 3 is associated with worse clinical status. In addition, high frame rate SW imaging was performed at rest in the parasternal long axis view. An anatomic M-mode was drawn along the ventricular septum, or if absent, in the corresponding anterior wall. In the color-coded M-mode maps for tissue acceleration, SW appear as tilted green bands after atrio-ventricular valve closure (AVVC), the slope of which represents their propagation velocity. A clinical diagnosis of Fontan circulatory failure was defined as one the following: dyspnea on exertion with NT-proBNP >300 ng/l, need for diuretics, a peak oxygen consumption (VO2) inferior to the lowest quartile according to age- and sex-adjusted Fontan norms, Fontan associated liver disease complicated by ascites or hepatocellular carcinoma, or protein losing enteropathy.

Results

Twenty-nine Fontan patients were included, of which 48.3% were female and 82.76% had a dominant left ventricle. The mean age was 33.7 ±8.6 years, the mean peak VO2 19.9 ± 5.9 ml/min/kg and the median NT-proBNP 225 ng/l (IQR 52-473.5). SW velocities increased with age (r = 0.63, p < 0.001) and time since Fontan palliation (r = 0.53, p = 0.005, Figure 1A). In addition, SW velocities significantly correlated with unfavorable clinical parameters: lower peak VO2 (r = -0.76, p < 0.001), elevated NT-proBNP (r = 0.53, p = 0.003) and an increased PVP/CO slope (r = 0.66, p < 0.001) (Figure 1 B-D). Of interest, SW velocities were significantly higher in patients with a clinical diagnosis of Fontan circulatory failure (mean 5.3 vs 7.4 m/sec, p = 0.003, Figure 2A). A cut-off value of 6.3 m/sec had a 90% sensitivity and 84% specificity to predict Fontan circulatory failure (AUC = 0.89; 95% CI [0.77 – 0.99], p = 0.001, Figure 2B).

Conclusion

Natural SW velocities after AVVC strongly correlated with parameters of Fontan circulatory failure. The preliminary results of this ongoing study highlight the potential of SW elastography in the assessment of patients with a Fontan circulation.

Figure 1

Figure 2
The effect of a dietary supplement containing glycosaminoglycans and fucoidanon endothelial glycocalyx integrity and vascular function in patients after COVID-19 infection
Authors: Ikonomidis I , Pavlidis G , Kountouri A , Katogiannis K , Kostelli G , Pliouta L , Thymis J , Korakas E , Michalopoulou E , Prentza V , Katsanaki E , Vlachomitros D , Parissis J , Lambadiari V
Published: January 2025

Background/Introduction

Coronavirus disease 2019 (COVID-19) has been associated with impaired subclinical markers of endothelial and vascularfunction.

Purpose

We investigated whether intervention with Endocalyx (Microvascular Health Solutions),a dietary supplement containing glycosaminoglycans and fucoidan, can improve endothelial glycocalyx integrity,arterial stiffness, and coronary microcirculationin patients after COVID-19 infection.

Methods

Fiftypatients within 15 days after a confirmed mild-to-moderate COVID-19infection were randomized to receive Endocalyx(n=25) or placebo (n=25) for 4 months. We measured at baselineand at 4 months of treatment: a) perfused boundary region(PBR) of the sublingual microvessels with a lumen diameter ranging from 4 to 25 μm, as a marker of endothelial glycocalyx integrity, b)carotid-femoral pulse wave velocity (PWV - Complior SP ALAM) and c)coronary flow reserve (CFR) using Doppler echocardiography.

Results

Four months after treatment, patients under Endocalyx showed an important reduction of PBR 4-25μm (2.24±0.2 vs. 2.37±0.23μm), PBR 10-19 μm (2.52±0.24 vs. 2.65±0.21μm), PBR 20-25 μm (2.75±0.4 vs. 3.04±0.48μm) and PWV (9.8±2.1 vs. 10.6±2.3m/s) and an improvement of CFR (2.68±0.53 vs. 2.47±0.64) (p<0.05 for all comparisons).No significant changes in the aforementioned markers were observed in placebo group (p>0.05; Table). In patients who were treated with Endocalyx, the percentage reduction of PBR 4-25μm was associated with thecorresponding decrease of PWV (r=0.31, p=0.047) and with the improvement of CFR (r=-0.59, p=0.008) at 4 months.

Conclusions

Four-month treatment with Endocalyx may improve endothelial glycocalyx integrity, coronary and vascular function in patients after COVID-19 infection.
Pulmonary artery acceleration time: a valid alternative when tricuspid regurgitation is missing
Authors: Cano Carrizal R , Casanova Rodriguez C , Velez Salas A , Rodriguez Alcudia D , Martin-Penato Molina A , Cadenas Chamorro R , Iglesias Del Valle D , De La Cruz Berlanga E , Paredes Gonzalez M B , Martinez Dosantos V , Aguilera Martinez M C , Lareo Vicente A , Garcia Garcia A
Published: January 2025

Background

the latest guidelines from the European Society of Cardiology (ESC) on the diagnosis of pulmonary hypertension recommend the use of peak tricuspid regurgitation velocity (TRV) as an initial measure. However, in a significant proportion of patients this measurement is not feasible due to the absence of regurgitation or inadequate quality of the Doppler signal curve. Pulmonary artery acceleration time (PAAT), on the other hand, is a measurement that can be easily obtained in nearly all patients.

Purpose

the aim of our study is to analyse the relationship between PAAT and TRV and to evaluate its diagnostic accuracy for the TRV values established in the latest ESC guidelines (2.8m/s and 3.4m/s), determining appropriate cut-off points for this purpose.

Methods

a retrospective analysis was conducted on 1,255 consecutive transthoracic echocardiograms in which both TRV and PAAT were measured. Patients with pulmonary stenosis (peak velocity ≥ 2m/s) were excluded. The relationship between both variables was analyzed using different linear and non-linear models, choosing the one with the lowest degree of residuals. Diagnostic accuracy was assessed using the area under the curve (AUC) and sensitivity (Se) and specificity (Sp) values. Optimal cut-off points (OCP) were derived from ROC curve analysis.

Results

the mean age of the sample was 72.5±13.8 years, with 54% (683) being women and 63% (795) in sinus rhythm. Eighty six patients (7%) exhibited severe, massive or torrential tricuspid regurgitation. The mean TRV was 2.77±0.47m/s and the mean PAAT was 100.50±29.40ms. The mean TAPSE was 21.34±4.70mm, with 196 patients (16%) having systolic dysfunction (defined as TAPSE < 17mm). The relationship between TRV and PAAT fits a quadratic model (p for the quadratic term <0.001). The diagnostic accuracy of PAAT for both TRV cut-off points was good: TRV > 2.8m/s: AUC 0.78 [95% CI 0.76-0.80], OCP 93ms [Se 72.4%, Sp 71.8%]; TRV > 3.4m/s: AUC 0.80 [95% CI 0.78-0.82], OCP 85ms [Se 77.5%, Sp 70.6%].

Conclusions

the relationship between TRV and PAAT follows a non-linear model. Cut-off points of 93ms and 85ms demonstrate good discriminatory power for identifying patients with TRV superior to 2.8m/s and 3.4m/s, respectively. Therefore, PAAT constitutes a reliable alternative for the initial echocardiographic assessment of the pulmonary hypertension probability in patients in whom TRV cannot be determined.

Relationship PAAT/TRV
Use of music as an adjunct for sedation in transoesophageal echocardiography
Authors: Rodrigues A C , Eng A V , Martins J A A , Lira E B , Oliveira F R C , Valelongo P O , Roveri P , Monaco C G , Daminello E , Silva M F I , Fischer C H , Oliveira W , Costa R C P L , Morhy S S , Vieira M L C
Published: January 2025

Background

Transoesophageal Echocardiography (TOE) is semi-invasive examination used for cardiac evaluation, frequently associated to a certain degree of anxiety, and often requiring sedation for patient comfort; alternatively, sedation can result side effects such as hemodynamic changes (hypotension) or hypoventilation and hypoxemia. Music has been used as a non-pharmacological strategy to reduce stress and anxiety levels during medical procedures; accordingly, we hypothesized that music could be used to decrease anxiety and/or sedation dose in patients referred for TOE.

Methods

63 patients over 18 years old undergoing TOE were randomized either to intervention (music group, 31 patients) or no intervention (control group, 32 patients); music was started before transthoracic echocardiography (TTE) and continued up to the end of TOE; an anxiety mini query consisting in 4 degrees of anxiety levels (no, mild, moderate and high) was answered before transthoracic echocardiography (TTE) and again just before sedation; data regarding hemodynamic status (blood pressure, heart rate, oximetry and respiratory incursions ) were examined before and after the intervention; additionally, groups were compared regarding administered total midazolam dose (initial dose plus additional doses).

Results

There was no difference between the groups regarding age (55.1 ±13.7 years vs 49.8± 15.5 p = NS), sex, ethnics, body mass index or the presence of comorbidities . Both groups presented a decrease in anxiety levels before TOE (p = 0.04), however the decrease was more substantial with music compared to control (p< 0.008). Hemodynamic variables were unchanged, except for diastolic blood pressure (p=0.03), showing a slight but significant decrease after music (Table). No difference was seen in the total midazolam dose between the groups (median 5.0 mg with range [4.5 - 7.0 mg] vs 5.0 mg [4.0 - 8.0 mg], p = 0.4; additionally, a negative correlation was found for midazolam dose and age, whereas no correlation was found for other hemodynamic parameters.

Conclusion

Despite no reduction in sedation dose in patients assigned for TOE, listening to music decreases the degree of anxiety, with a small decrease in blood pressure; therefore, music could be useful as an adjunct to sedation in this scenario.
Tricuspid leaflet identification on 2D multiplane transesophageal echocardiography: derivation and validation of a simple two-step approach
Authors: Vella A , Zannoni J , Tusa M , Donal E
Published: January 2025

Background

Tricuspid valve (TV) leaflet identification by two-dimensional (2D) transesophageal echocardiography (TOE) is complex due to the considerable variability in the visualized leaflets. While three-dimensional (3D) imaging can easily overcome this problem by acquiring the whole valve anatomy, the overall image quality is often suboptimal and the technique somewhat unsuitable for real-time monitoring during interventional procedures like TriClip implantation. Using information derived from both 2D and multiplanar reconstruction of 3D datasets, we elaborated a step-wise approach to identify TV leaflets during multiplane 2D TOE and tested it on a validation cohort.

Methods

TOE data from 83 patients was retrospectively collected. The 3D data of each patient was appropriately sliced to simulate and accurately match what would be seen by "sweeping" the cursor across the TV during real-time multiplane imaging (Fig. 1). Following data analysis, a "two-step" reference table was created and subsequently evaluated for accuracy on a validation cohort of 41 patients from a distinct hospital and country. To evaluate the usability of the approach, 11 echocardiographers were presented with a random selection of 5 multiplane images. They were then instructed to identify the visualized leaflets initially without using the reference table, and subsequently with its assistance.

Results

After removal of redundant information, 231 unique multiplane sets were obtained. Combining anatomical features (number of leaflets visualized and presence of the interventricular septum) from the 2D views allowed easy and consistent identification of TV leaflets (Fig. 2), as confirmed by correlation with the 3D dataset. The same "two-step" approach was subsequently tested on an independent validation cohort of 41 patients (96 unique multiplane sets). Accurate leaflet identification was possible in 35 patients (85%), while in 6 cases (15%) the image sector was too narrow to confidently assess the presence of the interventricular septum. The accuracy in exact leaflet recognition without the aid of the reference table was rather modest (mean score of 1 out of 5) among echocardiographers with different experience in TV TOE, but significantly increased (mean score of 3.2 out of 5) with the adoption of the proposed approach, accounting for a 44% improvement in accuracy (p< 0.001).

Conclusion

Simple anatomical features allow precise TV leaflet identification during multiplane 2D TOE. A streamlined "two-step" approach, validated on an independent cohort of patients, significantly improves accuracy in leaflet recognition among both beginner and advanced echocardiographers.
Prognostic role of left ventricular mechanical dispersion and global longitudinal strain for adverse cardiac remodeling in patients after ST-segment elevation myocardial infarction
Authors: Kobets A V , Petyunina O V , Kopytsya M P
Published: January 2025

ST elevation myocardial infarction (STEMI) remains to have high risk of mortality even in patients with percutaneous coronary intervention (PCI), that is considered to be the result of adverse cardiac remodeling (ACR) due to suboptimal reperfusion, microvascular obstruction and inflammation.

The aim of the study was to assess left ventricular (LV) mechanical dispersion (MD) and global longitudinal strain (GLS) as early predictors for ACR in patients after STEMI with successful PCI after 1 year.

Materials and Methods

Using the inclusion (acute STEMI, age >18 years old, PCI) and exclusion criteria (poor acoustic window, previous myocardial infarction, irregular heart rhythm, severe comorbidities), we finally enrolled 119 STEMI patients. Clinical, ECG, 2-dimensional echocardiography with Doppler and speckle-tracking parameters were measured at the baseline and after 1 year to estimate ACR. Circulating biomarkers levels were measured at the baseline. ACR was determined as an increase in LV end diastolic and/or end systolic volume>10% at 12 months (with the time window±14 days) follow-up period after PCI.

Results

A total of 119 post-PCI patients with STEMI with TIMI III were included in the study. They were mainly male (88.2%) with a mean age of 59 years. They were divided into 4 groups according to increased LVMD. The univariate log regression analysis revealed that GRACE score, N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) level, peak Troponin I level, LV ejection fraction, LVGLS and LVMD were found to be predictors for ACR. Multivariate log regression analysis displayed that LV GLS>–8%, high quartile of LVMD and NT-proBNP>953 pg/mL remained independent predictors for ACR.

ROC analysis showed that all 3 predictive models based on LVMD (AUC=0.84. p<0.001, sensitivity (sen) 80.8%, specificity (spe) 87.5%, cutoff point (CP)=68 msc), LV GLS (AUC=0.62; p<0.001, sen 82.0% and spe66.7%, CP=–8%) and NT-proBNP (AUC=0.60. p<0.001, sen78.2%, spe73.5%, CP=953 pg/mL) significantly distinguished from the basal model and allowed to identify patients with STEMI at baseline with high risk of ACR.

The addition of LVMD to the based predictive model (NT-proBNP>953 pg/mL) significantly improved the discriminative potency of the whole prognostic model (AUC 0.84(0.72-0.90), p=0.001), whereas LVGLS did not yield it neither alone (AUC 0.62(0.58-0.69), p=0.49), nor when in combination with LVMD (AUC 0.83(0.73-0.91), p=0.001). Thus only LVMD became an independent predictor of ACR that enabled to improve the discriminative potency of NT-proBNP.

Conclusion

Our study demonstrated that measurement of LVMD and LVGLS in acute period might be useful in prognosis of ACR in patients with STEMI after 1-year follow-up period. But only LVMD became an independent predictor of ACR in prognostic model.