bluuebunny/crossref_metadata_2025 huggingface dataset:
Utility of left atrial strain in characterizing patients with reablated atrial fibrillation
Authors: Serrano Lozano D , Margarida De Castro A , Cuesta Cosgaya J M , Llano Cardenal M F , Santiago Setien I , Lerena Saenz P , Fernandez-Valls Gomez M , Zarauza Navarro J , Coroas Pascual C , Carreiro Da Cunha E , Perez Barquin R , Alarcos Blasco H , Arrizabalaga Gil M , Olalla Antolin J J , Ruisanchez Villar C
Published: January 2025

Introduction and Objectives

Atrial fibrillation (AF) is a highly prevalent condition, with projections indicating it will increase in the future. Various ablation techniques exist to try to eliminate the arrhythmia, but the problem of recurrences and the need for reinterventions are not uncommon. We need markers to predict which patients will benefit from these procedures and which will recur despite our efforts. Atrial strain techniques have emerged as a novel tool in assessing the function and degree of atrial fibrosis, which could improve patient selection and increase the success of procedures.

Methods

A retrospective analysis was conducted, including adult patients who had undergone echocardiography at our center during the years 2023-2024. A total of 59 healthy patients with no history of cardiovascular disease, labeled as "normal studies" by the examiner, served as the control group, and another group of 47 patients with recurrent AF with at least two ablation procedures were included. Various left atrial strain values (Reservoir, Conduit, and Pump) of each patient were analyzed. Descriptive statistics were calculated for each group and segment, and the Mann-Whitney U test was used to compare the groups.

Results

Patients with reablated AF showed significantly lower absolute strain values compared to normal patients in all three analyzed varieties (Reservoir, Conduit, and Pump) with p<0.01 for all comparisons. The mean strain in the control group was 41.80 for reservoir strain, -24.01 for conduit strain, and -17.07 for pump strain; while the mean in the AF group was 17.42, -11.72, and -6.33, respectively.

Conclusions

We found significant differences in left atrial strain values between normal patients and patients with reablated AF. These findings suggest that left atrial strain could be useful in selecting patients for AF ablation procedures, as those more prone to recurrence exhibit lower absolute strain values, indicating a higher degree of atrial fibrosis where anomalous circuits may establish and perpetuate the arrhythmia over time.

Normal Vs Atrial fibrillation
Myocardial mechanics and outcomes after transcatheter aortic valve replacement. Does strain rate have added prognostic value?
Authors: Kipourou K , Abdelhafiz H , Barron A , Panoulas V , O'driscoll J , Jimeno M , Meric B , Rahman Haley S , Baltabaeva A
Published: January 2025

Introduction

Transcatheter aortic valve implantation (TAVI) has firmly become treatment option for elderly and/or high-risk patients with severe symptomatic aortic stenosis. Studies have shown that TAVI induces improvement in left ventricular (LV) systolic function, quantified using global longitudinal strain (GLS).

Purpose

To test if improvement in longitudinal deformation post TAVI is associated with changes in strain rate – the only non-invasive echo parameter associated with myocardial contractility. We wanted to assess impact of changes in longitudinal deformation and strain rate (SR) on clinical outcomes.

Methods

We studied retrospectively all consecutive patients who underwent TAVI in our Valve specialist center from 1st April 2023 to 31st March 2024. All participants underwent a transthoracic echocardiogram before and within 3 months following TAVI. We have re-measured mean trans-valvar pressure gradients and performed offline speckle tracking analysis using dedicated software (TomTec and GE EchoPAC) before and after TAVI. Data on all-cause mortality and cardiac hospitalizations were obtained from electronic medical records.

Results

Overall, 305 patients (mean age of 81±7.7 years) with severe aortic stenosis underwent TAVI. 255/305 patients (83%) had a successful and uncomplicated TAVI procedure, 26 (8.5%) developed complete heart block requiring permanent pacemaker insertion during the index admission, 15 (4.9%) experienced vascular access complications (pseudoaneurysm, haematoma), 5 (1.6%) developed haemopericardium requiring drainage and 5 (1.6%) had TAVI-related stroke, all patients were discharged with routine F/U in place.

247 (81%) who had complete echocardiography data were included into analysis, 45% were female. Significant reduction in trans-valvar gradient was accompanied by significant improvement in LV myocardial and endocardial GLS and average LV strain rate post-TAVI. The mean follow-up period was 246±107 days. There were 8 cases contributing to all-cause mortality and 12 cardiac hospitalizations. There was a significant difference in SR between alive and deceased patients (0.94±0.3 vs. 0.70±0.2, P=0.026). Post TAVI strain rate (HR 45.6; 95% CI 1.67 to 124.6, P<0.05) was the only independent predictor of all-cause mortality.

Conclusion

TAVI produces significant early improvement in LV mechanics. LV strain rate is an important independent predictor of all-cause mortality post TAVI. The addition of LV SR during echocardiographic assessment may be of value for the early identification of TAVI patients who are at greatest risk and who may benefit from early intensified risk factor management.

KM CURVE: SR & ALL CAUSE MORTALITY
Advanced mechanical analysis in STEMI in the pharmacoinvasive strategy era
Authors: Garcia Villarejo M , Latapi Ruiz Esparza X , Santos Alfaro H A , Cuellar Vargas J , Araiza Garaygordobyl D , Gopar Nieto R , Neri Bale R , Adib Gracia A E , Arias Mendoza M A , Sierra Lara Martinez J D
Published: January 2025

Background

Global Longitudinal Strain (GLS) and left ventricular-arterial coupling (VAC), calculated as the ratio between arterial elastance (Ea) and left ventricular end-systolic elastance (Ees), are part of modern non-invasive indices of left ventricular (LV) and arterial system function. Their interaction in determining prognosis in post-STEMI patients with acute coronary syndrome (ACS) is not well established, particularly in relation to reperfusion strategies.

Purpose

It aims to demonstrate through multiple mechanisms (and advanced mechanics analysis) that gaining reperfusion time has clinical benefits, and once again, pharmacoinvasive strategy (PhI) proves it is not inferior than percutaneous coronary intervention (PCI).

Methods

Echocardiography was performed on 144 post-STEMI patients who were followed up for 750 days after hospitalization. Each baseline characteristic variable was analyzed using Wilcoxon and Shapiro-Wilk tests. Kaplan-Meier methods with log-rank tests were employed to assess the presence of MACE (including heart failure, cardiogenic shock and death) in two main variables across four groups. The first compared VAC within the parameter range of 0.95-1.1 and reperfusion strategy (PhI vs PCI), while the second analyzed GLS <-18 and reperfusion strategy (PhI vs PCI).

Results

We included 144 patients, with 87% (n=125) being male, and a median age of 60 years. The most common comorbidities were hypertension (52%) and type 2 diabetes (40.3%). In our initial comparison between VAC and reperfusion strategy, Kaplan-Meier curves demonstrated significant differences in the presence of major adverse cardiovascular events (MACE) between VAC and the reperfusion strategy. There was a better prognosis observed in both PhI groups, particularly in the VAC 0.95-1.1 group (p-value < 0.032). Conversely, the group with the highest number of events included those with VAC outside the 0.95-1.1 range and PCI strategy. Furthermore, in the GLS analysis, the PhI-based reperfusion strategy yielded superior results in terms of MACE outcomes (p-value <0.041). Nonetheless, GLS remained significant with a value of <-18 for predicting the presence of MACE

Conclusions

Both GLS and VAC, as advanced mechanical analyses, serve as affordable predictors of MACE in post-STEMI patients. More importantly, our findings demonstrate that pharmacoinvasive therapy (PhI) offers superior prognosis for our patients. Therefore, prioritising early reperfusion treatment, whether pharmacoinvasive or primary, is imperative.

Fig 1. GLS and reperfusion strategy

Fig 2. VAC and reperfusion strategy
Beyond heart rhythm: 12 months in the echocardiographic evaluation of cardiac resynchronization
Authors: Mauricio A N A , Goncalves S U S A N A , Prata S A R A , Santos L A U R A , Bernardes A N A , Ribeiro F , Marques P E D R O , Sousa C , Pinto F A U S T O
Published: January 2025

Introduction

Cardiac resynchronization therapy (CRT) is recommended in patients with heart failure (HF), but 1/3 of patients are "non-responders". More recent resynchronization algorithms promote electrical optimization by dynamically adjusting atrioventricular intervals, reducing QRS duration. However, their impact on left ventricular function parameters remains unclear.

Objectives

The following echocardiographic parameters were evaluated and compared pre-CRT and at 12 months follow-up: left ventricular (LV) diastolic and systolic volume; ejection fraction (LVEF), global longitudinal myocardial strain (GLS), left atrial (LA) volume; and analytical parameters: NT-ProBNP.

Methods

Retrospective, comparative study of patients who underwent CRT. All patients underwent echocardiographic study and clinical analysis before CRT implantation and at 12 months follow-up. The following echocardiographic parameters were assessed post-procedure: LVEF (Simpson biplane method); LV volumes and LA volumes indexed to body surface area and GLS (GE Echopac). NT-ProBNP values were collected.

Results

50 patients (74 ± 1.3 years, 66% men) were studied, 50% with ischemic heart disease. In the comparative analysis before CRT and at 12-month follow-up, statistically significant differences were observed in LV diastolic and systolic volumes (96.5 ± 4.3 ml/m2 vs. 78. 2 ± 4 ml/m2, p=0.001; 65 ± 3 ml/m2 vs. 48 ± 3 ml/m2, p=0.001), with a significant improvement in LVEF at follow-up (33% ± 1.1 vs. 40% ± 1.4, p=0.001) as well as GLS (-7.8% ± 0.3 vs. -11.5% ± 1, p=0.003). LA volume also showed a significant decrease at follow-up (87 ± 4 ml vs. 71 ±3.8 ml). Reverse remodeling was more evident in patients without a history of ischemic heart disease, with a decrease in LV volumes, improved LVEF and GLS. NT-ProBNP levels also decreased significantly at follow-up (1945 ± 294 pg/mL vs. 783 ± 134 pg/mL, p=0.001).

Conclusions

CRT implantation is a therapeutic option for patients with HF refractory to medical treatment. Recent resynchronization algorithms show good results in reducing LV volumes as well as improving left ventricular function, and the prognosis of these patients.
What happens to myocardial work after transcatheter aortic valve replacement?
Authors: Carvalheiro R , Barbas De Albuquerque F , Lacerda Teixeira B , Galrinho A , Valentim Goncalves A , Rodrigues I , Grazina A , Mendonca T , Ramos R , Fiarresga A , Cacela D , Cruz Ferreira R
Published: January 2025

Background

Novel echocardiographic speckle-tracking techniques such as global longitudinal strain (GLS) and myocardial work (MW) have been used in many cardiac conditions for myocardial functional assessment. In severe aortic stenosis (SAS) this evaluation is more challenging since left ventricular (LV) systolic pressure (SP) does not equal non-invasive systolic pressure (NISP) owing to the fixed obstruction of a stenotic valve. Few studies have evaluated the immediate impact of transcatheter aortic valve replacement (TAVR) in patients with SAS on GLS and MW parameters.

Aim

To assess differences in GLS and MW parameters values, pre- and post-TAVR, in patients with SAS.

Methods

One-single center retrospective analysis of consecutive patients with SAS submitted to TAVR, between January 2018 and December 2021, who performed transthoracic echocardiography (TTE) bfore and after the procedure (within the same hospital admission).

NISP was determined at TTE performance. For pre-TAVR assessment, corrected SP by adding the mean aortic gradient was introduced in the software for MW parameters calculations, namely global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE).

Continuous variables were assessed for normality using Shapiro-Wilk test. Normal variables were represented as mean and standard deviation (SD) and compared using a paired-sample t-test. Non-normal variables were represented as median and interquartile range (IQR) and compared using a Wilcoxon-Signed rank test. Statistical significance was defined as two-sided p value < 0.05. All statistical analysis were done with JASP (version 0.16.0.0).

Results

50 patients entered the primary analysis. Mean age was 82 years and 56% were female sex.

Before TAVR, mean aortic gradient was 49 ± 15 mmHg, mean aortic valve area was 0.76 ± 0.22 cm2 and LV ejection fraction was 52 ± 11%.

Table 1 represents the mean GLS and MW parameters values pre- and post-TAVR from our study population. Patients had significant lower values of GWI (1764.4 ± 704.9 vs. 1197 ± 372.6, p < 0.001) and GCW (2309.5 ± 810.9 vs. 1627.8 ± 488.5, p < 0.001) post-TAVR when compared with the pre-TAVR values. There were no significant differences in GLS (p=0.837), GWW (p=0.055) and GWE (P=0.438) values pre- and post-TAVR.

Conclusion

In our study population, GLS was impaired in patients with SAS and it remained identical after TAVR, suggesting un underlying myopathy that does not reverse immediately after the procedure. Furthermore, MW as assessed by GWI was significantly reduced after TAVR, which may reflect the reduced workload needed after the procedure due to acute afterload reduction. Further studies with longer follow-up are needed to acess the long term impact of TAVR in MW.

TAVR MW
Global longitudinal strain during stress echocardiography predicts major adverse cardiovascular events in patients with suspected chronic coronary syndrome.
Authors: Sanchez Nieto J , Millan Vela J , Arias Godinez J A , Fritche Salazar J F , Posada Martinez E L , Ortiz Leon X A , Ruiz Esparza Duenas M E , Rodriguez Esparza J D , Suarez Lara N N , Rodriguez Zanella H
Published: January 2025

Background

Global longitudinal strain (GLS) is a robust prognostic marker in patients with coronary artery disease. The ABCDE stress echocardiography protocol has emerged as a novel tool for prognostic risk stratification beyond wall motion abnormalities. However, GLS during stress has not been incorporated in this protocol and its prognostic value remains to be confirmed.

Purpose

To assess the prognostic value of GLS during stress echocardiography to predict major adverse cardiovascular events in patients with suspected chronic coronary syndrome.

Methods

We recruited patients aged 18 years or older from 2017 to 2023 with suspected chronic coronary syndrome, who underwent clinically indicated stress echocardiography. Semiautomatic GLS of the LV was measured at rest and during stress. We included all types of stress: semi-supine bicycle, dobutamine, and dipyridamole. Logistic regression analysis was performed to assess the association between GLS and major adverse cardiovascular events (MACE).

Results

Eighty-one patients were included, age 61 (28-86) years, 52 were male (64 %), 60% had history of hypertension, 40% diabetes, 27% obesity and 14% previous acute coronary syndrome. Resting LVEF was 57% (± 11) and GLS 16% (± 4). After a mean follow up of 34 months, 24 patients (29%) presented MACE. Patients with MACE had lower LVEF 53 ± 13% vs 59% ± 10% (p<0.0328) and lower GLS 13.9± 4.5% vs 16.9 ± 3.9% (p<0.0029) at baseline. On univariate logistic regression analysis stress GLS was related to the occurrence of MACE, p=0.04. ROC curve analysis using Youden index identified that a cut off value of stress GLS <17% had a 47% sensitivity, 87% specificity. The survival analysis showed a 77.7% survival rate for those with GLS <17% than for those with GLS >17% (p=0.044) over 34 months of follow-up.

Conclusion

In patients with suspected chronic coronary syndrome undergoing stress echocardiography GLS during stress is a predictor for MACE. The survival of patients with less of 17% of GLS was significantly minor with a sensitivity of 47.37% and a specificity of 87.5%.

ROC curve(Above) and Kaplan Meier Curve.

Table 1.
Long-term outcomes after stress echocardiography in real-world practice: five year follow-up of the EVAREST study
Authors: Woodward W , Johnson C L , Krasner S , O'driscoll J , Balkhausen K , Chandrasekaran B , Firoozan S , Kardos A , Sabharwal N , Sarwar R , Senior R , Sharma R , Wong K , Augustine D X , Leeson P
Published: January 2025

Background/Introduction

Stress echocardiography is widely used to assess patients with chest pain. The clinical value of a positive or negative test result to inform on likely longer-term outcomes when applied in real-world practice across a national healthcare system has not been previously reported.

Purpose

We report patient outcome up to five years after stress echocardiogram for patients undergoing a clinically-indicated stress echocardiogram for ischaemic heart disease in a real-world, multi-centre national healthcare system and determine the event-free ‘warranty’ period following a normal stress echocardiogram.

Methods

Patients participating in the EVAREST/BSE-NSTEP (Echocardiography: Value and Accuracy at Rest and Stress/ British Society of Echocardiography National Review of Stress Echo Practice) prospective cohort study were recruited from 32 UK NHS hospitals between 2018 and 2022. Medical outcome data up to 2023 was available from NHS England. Stress echocardiography results were related to outcomes, including death, procedures, hospital admissions and relevant cardiovascular diagnoses, using Kaplan-Meier analysis and Cox proportional hazard ratios. Warranty period following a negative stress echocardiogram was defined as time the cumulative event rate of myocardial infarction or cardiac-related death remained below 5%.

Results

5503 patients were included in the analysis with a median follow-up of 829 days (IQR 224 – 1434). A positive stress echocardiogram was associated with a greater risk of myocardial infarction (HR 2.71, 95% CI 1.73 – 4.24, P<0.001), revascularisation (HR 10.52, 95% CI 8.26 – 13.42, P<0.001) and reaching a composite endpoint of cardiac-related mortality and myocardial infarction (HR 2.04, 95% CI 1.41 – 2.93, P<0.001). Hazard ratios for all events increased with ischaemic burden identified at stress echocardiography (Figure 1). A negative stress echocardiogram identified an event-free ‘warranty period’ of at least five years in patients with no prior history of coronary artery disease, and four years for those with disease (Figure 2).

Conclusions

In real-world practice, the degree of ischaemia recorded by clinicians at stress echocardiography correctly categorises risk of future events over the next five years. Reporting a stress echocardiogram as negative correctly identifies patients with no greater than a background risk of cardiovascular events over a similar time period.

Figure 1

Figure 2
Does ischemic stress echocardiography study in subjects with non-obstructive coronary artery disease predicts worse cardiovascular prognosis?
Authors: Kobal S , Murninkas M , Zeldetz V , Shmueli H , Shitrit A
Published: January 2025

Background

Many patients with signs of ischemia in stress echocardiography (SE) do not have obstructive coronary artery disease (CAD). There is concern that subjects with abnormal SE results without significant CAD have a worse prognosis than patients with normal SE.

Purpose

The aim of this study was to examine the cardiovascular prognosis and mortality of patients with ischemic SE test and normal or non-obstructive CAD.

Methods

A retrospective cohort study of patients with ischemic SE test who demonstrated a normal coronary arteries or non-significant CAD by coronary catheterization or computerized tomography angiography were compared to patients with normal SE study, matched by distribution of age, gender, and by the year that the test was performed for the rate of all-cause mortality and mayor adverse cardiac events (MACE).

Results

There were 55 out of 168 patients with ischemic SE that had normal or non-significant CAD (64 ± 9 years, 54% females). During a mean follow up of 7.9 ± 2.6 years, MACE was higher in ischemic SE group than the non–ischemic group (15% and 7%, respectively). The most common MACE component in the ischemic SE subjects was heart failure (11% and 2% for ischemic SE group and non-ischemic SE group, respectively) (HR 2.854). The rate of all-cause mortality was also higher in the ischemic SE group than the non-ischemic SE group (3.1% and 2.1%, respectively) By multivariate analysis the most powerful parameter that predicted all-cause mortality was hypertension (HR 1.195) and diabetes mellitus (HR 1.548).

Conclusions

The outcome of patients with ischemic SE and normal coronary arteries or non-obstructive CAD is worse for patients with normal SE. According to these findings patients with ischemic SE results and normal coronary arteries or non-obstructive CAD may benefit from different management that should include frequent medical follow up and tight control of risk factors.
Left anterior descending velocity reserve by supine ergometry in asymptomatic severe aortic stenosis: evidence for relationship with the valvuloarterial impedance
Authors: Armenis I , Leontiadis E , Tsiapras D , Kyrzopoulos S , Iakovou I , Athanassopoulos G D
Published: January 2025

Introduction

Myocardial perfusion is impaired in aortic stenosis (AS) due to microvascular dysfunction and exhaustion of autoregulation following the increased left ventricular (LV) afterload. Distal left anterior descending blood flow velocity (LAD-vel) and the respective reserve (CVR) during supine ergometry (Ex) represent a surrogate for the interrogation of the underlying perfusion pathophysiology.

Purpose

Purpose of the study was to assess the relationship between LAD profile and CVR with the LV functional capacity and valvuloarterial impedance (Za) in the context of asymptomatic severe AS and to evaluate the potential prognostic implications.

Method

Fifty four patients with asymptomatic severe AS, followed-up on valve clinic in a tertiary center (age 66±12 years), were referred for Ex. AS related cardiac events (independent decision for surgery, occurrence of AS-related symptoms) during a follow-up of 24±23 months occurred in 18 patients (EV group).

CVR at the distal LAD was estimated during Ex at the latest possible timing (time from onset Ex: 3.0±2.7 minutes, workload: 48±22 Watts (W), respective heart rate (HR): 92±17 (82±16% of the maximum achieved HR).

The following parameters were estimated both at rest-R/Ex: LV ejection fraction (EF:%), longitudinal strain (SR:%), transmitral E/e ratio, peak transtricuspid systolic pressure (TRPG: mmHg), AV mean gradient (meanGR: mmHg) and valvuloarterial impedance (Za: mm Hg·ml-1m2).

Results

EV and non EV groups had similar LAD-vel (26±9 vs 26±10cm/s). LAD-vel and CVR were not affected by sex (women/men=18±36 vs 26±9cm/s and 2.09±0.54 vs 2.25±0.45 respectively). LAD-vel was higher in the 24 patients with age>70years (28±9 vs 21±7cm/s p=0.03), implying relative autoregulatory dysregulation, whereas CVR was similar (2.18±0.46 vs 2.11±0.60, p>0.05).

CVR was not affected by the workload achieved [50W (10patients): 2.0±0.5 vs 75W (23patients): 2.3±0.6 vs 100W (19patients):2.1±0.5 vs 125W (2pts):1.9±0.2]

Linear regression analysis did not show any relationship of CVR with EF- R/Ex, SR-R/Ex, meanGR-R/Ex, E/e-R/Ex and %target HR. CVR had a weak negative relationship with age (r=-0.27 p=0.05).

However, CVR was related with Za at R (r= 0.5 p=0.008) and modestly at Ex (r=0.35 p=0.08, figures).

Conclusion

Despite the absence of obvious relationships with LV functional reserve and clinical outcome, perfusion reserve in asymptomatic severe AS, estimated by supine ergometry-induced CVR, compensates efficiently for the imposed valvuloarterial impedance at rest but with a less consistent support for the exercise induced increase in the LV afterload.
Non-invasive assessment of arterial elastance using three-dimensional echocardiography: an accurate alternative to invasive methods
Authors: Hammersboen L E R , Boe E A , Aalen J M , Odland H H , Kongsgaard E , Villegas-Martinez M , Frostelid V C , Khan F H , Sletten O J , Witsoe M , Skulstad H , Smiseth O A , Stugaard M , Re E W
Published: January 2025

Introduction

Assessing arterial elastance (Ea) is crucial for understanding vascular properties and managing conditions such as hypertension, heart failure, and valvular heart disease. While invasive pressure-volume (PV) analysis provides precise measurements, the procedures involved pose significant risks and limitations. Three-dimensional (3D) echocardiography, combined with non-invasive LV pressure curve estimation, however, offers a highly accurate method for generating non-invasive PV-loops. Thus, this approach has the potential to provide a safe and widely accessible means of assessing Ea.

Aim

Validate non-invasive Ea by PV analysis using 3D echocardiography, comparing it to gold-standard Ea derived from invasive measurements.

Methods

In 10 open-chest canines, invasive pressure was measured using a micromanometer, and volume determined from subendocardial piezoelectric crystals, using a three-axis ellipsoid model (Figure 1). Echocardiography provided non-invasive 3D LV volumes and valve event timings. The LV pressure curve was estimated by adjusting a reference curve to the valve events and measured peak LV pressure, which in clinical practice would be approximated as systolic brachial cuff pressure. Arterial elastance (Ea) was defined as the absolute slope of the line from volume axis interception at end-diastolic volume to the point on the PV-loop in the upper left quadrant with the longest normalized distance from the loop center. Recordings were performed at baseline and during aortic constriction.

Results

Panel A in Figure 2 illustrates how tightly non-invasive (dotted lines) followed invasive (solid lines) pressure-volume curves both during baseline (left) and aortic constriction (right) in a representative experiment. As can be seen, this resulted in very similar Ea. Panel B shows pooled data from all experiments, demonstrating that indeed, the non-invasive method captured similar changes in Ea during aortic constriction compared to the invasive method. Furthermore, as shown in panel C, there was an excellent correlation (r = 0.91, p < 0.0001) and good agreement (mean difference 0.3, SD 0.3) between the non-invasive and invasive Ea.

Conclusions

Three-dimensional echocardiography provides an accurate and non-invasive method for assessing arterial elastance, with excellent agreement with gold standard invasive method.

Ultrasound crystals placement

Invasive vs non-invasive Ea
Left atrial appendage: a comparative analysis using 2D and 3D transoesophageal echocardiography
Authors: Modan S , Madan K , Gunton J , Perry R , Parvar S , Gluyas K , Sinhal A , Joseph M
Published: January 2025

Background

Percutaneous left atrial appendage (LAA) closure is an alternative intervention to anticoagulation to prevent stroke in patients with atrial fibrillation with a higher risk of bleeding. The imaging of LAA is crucial to determine the optimal ostium dimensions for safe closure and procedural outcomes. Sizing using three-dimensional transoesophageal echocardiography (3D-TOE) is likely to offer a more accurate assessment, as seen in other structural interventions such as annular measurements in transcatheter aortic valve implantation (TAVI).

Aim

This study aimed to evaluate the accuracy of LAA sizing using two-dimensional transesophageal echocardiography (2D-TOE) and 3D-TOE. Furthermore, we assessed the accuracy of the measurements by correlating both imaging modalities with final device size and post-device leakage.

Methods

Our study prospectively analysed the LAA dimensions of 63 consecutive patients undergoing transoesophageal echocardiography (TOE) with measurements using both 2D and 3D-TOE (Figure 1 & 2). The assessing clinician remained blinded to measurements that were performed retrospectively by data analysts. Additionally, we retrospectively evaluated outcomes with 25 consecutive LAA closures (Figure 3 & 4), where 2D-TOE was utilised alongside fluoroscopy for sizing in 18 (72%), and 3D-TOE was employed in 8 (32%) of patients.

Results

The mean age of patients was 76 ± 7 years. The LAA annulus was eccentric in 47 (75%) and circular in 16 (25%) of patients. There was a good intraclass correlation (ICC) between 2D and 3D-TOE (ICC=0.81, p <0.001) and Pearson’s correlation (r=0.84, p <0.001). Bland-Altmann analysis (Figure 5) revealed a bias of 0.19, indicating 3D-TOE LAA measurements were larger overall, with limits of agreement between -0.33cm to 0.71cm.

The retrospective analysis showed that 2D-TOE underestimated the final device size by 1.86 ± 1.1 mm, while 3D-TOE underestimated by 0.6 ± 1.2 mm. Clinically, using only 2D-TOE measurements, 9 patients (36%) required upsizing, whereas 3D-TOE accurately predicted the final device size in all but one case. Additionally, in 18 cases guided solely by 2D-TOE, 9 (50%) were complicated by post-device leakage at the six-week follow-up, albeit they were all leaks were less than the guideline cut-off value of 6 mm. In contrast, for 8 patients where 3D-TOE was also used, there was only one case of post-device leak.

Conclusion

Our study demonstrates that while 2D and 3D-TOE values are mostly consistent, 3D-TOE measurements are larger and more accurately depict the irregular, eccentric nature of LAA orifices. 3D-TOE guidance had better correlation with true device size, resulting in lower post-device leakage and less intra-procedural upsizing. These findings align with TAVI literature, which notes that 2D echocardiography underestimates the true size of the aortic valve annulus compared to CT and 3D echocardiography techniques.
Effectiveness of cardiovascular rehabilitation programs among patients with heart failure based on myocardial deformation and atrial function echocardiographic predictors
Authors: Adam C , Marcu D T M , Mitu O , Costache C A , Mitu F
Published: January 2025

Background

Cardiac rehabilitation (CR) plays an important role in heart failure (HF) contributing to stopping functional decline, relieving symptoms and increasing quality of life in combination with optimal therapeutic management.

Purpose

We aimed to evaluate the impact of participating in a CR program after 6 months in terms of biological (N-terminal pro b-type natriuretic peptide [NT-proBNP], inflammatory biomarkers) and echocardiographic parameters (left and right ventricle global longitudinal [LV, RV GLS], left atrial strain) with a prognostic role in HF.

Methods

We conducted a prospective cohort study on 105 patients with HF admitted to a center specialized in CR programs. Based on functional status at enrolment assessed on the NYHA class, we divided the patients into two groups: with mild and moderate functional limitation (NYHA I-II class) (n=70) and with severe functional limitation (NYHA III class) (n=35) respectively.

Results

We analyzed demographics, anthropometrics, clinical and paraclinical parameters, with a focus on echocardiographic parameters of biventricular and atrial systolic function. Both at enrollment and at the 6-month assessment, functional status was assessed by cardiopulmonary exercise testing (CPET). At the 6-month follow-up patients in the second group had superior improvement in biological (p=0.039 for NT-proBNP) and echocardiographic parameters (p=0.041 for LV GLS, p=0.035 for RV GLS, p=0.017 for left atrial strain) compared to baseline. In the second group, LV GLS values were statistically significantly correlated with NT-proBNP (p=0.023), peak oxygen uptake (p=0.041) and maximum walking distance (p=0.031). RV GLS also positively correlated with peak oxygen uptake (p=0.017) at the follow-up. Receiver operating characteristic (ROC) curve analysis demonstrated that biventricular and atrial systolic function parameters amelioration are echocardiographic predictors for increased cardiorespiratory fitness. Lack of LV GLS and left atrial strain improvement in patients with severe functional limitation (group 2) is a negative predictor (AUC = 0.811, p = 0.015 for LV GLS and AUC = 0.649, p = 0.022 for left atrial strain).

Conclusion(s)

CR programs improve systolic dysfunction and atrial function in HF patients. Improvement of LV and RV GLS as well as left atrial strain can be used as echocardiographic markers of better cardiorespiratory fitness 6 months after the start of the CR program.
Early mortality predictors in COVID-19 pneumonia complicated with pulmonary embolism- unicentre analysis
Authors: Duraj I , Broncel M , Karina Wierzbowska-Drabik K W B
Published: January 2025

Background

Covid-19 took an huge death-toll in the era of its pandemic widespread in scale of the whole world imposing a new and still not completely understood not resolved threat to public health. Beyond the severity of lungs affliction and the subsequent respiratory failure thromboembolic complications with their crucial form of pulmonary embolism (PE) are seen as responsible of this high numbers of fatalities.

Aim

We aim to find predictors of in hospital death in subgroup of patients with COVID-19 pneumonia diagnosed simultaneously with CT-angiography of pulmonary embolism.

Methods

Our group included 39 patients from 42 to 95 year old (mean age 67±13, 27 males and 12 females) hospitalized in Internal Disease and Clinical Pharmacology Department since October 2020 to June 2021 with the diagnosis of SARS COV2 pneumonia and pulmonary embolism detected with CT angiography during the analysed hospitalization. We compared clinical, laboratory and treatment data between group who died during hospitalization (G1) and those who survived the early period of at least 1 month after disease onset (G2).

Results

During hospitalization and in extended to 1 month follow-up 12 deaths occurred, 8 in men (30%) and 4 in women (33%), however this difference did not reach statistical significance and moreover women were older than men among all PE patients (73±12 vs 64±13 years respectively, p=0.049). The compared groups did not differ significantly according to age (although some trend to higher age in G1), the prevalence of hypertension, diabetes, chronic obstructive pulmonary disease as well as provided treatment including heparin, oxygen therapy, remdesivir, tocilizumab and dexamethasone or heart rate, creatinine, troponin or NT-proBNP level, see Table. They differ, however, according to IL-6 concentration significantly higher in group with fatal outcome (108 (77-240) vs 52 (41-98) pg/ml, p =0.0162) as well as according to surprisingly higher lymphocyte count (0.95 (0.75-1.55) vs 0.6 (0.4-0.7) count X 1000, p=0.0058). Both these parameter showed significant predictive value of early death in studied group with sensitivity of 75% for both parameters and specificity of 74% for IL-6 > 91 and 78% for lymphocytes above 700/µl.
Myocardial strain and work parameter changes predict long term mortality and rehospitalization in an acute heart failure patient population after levosimendan use
Authors: Kormanyos A , Schvartz N , Nagy V , Takacs H , Racz G , Polestyuk B , Vidacs D L , Borbas J , Szili-Torok T , Sepp R
Published: January 2025

Introduction

Decompensated acute heart failure (HF) in patients with reduced ejection fraction (HFrEF) signifies a pivotal stage in the progression of chronic HF. This condition is closely linked to increased rates of rehospitalization and a higher risk of mortality and morbidity due to inadequate decongestion. Recently, the field of quantitative echocardiography has experienced significant advancements, particularly in myocardial work analysis (MWA), which measures the energy the heart uses during each cardiac cycle.

Purpose

This study aimed to investigate the immediate effects of levosimendan on myocardial mechanics and to determine if these effects can predict the composite endpoint of HF-related rehospitalization and cardiovascular mortality.

Methods

60 patients with HFrEF have been enrolled in the present study (age: 63.8±14.1, 46 males, 25 ischemic HFrEF, 35 non-ischemic HFrEF). or all patients, detailed baseline echocardiography, including strain imaging and myocardial work analysis (MWA), was conducted. Follow-up echocardiography was performed an average of 13.1±12.5 days after levosimendan administration. The clinical follow-up period lasted 496±191 days.

Results

Before levosimendan administration there was no significant difference in baseline echocardiographic, strain imaging and MWA parameters between ischemic and non-ischemic HFrEF groups. After the drug administration, left ventricular global wasted work (179±89 Hgmm% vs. 319±220 Hgmm%, p <0.05) was higher in the ischemic HFrEF group compared to non-ischemic HFrEF group. Among advanced echocardiographic parameters, global longitudinal strain (GLS) showed no significant improvement, however out of the MWA parameters, global work index (376±215 Hgmm% vs. 460±272 Hgmm%, p <0.05) improved significantly. The prognostic role of hemodynamic and novel echocardiographic parameters has been also assessed. Kaplan-Meier analysis revealed that LV stroke volume index improvement of 0.145 ml/m2 (p=0.01), LVEF improvement of at least 10% or more (p=0.032), LV GLS improvement of 0.85% (p=0.018) and lastly global constructive work improvement of 100 Hgmm% or more (p=0.021) resulted in significantly better event-free survival during the follow up period.

Conclusion

Levosimendan administration produces substantial immediate effects on hemodynamic parameters, myocardial deformation, and MWA metrics. These alterations appear to hold significant long-term prognostic value for predicting the composite endpoint and event-free survival.
Role of multimodality cardiovascular imaging for evaluation of the effect of enzyme replacement therapy
Authors: Gwak S , Seo J , Hong Y , Cho I , Shin C Y , Ha J , Hong G
Published: January 2025

Background

Fabry’s cardiomyopathy patients receiving enzyme replacement therapy (ERT) have no validated cardiac functional biomarkers to evaluate the effect of ERT.

Purpose

We aimed to investigate functional cardiac biomarkers to assess the response of ERT on the heart and to predict clinical outcomes.

Methods

Patients with Fabry’s disease having LV wall thickness ≥12mm were prospectively enrolled and treated with Agalsidase beta. The primary endpoint was the change of exercise peak E/e’ by diastolic stress echocardiography (DSE) during ERT; secondary endpoints were changes in conventional echo-Doppler parameters, LV global longitudinal strain (LVGLS), and diastolic reserve (DR25W) by DSE. We compared two groups (stable and progression groups) divided by LVMI change in CMR. Clinical outcomes were defined as a composite of cardiovascular death, aborted sudden cardiac death, and stroke.

Results

Between March 2015 and January 2021, 20 patients (mean age 46.6±12.8 years, 50.0% women) were enrolled and received Agalsidase beta during 2.0±0.9 years. 13 (65.0%) patients remained stable, and 7 (35.0%) experienced progression during ERT. The annual change of peak exercise E/e’ showed no significant differences between the two groups. However, LVGLS and diastolic reserve (DR25W) significantly improved in the stable group but not in the progression group. The annual change of LVGLS (AUC, 0.84 [95% CI, 0.64–1.00], sensitivity 57.1%, specificity 100.0%, P=0.007) and DR25W (AUC, 0.84 [95% CI, 0.63–1.00], sensitivity 71.4%, specificity 90.9%, P=0.008) had a significant predictive value for LV mass progression in ROC analysis (Figure). Kaplan-Meier analysis revealed that LV mass progression was significantly associated with poor clinical outcomes (Log-rank, P=0.014).

Conclusion

Cardiac functional imaging biomarkers were useful in predicting the effect of ERT in patients with Fabry’s cardiomyopathy. LV mass progression during ERT was associated with poor clinical outcomes.

ROC analysis
Hemodynamic forces: a novel cardiac MRI parameter to assess early cardiac involvement in sarcoidosis patients
Authors: Kante A , Afana A , Sene D , Champion K , Pagis V , Bigot W , Burlacu R , Baladi C , Bousson V , Goncalves T , Ballout E , Toupin S , Henry P , Comarmond C , Pezel T
Published: January 2025

Background

Cardiac sarcoidosis (CS) is an underdiagnosed condition characterized by the formation of non-caseating granuloma in the myocardium, potentially leading to arrhythmia, acute heart failure and sudden cardiac death. Early screening for diagnosis is crucial to optimize treatment and delay progression. Hemodynamic forces (HDFs) are a measurement of the global force exchanged between blood volume and myocardium assessed during cardiac magnetic resonance imaging (CMR), and are a novel noninvasive parameter used to detect early cardiac dysfunction. HDFs have not yet been studied in patients with suspected CS.

Purpose

To investigate left ventricle (LV) HDFs in suspected CS compared to healthy controls (HC). Among patients with suspected CS, to investigate the diagnostic role of HDFs between confirmed-CS and non-CS patients.

Methods

In a single-center study, patients with suspected cardiac involvement and biopsy-proven sarcoidosis were included and a 1.5T CMR exam performed. HDFs were obtained using an advanced post-processing software (Medis Suite). CMR from suspected CS were compared to age and sex-matched HC. In sarcoidosis patients, cardiac involvementwas confirmed using the WASOG (World Association for Sarcoidosis Other Granulomatous diseases) 2014 criteria. The performance of HDFs for diagnosing CS among sarcoidosis patient was assessed using a logistic regression model using 3 HDFs parameters: LV systolic peak, LV longitudinal force and LV impulse and adjusted for the presence of LGE.

Results

Among 45 sarcoidosis patients with suspected CS, 60% had a confirmed-CS using the WASOG criteria (22% had a positive cardiac FDG-PET, 11% had scintigraphy perfusion defects and 85% had LGE). In this population, systolic and diastolic HDFs were significantly altered compared to HC (LV impulse, p=0.045; LV systolic ratio, p=0.018; LV systolic-diastolic-transition, p=0.012; LV diastolic deceleration, p=0.013) (Figure 1). LV strain and LVEF (median [IQR]) were not statistically different between CS (56 [53–60] %) and non-CS patients (60 [55–64] %). However, HDFs parameters LV longitudinal force (p=0.041), LV impulse (p=0.018), and LV systolic peak (p=0.035) were significantly altered in confirmed-CS patients compared to non-CS patients. Furthermore, the combination of LV longitudinal force, LV impulse, and LV systolic peak enabled an accurate diagnosis of CS among sarcoidosis patients, with an AUROC (area under the receiver operating characteristic) of 0.88 (Figure 2).

Conclusions

Sarcoidosis patients with suspected CS had altered hemodynamic forces compared to HC due to altered LV geometry and mechanics. Furthermore, hemodynamic forces were superior to traditional volumetric and functional CMR parameters (LVEF and strain) to predict cardiac involvement in sarcoidosis patients.

Figure 1

Figure 2
Review of pretreatment and analytical methods for environmental endocrine disruptors: Phthalates
Authors: Ding Ding , Wang Yu , He Jiaxin , Gao Jiajia , Xu Zhizhen , Dou Yan , Guo Ling , Ji Xiaohui , Shu Mushui , Yue Tao
Published: January 2025

Phthalates, known as phthalate esters (PAEs), are among the most ubiquitous pervasive env7ironmental endocrine disruptors (EEDs), extensively utilized globally in various facets of modern life due to their irreplaceable role as plasticizers. The exponential production and utilization of plastic goods have substantially escalated plastic waste accumulation. Consequently, PAEs have infiltrated the environment, contaminating food and drinking water reservoirs, posing notable threats to human health. This review provides a comprehensive overview of research advancements in PAE detection and identifies key focal points from 2000 to 2022, utilizing the Web of Science Core Collection. Sample pretreatment and analytical methodologies for PAEs are examined based on bibliometric analysis findings. Pretreatment methods mainly include dispersive solid-phase extraction (DSPE), magnetic solid-phase extraction (MSPE), molecularly imprinted solid-phase extraction (MISPE) and solid-phase microextraction (SPME). Laboratory analytical methods such as gas chromatography (GC), liquid chromatograph (LC) and immunoassay have been described. Additionally, a discussion on the advantages and challenges of rapid on-site detection methods, in comparison to traditional approaches, is presented in alignment with the evolving demands of PAEs detection. Based on the current research progress, future studies can focus on the demand of rapid detection of PAEs.
Black and Latinx hermeneutical resources, hip hop music and white supremacy
Authors: Bayruns García Eric
Published: January 2025

I will argue that the diminishment of hip hop music as a hermeneutical resource for Black and Latinx persons by white supremacy promotes the ubiquity of ignorance of racial injustice in North America. To this end, I will defend what I call the hermeneutical-diminishment thesis. According to this thesis, white supremacy has diminished hip hop as a hermeneutical resource for Black and Latinx persons. To defend this thesis, I will substantiate two sub-theses. The first is the prescriptive-rap sub-thesis. According to this sub-thesis, white supremacy has caused prescriptive rap to predominate the content of hip hop in comparison to descriptive rap. The second sub-thesis is the descriptive-rap sub-thesis. According to this sub-thesis, if (i) hip hop can have prescriptive or descriptive content; (ii) hip hop with prescriptive content is a poorer hermeneutical resource for Black and Latinx people; and (iii) hip hop is dominated by rap music with prescriptive content; then (iv) hip hop is a poorer hermeneutical resource for Black and Latinx people. The defense that I present of the hermeneutical-diminishment thesis will take the following form. If the prescriptive-rap sub-thesis is true and the descriptive-rap sub-thesis is true, then the hermeneutical-diminishment thesis is true. I here show that both sub-theses are true, and therefore the hermeneutical-diminishment thesis is true.
Elucidating the life history parameters of Culicoides oxystoma (Diptera: Ceratopogonidae) under varied substrate compositions and temperatures
Authors: Sarkar Ankita , Banerjee Paramita , Mazumdar Abhijit
Published: January 2025

A comprehensive study was conducted on the life history parameters of an important vector Culicoides oxystoma Kieffer (Diptera: Ceratopogonidae), to standardize potential rearing procedures. Data on life history traits and rearing conditions are crucial for establishing laboratory colony and conducting vector competence-based studies utilizing specimens with a known rearing history. Six different substrate compositions were used to rear the larvae: S1: habitat mud containing cattle manure + nutrient broth + yeast, S2: yeast, S3: habitat mud containing cattle manure + nutrient broth, S4: nutrient broth, S5: sterile (habitat mud consisting cattle manure + nutrient broth + yeast) and S6: tap water. Gravid females preferred ovipositing on beds moistened with tap water compared to distilled water. Egg hatching recorded minimal (3%) in the sterile substrate (S5), hinting at the role of live microbial load. Progression of larval instars got disrupted at 1st instars in S5 and S6. Larval survival and adult emergence were the highest in S1 and the lowest in S4, indicating that S1 is highly effective in the rearing of this species. The life cycle parameters and duration between transitional stages were evaluated at 15 °C, 20 °C, 26 °C, 30 °C, and 35 °C using rearing substrate S1. The highest larval survival (>70%) and adult emergence (69%) were achieved at 26 °C. The duration from egg to adult was 16 to 20 d at 35 °C, 18 to 24 d at 26 °C, but up to 36 d at 15 °C. Elucidating the effective rearing conditionalities of this important vector species will be helpful to study the transmission cycles of pathogens.