bluuebunny/crossref_metadata_2025 huggingface dataset:
Right ventricular-arterial coupling in severe tricuspid regurgitation: prognostic relevance of longitudinal strain
Authors: Margonato D , Ancona F , Melillo F , Ingallina G , Stella S , Biondi F , Montorfano M , De Bonis M , Agricola E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND. Right ventricular-to-pulmonary artery (RV-PA) coupling integrates RV systolic function at a given afterload and has been shown to have a prognostic impact in different clinical settings. In the context of severe functional TR, it reflects RV adaptation to both volume and pressure overload. However, its prognostic relevance has not been extensively  examined in patients suffering from severe TR, and available data evaluated RV-PA coupling using the TAPSE/PASP ratio, with its intrinsic limitation especially in the setting of concomitant severe TR. In patients with severe TR, right ventricular free-wall longitudinal strain (RVFWLS) has been demonstrated to be more senstie in evaluation of subtle RV systolic dysfunction and to reclassify patients with impaired RV systolic function although conventional echocardiographic parameters within normal limits.

PURPOSE.  To analyze whether the noninvasive evaluation of RV-PA coupling with the use of the RVFWLS/PASP ratio could improve risk stratification in patients with severe TR.

METHODS. Baseline clinical and echcardiographic parameters and correlation with long-term outcome were assessed in 250 consecutive patients with severe TR referred at our center from December 2015 to December 2018.

RESULTS. Patients were predominantly female, with severe cardiovascular risk factors and major comorbidities, history of heart failure (HF) and atrial fibrillation.

RVFWLS/PASP ratio ≤ 0.32 (AUC 0.72, p < 0.001, sensitivity 70%, specificity 67%) marginally predicted the presence of baseline clinical RV HF (p = 0.05). After univariate and multivariate analyses, RV-PA coupling as assessed by RVFWLS/PASP ratio, but not by TAPSE/PASP, was independently associated with all-cause mortality (OR 0.007, p = 0.03) and, at follow-up, "RV-PA coupled patients", defined by RVFWLS/PASP ratio >0.26 (AUC 0.74, p < 0.001, sensitivity 77%, specificity 52%) showed higher surival rates (p = 0.02).

CONCLUSIONS. RVFWLS/PASP ratio was systematically measured to possibly evaluate RV-PA coupling as a novel echocardiographic parameter in the context of patients with severe TR: it is independently associated with poor long-term prognosis and different values seem to improve irsk stratification in this cohort of patients.
Severe isolated mitral stenosis: are we facing different phenotypes?
Authors: Vriz O , Anwar M , Fawzy N , Eltayab A , Wahid N , Alsomali A , Mushtaq A , Elshaer A , Shaik A , Alanazy A , Alamro B
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Rheumatic mitral valve stenosis (MS) causes progressive left atrial (LA) fibrosis and functional impairment, pulmonary artery systolic hypertension and right ventricular (RV) dysfunction.

Purpose

The aim of the study was the evaluate the different characteristics between high gradients (HG) and low gradient (LG) MS and, within the LG group those with high (LG-HF) or low flow (LG-LF). Moreover, we wanted to evaluate if there was any difference in overall complications and atrial fibrillation (AF) incidence.

Methods

A total of 147 patients with isolated severe MS were retrospectively enrolled from the institutional echo database.  Echocardiograms were read offline and clinical information were obtained from patients` records. Patients were divided into a group with HG (31 patients, mean MS gradient > 10 mmHg) and LG (116 patients, mean MS gradient ≤ 10 mmHg). The group of LG was then divided in low flow (Stroke volume index (SVi) ≤ 35 ml/m2, LF-LG: 68 patients) and in high flow (SVi > 35 ml/m2, HF-LG: 48 patients).

Results

The HG group was younger, although the difference did not reach statistical significance, higher percent of males (45% M vs 22% F, p = 0.02), higher heart rate (HR), left atrial volume, higher tricuspid regurgitation velocity (TVR) and derived pulmonary artery systolic pressure (PASP), RV fractional area changes (RV FAC) but similar RV longitudinal contraction. Moreover, the HG group had more severe MS calculated according to PHT.  The group of LG was divided according to SVi:  LF-LG group compare to HG-MS had higher percent of females (45% F vs 13% M, p < 0.001), similar AF (43% vs 32%, p = ns) and pre surgical complications (19% vs 16%, p = ns). LF-LG group had smaller LA systolic volume (117 ± 51 51 ml vs 148.6 ± 38 ml, p < 0.0001), lower LV-S` (5.3 ± 1.4 vs 6 ± 1.6 cm/s, p = 0.004), lower TRV (2.47 ± 0.5 vs 3.24 ± 0.7 m/s, p < 0.0001), higher TAPSE/PASP (0.64 ± 0.3  vs 0.45 ± 0.29, p < 0.001), lower RV S` (9.79 ± 2.01m/s vs 11.25 ± 3.1 m/s, p = 0.01), higher RVFAC (38.5 ± 9.6% vs 30.9 ± 9.2%, p = 0.0005). The group of LG-LF had also less severe MS (1.3 ± 0.6 cm2 vs 1.15 ± 0.3 cm2, p < 0.01).

Conclusion

Patients with HG MS were those with worst left ventricular involvement, higher PASP and lower RV function. The LF-LG MS were older, and more females were included and even though they had smaller LA, lower values of PASP they had significantly higher percent of AF and similar pre surgical complications.  It could be speculated that LF-LG severe MS patients could be a different phenotype of the disease.
The indexed systolic volume as a new tool for transcatheter aortic valve implantation further evaluation
Authors: Gonzalez Maniega C , Echarte-Morales J , Minguito Carazo C , Martin Centellas A , Borrego Rodriguez J , Larrabide-Eguren I , Santos Garcia C , Bergel Garcia R , Menendez Suarez P , Sanchez Munoz E , Maillo Seco J , Cuellas Ramon C , Perez De Prado A , Lopez Benito M , Fernandez Vazquez F
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The transcatheter aortic valve implantation (TAVI) it´s an alternative to surgery in patients with low, moderate and high risk. The indexed systolic volume (ISV) is a parameter that has been associated with adverse events in this scenario. However, there are conflicting reports. The aim of this study was to evaluate the impact of the ISV in patients with severe aortic stenosis in which TAVI was performed.

Methods

Observational, retrospective and single institution study of patients in which a TAVI was performed between 2010 and 2020. The baseline characteristics of the patients were recorded and then the data were analyzed in two cohorts depending on the presence or not of an increase 3.5 ml/m2 of the ISV after TAVI in relation to the baseline (cohort A and cohort B). The cut-off point of 3.5 ml/m2 was chosen due to the fact that it was the median of the difference in the ISV before and after the TAVI.

Results

A total of 131 patients were included with a mean age of 84 years old (81-86). 74 patients (56.5%) presented an increase 3.5 ml/m2 of the ISV after TAVI, while there was an increment less than 3.5 ml/m2 in 57 patients (43.5%). The cohort A patients were older and had less prevalence of high blood pressure (Picture 1). Differences in survival weren´t found between the two cohorts, neither in the patients that before the TAVI had an ISV <3.5ml/m2 in relation to those with an ISV 3.5 ml/m2.

Conclusions

In our population, an increase of the ISV after TAVI wasn´t associated with less adverse events in the follow up. The survival was similar between the patients that before the TAVI had an ISV <3.5ml/m2 and those with an incremented ISV. Prospective studies with bigger cohorts are needed in order to prove these results. Abstract Figure. Baseline Characteristics and Events  Abstract Figure. Kaplan Meier Graphics
Magnetic resonance derived regurgitant fraction, 3D vena contracta area, and B-natriuretic peptide: the most accurate prognostic markers in patients with chronic asymptomatic aortic regurgitation
Authors: Kockova R , Linkova H , Hlubocka Z , Tuna M , Medilek K , Maly J , Rezacova J , Penicka M
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic 17-28265A.

Background

 The optimal timing of surgical treatment is challenging in asymptomatic patients with severe aortic regurgitation (AR). A significant number of patients undergoing aortic valve surgery as per current guidelines have irreversible left ventricular (LV) myocardial damage with a negative impact on their long-term postoperative outcome. 

Purpose

We aimed to determine the value of magnetic resonance-, advanced echocardiography–derived indices and serum B-natriuretic peptide level (BNP) to identify patients with chronic asymptomatic AR who are at risk of early disease progression.

Methods

 We prospectively enrolled a group of asymptomatic patients with pure chronic severe AR, without an indication for surgical treatment as per the current guidelines, in a multicenter study. Baseline examination consisted of serum BNP level analysis, comprehensive echocardiography including 3D vena contracta area (VCA) and 2D global longitudinal strain (GLS), and a comprehensive MRI including regurgitant fraction (RF) measurement; all imaging data were analyzed in Corelab. Patient follow-up was every 6 months. The primary endpoint was a new guideline-directed indication for surgical treatment. 

Results

 In total, 129 patients were enrolled between 2015 and 2019, the endpoint occurred in 43 patients during a median follow-up of 1375 (IQR 1041-1783) days. Baseline clinical data did not differ between patients with the endpoint (surgical group) and stable patients (medical group). Baseline BNP levels were significantly higher in the surgical group (55 vs. 21 ng/L, P = 0.008). MRI-derived LV ejection fraction was not different (61 vs 61 %, P = 0.815) at baseline while both CMR-derived end-systolic and end-diastolic LV volumes were significantly higher in the surgical group (all P < 0.01). Both baseline 3D VCA and 2D GLS were different between the surgical and medical groups (33 vs. 25 mm2, P = 0.006 and 18 vs 19 %, P = 0.07). Magnetic resonance derived RF was significantly higher in the surgical group (46 vs 32 %) with P < 0.01. A combined model including independent markers such as BNP (cut-off > 31 ng/L), MRI RF (cut-off value > 34 %), 3D VCA (cut-off value 36 mm2) or 2D GLS (cut-off value < 17 %) showed the highest predictive accuracy (P = 0.002) to predict the primary endpoint. (Figure 1).

Conclusion

A combination of baseline parameters of AR severity (3D VCA, MRI-derived RF) and myocardial impairment (2D GLS, serum BNP level) present an accurate tool for the identification of patients with chronic asymptomatic AR who are at risk of early disease progression. Abstract Figure 1
Functional mitral regurgitation in advanced heart failure
Authors: Dias Ferreira Reis JP , Bras P , Goncalves A , Pereira Da Silva T , Soares R , Timoteo AT , Galrinho A , Branco L , Ferreira R
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Moderate-to-severe functional mitral regurgitation (fMR) is present in about one-third of patients with heart failure (HF) with reduced left ventricular (LV) ejection fraction (HFrEF) and contributes to progression of the symptoms of HF and is and independent predictor of worse clinical outcomes.

Objective

To characterize the population of advanced HF patients with severe fMR and assess its prognostic impact.

Methods

Prospective evaluation of adult patients with advanced HFrEF were referred to our Institution for evaluation with HF team and possible indication for urgent heart transplantation (HT) or MCS. Patients were followed up for 1 year for the primary endpoint of cardiac death and HT. Severe fMR was defined by an EROA ≥ 20 mm2 and/or a regurgitant volume (RVol) ≥ 30 mL either taken from TTE or TOE. A survival analysis was performed to evaluate the prognostic impact of fMR and survival curves were compared using the log-rank test.

Results

A total of 450 HFrEF patients (mean age of 56 ± 12 years, 80% male, mean LVEF of 29 ± 4%) of which 14.4% had severe fMR, with a mean EROA of 29.2 ± 3.1 mm2 and a mean RVol of 43.6 ± 4.7 mL. Thirty patients (6.7%) met the primary endpoint. Patients with severe fMR were more likely to be female (69.2% vs 81.5%, p = 0.026) and to have atrial fibrillation (27.0% vs 14.1%, p = 0.028), had a higher NT-proBNP value (3625.8 ± 496.9 vs 1940 ± 212.4 pg/mL, p = 0.001), a lower LVEF (25.9 ± 6.8 vs 29.0 ± 6.7, p = 0.001), more dilated LV (LV end-diastolic diameter: 72.8 ± 13.3 vs 66.9 ± 9.0 P = 0.036), a lower HFSS value (8.1 ± 1.0 vs 8.6 ± 1.0). There was no difference regarding HF etiology, NYHA class or cardiopulmonary fitness (pVO2: 16.6 ± 5.6 vs 16.5 ± 6.3 ml/kg/min, p = 0.19; VE/VCO2 slope: 35.4 ± 9.9 vs 34.0 ± 9.7, p = 0.328). EROA was an independent predictor of the primary outcome (OR 1.23, 95% CI 1.08-1.54, p = 0.039) and patients with severe fMR had a lower survival free of events during the first follow-up year (log-rank p = 0.012).

Conclusion

Severe fMR was associated with worse clinical outcomes in advanced HF population. Abstract Figure.
The five phenotypes of tricuspid regurgitation: insight from cluster analysis of clinical and echocardiographic variables
Authors: Anand V , Hyun MC , Lara-Breitinger K , Scott CG , Nkomo VT , Pislaru C , Kane GC , Schulte PJ , Pislaru SV
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Tricuspid regurgitation (TR) is a prevalent valvular lesion with three broad morphologic subtypes: primary due to intrinsic pathology of the valve or subvalvular apparatus; secondary due to pulmonary hypertension; and isolated TR associated with chronic atrial fibrillation. The complex pathophysiological, clinical and echocardiographic features between these subtypes require further investigation.

Purpose

We aimed to identify the different phenotypes of TR using cluster analysis, and determine differences (if present) in clinical outcomes associated with these phenotypes.

Methods

We included 13611 patients with ≥ moderate TR, either primary or secondary, in the final analyses. The demographic, clinical and echocardiographic data of these patients were evaluated using Ward’s minimum variance cluster analysis including a total of 38 variables. Survival analysis for all-cause mortality was performed using the Kaplan-Meier method, and groups were compared using the log-rank test.

Results

The mean age of patients was 72.5 ± 13.4 years, 7590 (56%) were females. The clustering identified 5 distinct phenotypes. Cluster 1 represented "low-risk TR" with lesser severity likely related to chronic atrial fibrillation. This cluster had less severe TR, normal sized right ventricle and fewer comorbidities. Clusters 2-5 represented "higher severity TR", "TR associated with lung disease", "TR associated with coronary artery disease and ischemic cardiomyopathy" and "TR associated with chronic kidney disease" respectively (Figure 1). Cluster 1 had the best overall survival, followed by clusters 2, 3 and 4, and lastly cluster 5, with the worst outcome (Figure 2).

Conclusions

Cluster analysis identifies 5 phenotypically distinct novel subgroups of TR with differences in all-cause mortality. This phenotype-based classification improves our understanding of interaction of different co-morbidities with this complex valve lesion and can inform clinical decision making. Abstract Figure. Cluster Dendrogram  Abstract Figure. Kaplan-Meier survival curves
Machine learning analysis including social determinants of health for predication of mortality following transcatheter aortic valve implantation: a single center experience
Authors: Husband G , D"amico A , Hasnie U , Batra N , Cochrun S , Gann A , Li E , Nguyen D , Philip George A , Soto M , Rogers C , Ahmed M , Andrikopoulou E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Social determinants of health (SDOH) are increasingly being recognized as critical, independent prognosticators in cardiovascular disease. Despite this, little is known about the role of SDOH in predicting outcomes following transcatheter aortic valve implantation (TAVI).

Purpose

To assess the value of adding census-derived SDOH in developing machine learning (ML) models for prediction of all-cause mortality in patients following TAVI.

Methods

A total of 398 patients, who underwent TAVI in 2019, were studied. Clinical, demographic, echocardiographic (echo) and census-derived SDOH data were collected. All-cause mortality at 1 year was the endpoint. A general linear ML model was fit with 100 iterations and a 70:30 training-test split. We compared the predictive performance of the model with and without adding SDOH. The SDOH included in the ML model were race (white vs. non-white), % zip code population as female, and zip code average yearly income less than $45,000.

Results

Baseline SDOH, demographic, clinical, and echo data are shown in Table 1. Following univariate and multivariate predictor analysis, the following input data were used for the ML model without the SDOH: post TAVI all-cause hospitalizations, history of outpatient hemodialysis, atrial fibrillation, heart failure with reduced ejection fraction, myocardial infarction, coronary artery disease and beta-blockers. The ML model with SDOH used the same input as well as the SDOH variables. The model with vs. without SDOH had a median AUC of 0.75 vs. 0.73 (p = 0.9957).

Conclusions

Despite not reaching statistical significance, our ML model provides a holistic picture of mortality predictors. Larger studies are needed to more assess the predictive value of SDOH post TAVI. Abstract Figure. Baseline patient characteristics  Abstract Figure. ML Model: Area Under Curve
Mitral annular dysjunction in surgical mitral valve prolapse
Authors: Gray R , Cheuk-Lam H , Turner D , Mamo A , Cranney G , Mathur R , Yu J
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Mitral valve prolapse (MVP) affects 3% of the population and is the leading indication for mitral valve surgery.[1] Mitral annular disjunction (MAD) is a structural abnormality commonly seen in patients with MVP.[2] MAD is defined as an abnormal separation (>5mm) between the left atrial wall-mitral valve junction and the left ventricle myocardium,[2] associated with hypermobility and myxomatous degeneration of the mitral valve leaflets.[3]  There is a paucity of literature regarding MAD, however evidence is growing that it may be associated with ventricular arrhythmia and sudden cardiac death.[3] We examined the prevalence, imaging characteristics and clinical associations of MAD among patients who have undergone mitral valve surgery for MVP.

Methods

Single centre cohort study of consecutive patients undergoing mitral valve surgery for MVP over a 3-year period. Patient baseline characteristics, echocardiographic parameters, surgical outcomes, frequency of arrhythmic events and 3-year cardiac and all-cause mortality were recorded.  Single site data was obtained from a prospective Australia-wide cardiac surgery registry, as well as retrospective analysis of holter-monitor reports, device interrogation and review of medical records. Transthoracic echocardiogram images were re-examined, and parameters re-measured by a qualified examiner.

Results

Among 73 patients with surgical MVP, 20 patients had MAD (27.4%). The median MAD length was 8.1 (IQR 6.8-11.8) mm. The most severely affected patient had a disjunction length of 28 mm. MAD was associated with younger age at surgery (60 vs 66, P = 0.005), female sex (40.0% vs 22.6%, P = 0.138), bileaflet MVP (50% vs 10.6%, P = 0.004) and less cardiovascular comorbidities, including hypertension (25.0% vs 57.7%, P = 0.013) and hypercholesterolaemia (30.0% vs 61.5%, P = 0.016). Patients with MAD had greater mitral valve leaflet lengths, mitral annular diameters, and high-velocity systolic signal on tissue doppler of the mitral valve annulus (pickelhaube sign). Three patients in the MAD positive group had an arrhythmic event (VF or VT) at 3 years compared to one in the MAD negative group. There was no significant difference in 3-year cardiac or all-cause mortality between groups.

Conclusion

MAD is a common anatomical abnormality in patients with surgical MVP, and is easily detected on transthoracic echocardiography. It is associated with younger age at surgery, female sex, bileaflet MVP, increased leaflet length and annulus diameter. There was a signal towards increased arrhythmic events in patients with MAD despite younger age and less cardiovascular risk factors. Large longitudinal studies are needed to further assess the association of MAD with arrhythmic events to help guild appropriate investigation and risk stratification of these patients. Abstract Figure. MAD on Parasternal Long axis view  Abstract Figure. Pickelhaube sign
Mitral regurgitation and in-hospital mortality in patients with heart failure and low flow low gradient aortic stenosis
Authors: Ferruzzi GJ , Peluso AP , Attisano T , Migliarino S , Vigorito F , Bellino M , Iuliano G , Silverio A , Provenza G , Cristiano M , Galasso G , Baldi C , Citro R
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Aim

this study sought to determine the prevalence, clinical impact, and in-hospital outcome of moderate to severe mitral regurgitation (MR) in patients with low-flow, low-gradient aortic stenosis (LFLG-AS) hospitalized for heart failure (HF).

Methods

Patients with aortic valve thickness and aortic velocities >2.5 m/s hospitalized for heart failure in a single referral center were prospectively enrolled from 2013 to 2021.

LFLG-AS was defined as indexed aortic valve area (iAVA) ≤0.6 cm2/m2, mean transaortic gradient <40 mmHg and stroke volume index <36 ml/m2. Complete demographic, clinical characteristics and echocardiographic data were collected. Mitral regurgitation severity was graded according to current guidelines. Patients were divided into two subgroups according to MR severity: no/mild MR vs moderate/severe MR. In hospital all cause death has been considered as the primary outcome.

Results

A total of 136 patients  (78 ± 9 yy; 68 (50%) male) hospitalized for HF with a new diagnosis of LFLG-AS were included in the study.

The most frequent comorbidities were hypertension (121, 89%), dyslipidemia (106, 78%), chronic kidney disease (85, 63%), diabetes (56, 41%) and obesity (44, 32%). Atrial fibrillation/flutter was detected in 61 (45%) patients. Moderate to severe MR was detected in 33%. Mean functional NYHA class was 2,8 ± 0,8.

Concerning echocardiographic evaluation, the mean gradient of the aortic valve was 26 ± 7 mmHg and the mean iAVA was 0.42 ± 0.10 cm2/m2. The mean left ventricular ejection fraction (LV EF) was 46 ± 13%. Paradoxical LFLG-AS with a preserved LV EF was detected in 73 patients (54%) and the LFLG-AS with a low LV EF was detected in 63 (46%).

In this population, 26 patients (19%) underwent surgical valvular replacement, 15 patients (11%) had aortic percutaneous valvuloplasty and 33 patients (24%) underwent TAVI. The remaining patients (45%, n = 62) were maintained under optimized medical therapy.

In-hospital death occurred in 17 (12,5%) patients (just 1 for non-cardiovascular causes).

Moderate/severe MR was detected in 44 (33%) patients.

When comparing the two subgroups statistically significant differences between age (p = 0,035), male sex (p = 0,028), atrial fibrillation/flutter (p = 0,003), obesity (p = 0,040) and in-hospital mortality (p = 0,013) were detected. In the overall population the multivariate regression analysis showed that only the presence of moderate /severe MR was a significant independent predictor of all-cause in-hospital death (p = 0.017 ; OR 3.571 ; IC  1.257-10.151).

Conclusion. Moderate to severe MR is frequently detected in patients with LFLG AS and HF. In this peculiar cohort significant MR has a negative impact on outcome and is independently associated with in-hospital mortality.
Adverse prognostic value of supernormal left ventricular force noninvasively assessed by resting transthoracic echocardiography in hypertrophic cardiomyopathy
Authors: D"alfonso MG , Tesic M , Peteiro J , Palinkas ED , Re F , Losi MA , Palinkas A , Cruz I , Torres M A R , Van De Heyning CM , Djordjevic-Dikic A , Mori F , Ciampi Q , Olivotto I , Picano E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

Stress Echo 2030 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI).

Background The excessive cross-bridging of cardiac myosin and actin, resulting in increased left ventricular (LV) force development, is one of the biomechanical abormalities inhypertrophic cardiomyopathy (HCM).

Purpose

To assess the prognostic value of increased LV force development at rest in patients with HCM

Methods

We enrolled 918 HCM patients (age 48 ± 16 years, 502 males, New York Heart Association I or II, Class III in 48 patients, 6% and with LVOTG >30 mmHg in 211patients, 23%) with ejection fraction (EF) ≥50%, referred for rest transthoracic echocardiography (TTE) in 10 quality-controlled labs from 7 countries (Belgium, Hungary, Italy, Portugal, Serbia, Spain, Brazil). The maximal wall thickness was 21 ± 5 mm. TTE assessment included left ventricular outflow tract gradient (LVOTG, mmHg), EF (%), and LV force (systolic arterial pressure + LVOTG/LV endsystolic volume assessed with 2-D, mmHg/mL). All patients were followed-up. An age- and gender matched control group of 95 healthy subjects was also evaluated.

Results.  Compared to normals, HCM showed higher values of EF (68 ± 8 vs 65 ± 5%, p < 0.001) and force (7.2 ± 5.5 vs 4.0 ± 1.8 mmHg/mL, p < 0.001). At a median follow-up of 94 months [interquartile range 40-140 months], 95 all-cause deaths occurred. Mortality was significantly increased in the force highest quartile compared to other quartiles (see figure). At multivariable Cox analysis, increased Force (highest quartile >8.5 mmHg/mL hazard ratio= 2.189 95% CI = 1.095-4.377, p = 0.027 and the intermediate quartile: Force 5.7-8.5 mmHg/mL hazard ratio= 2.525 95% CI = 1.2205.228, p = 0.013) were independent predictors of mortality with age (hazard ratio= 1.065 95% CI = 1.047-1.084, p < 0.001) and maximal wall thickness (hazard ratio= 1.094, 95% CI = 1.055-1.135, p < 0.001). At univariate analysis neither LVOTG (hazard ratio= 1.430, 95% CI = 0.920-2.222, p = 0.112) nor quartiles of EF (hazard ratio= 1.497, 95% CI = 0.868-2.582, p = 0.147) were significant.

Conclusion

HCM patients with preserved baseline LV function and higher values of resting LV force ("too good to be normal") show a worse survival, highlighting the dark prognostic side of an excess of force. The hypercontractile phenotype possibly indicates an increased activity of myosin resulting in increased force production at the sarcomere and cellular levels that propagates at the whole-organ level with unfavorable long-term effects on outcome.

Figure

Mortality rate based on quartiles of resting LV Force in HCM. Abstract Figure. Mortality rate
Pregnancy history and long-term progression of cardiomyopathy in LMNA genotype-positive women
Authors: Castrini I , Skjolsvik E , Estensen M , Almaas V , Skulstad H , Lyssegen E , Edvardsen T , Lie O , Picard K , Lakdawala N , Haugaa K
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Precision Health Center for optimized cardiac care (ProCArdio), Oslo, Norway Fripro gene positive, Norwegian Research Council, Oslo, Norway

Background

Competitive and non-competitive exercises have been reported to be deleterious on prognosis of LMNA genotype-positive patients. Comparable to exercise, pregnancy is a prolonged hemodynamic stress situation.

Aims

We aimed to assess the association between pregnancy history and long-term progression of cardiomyopathy in women with pathogenic or likely pathogenic variants of LMNA (LMNA+).

Methods

We retrospectively included consecutive LMNA+ females and recorded pregnancy data. We analyzed repeated echocardiographic examinations, including data on left ventricular (LV) end-diastolic diameter (EDD), LV ejection fraction (EF) and LV global longitudinal strain (GLS). We recorded the occurrence of atrial fibrillation (AF), atrioventricular block, sustained ventricular arrhythmias (VA), and implantation of cardiac electronic devices (ICD/CRT-D). We analysed retrospectively complications during pregnancy and peripartum period.

Results

We included 89 LMNA+ women (28% probands, age 41 ± 16 years), of which 60 had history of pregnancy. Follow-up duration was 5 [IQR: 3-9] years. We analysed 452 repeated echocardiographic examinations. Women with previous pregnancy and nulliparous had a similar annual deterioration of LV EF (-0.5/year vs -0.3/year, p = 0.37, figure left panel), LV GLS (0.1/year vs 0.0/year, p = 0.35, figure right panel) and LV EDD (0.1/year vs 0.2/year, p = 0.09). Number of pregnancies was not associated with increased long-term risk of AF, atrioventricular block, sustained VA or ICD/CRT-D implantation. Pregnancy history was not associated with worse survival free from death, left ventricular assist device or need for cardiac transplantation. Arrhythmias occurred in 9% of pregnancies. No increase of maternal and fetal complications was observed.

Conclusions

In our cohort of LMNA+ women, pregnancy was not associated with long-term adverse progression of cardiac dysfunction, worsening in arrhythmic progression or reduced event-free survival. Likewise, LMNA+ women generally tolerated pregnancy well, with a small proportion of patients experiencing arrhythmias. Abstract Figure.
Diagnostic and prognostic implications of right ventricular-arterial coupling in cardiac amyloidosis and in genetic and non-genetic cardiomyopathies with hypertrophic phenotype
Authors: Palmiero G , Rubino M , Monda E , Lioncino M , Verrillo F , Dongiglio F , Caiazza M , Vetrano E , Cirillo A , Fusco A , Ascione L , Caso P , Limongelli G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND & PURPOSE. Right ventricular (RV) dysfunction in cardiomyopathies is a consequence of chronic overload (i.e. aortic stenosis, AS) or direct involvement of systemic disorders (i.e. cardiac amyloidosis, CA). The Tricuspid Annular Plane Systolic Excursion/Systolic Pulmonary Artery Pressure (TAPSE/sPAP) ratio has been recently proposed as a surrogate of RV-arterial coupling (RVAC). This study aims to compare RVAC between CA subgroups and between CA and other forms of genetic and non-genetic cardiomyopathies with hypertrophic phenotype.

METHODS. We enrolled 50 patients with CA (26 AL and 24 wtATTR) and 75 cardiomyopathies with hypertrophy phenotype (LVH group) [25 pts with hypertrophic cardiomyopathy (HCM), 25 hypertensive pts(HypCM), and 25 pts with AS]. Besides routine echocardiographic measurements, we analysed right chambers dimensions and classical and novel parameters of RV function [TAPSE, TAPSE/sPAP, St wave, global (RVGLS) and free-wall (RVFWS) strain].

RESULTS. Compared to AL, the ATTR group showed higher right chambers dimensions, without differences in all RV systolic parameters. Compared to the LVH group, CA patients showed no differences in RV dimensions while RV systolic parameters,  including the TAPSE/sPAP ratio, were significantly reduced in the presence of significantly higher LV filling pressures.  At ROC curve analysis, TAPSE (AUC 0.877; 95% CI: 0.811-0.943; p < 0,0001) and TAPSE/sPAP ratio (AUC 0.859; 95% CI: 0.783-0.935; p < 0,0001) showed the best ability in discriminating CA among other forms of LVH (cut-off 20.5 mm for TAPSE with sensibility of 80.5% and specificity of 78.8%, respectively; cut-off 0.62 for TAPSE/sPAP ratio with  sensibility of 85.4% and specificity 81.8%). At 24 months follow-up, there were 15 deaths in CA (30%) and 4 in LVH group (5%). At Kaplan-Meier estimation, the TAPSE/sPAP ratio showed progressively a significantly reduced survival in the lowest interquartile ranges. Moreover, at multivariate analysis, TAPSE/sPAP was the only independent prognostic factor (β -5,644; 95% IC: 0,000-0,522; p < 0,027).

CONCLUSIONS. The RVAC is significantly impaired in CA compared to the LVH group but not between CA subgroups. Its reduction seems attributable to both increase LV filling pressure, due to the restrictive nature of the infiltrative cardiomyopathy, and reduced RV systolic function, due to either indirect RV chronic overload and direct myocardial infiltration. The TAPSE/sPAP ratio is a surrogate of RVAC and proved to be a novel echocardiographic parameter useful in both discriminating CA among genetic and non-genetic forms of LVH, and stratifying the prognosis. Abstract Table 1  Abstract Figure 1
Assessment of LAA strain and thrombus mobility and its impact on thrombus resolution - value of a novel echocardiographic thrombus tracking method
Authors: Morais P , Nelles D , Vij V , Al-Kassou B , Weber M , Nickenig G , Schrickel JW , Vilaca J , Sedaghat A
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): FCT – Fundação para a Ciência e Tecnologia Portugal 2020 Partnership Agreement, through the European Regional Development Fund (FEDER)

Background

The left atrial appendage (LAA) is the major nidus for thrombus in patients with non-valvular atrial fibrillation. LAA thrombus mobility and changes hereof under anticoagulation may serve as a marker of both risk of embolism and efficacy of treatment. In this study, we hypothesized that LAA dynamics and thrombus mobility could serve as a baseline marker of thrombus dissolvability.

Methods

Transesophageal echocardiographic (TEE) images of in whom LAA thrombi were previously diagnosed were evaluated. Each image was tracked using a state-of-the-art tracking toolbox and functional information from the LAA and thrombi extracted. Global LAA motion was quantified through the longitudinal strain, while thrombus mobility was measured through a novel tracking scheme by directly capturing and measuring the thrombus motion isolated from the global cardiac motion. Baseline characteristics and echocardiographic parameters were compared between responders (thrombus resolution, i.e. no thrombus found at follow-up TEE) and non-responders (thrombus persistence or growth, i.e. thrombus found at follow up TEE) groups.

Results

35 patients (54.3% male and 45.7% female) with a mean age of 72.9 ± 14.1 years were included. Atrial fibrillation was present in all patients, showing a high risk for thromboembolism (CHA2DS2-VASc-Score 4.1 ± 1.5). Moderately reduced LVEF (41.7 ± 14.4%) and signs of diastolic dysfunction (E/E’ = 19.7 ± 8.5) was found in the cohort. While anticoagulation was initiated in all patients, resolution was achieved in 51.4% of patients. Significantly higher thrombus mobility (0.33 ± 0.13mm vs. 0.18 ± 0.08mm, p < 0.01 – Figure 1A) and LAA peak strain (-3.0 ± 1.3 vs -1.6 ± 1.5%, p < 0.01 – Figure 1B) were observed in responders against the non-responders group.

Conclusions

The quantification of the thrombus mobility through a tracking scheme is feasible. In our study population, higher thrombus mobility appeared to be associated with thrombus resolution. Further studies are required to evaluate the additional prognostic of the proposed technique.

Figure 1 – Quantification of the thrombus mobility (A) and peak LAA longitudinal strain (B) in both responder (blue) and non-responder group (green). *p < 0.05, unpaired t-test between non-responder and responder groups. Abstract Figure 1
Differences in Left atrial stain, endothelial glycocalyx and arterial elasticity between ESUS, lacunar and atherosclerotic type of stroke
Authors: Katogiannis K , Ikonomidis I , Stamoulis K , Frogoudaki A , Vrettou AR , Thymis J , Kostelli G , Kountouri A , Korakas E , Michalopoulou E , Vythoulkas D , Koliou GA , Benas D , Lambadiari V , Tsivgoulis G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background and Aims

Patients with stroke are at high risk to develop cardiovascular complications. We assessed endothelial glycocalyx, aortic elastic properties, left atrial and ventricular function in patients with lacunar, atherosclerotic and stroke of undetermined source (ESUS).

Patients and methods

In 75 patients (age 55.2 ± 10.6) with acute cerebral stroke (25 lacunar, 20 atherosclerotic and 30 ESUS) and 20 controls with similar risk factors, we measured: (1) perfused boundary region (PBR) of the sublingual arterial microvessels (range 5–25 µm), a marker inversely related with glycocalyx thickness, (2) pulse wave velocity (PWV), central systolic blood pressure (cSBP), and augmentation index (AIx), (3) Left atrial (LA) strain using speckle-tracking imaging, and (4) left ventricular global longitudinal strain.

Results

Compared with controls, patients with stroke had higher PWV (11.38 ± 3.62 vs 9.51 ± 1.57 m/sec, p = 0.045), PBR (2.10 ± 0.27 vs 1.94 ± 0.20, p = 0.039) and central SBP (139.64 ± 26.31 vs 116.36 ± 37.23 mmHg, p = 0.039), while ventricular (-17.902 ± 3.77 vs - 19.87 ± 1.17%, p = 0.025) and atrial deformation (24.8 ± 9.99 vs 39.05 ± 2.08%, p < 0.001) were impaired in patients with stroke (p < 0.05).

LA reservoir strain was more reduced in ESUS patients compared to other 2 stroke types (ESUS 21.7 ± 6.6%, Lacunar 25.6 ± 13.2%, atherosclerotic 22.3 ± 7.8%, P < 0.05).

Regarding endothelial glycocalyx, PBR5-9 (the smallest vessels with diameter 5-9 μm) was higher in patients with ESUS than in the other two types of stroke (ESUS 1.22 ± 0.12 μm, LACUNAR 1.19 ± 0.12 μm, ATHEROSCLEROTIC 1.15 ± 0.09 μm, p < 0.05), despite the fact that PBR5-25 was similar between all stroke types (ESUS 2.09 ± 0.23 μm, LACUNAR 2.13 ± 0.33 μm, ATHEROSCLEROTIC 2.09 ± 0.24 μm, p = 0.8).

PWV was significantly higher in patients with atherosclerotic stroke (15.57 ± 5.50 m/sec, p = 0.007), while in patients with lacunar it was mildly elevated (10.53 ± 3.22 m/sec) and in ESUS patients it was moderately increased (11.7 ± 3 m/sec).

Conclusions

Patients with stroke have impaired atrial strain, endothelial glycocalyx and arterial elasticity, compared with controls. Arterial stiffness is more affected in atherosclerotic stroke, while LA deformation and glycocalyx of small size micro vessels are more affected in ESUS patients.
Pulmonary hypertension in mitral stenosis patients submitted to percutaneous balloon mitral valvuloplasty: an innocent bystander?
Authors: Ferreira V , Rodrigues I , Almeida Morais L , Bernardes L , Cacela D , Patricio L , Galrinho A , Reis JP , Grazina A , Castelo A , Cruz Ferreira R
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Percutaneous balloon mitral valvuloplasty (PBMV) is the cornerstone of the treatment of rheumatic mitral stenosis (MS) in suitable patients. Pulmonary hypertension (PH) is a common coexisting finding and an indication for intervention. We sought to assess the influence of PH in PBMV immediate results and in very longterm outcome.

Methods

Between 1991 and June 2021, 202 consecutive patients underwent PBMV in a single tertiary centre. Clinical data, echocardiographic parameters, and MACE (cardiovascular mortality, need for percutaneous or surgical mitral reintervention) were analysed.

Results

Mean age was 47.3 ± 13.6 years and 89.6% were women. A previous commissurotomy or PBMV was found in 10.4% and mean Wilkins score was 7.6 ± 1.4. PH, defined as pulmonary artery systolic pressure (PASP) ≥45mmHg, was present in 32.7% of patients. A successful procedure was achieved in 89.1% of total population. Mean mitral valve (MV) gradient decreased from 13.1 to 5.0 mmHg (p < 0.001) and MV area increased from 1.1 to 1.8 cm2 (p < 0.001). A significant reduction also occurred in left atrium diameter (48.8 to 46.8 mm, p < 0.001) and PASP (50.5 to 38.5 mmHg, p < 0.001). During a mean follow-up of 12.0 ± 8.8 years, 7 cardiovascular deaths occurred (3.5%) and 33.2% of patients needed MV reintervention. Baseline PH did not impact immediate success and was not related with MACE in the follow-up. However, PH persistence after PBMV was correlated with unsuccessful procedure (p = 0.023) and with the occurrence of MACE during FU (HR 3.3, CI 95% 1.1-9.6, p = 0.028 and Kaplan-Meier analysis, log-rank 0.020).

Conclusions

PBMV in patients with MS and PH is a safe and effective intervention, achieving a significant decrease in PASP after procedure. Baseline PH was not associated with success or MACE. However, PH persistence after PBMV, correlated with worse prognosis in longterm follow up. Special attention and further investigation for this subgroup is needed. Abstract Figure.
Diversity in the european association of cardiovascular imaging (EACVI) research and training grants: gender, geographic and economic perspectives
Authors: Dakhil ZA
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Training and research grants are crucial for professional and academic advancement especially in a rapidly evolving specialty like cardiac imaging. Equity, inclusion and diversity in funding research and training are fundamental in achieving research and training excellence. No prior data evaluated the diversity in the research and training grants awarded by international cardiovascular societies.

Purpose

Current analysis aimed to evaluate the distribution of awarded EACVI grants according to the country and gender of the grantsˈ winners.

Methods

Official ESC website was searched for names of EACVI research and training grantsˈ winners, gender, and affiliating country as well as hosting country of the awardee were documented. If any of this data was missed in the ESC website, then the awardeesˈ gender and affiliation were searched via google scholar, ResearchGate and LinkedIn platforms. The countries of the awardees were classified according to the continent and World Bank Economic classification [High income (HIC), middle (MIC) and low income (LIC) countries].

Results

A total of 57 EACVI grants[36 research grants (from 2009 to 2021) and 21 training grants (from 2015 to 2021)] were analysed. Women won 54.38% of total grants [55.56% of research grants and 52.38% of training grants].  Winners of research grants were from HIC and MIC in 63.89% and 36.11% respectively, while winners of training grants were from HIC and MIC in 66.67% and 33.33% respectively. Winners of research grants were from Europe in 80.55%, and Asia in 16.66%, while winners of training grants were from Europe in 66.67% and Asia in 19.04%. The most common EACVI research grant hosting countries were Belgium (27.77%), UK (22.22%), Netherlands and Italy (16.66% for each), while the most common EACVI training grant hosting countries were UK (52.38%), Italy (23.8%) and Belgium (9.52%).

Conclusions

Women were well represented in EACVI research and training grants. Yet, both low-income countries and non-European countries were remarkably under-represented in EACVI grants. Considering the high burden of cardiovascular diseases in LIC and MIC, every effort should be made to increasingly include cardiologists from these countries in research and training opportunities to achieve the main ESC mission of decreasing the cardiovascular disease burden worldwide beyond the limits of geography. Abstract Figure.  Abstract Figure.
Echocardiographic characteristics of patients admitted with acute heart failure with a previous history of cancer: a single-centre observational study
Authors: Todd F , Wong C , Mohamed A , Hewitson L , Doolub G , Gogola L , Skyrme-Jones A , Aziz S , Ghosh A , Sammut E , Dastidar A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Cancer and heart failure frequently co-exist, with cancer and chemotherapy exerting a number of pathological effects on the myocardium. Despite this, our understanding of the clinical impact of previous history of cancer in acute heart failure remains unclear.  We therefore performed a retrospective cohort study to identify the echocardiographic characteristics in patients admitted with acute heart failure with and without a diagnosis of solid organ cancer.

Methods

Consecutive patients with signs and/or symptoms of acute heart failure admitted over a period of 33 weeks (7th January – 28th August 2020) were identified. Discharge summaries, electronic notes and shared care networks were manually searched to determine baseline demographics, admission bloods, comorbidities, cancer diagnoses, imaging and echocardiography. Univariate and multivariate Cox regression analysis was performed to identify clinical and biochemical predictors of mortality.

Results

In total, 478 patients were admitted with acute heart failure over the study period (mean age 80 ± 11 years, 53.6% were male and mean NT pro-BNP was 9106). 386 had echocardiography available for review. Of these, 64 (16.6%) had a past or current history of solid organ cancer.

Patients with a past or current history of solid organ cancer had a significantly higher ejection fraction (48% (±9%) vs 44% (±11%), p = 0.003), higher incidence of heart failure with preserved ejection fraction (57.8% vs 33.5%, p < 0.001) and lower incidence of right ventricular impairment (defined using both visual inspection and TAPSE measurements) (25.0% vs 47.8%, p < 0.001).

There were no significant differences in any valvular pathologies between groups (overall prevalence 71.9% vs 71.7%, p = 0.982) No difference was observed between the rate of prior myocardial infarction (28.1% vs 26.0%, p = 0.727) or lung disease (34.4% vs 37.0%, p = 0.692).

Overall, mortality at six months follow up was significantly higher in the group with a current or previous cancer diagnosis (43.4% vs 32.0%, p = 0.046) compared to the group without.

Conclusion

Patients admitted with acute heart failure and a past or current history of cancer have a significantly higher ejection fraction and lower prevalence of right ventricular impairment. Despite the higher ejection fraction their prognosis is worse. Further work is needed to determine potential mechanisms for this, as well as its clinical implications. Abstract Figure. Six Month Survival Kaplan Meier Graph  Abstract Figure. Echocardiogrpahic Features