bluuebunny/crossref_metadata_2025 huggingface dataset:
Regadenoson stress echocardiography: a road ahead
Authors: Romero Castro M , Fernandez Galindo M , Garcia Robles JA , Musa LA , Fernandez Herrero I , Priego Rodenas MA , Sanchez V , Jimenez Lopez-Guarch C , Corros-Vicente C , Carbonell San-Roman AS , Arribas Ysaurriaga F , Solis J
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Drugs use in stress echocardiography (SE) have important limitations due to side effect and contraindications. Regadenoson (R) is emerging as a selective coronary vasodilator for pharmacological stress tests. Several studies have analyzed its diagnostic accuracy, but its prognostic value has not yet been studied.

Purpose

The objective is to assess safety and short-medium term prognosis in patients (p) who underwent SE with R.

Methods

Retrospective observational study. 126 patients were included from 2017 to 2020 and SE to study the detection of myocardial ischemia with R were performed. A positive SE test were consider if presented at least one of the follow: segmental changes in myocardial contractility, electrocardiography ischaemic changes or ischaemic symtomps. Adverse events (AE) were collected. To assess prognosis, we evaluated cardiovascular events (CV) with a median follow-up of 23 months, considering heart failure, angina, myocardial infarction (AMI) o cardiovascular death. We compare negative result SE test group (NG) with group of positive results (PG).

Results

Sixteen (13%) patients, presented AE, generally mild, with nausea in 4 patients. Two patients (1.6%) required the use of aminophylline for severe AE type bronchospasm.

Nineteen studies (15%) were positive: 17 (89%) showed echocardiographically positive results, 5 of them also had clinical or electrocardiographic positivity, one (5%) was considered positive only by electrocardiographic criteria and another by clinical criteria.

 There were no CV deaths at follow-up. In the NG, 6 events were observed versus 2 in the PG (6 vs 11%). Time to event of the NG was a median of 90 [3-600] days versus 110 [40-180] days in the PG. The most frequent event was HF (4 NG vs 1 PG), coronary angiography was performed in only 2 patients with HF of the NG and did not show significant lesions. In the NG there were 2 IAM (2 vs 0), one had severe stenosis in the right coronary artery and the other several moderate diffuse stenosis. There was no events for angina in the NG (0 vs 1). The annual cumulative incidence was 11% in the PG compared to 4% in the NG.

Conclusions

Stress echocardiography with regadenoson is a safe test with a low serious adverse events rate. As concern as prognosis, In our sample, NG presented a lower proportion of events with a lower annual cumulative incidence than PG and also in a 23-month follow-up. Abstract Figure.
Prevalence and clinical impact of latent obstruction in hypertrophic cardiomyopathy
Authors: Cardoso A , Lourenco MR , Von Hafe P , Dias G , Pereira T , Tinoco M , Fernandes M , Azevedo O , Lourenco A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Hypertrophic cardiomyopathy (HCM) is characterized by varying degrees of left ventricular outflow tract obstruction (LVOTobs). We aim to define the prevalence, clinical profile and impact of LVOTobs under physiological exercise in HCM patients (pts).

METHODS

Single center retrospective study of consecutive HCM pts without LVOTobs at rest (resting gradient <30mmHg), referred for exercise stress echocardiogram (ESE) between 2015 and 2019. Significative latent obstruction was defined as a LVOT gradient ≥50 mmHg during exercise or at early recuperation.

RESULTS

A total of 56 pts were included (64% men, mean age 57 ± 11 years, 61% septal HCM). The majority of pts (47; 84%) were in NYHA I functional class, 20 (36%) had history of syncope or pre-syncope (S/pS) and 7 (13%) had an implantable cardioverter defibrillator (ICD). Twelve (21%) pts had systolic anterior motion (SAM) of the mitral valve at rest.

Thirty-five (63%) pts performed ESE under beta-blocker (BB) therapy. Mean exercise time was 8 ± 3 min. During ESE, 2 (4%) pts developed a LVOT gradient between 30 to 50 mmHg and 17 pts (30%) developed a significative LVOTobs gradient (mean 85 ± 18 mmHg).

Pts with significative latent LVOTobs had more previous complaints of S/pS (59% vs 26%, p=.017), a tendency for a higher NYHA functional class (p=.082) and were more frequently on BB therapy (82% vs 18%, p=.043). Mean septum thickness was similar between groups (17 ± 0.7 vs 16 ± 0.6 mm, p=.536). The presence of SAM at rest was more frequent in the significative latent LVOTobs pts (p<.001). No differences were noted in exercise tolerance (p=.526).

During a median follow-up of 43 (IQR 15-53) months, 7 (41%) pts with significative latent LVOTobs had a pre-syncope, 3 (18%) were diagnosed with atrial fibrillation and 2 (12%) had a cardiovascular admission . There was up-titration/initiation of BB therapy in 5 (29%) pts, referral for septal myectomy in 3 (18%) and ICD implantation for primary prevention in 3 (18%) pts. No proper ICD shocks, sustained ventricular arrythmias or deaths occurred.

Comparing significative latent to non LVOTobs pts, the first ones had more ICD implantation (log rank p =.04) and performed a surgical myectomy more frequently (log rank p= .018) during the follow-up.

CONCLUSION

In our study, significative latent LVOTobs was observed in 30% of pts. Its presence can have clinical implications in HCM pts approach and should be suspected in more symptomatic pts and when SAM is present at rest.
Prognostic value of E/e ratio changes with exercise in symptomatic patients referred for exercise echocardiography
Authors: Peteiro J , Bouzas-Mosquera A , Barbeito-Caamano C , Souto-Cainzos B , Martin-Alvarez E , Bas-Gonzalez M , Vazquez-Rodriguez JM
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

We have previously noticed that some patients with decrease of the ratio of early LV inflow velocity to early tissue Doppler annulus velocity (E/e`) with exercise might have better outcome than others that exhibit raised values at both rest and exercise. In this research, we aimed to assess the prognostic value of E/e´ change with exercise in patients with normal or abnormal resting diastolic function (DF) referred for a clinically indicated ExE.

Methods

LV systolic and diastolic function (DF) according to ASE/EACVI guidelines, were evaluated at rest in 750 patients (age 67 ± 12 years) with preserved LV ejection fraction (≥50). We assessed regional/global LV systolic function at peak exercise, while E/e’ was evaluated in the immediate post-exercise period. Abnormal ExE was defined as ischemia or fixed wall motion abnormalities, and raised E/e´values as >15 at rest and at exercise (e´ at the septal level). Patients were grouped as having raised E/e´ at both rest and exercise (R-RestEx, n = 77), raised E/e´ only at exercise (R-Ex, n = 47), raised only at rest (R-Rest, n = 71) and non-raised (NR, n = 555). Events were overall mortality, myocardial infarction, admission for unstable angina or cardiac failure, coronary revascularization, pulmonary thromboembolism, and stroke.

Results

Abnormal resting DF was present in 219 patients (29%), indeterminate in 70 (9%). Percentages of abnormal resting DF were 13% in group NR, 90% in group R-Rest, 28% in group R-Ex and 88% in group R-RestEx (p < 0.001), whereas the percentages of indeterminate DF were similar (9, 10, 13, and 12%, respectively). Abnormal ExE was present in 21% of group NR, 32% of group R-Rest, 36% of group R-Ex, and 40% of group R-RestEx (p < 0.001). During a median follow-up of 0.9 years (25-75th percentiles 0.4-1.7) there were 108 events. Independent predictors included peak exercise LVEF (HR = 0.93, 95% CI = 0.91-0.94, p < 0.001), and exercise E/e´ (HR= 1.04, 95% CI = 1.01-1.08, p = 0.01). Neither resting E/e´ values nor resting abnormal DF by ASE/EACVI guidelines, were independent predictors. Annualized event-rates were similar in groups NR (6.9%) and R-Rest (5.6%), but higher in groups R-Ex (10.9%) and R-RestEx (27.2%).

Conclusions

E/e´ changes during exercise may help to reclassify risk of patients. Patients with normal E/e´ values at exercise have better outcome, despite resting values. Abstract Figure.
Evaluation of right ventricular contractile reserve in healthy subjects using stress echocardiography
Authors: Alborikan S , Badiani S , Van Zalen J , Lloyd G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The assessment of right ventricular (RV) systolic functional augmentation in healthy subjects is not well described. The objective of this study was to evaluate normal augmentation of RV systolic functional parameters in relation to maximum predicted oxygen uptake (VO2) during stress echocardiography in healthy adults.

Methods

  Untrained healthy volunteers were recruited prior starting their first time London Marathon and underwent cardiopulmonary exercise test with echocardiography focussed on left ventricular assessment.  Patients with satisfactory RV windows were included in this analysis. 20 participants with good RV delineation were evaluated retrospectively at baseline and at peak level of exercise. We defined RV systolic function by tricuspid lateral annular systolic velocity (RVS’) using Doppler tissue imaging, Tricuspid Annular Plane Systolic Excursion (TAPSE) using M-mode echocardiography, and Fractional Area Change (FAC) using 2D echocardiography to calculate the percentage of change in RV area between systole and diastole. All parameters were evaluated at baseline and at peak stress.

Results

There was statistically significant augmentation of all RV systolic functional parameters between baseline and peak stress (10.3 ± .8 vs 16.4 ± .7 cm/s, p <.000), (21 ± 2.6 vs 32 ± 3.3, mm, p <.000) and (41 ± 2.7, % vs 55 ± 5.1, %, p<.000) for RVS’, TAPSE and FAC respectively. At peak stress, RVS’ increased by 59 ± 11.1, %, TAPSE by 53 ± 15.4, %, and FAC by 34 ± 11.8, %. Mean peak VO2 was 107 ± 17, %. The augmentation of RV longitudinal function showed moderate correlation with peak VO2 throughout exercise for the RVS’ and TAPSE (r= .54, p 0.001), (r=.45, p0.04) respectively, and this was not observed in FAC (r=.15, p>.05).

Conclusion

In normal individuals, we have demonstrated that the RV augments by 59% for RVS’, 53% for TAPSE, and 34% for FAC. Longitudinal RV augmentation by RVS’ and TAPSE was correlated with maximum exercise capacity suggesting that these parameters could be able to predict VO2 peak values in larger context. Abstract Figure.
Rate of transesophageal echocardiography related complications during 1229 TEE-guided structural heart disease procedures
Authors: Kronzer EK , Thaden JJ , Alkhouli MA , Eleid MF , Nkomo VT , Pislaru SV , Kane G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction: Transesophageal echocardiography (TEE) has long provided excellent diagnostic imaging of left-sided valvular pathology with an excellent safety profile; however, recent data has suggested an increased risk of injury related to TEE guidance.

Purpose

This study aims to evaluate the incidence and nature of TEE-related oropharyngeal or esophageal complications in patients undergoing TEE-guided structural heart procedures and identify associated risk factors.

Methods

We reviewed consecutive patients undergoing TEE-guided structural heart procedures from 2005-2020. All procedures were performed under general anesthesia. TEE-related oropharyngeal or esophageal complications were defined as those occurring within 30 days of the procedure resulting in i) persistent dysphagia, odynophagia, or upper gastrointestinal bleeding requiring prolonged endotracheal intubation, therapeutic endoscopic or surgical intervention, or diagnostic imaging that demonstrated oropharyngeal or esophageal injury.  ii) upper gastrointestinal bleed requiring transfusion, hemodynamic compromise warranting mechanical or pharmacologic support; or iii) oropharyngeal or esophageal complications leading to death. For multivariate analysis, all variables with a p < 0.15 at univariate analysis were included in the model.

Results

Among 1229 adult patients undergoing TEE-guided structural heart procedures between 2005-2020, 274 underwent a transcatheter aortic valve replacement (TAVR) with the remaining 955 undergoing either mitral valve transcatheter edge-to-edge repair (mTEER, n = 278), mitral paravalvular leak closure (PVLC, n = 354), mitral valve-in-valve replacement (VIV, n = 41), or left atrial appendage closure (LAAO, n = 282). Of these, 6 (0.5 %) had TEE-related complications; 0% TAVR, 0% VIV, 0.36% LAAO, 0.28% PVLC, 1.41% mTEER (p = 0.14). Of the six patients with complications 3 required at least one day of prolonged tracheal intubation and one a blood transfusion. None required surgical repair.  Factors associated with increased complication risk (Table) included a prior history of gastrointestinal bleed (Odds ratio 5.44 [0.98-30.04; p = 0.05]) and longer procedural time (OR per 30 min 1.15 [1.01-1.31, p = 0.03]). Patients undergoing mTEER had an increased risk of complication (OR 6.76 [1.23-37.1 p = 0.03]) and longer procedural time (OR per 30 mins 1.15[1.01-1.31, p = 0.04]) compared to other all other procedures.

Conclusion(s): In a large series of patients undergoing cardiac structural interventions under general anesthesia with TEE-guidance, rates of TEE-induced injury were low. Risk of oropharyngeal or esophageal complications was increased with longer procedure times, prior gastrointestinal bleeding history, increased age, increased pre-procedural creatinine, procedural type being mTEER and in male patients, lower height. Abstract Table
Echocardiographic findings of filipino patients with COVID-19 pneumonia: a single-center experience
Authors: Loquias M , Santillan C , Locnen S
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Acute respiratory injury is the main culprit for majority of the morbidity and mortality among COVID-19. However, there is a high prevalence of cardiovascular complication among these patients. Assessment of echocardiographic parameters provides clinical characteristics for utilization in the management of patients with COVID-19.

OBJECTIVE

To determine the predictors of mortality and analyze the echocardiographic findings of Filipino patients with COVID-19 Pneumonia and its correlation to the severity of the disease.

METHOD

This is a retrospective observational cohort study of the echocardiographic findings among 173  Filipino patients who acquired COVID-19 pneumonia from June to August 2020. Logistic regression analysis was used to identify predictors of dichotomous outcome variable.

RESULTS

The results showed that there was a significant direct correlation between the severity of COVID-19 and wall motion abnormality (r = 0.171; p = 0.024). There was also a significant direct correlation between length of hospital stay and the wall motion abnormality (r = 0.140; p = 0.050). Furthermore, there was a significant difference noted in the proportion of subjects with or without wall motion abnormality according to mortality (p = 0.007). The results also exhibit significant difference in the left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and left atrium according to mortality as shown by the p values 0.001, 0.001 and 0.030 respectively. However, there is no significant correlation noted between the severity of COVID-19 and mortality to the right ventricular size and function. Multivariate analysis using logistic regression, two variables were found to be significant predictors of mortality, this includes LVEDD and LVEF.

CONCLUSION

Among Filipino patients with COVID-19 pneumonia, the study demonstrated that left ventricular end diastolic diameter and left ventricular ejection fraction are significant predictors for mortality.
Mild autonomous cortisol secretion portends similar cardiac compromise as overt endogenous Cushings syndrome
Authors: Morbach C , Hoffmann K , Sahiti F , Detomas M , Eichner F , Kroiss M , Gelbrich G , Frantz S , Fassnacht M , Heuschmann PU , Hahner S , Stoerk S , Deutschbein T
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): German Ministry of Research and Education within the Comprehensive Heart Failure Centre Würzburg

OnBehalf

CV-CortEx

Background

Endogenous Cushing’s syndrome (CS) results in increased cardiovascular morbidity and mortality. This risk seems to be lower in patients with incidentally discovered mild autonomous cortisol secretion (MACS) but without the clinical features of CS. We aimed to describe and compare the cardiac morphology and function in patients with overt CS and MACS to a representative sample of a local prospective population-based cohort (STAAB).

Methods/Results: We comprehensively characterized 40 patients with overt CS (mean age 47 ± 13 years, 75% women) and 18 patients with MACS (62 ± 11 years, 56% women; both p ≤ 0.001 when compared to CS) including detailed transthoracic echocardiography. Logistic regression adjusted for age and sex showed no significant differences between both groups regarding body mass index (BMI), systolic and diastolic blood pressure (BP), lipids, HbA1c, and echocardiographic parameters of cardiac morphology and function (table). The comparison with STAAB participants (n = 4965, 55 ± 12 years, 52% women; logistic regression adjusted for age and sex) revealed significantly higher BMI, triglycerides, HbA1c, and diastolic but not systolic BP (table). Compared to STAAB participants, patients exhibited a smaller left ventricle (LV) with thicker septal and posterior walls, and a less favorable diastolic function. LV ejection fraction (LVEF) was higher, although longitudinal contraction, measured by tricuspid annular plane systolic excursion (TAPSE), and LV global longitudinal strain (GLS) were lower in both ventricles compared to STAAB participants (table).

Conclusion

Patients with both MACS or CS exhibited a compromised metabolic profile and diastolic function pattern when compared to a population-based cohort. Higher LVEF despite lower GLS suggests a compensatory increase in LV radial contraction in states of hypercortisolism. Cardiac impairment was similar in patients with CS or MACS suggesting an adverse effect of hypercortisolism even at clinically inconspicuous levels. Abstract Figure.
Diastolic dysfunction worsen prognosis in patients with dilated cardiomyopathy independently of left ventricular systolic dysfunction
Authors: Dziewiecka E , Winiarczyk M , Karabinowska A , Gliniak M , Robak J , Kaciczak M , Wisniowska-Smialek S , Rubis P
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

The heart failure (HF) symptoms and prognosis in patients with HF with reduced ejection fraction (LVEF; HFrEF) is mostly associated with left ventricle (LV) remodelling and systolic dysfunction. However, in HFrEF patients the LV diastolic function is usually also impaired and worsen the prognosis. The significance of LV dysfunction in dilated cardiomyopathy (DCM) is well recognised, but not the diastolic dysfunction.

Aim

The analysis of diastolic function in DCM with different systolic impairment and its impact on the prognosis.

Methods

Between 2010 and 2020 we retrospectively analysed out- and in-hospital records of 567 DCM patients (age 52 ± 13 years, 78% male, NYHA 2.4 ± 0.8) with complete echocardiographic and outcome data. Patients were divided into 3 groups based on LVEF (EF1 <20%, EF2 20-29%, EF3 ≥30%) and into 3 groups according to diastolic function based on the ASE/EACVI 2016 recommendations.

Results

Most patients had no or mildly impaired diastolic function, however nearly 50% of EF1 patients had abnormal diastolic function (Table 1). During observation of 41 ± 27 months, 88 (16%) patients died (Table 1). Impaired diastolic function (G2 or G3) was found to be significant prognostic factor independently of LVEF (G2-3: HR 2.44 [95%CI 1.59-3.70], p < 0.001; LVEF: HR 0.10 [95%CI 0.09-0.10] for every 10%, p = 0.002) (Figure 1).

Conclusion

Most DCM patients had severely impaired LV systolic function and no or mildly impaired diastolic function. In DCM patients the diastolic dysfunction significantly worsens the prognosis independently of LVEF. Abstract Table 1.  Abstract Figure 1.
Is left ventricular function reduced after ultra-endurance exercise?
Authors: Witso M , Sletten OJ , Hisdal J , Melau J , Smiseth OA , Remme EW , Skulstad H
Published: February 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Norwegian Health Association

Introduction

Ultra-endurance exercise can be harmful according to previous studies, indicated by reduction in functional parameters and increase in cardiac biomarkers. Changes in load and heart rate with exercise influence left ventricle systolic function, making assessment of standard echocardiographic examination difficult.

Purpose

We investigated the effect of ultra-endurance exercise on myocardial function acutely and at restitution.

Methods

We investigated 10 participants aged 46 ±7 years, before (baseline), within 142 ± 78 minutes after finish (post run) and 5-10 days after (restitution) an ultra-endurance race (3.8 km swimming, 180 km bicycling and 42 km running with a total elevation of 5200 m). Echocardiography was performed at the three time points, including cardiac morphology and -function. Ejection fraction (EF) and stroke volume (SV) were measured by Simpson biplane. Cardiac output was calculated from SV and heart rate (HR). Cardiac power was calculated as the product of CO, mean arterial blood pressure and the conversion factor to Watt (W) 0.00222. Global longitudinal strain (GLS) was calculated using speckle-tracking echocardiography, and myocardial work was calculated by non-invasive pressure-strain analysis.

Results

Acutely after exercise, myocardial function by GLS (p = 0.002), myocardial work (p < 0.001), mitral annular plane systolic excursion (MAPSE, p = 0.003) and EF (p = 0.004) were substantially reduced compared to baseline, whereas cardiac power and cardiac output (CO) were maintained (see table and figure). Heart rate was moderately increased (p < 0.001). End-diastolic volume (EDV) as an index of preload was numerically, but not significantly reduced. End systolic volume (ESV) was numerically increased (p = NS) even though systolic blood pressure (sBP) was reduced (p = 0.01) post race. After restitution all parameters returned to baseline levels.

Conclusions

The temporary reduced strain and EF may be a physiologic response due to the higher heart rate. However, despite reduced systolic pressure the heart did not contract to a lower end systolic volume. This suggests loss of contractile function compensated by increase in heart rate. The findings should be explored in further studies. Abstract Figure  Abstract Table
Comparison of mitral regurgitant volume assessment between proximal flow convergence and volumetric methods in patients with significant primary mitral regurgitation
Authors: Altes A , Levy F , Iacuzio L , Dumortier H , Toledano M , Tartar J , Tribouilloy C , Marechaux S
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. Discrepancies have been observed between transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (MRI) severity grading in primary mitral regurgitation (MR).

Purpose. To compare mitral regurgitant volume (RV) obtained by the proximal flow convergence method (PISA) method by TTE and by volumetric methods (TTE and MRI), and study the relationship between LV size and RV obtained by either the PISA or volumetric methods.

Methods and results. 188 patients from 2 heart valve clinics with at least moderate-to-severe primary MR due to prolapse in sinus rhythm who underwent evaluation with TTE and MRI were included. RV was estimated by either PISA or volumetric methods (Left ventricular [LV] stroke volume minus systolic aortic outflow volume)) by either MRI (MRI-RV) or TTE (TTE-RV)). PISA-RV and either MRI-RV or TTE-RV weakly correlated (r = 0.29 and 0.30,p < 0.001). On multivariable analysis, LV end-diastolic volume (LVEDV) and bileaflet prolapse independently correlated with the magnitude of the difference between PISA and volumetric methods. While PISA-RV and LVEDV were unrelated, MRI-RV and TTE-RV strongly correlated with LVEDV (r = 0.66 and 0.68,p < 0.001). In contrast, LVEDV and regurgitant fraction (RF = RV/LVEDV) either with TTE or MRI were poorly related (r = 0.17,p = 0.02 and r = 0.12,p = 0.10).

Conclusion. RV estimated by the PISA and volumetric methods are not comparable. The expected proportional relationship between volumetric RV and LV size, which is not observed with PISA-RV suggests the inaccuracy of PISA-RV. Given that RV by volumetric methods depends on LV size, determination of a unique RV threshold for severe MR is challenging. Calculation of RF may overcome this limitation. Abstract Figure. RV assessed by PISA or volumetric method  Abstract Figure. Illustrative example
Intracardiac device associated interference with tricuspid valve apparatus on echocardiography: What can we learn from pathology?
Authors: Henry M , Abutaleb A , Jeevanandam V , Smith H , Belkin M , Husain A , Pinney S , Ota T , Mor-Avi V , Lang RM , Addetia K
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

 New or worsening tricuspid regurgitation (TR) is associated with right-sided heart failure and worsened outcomes. Cardiac Implantable Electronic Devices (CIEDs), which are being implanted at growing rates worldwide, are increasingly being recognized as associated with TR occurrence related to interference with the tricuspid valve (TV) apparatus. Purpose: We sought to identify echocardiographic features in the right ventricle and TV that differentiate patients who have anatomically demonstrated interference with the TV on direct pathology inspection. 

Methods

 Explanted hearts from 44 consecutive patients undergoing orthotopic heart transplant (55 ±13 yrs, 68% men) with known implanted CIEDs were dissected to assess the presence (n = 18) or absence (n = 26) of CIED interference with the TV (Figure). Echocardiographic measurements performed prior to transplantation, including left and right ventricular (LV, RV) size and performance metrics as well as TR severity, were compared between both groups using non-parametric testing. 

Results

 Echocardiographic features of patients with and without anatomically demonstrated TV interference are shown in the Table. Although overall LV dimensions and volumes were not different between the two groups and LV ejection fraction was severely reduced in both groups, patients demonstrating CIED interference trended towards larger right atrial volumes (Table) and also larger RV and tricuspid annular sizes. Importantly, however, they were more than 4 times likely to have abnormal right ventricular function. Lastly, patients with tricuspid apparatus interference tended to have more significant TR, although these differences have not reached statistical significance (Table). 

Conclusion

 CIED interreference with tricuspid valve apparatus occurs frequently (41%) among patients with CIEDs, who undergo orthotopic heart transplantation. This may be associated with worsening TV function with subsequent changes in right atrial and ventricular geometry and function. In light of prior data showing poor outcomes with CIED associated TR, this study emphasizes the importance of non-invasive assessment of CIED interference with the tricuspid valve, in order to improve device placement and patient outcomes. Abstract Figure  Abstract Table
Right heart interplay with secondary tricuspid regurgitation. How can we predict clinical events?
Authors: Lofficial G , Chen E , Guerin A , Dreyfus J , Sportouch C , Galli E , Oger E , Donal E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

TRAP

Introduction. Secondary Tricuspid Regurgitation (TR) is a turning point in cardiac diseases. Symptoms occurred too late according to the right heart reverse remodelling capabilities. The ideal timing for proposing a valve repair remains a challenge. We sought to analyse characteristics of patients with significant secondary TR, seeking for changes in parameters over time that could be related to the risk of clinical event.

Material and method. We designed a prospective observational French multicentre study of 160 patients with significant secondary TR (effective regurgitant orifice area > 30 mm²) and LVEF > 40%; we collected clinical, echocardiographic, and EKG data at baseline, 1- and 2-year follow-up. All echocardiographies were centrally analyzed. The primary outcome was death or hospitalization for heart failure

Results. At 2-year 95 patients (59.3%) presented the primary outcome. They had significant morphological and functional alteration of the right heart parameters. Right Atrial Volume Index (RAVI) and right ventricular free wall Strain were respectively 73mL/m² and -19.8% versus 64.7mL/m² and 22.3% in the event-free group. None of them had significant group*time interaction. In the multivariable analysis, TAPSE/sPAP ratio > 0.4 (OR = 0.41 95%CL 0.2 to 0.82) associated to RAVI > 60mL/m² (OR = 2.13 95%CL 0.96 to 4.75) were the two independent parameters that enable the fairest and parsimonious evaluation.

Conclusion. We demonstrated that short analysis using RAVI and TAPSE/sPAP almost reached us to an easier patient assessment by limiting the number of involved parameters. These parameters are now to be for defining the best timing and response to interventions. Abstract Figure. LAVI and TAPSE/sPAP according to events
Prognostic value of left ventricular global longitudinal strain in patients with moderate aortic stenosis
Authors: Stassen J , Pio SM , Ewe SH , Singh GK , Hirasawa K , Butcher SC , Marsan NA , Delgado V , Bax JJ
Published: February 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741

Background

Impaired left ventricular (LV) global longitudinal strain (GLS) is associated with worse outcomes in patients with severe aortic stenosis, but its prognostic value in patients with moderate aortic stenosis (MAS) is largely unknown.

Purpose

To investigate the prognostic implications of LV GLS in patients with MAS and preserved LV ejection fraction (EF).

Methods

LV GLS was evaluated by speckle tracking echocardiography in 621 patients (age 71 ± 12 years, 59% men) with MAS (aortic valve area 1.0 – 1.5cm2) and preserved LVEF (≥50%). Impaired LV GLS was defined as an LV GLS value <16%, based on spline curve analysis (i.e. where the hazard ratio for all-cause mortality was ≥1). Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement.

Results

Patients with LV GLS <16% (n = 282) were significantly older, more likely to be male and had more comorbidities (diabetes mellitus, atrial fibrillation, more impaired renal function) compared to patients with LV GLS ≥16% (n = 339). In terms of echocardiographic data, patients with LV GLS <16% had larger LV volumes, lower LVEF and higher E/e’. During a median follow-up of 53 (27 – 102) months, 199 (32%) patients died. For the composite endpoint, 409 patients (66%) underwent AVR (n = 290) or died (n = 119) during a median follow-up of 29 (IQR 14 – 54) months. Patients with LV GLS <16% experienced significantly lower survival rates (p < 0.001) and event-free survival rates (p = 0.001) compared to patients with LV GLS ≥16% (Figure 1). On multivariable analysis, LV GLS was independently associated with all-cause mortality (HR 2.442; 95% CI: 1.762 – 3.384; p < 0.001) and the composite endpoint of all-cause mortality and aortic valve replacement  (HR 1.862; 95% CI: 1.498 – 2.315; p = 0.040) (Figure 2).

Conclusions

In patients with MAS and preserved LVEF, reduced LV GLS is associated with an increased risk of all-cause mortality and the composite endpoint of all-cause mortality and AVR. Assessment of LV GLS may be useful in the risk stratification of these patients. Abstract Figure. Kaplan-Meier curves  Abstract Figure. Cox regression analysis
Stress echocardiography in patients with ischemic mitral regurgitation and left ventricular dysfunction qualified to cardiosurgery treatment
Authors: Piatkowski R , Kochanowski J , Budnik M , Peller M , Grabowski M , Opolski G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Ischemic mitral regurgitation (IMR) is predominantly related to left ventricle (LV) remodeling and mitral valve deformation. Although coronary artery bypass grafting alone (CABGa) or with mitral annuloplasty (CABGmp) is considered the best therapeutic strategies for patients with IMR, some recurrences are still reported.

Purpose

The aim of this study was to evaluate use of the mitral deformation indices (MDI) as a predictor of recurrence of IMR in 1-year follow-up after surgery.

Methods

A total of 145 patients after myocardial infarction with significant IMR, eligible for CABG, were prospectively enrolled in the study. Patients were referred for CABGa (gr.1; n = 90) or CABGmp (gr.2; n = 55), based on clinical assessment and the results of rest and stress echocardiography. One year after surgery each patient underwent the evaluation of cardiovascular events. Univariable logistic regression analysis was used to identify factors of recurrence of IMR in 1 year follow-up.

Results

Logistic regression analysis revealed that in CABGa group preoperative changes of TA and CH during DBX remained the predictors of the recurrence of IMR in 12 months follow-up. TAdbx > 1 cm2 provided sensitivity of 90% and specificity of 29%, (AUC 0.6436); The best cut-off value for CHdbx was 0.4 cm (sensitivity 90%, specificity 34%; AUC 0.6432). In both groups no significant differences were observed in 12-month mortality (1.2% vs 0%; p = 1.0), hospitalizations due to the heart failure (HF) exacerbation (5.9% vs 8.5%; p = 0.72) and in the incidence of the composite endpoint (deaths/CV hosp/stroke) (7% vs 8.5%; p = 0.742).

Conclusion

Preoperative assessment of MDI changes during dbx can be used to identify patients with IMR at increased risk of recurrence of significant IMR in 1 year follow-up. Abstract Figure 1  Abstract Figure 2
Effects of early initiation of comprehensive heart failure therapy on echocardiographic parameters of young patients with newly diagnosed idiopathic dilated cardiomyopathy
Authors: Hassan KM , Chipamaunga T , Joubert LH , Doubell AF
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Heart failure with reduced ejection fraction (HFrEF) is a growing problem worldwide and is associated with significant morbidity and mortality. Angiotensin receptor neprilysin inhibitors (ARNI) and sodium-glucose cotransporter 2 inhibitors (SGLT2-i) are now seen as disease modifying agents with growing evidence to support their early initiation in order to prolong lives of patients with HFrEF. However, most of these trials were conducted in the developed world involving older patients with ischaemic cardiomyopathies, in contrast to younger patients with idiopathic dilated cardiomyopathies (DCMO) typically seen in Africa. Further, these drugs are expensive and remain out of reach for most patients in the developing world.

Purpose

To determine the effects of early initiation of comprehensive heart failure (HF) therapy consisting of ARNI, SGLT2-i, β-blocker and mineralocorticoid receptor antagonist on transthoracic echocardiography (TTE) parameters of patients with newly diagnosed idiopathic DCMO.

Methods

This is prospective cohort study. All patients presenting to a single tertiary centre in South Africa between January and July 2021 with newly diagnosed idiopathic DCMO that were initiated on a regimen of comprehensive heart failure therapy as first line therapy were included. TTE were performed at initiation and at monthly follow up visits.

Results

Eight patients (mean age 35.4 ± 7 years, 25% females) were included. At baseline, the mean left ventricular ejection fraction (LVEF) was 17.1 ± 3.2%, mean left ventricular end diastolic diameter (LVEDD) was 68.0 ± 7.6mm, mean E’ (average) 4.0 ± 1.9m/s, mean LV global longitudinal strain (GLS) -4.5 ± 1.9%, mean LVOT VTI 10.9 ± 3.2cm and mean TAPSE 14.3 ± 4.1mm. The patients were followed up for an average of 4 months (range 1 – 5 months). TTE performed at the latest follow up visit showed a significant increase in LVEF (21.3%; 95% CI 13.5 - 29.0; p = 0.01), average E’ (2.5m/s; 95% 0.3 - 4.7; p = 0.05), GLS (-6.7%; 95% CI -1.0 - 8.9; p = 0.01), LVOT VTI (5.0cm; 95% CI 1.4 - 8.5; p = 0.03) and TAPSE (7mm; 95% CI 2.6 - 11.4; p = 0.02), and a significant reduction in LVEDD (6.5mm; 95% CI 1.1 - 11.9; p = 0.03).

Conclusion

Early initiation of comprehensive HF therapy including ARNI and SGLT2-i is associated with significant improvements in left and right ventricular function and LV reverse remodelling in a small cohort of young South African patients with newly diagnosed idiopathic DCMO. This supports the widespread adoption of this therapeutic strategy, even in a resource limited setting, in a population of patients with limited access to other therapeutic options such as mechanical circulatory support and cardiac transplantation. Abstract Table 1  Abstract Figure 1
Left atrial myopathy is associated with exercise capacity and ventilatory efficiency in hypertrophic cardiomyopathy
Authors: Zegkos T , Kamperidis V , Gossios T , Ntelios D , Parcharidou D , Papanastasiou CA , Katranas S , Rouskas P , Karvounis H , Efthimiadis GK
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Data about the predictive value of left atrial (LA) myopathy for exercise capacity and ventilatory efficiency in patients with hypertrophic cardiomyopathy (HCM) are limited.

Purpose

The aim of this study was to evaluate the association of LA myopathy, evaluated by echocardiography LA strain, with exercise capacity and ventilatory efficiency, evaluated by cardiopulmonary exercise testing (CPET), in HCM patients.

Methods

In total, 241 consecutive HCM patients (51 ± 16 years old; 67.2% male) on sinus rhythm that underwent CPET and transthoracic echocardiography at the same visit were studied. Exercise capacity (maximal oxygen consumption/predicted [%peakVO2]) and ventilatory efficiency (ventilation/carbon dioxide output [VE/VCO2] slope) were assessed by CPET. LA myopathy was examined by speckle tracking myocardial deformation parameters: LA reservoir, conduit and booster strain.

Results

All the three LA strain values were univariate predictors of exercise capacity and ventilatory efficiency. Among them, LA reservoir strain had the higher r correlation coefficient for predicting both %peakVO2 and VE/VCO2 slope and was included in multivariable analyses. LA reservoir strain, male gender and E/E’ ratio were independent predictors of exercise capacity. LA reservoir strain, male gender, non-sustained ventricular tachycardia and LA volume index were independent predictors of ventilatory efficiency (Table).

Conclusion

LA myopathy, as reflected by the LA strain values, was associated with exercise capacity and ventilatory efficiency in HCM individuals. LA reservoir strain was the only common independent predictor for %peakVO2 and VE/VCO2 slope. Abstract Table
Left atrioventricular coupling index in hypertrophic cardiomyopathy and risk of new-onset atrial fibrillation
Authors: Meucci MC , Fortuni F , Galloo X , Bootsma M , Crea F , Bax JJ , Ajmone Marsan N , Delgado V
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

 In patients with hypertrophic cardiomyopathy (HCM) accurate risk stratification for new onset atrial fibrillation (AF) has important prognostic implications. Left atrioventricular coupling index (LACI) has been recently associated with the occurrence of AF in patients without history of cardiovascular disease.

Purpose

The objective of this study was to investigate the association between LACI and new onset AF in HCM patients and its incremental value over conventional left atrial (LA) parameters.

Methods

A total of 373 HCM patients without history of AF (48 ± 17 years, 66% men) were evaluated by transthoracic echocardiography. LACI was defined by the ratio of the LA end-diastolic volume divided by the LV end-diastolic volume. The cut-off value for LACI (≥40%) to identify LA-left ventricular (LV) uncoupling was chosen based on the risk excess of new-onset AF described with a spline curve analysis. Cox proportional hazard models were used to evaluate the association between LACI and the occurrence of AF.

Results

The median LACI was 38% (interquartile range: 24-56) and LA-LV uncoupling (LACI ≥40%) was observed in 171 (45.8%) patients. During a mean follow-up of 11.0 ± 5.6 years, 118 subjects (31.6%) developed new-onset AF. The cumulative event-free survival at 10 years was 53% for patients with LA-LV uncoupling (LACI ≥40%) versus 94% for patients without LA-LV uncoupling (LACI <40%) (p < 0.0001; Figure 1). Multivariable analysis showed an independent association between new-onset AF  and LA maximum volume indexed (LAVImax) (hazard ratio [HR], 1.03; 95% CI, 1.02–1.04), LA minimum volume indexed (LAVImin) (HR, 1.04; 95% CI, 1.03–1.05), LA emptying fraction (HR, 0.97; 95% CI, 0.96–0.98) and LACI (HR, 1.02; 95% CI, 1.01–1.02; all p < 0.0001). The inclusion of LACI in the multivariate model provided larger improvement in the risk stratification for new-onset AF, as compared to conventional LA parameters (Figure 2). Furthermore, the likelihood ratio test demonstrated incremental value of LACI assessment on the top of the multivariate model including LAVImin to predict new-onset AF (p = 0.02), while the addition of LAVImin did not improve the risk discrimination of the multivariate model including LACI (p = 0.36).

Conclusion

Greater LACI, indicative of LA-LV uncoupling, was independently associated with the occurrence of new-onset AF in patients with HCM and demonstrated a stronger risk discrimination power compared to conventional LA parameters. This simple ratio may be easily implemented in clinical practice to improve risk stratification for new-onset AF in HCM. Abstract Figure. Incident AF according to LACI  Abstract Figure.
The presence and extent of coronary microvascular dysfunction is associated to the severity of cardiomyopathy in patients with Fabry disease
Authors: Graziani F , Lillo R , Leccisotti L , Bruno I , Ingrasciotta G , Marano R , Rovere G , Manna R , Pieroni M , Camporeale A , Lanza GA , Crea F
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Coronary microvascular dysfunction (CMD) occurs before left ventricular hypertrophy (LVH) in Anderson Fabry Disease (AFD). Few data exist about the role of CMD in Fabry cardiomyopathy, when overt LVH has already established.

Purpose

Aim of our study was to assess the relationship between CMD and clinical and echocardiographic features in a cohort of Fabry cardiomyopathy patients.

Methods

We performed coronary CT scan to exclude epicardial coronary artery disease (CAD) in 27 AFD cardiomyopathy patients with angina and/or evidence of silent ischemia at treadmill stress test. All consenting patients with no CAD (n = 17) were submitted to resting and stress 13N-Ammonia myocardial perfusion PET/CT to assess the presence of CMD. All patients also underwent complete echocardiography. Patients were followed-up for 17.3 ± 12.5 months.

Results

Global coronary flow reserve (CFR) resulted <2.5 in 7 (41%) patients. Global stress myocardial blood flow (MBF) was <1.85 mL/min/g in 5 (29%) patients. Global transmural perfusion gradient (TPG, subendocardial MBF/subepicardial MBF) during stress was <1.0 in 13/17 (76.5%) patients. Resting global TPG was ≥1 in 16 (94%) patients. Patients with CFR < 2.5 were older (p = 0.02), had more severe LVH (maximal wall thickness p = 0.04), worst global longitudinal strain (p = 0.03) and E/e’ (p = 0.04) and higher troponin levels (p = 0.002) as compared to patients with CFR ≥ 2.5. They also performed less at treadmill stress (METs p = 0.045). No variables were associated to major cardiovascular events at multivariable analysis.

Conclusions

In Fabry cardiomyopathy patients with angina and/or evidence of silent ischemia, the prevalence of CMD is high and it is associated to a more severe cardiac phenotype, including cardiac biomarker and functional capacity. We are not able to draw any conclusion on the possible prognostic role of CMD in Fabry cardiomyopathy.
Myocardial work in hypertrophic cardiomyopathy - a new non-invasive parameter for segmental myocardial function?
Authors: Batzner A , Seggewiss H , Hahn P , Sahiti F , Maack C , Gerull B , Stoerk S , Morbach C
Published: February 2022

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): DFG

Introduction

Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease. Alcohol septal ablation (PTSMA) is an established treatment option for patients with intracavitary obstruction. In non-obstructive patients, measurement of myocardial work (MW) using pressure strain loops was introduced as a new non-invasive tool to estimate myocardial performance.

Purpose

In this preliminary study, we compared global constructive work (GCW) and global wasted work (GWW) as well as the respective values for the septal- and lateral-basal segments in HOCM after successful PTSMA and non-obstructive HCM.

Methods

We included 12 patients (4 women, mean age 59.1 ± 17.6 years) with non-obstructive (maximal left ventricular gradient <30 mmHg; mean 10.6 ± 6.2 mmHg) HCM. 7 (58%) patients (subgroup A) had successful gradient reduction by PTSMA ≥3 months before analysis, whereas 5 patients had non-obstructive HCM (subgroup B). Using echocardiographic measurements of longitudinal strain and non-invasive measurements of peripheral- and calculated (PWA) central blood pressure (BP) as left ventricular systolic pressure (LVSP), we estimated and compared GCW and GWW as well as constructive work (CW) and wasted work (WW) of septal-basal and lateral-basal segments.

Results

In subgroup B, NTproBNP was significant higher than in subgroup A (2050 ± 1957 vs. 552 ± 845 pg/ml; p < 0.05). There were no differences between both subgroups in maximal septal thickness (20.7 ± 2.9 mm (A) vs. 22.2 ± 3.6 mm) and left atrial volume (91.6 ± 33.0 (A) vs. 114.0 ± 49.8 ml (B)). Using the measured peripheral BP as LVSP, GCW (1653 ± 347 (A) mmHg% vs 1641 ± 698mmHg%) and GWW (171 ± 89mmHg% (A) vs. 200 ± 126 mmHg%) showed no differences between both subgroups. Compared to published data of a healthy population, values of GCW were lower and values of GWW higher in HCM. Comparison in segmental analysis in subgroup A showed lower CW in septal-basal than in lateral-basal segments (1032 ± 385mmHg% vs. 1929 ± 699 mmHg%). In the subgroup B the finding was the same pattern (1024 ± 504mmHg% vs. 2301 ± 1069 mmHg%). In contrast, WW showed no difference between basal-septal and lateral-basal segments in both subgroups.

Conclusions

Our preliminary data show decreased GCW and increased GWW in HCM patients without obstruction at rest. As expected, we found lower CW in septal-basal segments than lateral-basal in patients after PTSMA with basal-septal-induced therapeutic infarction. Surprisingly, we found the same pattern in non-obstructive HCM patients. This finding might be one pathophysiological reason for not developing LVOT obstruction, which should be investigated in further detail.