bluuebunny/crossref_metadata_2025 huggingface dataset:
Incremental value of right atrial strain analysis to predict atrial fibrillation recurrence after electrical cardioversion
Authors: Tomaselli M , Cannone V , Badano L P , Radu D N , Curti E , Perelli F P , Heilbron F , Gavazzoni M , Rella V , Oliverio G , Caravita S , Baratto C , Parati G , Brasca F M , Muraru D
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Atrial fibrillation (AF) is the most frequent cardiac arrhythmia, associated with elevated risks of cardiovascular events and death. The assessment of left atrial (LA) mechanics has been reported to refine AF risk prediction, however it does not completely predict AF relapse. The potential added role of right atrial (RA) function in this setting is unknown.

Purpose

This study sought to evaluate the added value of RA longitudinal reservoir strain (RARS), on top of LA longitudinal reservoir strain (LARS) analysis, for the prediction of AF recurrence after electrical cardioversion (ECV).

Methods

We retrospectively studied 132 consecutive adult patients (men 55%, 72±10 years) with persistent AF undergoing ECV in hospital setting. Exclusion criteria were: pregnancy, previous cardiac surgery, pacemaker or implantable cardioverter defibrillator, severe valvular regurgitation/stenosis, ventricular systolic dysfunction, poor apical acoustic window, unsuccessful ECV, early recurrent AF and lack of follow-up. LA and RA size and function were analyzed by conventional 2D and speckle-tracking echocardiography before ECV. The endpoint was AF recurrence.

Results

After a total follow-up of 12 months, 63 patients (48%) showed AF recurrence. Both LA and RA reservoir strain were significantly lower in patients experiencing AF recurrence than in patients with persistent sinus rhythm (LARS 10±6 vs 13±7%, RARS 14±10 vs 20±9 %, respectively, p<0.001 for both). By receiving operating curve (ROC) analysis, the best cut-offs associated to AF recurrence after ECV were 15% for RARS [AUC 0.77 (95%CI 0.69–0.84), p<0.0001] and 10% for LARS [AUC 0.69 (95%IC 0.60–0.77), p<0.0001]. Kaplan-Meier curves showed that patients with both LARS≤10% and RARS ≤15% had a significant risk for AF recurrences (log-rank, p<0.001) (Figure 1). However, at multivariable Cox regression, RARS [HR 3.26, 95%CI (1.73–6.13), p< 0.001] was the only parameter independently associated with the AF recurrence. RARS provided incremental prognostic value over LARS, LA and RA volumes concerning the prediction of AF relapse after ECV (Figure 2).

Conclusions

RARS was independently associated with AF recurrence after ECV and provided an incremental prognostic value over LARS. This study highlights the importance of assessing the functional remodeling of both RA and LA in patients with persistent AF.

Figure 1. Atrial fibrillation recurrence freedom according to left and right atrial reservoir longitudinal strain. Kaplan-Meier plots of patients grouped according to the threshold levels of left (left panel) and right (right panel) values of reservoir longitudinal strain identified by the Receiver Operating Curve analyses.
Cardiac sarcoidosis in the modern era: continued challenges of presentation, management and adverse outcomes
Authors: Curtis E , Scott T , Edwards N C
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): New Zealand Heart Foundation

Background

Detection of cardiac sarcoidosis (CS) has increased with improved availability of imaging modalities including cardiovascular magnetic resonance imaging (cardiac MRI) and positron emission tomography (CT-PET). However, clinical presentation remains highly variable ranging from asymptomatic incidental findings to malignant ventricular arrhythmias. Improved awareness of heterogenous presentations and markers of adverse outcomes is pivotal to guide a consistent and optimal management approach.

Methods

Retrospective observational study of patients with confirmed CS defined according to Heart Rhythm Society (HRS) consensus criteria (2014) between 2004–2022. Data on demographics, mode of presentation, serum and imaging biomarkers, and treatments regimens was assessed. Adverse clinical outcomes defined as heart failure hospitalization, ventricular arrhythmia (VA), new conduction disease, antitachycardic device therapies (ATD), death, cardiac transplant, atrial arrhythmias and strokes were evaluated.

Results

A confirmed diagnosis of CS was identified in 99 patients; n=23 (23%)isolated CS, median age 55 years ±11 years, 52% male). The common clinical presentations were; symptomatic conduction disease 53%, heart failure 24% and ventricular arrhythmia 16%, incidental 6%. Diagnosis was confirmed by imaging studies; cardiac MRI n=85 (86%) with late gadolinium enhancement in n=77 (78%) and / or positive CT-PET n=47 (47%). Concomitant cardiac biopsy was performed in 25%. Advanced device therapies were prescribed in 84 patients; bradycardic pacemaker n=17, defibrillator capable devices n=67 with 22 patients outside of standard Class I HRS Consensus (LVEF >35%). In total, 69 patients (70%) had a total of 158 adverse outcomes including heart failure (28%), VA’s (27%), ATD’s 21%, death 8%, conduction disease 7%, transplant 4%, atrial arrhythmias 3% and stroke in 1%. Treatment regimens for metabolically active disease included immunosuppression with 30–40mg prednisone in 65% with a tapering regimen after 12–36 weeks. An additional steroid sparing agents (methotrexate, azathioprine, mycophenolate, infliximab) were used in 55% of patients. Complete suppression of active disease assessed by repeat PET scan at 3 months after initiation of high dose steroid was observed in 55% of treated patients. One patient refused treatment had remission of activity seen on follow up CTPET. Overall 13% died and 6% patients required transplantation.

Conclusion

Presentation with conduction disease in a young patient should be considered a red flag for potential CS diagnosis. Multimodality imaging is pivotal in the diagnosis and PET scanning can aid management decisions by assessing disease activity pre and during treatment. Adverse events with CS are frequent and warrant close follow-up and longer-term collaborative studies to ensure a consistent and optimal management.
Coronary artery calcium score predicts outcome in patients with COVID-19
Authors: Braun C , Zehnpfennig M , Kasprzak J , Szymczyk K , Lipiec P
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Aim

Coronary artery calcium (CAC) score is a proven prognostic marker of cardiovascular risk. The aim of this study was to evaluate the prognostic value of CAC score on standard chest computed tomography (CT) in patients admitted with COVID-19.

Methods

We enrolled 144 consecutive patients (mean age 67± 13, 60.7% male) hospitalized with COVID-19, who on admission underwent chest CT to detect and assess pulmonary involvement. CAC score was calculated by two investigators blinded to patients clinical data. Patients were followed-up for 12 months after their admission.

Results

106 patients had image quality sufficient for analysis. The median CAC score was 249 Agatston units (interquartile range 658). 33 deaths were recorded in the study group during the follow-up period. The median values of CAC of patients who died during the study period and of the survivors were 592 (interquartile range 1492) and 142 (interquartile range 400), respectively. The difference in CAC between these two subgroups was statistically significant (p = 0,0001). The area under the ROC curve for CAC score for predicting all-cause mortality was 0.738 (95% CI 0,644 to 0,819). The criterion with the highest prognostic accuracy was CAC score >143 Agatston units (positive and negative predictive values were 44,4% and 88,4%, respectively). The presence of this criterion was associated with 3,82 times higher relative risk of mortality (95%CI 1.60 – 9,11; p = 0.0025).

Conclusion

CAC score measurement based on standard chest CT performed on admission in patients with COVID-19 to detect pulmonary involvement is a prognostic marker of increased mortality during the 12-month follow-up.
Use of advanced 3D modelling and printing for congenital heart disease at a large surgical center
Authors: Farooqi K A N W A L , Pasumarti N , Shah A , Crystal M , Kalfa D , Bacha E B
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Rachel Cooper Innovative Technologies Fund

Background

3D cardiac models, digital and physical, are being used for pre-procedural planning for management of congenital heart disease.

Purpose

We describe the application of 3D cardiac modelling with details regarding which indications were typically useful to 3D print at our high volume congenital cardiac surgical center.

Methods

We reviewed patients with congenital heart disease for whom 3D models were created at our institution from January 2018 to December 2022. The diagnosis and indications for the 3D model were collected. Indications for model were separated into 1) complex intracardiac anatomy 2) ventricular assist device/transplant planning 3) anomalous coronary artery origins and 4) other. The mode of 3D modelling was identified as digital model or 3D print.

Results

A total of 61 models were created over the 5 year period. Indications for advanced modelling were: 30 with complex intracardiac anatomy, 17 ventricular assist device/transplant planning, 9 with anomalous coronary artery and 6 with other indications. Patients included in the "other" category were those with extracardiac congenital anomalies. A total of 25 3D printed cardiac models were created. These included 12/30 of the complex intracardiac anatomy patients, 12/17 of the ventricular assist device/transplant planning patients and 1/6 of the patients with complex extracardiac anatomy (Figure 1). An example of a 3D printed cardiac model used for presurgical planning for a patient with anomalous right pulmonary venous drainage to the inferior vena cava is demonstrated in Figure 2. Right atrium (RA), left atrium (LA), inferior vena cava (IVC), right pulmonary artery (RPA), aorta (Ao).

Conclusion

3D printed cardiac models were more commonly utilized at our center than digital models for ventricular assist device and transplant planning than for any other indication including complex intracardiac anatomy.
Variation evaluation of biometric and sonographic parameters on left atrial strain values
Authors: Duijnhouwer A L , Wijnands L
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Speckle tracking echocardiography is an upcoming modality to quantify left atrial function. Left atrial function is disturbed in many disease and left atrial systolic strain (LASr) has already been associated with the prognosis of atrial fibrillation and with the degree of diastolic dysfunction. Some modifying parameters have been identified in relatively small studies.

Purpose

We aim to assess the influence of known and some unknown biometric and sonographic parameters on LASr values in a large cohort.

Methods

This prospective cohort study included 211 individuals and assessed general sonographic parameters and LASr. Patients included had normal ejection fraction (≥50%), reasonable image quality with frame rate ≥50FPS and no significant valvular heart disease. The sonographic parameters collected were left ventricular ejection fraction, global longitudinal strain (GLS) and Left atrial volume Index (LAVI). Speckle tracking analysis was done offline by semiautomatic contour detection and R-R gating was used.

Results

Mean LASr was 35.5 ± 11%. There were significant differences in LASr for age, global longitudinal strain (GLS), left atrial volume Index (LAVI) and vendor (GE versus Philips). LASr was significantly lower in the oldest groups (60–69jr and 70–84jr) and decreasing with progression of LAVI. LASr was significantly lower when the vendor Philips was used compared to GE. Gender was not associated with a change in LASr.

Conclusion

This study shows a significant influence of ageing, LAVI, GLS and vendor on left atrial strain values. The significant difference in LASr was probably due to a significant difference in frame rate between the two vendors used.
Left atrium function depression and left ventricle rotational parameters in patients with dilated cardiomyopathy and narrow QRS
Authors: Toader D M , Neagoe O , Carstea I , Craciun-Mirescu A , Mirea O , Florescu D , Iordache S , Munteanu I , Iovanescu M , Ispas I , Vaduvescu A , Istratoaie O , Militaru C , Oprita O , Aniculesei A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

In advanced stages of dilated cardiomyopathy (DCM), both atrial function and left ventricle (LV) myocardial mechanics are blunted. Left atrial reservoir strain (LASr) is a sensitive parameter for left atrial (LA) function evaluation. Our study aimed to find a correlation between LASr depression and rotational parameters damage in patients with DCM, using 4-Dimensional automated LA and LV quantification.

Methods

We enrolled 75 patients with DCM and narrow QRS and 30 healthy volunteers. The evaluation consisted of clinical examination, laboratory tests, 12 leads electrocardiography. All participants underwent a complete transthoracic echocardiogram to determine cardiac structure and function according to the current guidelines. Measurement of LA and LV strain was performed using 4D Auto-quantification software. The study evaluated LASr by 4D Auto Atrial Quantification. 4D LV Quantification measured twist and torsion.

Results

1. We divided the patients into two groups: 27 with DCM and atrial fibrillation (AF) and 48 with DCM and sinus rhythm (SR). 2. Mean values of LASr were 10.20 in patients with DCM and 30.36 in the healthy volunteers’ group. (P<0.0001). Rotational parameters were LV twist=1.66, LV torsion=0.44 in DCM patients, LV twist=10.1, and LV torsion=1,73 in the healthy group. (P<0.0001). In DCM patients with AF, mean values were lower ( LASr =9.52, LV twist=0.97, LV torsion=0.28, LV torsion=0.4) than in patients with SR (LASr=10.59, LVtwist=1.93, LV torsion=0.5) 3. A correlation was found between LASr and LV twist (r=-0.8), between LASr and torsion (r=-0.78), in patients with AF, and also in those with DCM and SR ( r=-0.74 for the twist, r=-0.73 for torsion).

Conclusions

1. LASr reduction was related to rotational damage of the left ventricle in DCM patients. 2. LASr, LV twist, and LV torsion were lower in cases with AF. 3. LA function is a parameter of chronic increased LV filling pressure. The correlation between LASr decrease and anomalies of twist and torsion may suggest a link between increased LV filling pressure and rotational dysfunction in patients with dilated cardiomyopathy phenotype.
How different triggers affect CMR parameters in takotsubo syndrome
Authors: Impellizzeri A , Fabrizio M , Bergamaschi L , Amicone S , Suma N , Bodega F , Canton L , Fedele D , Paolisso P , Bertolini D , Urbani A , Foa' A , Casella G , Pontone G , Pizzi C
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Ospedale Sant'Orsola (Bologna)

Background

Takotsubo syndrome (TTS) is an acute and transient heart failure syndrome characterized by a temporary wall motion abnormality of the left ventricle. Cardiac magnetic resonance (CMR) has a crucial role to assess ventricles function, regional wall motion abnormalities (RWMA), myocardial edema, late gadolinium enhancement (LGE) and complications. To date, there is a lack of how trigger events impact CMR parameters.

Purpose

To evaluate the clinical presentation, triggers of TTS and CMR parameters in patients hospitalized for Takotsubo Syndrome (TTS).

Methods

In our study we evaluated 128 patients hospitalized with TTS between January 2016 and December 2021 in Italy. Diagnosis of Takotsubo syndrome was based on the international Takotsubo diagnostic criteria (InterTAK Diagnostic Criteria).

Results

The mean age of the study population was 68.7 ± 11.1 years, and 81 % were females. Concerning the event trigger of TTS, 44% of patients experimented with an emotional event and 56% with physical stress.

CMR was available in 66 patients, performed 7.5 ± 3.7 days after admission during hospitalization. CMR confirmed that most patients had typical TTS with apical ballooning (87%) while only 4.5% had a midventricular pattern. Left ventricular ejection fraction (LV-EF) mean was 55.3 ± 10.9 %. Mean LV-EF did not significant differ between emotional and physical trigger populations (51±12.5 vs 56.3±7.7; p = 0.12).

Myocardial edema was present in 64.2% of patients and the mean number of segments involved was 6.2. ± 5.9. No statistical correlation between TTS trigger and the presence of edema at T2-weighted imaging was noticed. Spotty LGE was observed in 23.1 % of CMR exams, most evidenced in lateral (11.9 %) and inferior segments (10.4 %). LGE was evidenced more frequently in TTS triggered by physical events (38.1% vs 13%; p value=0.04) unlike pericardial effusion (0% vs 14%; p value= 0.04). Moreover, Hs-troponin I peak value was higher in the TTS physical triggered population than TTS with emotional trigger (3413 ± 4457 ng/l vs 2018 ± 2064 ng/l; p value= 0.04).

Conclusions

Early execution of CMR is essential in suspected TTS because several parameters are relatively time-dependent and derived from dynamic alterations that might resolve over time (such as myocardial edema). In our study patients with a physical trigger had a higher Hs-Troponin I max peak value and, more frequently spotty LGE on CMR. This could be the manifestation of more consistent myocardial damage compared to emotional triggers. However, the physiopathological and prognostic role of LGE in TTS remains unclear.
Left ventricular cellular regression occurs without matrix changes at two months post aortic valve replacement in severe aortic stenosis
Authors: Bennett J , Thornton G , Nitsche C , Gama F , Mravljak R , Abiodun A , Aziminia N , Gautam-Aitken E , Pierce I , Kellman P , Manisty C , Hughes A , Davies R , Moon J C , Treibel T A
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Background

Increased left ventricular mass (LVM) in severe aortic stenosis (AS) is a result of the combined expansion of myocardial cellular and extracellular compartments in response to chronic pressure overload. Upon relief of pressure overload by aortic valve replacement (AVR), LVM regresses significantly however patients remain at risk of post-AVR heart failure and mortality.

T1 mapping, by cardiovascular magnetic resonance (CMR), can quantify the proportion of cellular and extracellular volume.

Purpose

We sought to determine the relative contributions of cellular and extracellular remodelling early after AVR to gain insight into potential post-AVR mechanisms of heart failure.

Methods

Patients with severe symptomatic AS underwent CMR (volumes, function, pre- and post-contrast T1 mapping using 0.1mmol/kg Dotarem) prior to and 8-weeks after surgical or transcatheter AVR. Global extracellular volume fraction (ECV%) was quantified from pre- and post-contrast T1 mapping and synthetic haematocrit. ECV% was used to calculate cellular compartment volume (CellVol) and extracellular volume (ECVol) from total LV volume (LVM/1.05[specific gravity of myocardium]). Segments with focal LGE were excluded from ECV% calculation.

Statistical analysis was via paired t-test denoted by standard deviations (SD), or Wilcoxon signed-rank test with reported interquartile ranges (IQR).

Results

27 patients (age 71.2 SD±9.8, male 70.3%) returned for repeat investigation at median 8.5 [IQR 7.1–11.6] weeks post-AVR (surgical: 16 / transcatheter: 11). Aortic valve peak velocity significantly improved (4.5 SD±0.5m/s to 2.4 SD±0.4m/s; p<0.001) alongside median NYHA class (2 [IQR 0] to 1 [IQR 0.5]; p<0.001).

LVM regressed 10.3% (170.8 SD±36.6g to 153.2 SD±39g; P<0.001), which comprised of a 13.8% reduction in CellVol (134.8 SD±29.4mL to 116.2 SD±30.5mL; P<0.001). However, ECVol remained unchanged (44.4 SD±10.2mL to 44.7 SD±11.2mL; P=0.78) resulting in an ECV% increase of 3.1% (24.8 SD±2.4% to 27.9 SD±2.1%; P<0.001).

We show for the first time that the rapid early LVM reduction after AVR is driven entirely by regression of cardiomyocyte hypertrophy. The extracellular compartment volume is unchanged at two months post-AVR. This relative increase in the ratio of fibrosis and cell volume may result in early worsening myocardial stiffness and could be a contributing factor to post-AVR diastolic dysfunction and heart failure.
Prediction of low left atrial appendage velocity from echocardiographic left atrial function parameters in patients with atrial fibrillation undergoing catheter ablation
Authors: Uzieblo-Zyczkowska B , Kiliszek Marek M K , Malgorzata Maciorowska M M , Agnieszka Jurek A J , Krystian Krzyzanowski K K , Pawel Krzesinski P K
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Decreased left atrial appendage velocity (LAAV) measured by transesophageal echocardiography is considered a significant risk factor for the presence of thrombus in both the left atrium (LA) and left atrial appendage (LAA).

Purpose

The aim of the study was to assess the role of echocardiographic LA function parameters in predicting low left atrial appendage velocity (LAAV) in patients with persistent atrial fibrillation (AF) undergoing catheter ablation.

Methods

We prospectively enrolled consecutive patients with persistent AF undergoing transesophageal echocardiography (TEE) directly before first AF ablation in 2019–2022. All patients underwent conventional two-dimensional (2D) echocardiography and 2D speckle tracking echocardiography on the day of ablation. Patients were divided into two groups according to the presence or absence of decreased LAAV≤25cm/s at TEE.

Results

Out of total 150 patients enrolled in the study, 29.3% (n=44) had a reduced LAAV ≤25cm/s. Patients with decreased LAAV value exhibited significantly lower left atrial reservoir and conduit strain (LASr and LAScd) (p<0.001 for both); LA emptying fraction (p<0.001) and average e’ value (p<0.001). At the same time, this group presented higher LA stiffness index (LASI) (defined as E/e' ratio/LASr) (p<0.001); LA and right atrial area (p = 0.002 and 0.004 respectively); LA volume index (p<0.001) and E/e’ ratio (p<0.001).

In multivariable logistic regression analysis only LASI and LAVI remained significant predictors of the lower LAAV (odds ratio (OR) for LASI 3.065, 95% confidence interval(CI) 1.415–6.639, p<0.001; for LAVI OR 1.05 (1.011–1.091). The diagnostic accuracy of these two parameters in predicting low LAAV value calculated as the area under receiver operating characteristic curves (ROC) were 0.809 (95% CI 0.726–0.892) for LASI and 0.755 (CI 0.676–0.835) for LAVI. A ROC analysis found a LASI threshold of 1.6 with 64% sensitivity and 90% specificity and LAVI threshold of 44.47ml/m2 with 91% sensitivity and 53% specificity in predicting reduced LAAV defined as ≤ 25cm/s.

Conclusions

Among all noninvasive parameters assessed by conventional 2D and 2D speckle tracking echocardiography, LASI and LAVI were found to be the best predictors of reduced LAAV in patients with persistent non-valvular AF undergoing TEE before catheter ablation, with good sensitivity and specificity.
Exploring the prognostic value of myocardial inflammation in Fabry cardiomyopathy
Authors: Guida G , Disabato G , Attanasio A , Tondi L , Pasqualin G , Bevilacqua F , Lombardi M , Camporeale A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac involvement in Fabry Disease (FD) manifests as left ventricular hypertrophy (LVH) often complicated by myocardial fibrosis and/or inflammation. Indeed, glycosphingolipid storage does not explain the whole spectrum of FD pathophysiology. Lysosomal deposits of unmetabolized glycolipid substrates stimulate the activation of immunological pathways, taking to a chronic inflammatory process.1 In a subgroup of FD patients with late gadolinium enhancement (LGE), signs of myocardial inflammation can be detected by cardiac magnetic resonance (CMR) using T2-weighted (T2w) sequences and T2 mapping. T2 value in inferolateral wall (IL) has been described as the strongest predictor of increase in troponin level. 2

Aim

The aims of the study were: 1) to compare CMR parameters in LVH and LGE positive FD patients with and without myocardial inflammation; 2) to verify if myocardial inflammation plays an incremental prognostic role in FD compared to LVH and LGE.

Methods

Among 190 consecutive FD patients referred for CMR, 47 patients with LVH and LGE were selected for this study. All patients underwent an extensive CMR protocol to provide a detailed evaluation of cardiac morphology and function, with multiparametric tissue characterization. Myocardial inflammation was detected by T2w and T2 mapping sequences. A comparison of CMR parameters between patients with and without inflammation was performed. A composite endpoint of cardiovascular (CV) events was used for survival analysis.

Results

No differences in age and Mainz Severity Score Index were found between LVH+/LGE+ FD patients with and without myocardial inflammation. Patients with inflammation showed significantly greater left ventricular mass index (LVMI) compared to patients without inflammation. Regarding tissue characterization, patients with myocardial inflammation had more extensive LGE and significantly higher ECV in IL wall. Native myocardial T1 was reduced in both groups without statistically significant difference. (Table 1) Myocardial inflammation always involved IL wall. During a median follow-up of 30 months, Kaplan-Meier curves showed similar event-free survival probability in patients with and without myocardial inflammation (Log-Rank p = 0,215, Figure 1).

Conclusion

In a population of LVH+/LGE+ FD patients, the presence of CMR signs of myocardial inflammation was associated with more severe LVH and more extensive LGE. However, the presence of myocardial inflammation did not showed an incremental prognostic value on CV outcomes on top of LVH and LGE. Larger studies are needed to verify this findings.
Extrapolation of CT aortic annulus derived diameter/CT aortic annulus area from 2D echocardiography aortic annulus diameter in TAVR: not a reliable tool
Authors: Medilek K , Bis J , Polansky P , Dusek J , Brtko M , Tuna M , Praus R , Ballon M , Stasek J , Parizek P
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Computed tomography (CT) aortic annulus area, CT area derived diameter and two-dimensional echocardiography (2D ECHO) diameters are used for valvular sizing in transcutaneous aortic valve replacement (TAVR). According to our previous study, 2D ECHO annulus diameter was smaller in comparison to CT derived diameter (22.6±2.9 vs 25.0±5.5mm, p = 0.013), but both CT aortic annulus area derived diameter/CT aortic annulus and 2D ECHO diameter predicted correct valve size selection with the same accuracy of 79–80%. However, CT requires radiation and iodine contrast administration, which might be the limitation in patients with chronic kidney disease or history of iodine allergy.

Purpose

To determine if 2D ECHO diameter can be used for reliable estimation of CT area derived diameter/CT aortic annulus area.

Methods

139 consecutive patients with favourable outcome of Sapien XT/Sapien S3 TAVR (no more than mild aortic regurgitation, only one valve implanted) were included in the study. 2D ECHO diameter was measured from mid oesophageal three-chamber view (110–135°) just below the anatomical aortic valve annulus. CT aortic annulus was obtained as double oblique plane by manual multiplanar reconstruction of CT dataset, defined by three lowest attachment points of valvular leaflets. Aortic annulus area was measured by manual tracking of lumen contours, area derived diameter as 2*√(area/π). Linear regression analysis between pre-implant CT area derived diameter and 2D ECHO diameter was performed; extrapolated CT annulus area diameter and CT aortic annulus area [π*(d/2)2] were calculated from 2D ECHO diameter. Concordance of valve size selection based on extrapolated CT area derived diameter vs original CT area derived diameter and extrapolated CT aortic annulus area vs original CT aortic annulus area was determined on patients where CT aortic annulus area/annulus derived diameter were falling outside the overlap of the manufacturer recommended ranges for neighbouring valve sizes.

Results

Significant relationship between CT aera derived diameter and 2D ECHO diameter was found (r=0.720, p<0.001, Fig 1,2). Extrapolated CT area derived diameter would have led to inappropriate size selection in 33/100 more cases (undersizing in 16%, oversizing in 17%), similar to extrapolated aortic annulus area, where both undersizing and oversizing was observed in 18/106 (17%) more cases in comparison to original CT based parameters.

Conclusion

Extrapolation of CT aortic annulus area/area derived diameter from 2D ECHO diameter is not a reliable tool in valvular sizing for balloon expandable Sapien valve. In patients with chronic kidney disease or history of iodine allergy, three-dimensional (3D) ECHO aortic annulus assessment remains the only viable alternative tool.
Mitral annulus excursion depression as the expression of left ventricle strain parameters damage in patients with dilated cardiomyopathy
Authors: Toader D M , Neagoe O , Scorbura T , Craciun-Mirescu A , Mirea O , Oprita O , Carstea I , Istratoaie O , Militaru C , Florescu D , Munteanu I , Iordache S , Ispas I , Aniculesei A , Vaduvescu A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

4D echocardiography is a useful tool to identify both decreasing of mitral annular excursion (MAE) and left ventricle (LV) strain damage in patients with dilated cardiomyopathy (DCM). Our study aimed to identify a correlation between MAE decreasing and LV strain parameters in patients with DCM.

Methods

We enrolled 75 patients with DCM and 30 healthy volunteers. The evaluation consisted of clinical examination, laboratory tests, 12 leads electrocardiography. All participants underwent a complete transthoracic echocardiogram to determine cardiac structure and function according to the current guidelines. The study evaluated MAE by 4D Auto Mitral Valve Quantification (4D - MVQ). 4D LV Quantification (4D-LVQ) measured global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS).

Results

1. We divided the patients into two groups: 27 with DCM and atrial fibrillation (AF) and 48 with DCM and sinus rhythm (SR). 2. Mean values of MAE were 3.89 (SD=2.2, CV=0.56) in patients with DCM and 11.1 (SD 1.08, CV 0.09) in the healthy volunteers’ group. (P<0.0001). In patients with DCM and RS MAE mean value was 4.24 (SD=2.34, CV=0.54), and in the AF group was 2.98 (SD=1.38, CV=0.45) (p = 0.0125). 3. Mean values of strain in patients with DCM and RS compared with those in AF were: GLS −6,63 vs. −4,1 (P = 0.0005), GCS −6.08 vs. −5,2 (P = 0.1931), GAS −11.22 vs. −8.47 (P = 0.0181), GRS = 14.5 vs. 10.89 (P = 0.0493). 4. The correlations obtained between MAE and LV strain in patients with DCM were: GLS (r=-0.67), GAS (r=-0.61), GRS (r=0.5), and GCS (r=-0.39).

Conclusions

1. MAE was significantly reduced in patients with DCM compared with healthy volunteers. 2. The patients with DCM and AF presented the lowest values of MAE and LV global strain parameters. 3. MAE correlated better with GLS and GAS, moderate with GRS, and weak with GAS in patients with dilated cardiomyopathy phenotype.
TAPSE/PAPS ratio as a predictor of hospital staying in patients affected by severe degenerative mitral regurgitation undergoing mitral valve surgery
Authors: Barki M , Ingallina G , Paci G , Margonato D , Stella S , Biondi F , Ancona F , Morosato M , Fanti D , Castiglioni A , De Bonis M , Maisano F , Slavich M , Agricola E
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Chronic severe degenerative mitral regurgitation (DMR) is a progressive disease with a negative impact on prognosis and surgical repair or replacement represents the standard of care. Recently, the coupling between right ventricular (RV) function and the pulmonary circulation (Pc) emerged as a prognostic index in patients undergoing transcatheter edge-to-edge mitral repair. However, the relationship between pulmonary circulatory right ventricular uncoupling and clinical outcomes in patients undergoing surgery for DMR has poorly been investigated.

Purpose

In a cohort of patients affected by DMR undergoing mitral valve surgery (repair or replacement), we investigated the association between the degree of RV-to-Pc uncoupling, assessed by the ratio between tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PAPS), and the time of hospitalization.

Methods

389 consecutive patients affected by DMR who underwent mitral surgery (repair or replacement) were retrospectively enrolled. In the pre-operatory phase, all patients underwent a transthoracic echocardiography. The degree of RV-to-PC uncoupling was defined by TAPSE/PASP ratio with a cut-off of 0.4 mm/mmHg and was correlated with the time of hospitalization expressed in days.

Results

A total of 389 eligible patients (mean age 52±14 y, 65% male, 85% in sinus rhythm) who were admitted for mitral valve surgery at San Raffaele hospital (85% repair, 15% replacement) for hemodynamically significant DMR were retrospectively enrolled from January 2019 to June 2022. Mean hospital stay was 11±8 days. At baseline, only 28% of the cohort exhibited normal left ventricular (LV) and left atrial (LA) size and function, with the majority of the cohort exhibiting increased LA dimension (mean LAVi 49±10 ml/m2). RV to PC coupling was measured before surgery (mean TAPSE/PAPS: 0.8±0.2 mm/mmHg) and only 15% of the cohort had a TAPSE/PAPS≤0.4 mm/mmHg. Interestingly, patients with lower TAPSE/PAPS ratio had longer hospitalization (TAPSE/PAPS≤0.4 mm/mmHg: 15±8.2 days vs TAPSE/PAPS >0.4 mm/mmHg: 11±7.5 days; p = 0.04) and an inverse relationship was found between TAPSE/PAPS values at admission and the length of hospitalization (r=0.4, CI 95% 0.21–0.57; p<0.001; Figure 1).

Conclusions

In DMR, a strong association was noted between TAPSE/PAPS ratio and length of hospitalization in patients undergoing mitral valve surgery. These data, although preliminary, underline the impact of RV dysfunction and PC uncoupling on clinical outcomes also in the short-term evolution after surgery.
Myocardial deformation as a stratification tool in HCM
Authors: Stolpe G , Martel H , Lucas C , Morel V , N'guyen K , Donal E , Reant P , Habib G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Sudden cardiac death (SCD) is a major issue in hypertrophic cardiomyopathy (HCM) management, and its risk prediction stays challenging for clinicians.

Ventricular arrythmias (VAs) have to be treated rapidly, indeed VAs lower prognosis in HCM patients.

Current ESC guidelines for cardioverter-defibrillator implantation include left atrial (LA) whereas left ventricle (LV) ejection function (LVEF) is incorporated in AHA latest guidelines. We explore the potential role of LA and LV strain as more sensible parameters in HCM rhythmic prognostication.

Purpose

To assess LA and LV strain in risk stratification in HCM patients as accurate markers of SCD.

Methods

Patients with newly diagnosed HCM were enrolled in three French University Hospital (Marseille, Bordeaux and Rennes) between 2007 and 2018. At the inclusion we realized a comprehensive clinical exam, biological analysis, an echocardiography including LA strain in two and four apical-chambers, and a MRI.

Composite primary endpoint (PE) analysis was occurrence of rhythmic related adverse cardiac events: ventricular tachycardia (VT), ICD therapy for ventricular arrhythmia, or all-cause death.

Occurrence and dates of endpoints were retrieved by patient’s medical records and phone calls to all patients and family members.

Results

At a mean follow-up of 57 (34–82) months, patients with adverse cardiac events (n = 52) presented with more impaired LA and LV deformation function. After multivariate analysis, we found a significant association between impaired LA strain and our composite primary endpoint P 0,023 HR 0,95.

LV strain revealed to be correlated with our PE P 0,012 HR 2,48.

Conclusions

Myocardial deformation appears to be a relevant marker which could be linked to sudden cardiac death in HCM.

These parameters might be relevant in new risk calculators.
Cardiac troponin T, NT-proBNP and GDF-15 associate with future focal myocardial scar types, but not diffuse fibrosis assessed by cardiac magnetic resonance
Authors: Wimalanathan T , Paus M F , Skranes J B , Berge T , Tveit A , Roesjoe H , Omland T , Lyngbakken M N , Heck S L
Published: June 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Akershus University Hospital Trust, Vestre Viken Hospital Trust, South-Eastern Norway Regional Health Authority, Roche Diagnostics provided reagents for hs-cTnT analyses

Background

In cardiovascular risk prediction, there is growing evidence that imaging and circulating cardiac biomarkers provide incremental prognostic value compared to single biomarkers or traditional risk factors. In patients with suspected or established cardiovascular disease (CVD), cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) associate with focal and diffuse fibrosis assessed by cardiac magnetic resonance (CMR) imaging. There is limited data on the associations between established and emerging circulating cardiac biomarkers with subsequent myocardial fibrosis in subjects without CVD recruited from the general population.

Purpose

Assess the associations between biomarkers of cardiac injury (cTnT), stress (NT-proBNP) and fibrosis and inflammation (growth differentiation factor-15, GDF-15), and subsequent focal and diffuse myocardial fibrosis assessed by CMR imaging.

Methods

We recruited 200 study participants born in 1950 from the general population. All participants were without known coronary artery disease or renal dysfunction. cTnT, NT-proBNP, and GDF-15 were measured in samples collected at baseline in 2012–2015, and CMR was performed 4–7 years later. Presence and type (ischemic/non-ischemic) of focal myocardial fibrosis were assessed by late gadolinium enhancement (LGE) imaging. Diffuse fibrosis was assessed by the extracellular volume (ECV) in the midventricular septum. Logistic regression analysis was used to examine relationships between log transformed concentrations of cardiac biomarkers and CMR parameters.

Results

The median age was 63.9 (63.4–64.5) and 52% were male (Table 1). cTnT was associated with presence of any LGE scar adjusted for common cardiovascular risk factors (OR 1.85, 95% CI 1.25–2.72), but this association was attenuated when left ventricular mass was added to the model (Table 2). NT-proBNP (OR 1.66, 95% CI 1.10–2.72) and GDF-15 (OR 4.45, 95% CI 1.29–15.27) were associated with presence of any LGE scar in the fully adjusted models (Table 2). cTnT (OR 1.90, 95% CI 1.06–3.39) and NT-proBNP (OR 2.72, 95% CI 1.29–5.76) were associated with ischemic scars. Only GDF-15 (OR 4.52, 95% CI 1.09–18.72) associated with non-ischemic scars in adjusted models. None of the biomarkers were significantly associated with ECV.

Conclusion(s)

In a general population cohort, biomarkers of myocardial injury and stress associate with ischemic type scars, but not diffuse fibrosis. GDF-15, an emerging circulating biomarker of fibrosis and inflammation, associates with non-ischemic type scars.
Determinants of post-operative left ventricular dysfunction in degenerative mitral regurgitation
Authors: Althunayyan A , Alborikan S , Badiani S , Wong K , Uppal R , Patel N , Petersen P , Lloyd G , Bhattacharyya S
Published: June 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Saudi Arabian Cultural Bureau.

Background

Chronic degenerative mitral regurgitation leads to volume overload causing left ventricular (LV) enlargement and eventually LV impairment. Current guidelines determining thresholds for intervention are based on LV diameters and ejection fraction. There is sparse data examining the value of LV volumes and newer markers of LV performance on outcomes of surgery in mitral valve prolapse.

Purpose

Identify the best markers of LV impairment after mitral valve surgery.

Methods

Prospective, observational study of patients with mitral valve prolapse undergoing mitral valve surgery. Pre-operative LV diameters, volumes, ejection fraction (LVEF), global longitudinal strain (GLS) and myocardial work measured. Post-operative LV impairment defined as LVEF < 50% at 1 year post-surgery.

Results

Eighty-seven patients included. 13% developed post-operative LV impairment. Patients with post-operative LV dysfunction showed significantly larger indexed LV end-systolic diameters (LVESD), volumes (LVESV), lower LVEF and more abnormal GLS than patients without post-operative LV dysfunction. In multivariate analysis, indexed LVESV (Odds ratio 1.11 (95% CI 1.01 – 1.23), p = 0.039) and GLS (odds ratio 1.46 (95% CI 1 – 2.14), p = 0.054) were the only independent predictors of post-operative LV dysfunction. The optimal cut-off of 36.3 ml/m2 for indexed LVESV had a sensitivity of 82% and specificity of 78% for detection of post-operative LV impairment.

Conclusion

Post-operative LV impairment is common. Indexed LV volumes (36.3ml/m2) provided the best marker of post-operative LV impairment.
Prognostic value of left atrial strain by speckle-tracking echocardiography in patients admited for heart failure
Authors: Garcia Duran A B , Rodriguez C , Covas X , Garcia-Alonso A , Moreno J M , Vicente M , Mojon D , Gonzalez Guardia A , Mas-Stachurska A , Llagostera M , Molina L , Cladellas M , Ble Gimeno M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Clinical practice guidelines support the diagnostic value of left atrial volume in preserved heart failure (HF), but there is little evidence in left atrial (LA) function prognostic usefulness. Some recent studies have proved the diagnostic and prognostic value of atrial strain independently of ejection fraction (EF) in patients with HF.

Objectives

We aim to assess the usefulness of measuring the LA reservoir function by echocardiogram with speckle-tracking in patients admitted for HF, both in sinus rhythm (SR) or atrial fibrillation (AF). First re-admission due to HF or cardiovascular mortality were evaluated as a combined primary endpoint during follow-up.

Methods

We conducted a prospective study of all patients admitted for HF during 12 months. The study of the LA reservoir function was analysed by peak atrial longitudinal strain (PALS) measurement, divided into tertiles, and biplane auricular EF.

Results

122 patients were included (39% with reduced EF). Age 72±11 years, men 83(68%), AF 57(47%), previous HF 41(34%), with median follow-up 3.7 years. During follow-up, 65 cases (53%) were readmitted for HF and 14 (18%) died of cardiac causes. The univariate analysis showed significant differences in rhythm and atrial volume, but not with NT-proBNP nor left ventricular EF. The multivariate analysis adjusted for age, sex, rhythm, atrial volume, previous HF and LA EF showed a significant association between the minor tertile of PALS and admission for cardiac decompensation or death (HR 2.05; CI 95% 1.08–3.90; p = 0.028).

Conclusions

The study of atrial strain in HF is a prognostic marker of readmission for HF or cardiac death, assessable both in SR or AF. The minor tertile of PALS was associated significantly with the combined endpoint of re-admission due to HF and/or cardiovascular mortality.
Pectoralis muscle measures on preoperative computed tomography are strong predictors of early rehospitalization after left ventricular assist device implantation
Authors: Tanabe J , Akazawa Y , Nakamura D , Nakamoto K , Sera F , Oka T , Mizote I , Ohtani T , Hikoso S , Kawamura T , Yoshioka D , Miyagawa S , Sakata Y
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Skeletal muscle mass is reduced in severe heart failure and has a significantly impacts on subsequent outcomes and quality of life. The assessment of pectoralis muscle measures by computed tomography (CT) scan may be predictive of outcomes after left ventricular assist device (LVAD) implantation.

Purpose

This study aims to assess preoperative pectoralis muscle measures before LVAD implantation to predict early rehospitalization of the patient.

Methods

We measured the cross-sectional area and mean CT values of the unilateral pectoralis muscle (PHUm: mean Hounsfield unit of pectoralis muscle) by CT scans within 3 months before surgery in patients who underwent HeartMate 3 implantation for the bridge to transplant (BTT) or destination therapy (DT) at our hospital, by August 2022. The cross-sectional area of the unilateral pectoralis muscle was corrected for body surface area (PMI: pectoralis muscle index). The pectoralis muscle was measured by SYNAPSE VINCENT image analysis (Fuji Film) using an axial section of the superior margin of the aortic arch (Figure A). The area under the curve (AUC), sensitivity, and specificity of each index was calculated by receiver operating characteristic (ROC) analysis for the prediction accuracy of PHUm, PMI, and the product of PHUm and PMI in rehospitalization 30, 60, 90 and 180 days from discharge.

Results

Of reviewed 39 patients who underwent HeartMate 3 implantation, 32 (82%) were male, and 32 (82%) underwent BTT. The median age at LVAD implantation was 52 years (interquartile range [IQR], 42–57). During the follow-up period after discharge (median: 520 days, IQR: 116–707), 19 patients (53%) had unscheduled hospitalizations due to 8 LVAD-related infections, 1 heart failure, 1 cardiac arrhythmia, and 9 other reasons. The median time between discharge and rehospitalization was 70 days (IQR, 31–139).

ROC analysis showed that the AUC was particularly high for early rehospitalization within 30 days, with the optimal cutoff of 21.8 Hounsfield unit (HU) for PHUm (sensitivity 0.903, specificity 0.800, AUC 0.884), 6.37 cm2/m2 for PMI (sensitivity 0.806, specificity 0.800, AUC 0.735), and 142.8 for the product of PHUm and PMI (sensitivity 0.903, specificity 1.000, AUC 0.948) (Figure B).

Conclusion

The product of PHUm and PMI may be a strong predictor of early rehospitalization within 30 days of discharge after LVAD implantation.