bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and risk factors for mechanical injuries caused by the transesophageal ultrasound probe manipulation in the setting of transfemoral transcatheter tricuspid repair
Authors: Kuecken T , Bannehr M , Lalou E , Haase-Fielitz A , Butter C
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Leading right heart failure due to tricuspid regurgitation results in retrograde hepatic venous congestion with subsequent gastropathy and hyperemia of the gastric mucosa. Due to increased portal pressure as well as possible cirrhosis cardiaque, the risk for esophageal varices is greatly increased. In addition, associated with atrial dilatation, these patients usually suffer from atrial fibrillation and receive an oral anticoagulation/ direct anticoagulation (OAC/DOAC) as insult prophylaxis. Heparinization with a target ACT > 250 seconds is necessary during transfemoral transcatheter tricuspid repair (TTTR). Alternation between transgastric and midesophageal view with the transesophageal ultrasound probe is usually performed to better guide TTTR. Sufficient wall contact is crucial for good imaging. All of these conditions increase the risk for periprocedural gastric and/or esophageal injury.

Purpose

The aim of this study was to assess the incidence and risk factors for mechanical irritation and bleeding caused by the TEE probe manipulation in the setting of TTTR.

Methods

In this prospective cohort study patients received gastroscopy preinterventional and on the first day after TTTR. Statistical analysis was performed with IBM SPSS.28, t-Test was used to compare patients with and without postinterventional lesions.

Results

From December 2020 to July 2021, 18 patients with indication for TTTR were included in this study. The mean age of the patients was 77.8 (± 7.5) years. Thirteen patients (72.2%) had antral gastritis and 4 patients (22.2%) had corpus gastritis preinterventionally. Esophageal varices were not detectable in any patient. Postinterventionally, 10 patients (55.6%) showed lesions (hematoma or coagulated pressure points) (Fig. 1), and 2 patients (11%) required interventional treatment with hemoclips. The main lesion sites were midesophageal at 20-25 cm, 1 lesion at the Z-line. A mean of 5.7 (± 2.5) position changes took place; the mean procedural duration was 88 (± 27.8) min.

The number of clips placed (p = 0.64), the procedural duration (p = 0.99) and the number of position changes (p = 0.48) did not differ between the group of patients with and without injuries after TTTR (Tab 1).

Conclusion

More than 50% of patients with TTTR showed postprocedural injuries (lesions) of the esophagus.  Contrary to our assumption, mainly lesions midesophageal could be detected. Due to the procedure as well as the severe underlying disease, gastrointestinal bleeding is a potential complication in the context of a TTTR. Consideration should be given to implementing regular control gastroscopy after TTTR to reduce the procedure-related complication rate. Due to the high incidence of procedure-related lesions, further research in larger patient collectives is necessary. Abstract Figure.  Abstract Figure.
Percutaneous closure of atrial appendage with thrombus - a strategy shift? Report of a case series
Authors: Kasprzak JD , Peruga JZ , Filipiak-Strzecka D , Szymczyk E , Wdowiak-Okrojek K , Lipiec P
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background. Percutaneous closure of left atrial appendage (LAAO)  is a recent preventive modality in atrial fibrillation. (AF) However, presence of thrombus which is a strong stroke risk multiplier represented a standard contraindication to purely percutaneous approach. 

Aim. To test the safety and feasibility of LAAO in patients (pts) with appendage blood stasis and distal thrombus.

Methods. Using a novel generation transvascular device allowing "shallow dive" implantation we tested the feasibility of LAAO in pts with appendage blood stasis and distal thrombus. Additionally, hybrid transvascular approach with arch protection device was also tested. Indications included development of heart failure in AF or recurrent cerebral events in pts with LAA thrombi.

Results. We successfully performed 3 procedures in pts (2F, 1M, age 73-76) with distal LAA thrombus confirmed in 3D TEE / CT. After 3D echocardiographic sizing omitting appendage angiogram, occluder was implanted from right femoral venous access via septal puncture. In 2 patients right radial access was additionally used to introduce commercially available arch protection device. In all cases the occluder did not engage distal appendage zone and was appropriately deployed. However in patients with arch protection 1-2 mm debris was captured by protection device. No neurological sequelae were noted.

Conclusion. Our initial experience documents safety and feasibility of percutaneous LAAO in presence of appendage blood stasis and distal thrombus based on 3DE sizing and novel genertaion device with optional percutaneous aortic arch protection. The long term efficacy of such unorthodox has yet to be determined in the setting of severely prothrombotic milieu, abnormal left ventricular function but with potential for risk reduction or even reopening options of cardioversion. Abstract Figure. Occlusion of LAA appendage with thrombus
Sex differences in athlete"s heart are evident from early adolescence
Authors: Forsaa M , Bjerring AW , Haugaa KH , Hallen J , Sarvari S , Edvardsen T
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority

OnBehalf

ProCardio Center for Innovation

Introduction

Athlete’s Heart (AH) is characterized by cardiac remodelling as a response to exercise, but data on sex differences in adolescent athletes is limited.

Purpose

To study the impact of sex on development of AH in adolescent athletes. We hypothesize that male adolescent athletes develop greater morphological changes than females, also when adjusted for body surface area (BSA).

Methods

We recruited 12-year-old cross-country skiers of both sexes in a longitudinal cohort study. We examined them with echocardiography at age 12, 15 and 18.

Results

We recruited 76 athletes (48 males and 28 females). We could follow 48 participants at age 15 (34 males and 14 females), and 34 participants at age 18 (23 males and 11 females). There were no sex differences in exercise hours at any time point. Adolescent males had greater indexed LV end-diastolic volume (LV EDVi) at all time points (Figure 1). Both sexes displayed LV enlargement already at age 12, and athletes of both sexes displayed LV EDVi close to or above upper reference values for the adult population. Only males increased their indexed LV mass (LVMI) from 12 to 18 years (LVM/BSA, Δg/m²; 33 ± 27 vs 4 ± 19, P = 0.006). Male adolescent athletes increased their LVMI by 7.4 grams more and LV EDVi by 4.0 ml more than female athletes did for every 1000 hours of exercise training. Cardiac function was within normal range in both sexes throughout the study period.

Conclusion

 Sex-related differences in cardiac adaptation to exercise are evident from early adolescence. Both sexes demonstrate cardiac remodelling, but adolescent male athletes display greater morphological changes compared to female athletes. Abstract Figure 1
Echocardiographic assessment of diastolic dysfunction in elderly patients with severe aortic stenosis before and after aortic valve replacement
Authors: Rosner A , Caglayan HA , Kjonaas D , Malm S , Schirmer H
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Helse Nord

Background

 The 2016 guidelines of the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) for evaluation of left ventricular (LV) diastolic dysfunction do not adjust assessment of high filling pressures for patients with aortic stenosis (AS). However, most of the studies on this patient group indicate age independent specific diastolic features in AS.

Purpose

The aim of this study is to identify disease-specific range and distribution of diastolic functional parameters and their ability to identify high N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels as a marker for high filling pressures.

Methods

In this study, 169 patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were prospectively enrolled. Resting echocardiography was performed including Doppler of the mitral inflow, pulmonary venous flow, tricuspid regurgitant flow and tissue Doppler in the mitral ring and indexed volume-estimates of the left atrium (LAVI). Echocardiography, and NT-proBNP levels were assessed before TAVR/SAVR and at two postoperative visits at 6 and 12 months.

Results

Pre- and postoperative values were septal e´; 5.1 ± 3.9, 5.2 ± 1.6 cm/s; lateral e´ 6.3 ± 2.1; 7.7 ± 2.7 cm/s; E/e´19 ± 8; 16 ± 7 cm/s; E velocity 96 ± 32; 95 ± 32 cm/s; LAVI 39 ± 8; 36 ± 8 ml/m2, pulmonary artery pressure (PAP) 39 ± 8; 36 ± 8 mmHg, respectively.  The scoring recommended by ASE/EACVI detected elevated NT pro-BNP with a specificity of 25%. Adjusting thresholds according to the cut-off values of the table increased prediction of  NT-proBNP levels ≥ 500 ng/L with substantially increased specificity (>85%).

Conclusion

Diastolic echocardiographic parameters in AS indicate persistent impaired relaxation and NT-proBNP indicate elevated filling pressures in most of the patients, improving only modestly 6-12 months after TAVR and SAVR. Applying the 2016 ASE/EACVI recommendations for detection of elevated filling pressures to patients with AS, elevated NT pro-BNP levels could not be reliably detected. However, adjusting thresholds of the echocardiographic parameters increased specificities to useful diagnostic levels. Abstract Table Cut-off values for high ProBNP  Abstract Figure. Examples for diastolic parameters in AS
Right ventricular dysfunction in patients with non-severe ischemic mitral regurgitation qualified to cardiosurgery treatment
Authors: Piatkowski R , Budnik M , Kochanowski J , Grabowski M , Opolski G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Right ventricular (RV) dysfunction worsens prognosis in patients (pts) after myocardial infarction (MI).

Purpose

The purpose of this study was to assess RV function as a predictor of mortality and hospitalizations due to exacerbation of HF in pts with ischemic mitral regurgitation (IMR) qualified for cardiosurgical treatment - coronary artery by-pass grafting alone (CABGa) or CABG with mitral reconstruction (CABGmr).

Methods

We prospectively analyzed 104 pts (M 57, 64 ± 7 years) with non-severe IMR, 3-24 weeks after MI. Effective regurgitation orifice (ERO) was used for quantitative IMR assessment (non-severe ≥10-20 mm²). All the pts were qualified for CABG (multiple vessel coronary disease, ejection fraction (EF)-44 ± 8%). The patients were referred for CABGa (gr.1; n = 77) or CABGmr (gr.2; n = 27) based on clinical assessment, 2D and 3D echo at rest and exercise. Tricuspid annular plane systolic excursion (TAPSE) was acquired to evaluate RV function (measured with M-mode imaging in the 4-chamber view). RV function was related to clinical outcome (median follow-up: 12 months).

Results

During the follow-up period of 12 months, 5 deaths (5 %) and 8 hospitalizations (8%) due to exacerbation of HF occurred. With use of the following cut-off points of TAPSE ≤ 12 mm (group I), and TAPSE >12 mm (group 2)—an association was found between the lower TAPSE and increased mortality. In group 1 (n =54 pts), 5 pts (9.2%) died and 6 pts was hospitalized due to HF (11.1%); in group 2 (n =50), no patient died, and 2 pts was hospitalized (4%). There was a significant difference (p = 0.02) in clinical outcomes between group I and II. ROC analysis identified TAPSE ≤12 mm as predictive cut-off for prediction adverse clinical outcome in all study group: (death: sensitivity 80%, specificity 76%, area under curve [AUC] = 0.807 (Fig.1); death and HF hospitalizations: sensitivity 69%, specificity 79%; AUC =0.767).

Conclusion

TAPSE is simple and useful quantitative measurement of RV function and have a predictive value in pts with non-severe IMR referred for cardiosurgery treatment. Abstract Figure 1
Validation of a new intuitive software for automatic heart function analysis. An intraobserver variability study
Authors: Di Candia A , Castaldi B , Cati A , Basso A , Fumanelli J , Sabatino J , Di Salvo G
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): University Hospital of Padua

Background/Introduction: In recent years there has been a growing interest in artificial intelligence (AI) applications in the echocardiography field. This is in order to simplify, reduce time and amplify the use of advanced analyses in the echo lab.

Purpose

to compare results of the fully automated analysis and manual tracing analysis using a new intuitive software.

Methods

28 consecutive previously healthy patients less than 18 years old who were screened at our Center for cardiac evaluation within 6 months after an asymptomatic or paucisymptomatic COVID19 infection were enrolled. All they were in sinus rhythm. Standard transthoracic echocardiography (TTE) was performed for each patient using Canon Aplio i900, software 2D Wall Motion Tracking. Optimized apical 4-, 3- and 2- chamber views, mitral valve inflow pattern and LVOT Doppler interrogation were collected. Off-line data analysis of each examination was performed by both fully automated analysis (AI) and pediatric cardiologists with experience in echocardiography i.e. by manual tracing, evaluation and adjustment of the track by the operator (Echocardiographers). Operators were blinded to the AI analysis. To measure intraobserver variability, evaluations of 16 patients datasets were performed twice by both operators and AI.

Results

Patients’ demographic data were: age 9,8+/-4,7 years; males 22 (78%); height 134,3+/- 34,9 cm; weight 41,8+/-28,7 kg; BSA 1,2+/-0,4 mq, HR 85+/-15/min.

The time taken for off-line analysis by AI and echocardiographers was 4-5 and 13-20 minutes, respectively.

Reproducibility of echocardiographers’ analysis was found to be excellent for left ventricle assessment (IC from 0,88 to 0,98); moderate for LVOT mean gradient (IC 0,73), RV end diastolic area (IC 0,69) and right atrial strain (IC 0,59); poor for deceleration time (IC 0,5), left ventricle strain (IC 0,49), RV FAC and strain (IC from 0,27 to 0,45).

Conversely, reproducibility of the AI analysis was found to be excellent for any parameter (ICC from 0,87 to 0,99) (Table 1).

About the mitralic valve inflow pattern assessment, despite the excellent reproducibility of AI analysis, the margin of error was found to be high. Particularly, a systematic error was observed with a tendency of the AI to overestimate deceleration time (DT-AI 176,6 ± 63,8 vs DT-Ecocardiographers 150,4 ± 24,3).

Conclusion(s): Fully automated analysis is technically simple, less time consuming and highly reproducible. AI analysis of the mitralic inflow pattern should be optimized, having found a systematic error in the calculation of deceleration time. Reproducibility is the strong point of AI. This reduces the variability of manual measurements between different sonographers and at different times. Abstract Table 1. Echocardiographic measurements
Transcatheter tricuspid valve-in-valve: evolution of tricuspid hydraulic performance and respective changes of right ventricular anatomy and function
Authors: Armenis I , Leontiades E , Tsiapras D , Karatasakis G , Iakovou I , Voudris V , Athanassopoulos GD
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Transcatheter tricuspid valve-in-valve replacement (TVIV) is an emerging therapy for dysfunctional surgically implanted bioprostheses. There are few data about the evaluation of hydraulic performance of these valves.

Purpose

Purpose of this single-center study was to evaluate the evolution of the right ventricular anatomy and function and the respective changes of TVIV hydraulics.

Methods

Six patients who underwent Sapien S3 TVIV (size 29mm) were studied (age 57 ± 11years, 3/6 in sinus rhythm, all in NYHA class III/IV). Inspiratory (insp) and expiratory (exp) TV mean gradients (mGR) , respective heart rate (HR), right ventricular end-diastolic diameter (RVEDd mm), RV fractional area change (FAC%) and RV free wall longitudinal strain (RV strain) were estimated at baseline (B), 1 month (1m) and later than 6 months (>6m).

Results

NYHA class fell by at least 1 scale at 1m and remained either stable or further improved at 6m.

RVEDd increased early at 1m (B: 33.5 ± 5.3mm vs 1m: 41.3 ± 3.3mm, p = 0.018) and remained unchanged at >6m (>6m: 41 ± 4.2mm vs 1m: 41.3 ± 3.3mm, p = ns). FAC improved late at 6m (B: 42.6 ± 2.8% vs 6m: 56 ± 6.2% p = 0.04). RV strain remained unchanged (B: -17 ± 5.5% vs 1m: 16 ± 7% vs >6m: -20 ± 6%, p = ns).

The improvement in both mGR-exp and mGR-insp was evident at 1m and remained unchanged afterwards: (mGR-exp: B 9 ± 4mmHg, 1m: 3 ± 2, >6m: 5 ± 1, both p < 0.05 vs B, mGR-insp: B 15 ± 5mmHg, 1m: 6 ± 2, >6m: 8 ± 2, both p < 0.05 vs B). The respective heart rates during measurements at inspiration and expiration were similar (HR-exp: B 72 ± 22bpm, 1m: 81 ± 22bpm, >6m: 65 ± 9bpm, HR-insp: B 75 ± 27bpm, 1m: 79 ± 18bpm, >6m: 69 ± 3bpm)

Absolute values for both mGR-insp and mGR-exp, despite progressive improvement, showed variations exceeding the conventional cut-off for TV prosthetic valve dysfunction of 6 mmHg, despite preserved clinical improvement. Variations of mGR were not related with the respective HR.

Conclusion

Following TVIV, early clinical improvement was related with a concomitant increase in RV volume, whereas RV functional indices showed a delayed response. Conventional echocardiographic hydraulics showed variability, often exceeding threshold for definition of prosthetic valve dysfunction. Thus, the significance of TV gradient after TVIV should be interpreted in the clinical context, taking into account respiratory changes.
The role of echocadiography in the differential diagnosis between PRKAG2 syndrome and Fabry disease
Authors: Pena JL , Diniz MVP , Moura ICG , Cristovao PMM , Linhares FM , Sternick EB
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Storage of glycogen and glycosphingolipids occurs in the heart with PRKAG2 Syndrome and Fabry Disease (FD), respectively. Identification of specific echocardiographic parameters could contribute to early diagnosis, which is fundamental to initiate appropriate treatment and improve prognosis. Material and methods: Prospective, transversal, observational study involving 45 patients, 30 genetically identified with the PRKAG2 gene mutation and 15 with FD. Conventional transthoracic, bi-, and tridimensional echocardiography as well as strain/strain rate speckle tracking were measured during one examination. Specific echocardiographic measurements were obtained and the data exported to a workstation for subsequent evaluation. Analyses were performed with 5% significance using the R program, version 3.1.3. Results: Compared to FD patients, PRKAG2 patients presented increased left atrium volume index, mean LV septum, posterior wall thickness, right ventricle (RV) dimensional values, and RV thickness in diastole. LV hypertrophy was found in varying degrees in 25 (86%) of PRKAG2 and 8 (53%) of FD Pts. We detected a binary appearance of LV endocardial border ("binary sign") and hypertrophy of the anterolateral papilary muscle in 60% of FD Pts. PRKAG2 Pts showed reduced global longitudinal strain (2DGLS), 4D GLS, 4D global radial strain (GRS), and aortic diameter compared to FD patients. In PRKAG2 Pts the bull’s-eye plot showed a stripe-like pattern. In FD Pts, however, it showed a peak systolic strain reduction in basal and mid- anterolateral segments. Conclusion: Echocardiography is an important technique in differentiating both diseases to determine adequate treatment and prognosis. We have demonstrated that PRKAG2 Pts present moderately greater cardiac involvement than FD Pts.
Diagnostic and prognostic implications of myocardial work in cardiac amyloidosis and in genetic and non-genetic cardiomyopathies with hypertrophic phenotype
Authors: Palmiero G , Rubino M , Monda E , Lioncino M , Verrillo F , Vetrano E , Caiazza M , Fusco A , Cirillo A , Dongiglio F , Ascione L , Caso P , Limongelli G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND & PURPOSE. Cardiac amyloidosis (CA) is an infiltrative disorder characterized by left ventricular (LV) thickening with early systolic and diastolic dysfunction. Due to it poor prognosis, and the beneficial impact of novel treatments when started in early stages of disease, its forward detection is crucial. Aim of this study is comparing the diagnostic accuracy of classical and novel echocardiographic parameters in detecting CA among other forms of genetic and non-genetic cardiomyopathies with hypertrophic phenotype.

METHODS. We enrolled 50 pts with CA (26 AL and 24 wtATTR) and 75 phenocopies (LVH group) [25 hypertrophic cardiomyopathy (HCM) pts, 25 hypertensive (HypCM) pts, and 25 pts with non-severe aortic stenosis (AS)]. Standard and novel LV morpho-functional echo parameters [LV ejection fraction (LVEF), myocardial contraction fraction (MCF), global longitudinal strain (GLS), relative regional strain ratio (RRSR), ejection fraction on strain ratio (EFSR)], and novel Myocardial Work (MW) parameters [Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), Global Work Efficiency (GWE)] were analyzed.

RESULTS. LV standard, novel and MW-derived systolic parameters were more impaired in CA compared to LVH group. At ROC curve analysis, GCW showed the best performance in discriminating CA from other forms of LVH (AUC 0.886; 95% CI: 0.819-0.954; P < 0.0001), with a cut-off value < 1473 mmHg% showing 90% of sensitivity and 82% of specificity). At linear regression analysis, GCW correlated with many echocardiographic parameters (IVSD, PWD, RWT ratio, LVMi, MCF, LVESV, LVEF, EFSR and RRSR). At multivariate analysis, PWD (P < 0,029) and RWT ratio (p < 0,014) were the only parameters associated with GCW. At 24 months follow-up, there were 15 deaths in CA and 4 in LVH group. At Kaplan-Meier analysis the overall survival free of cardiovascular death was reduced in the lowest GCW interquartile ranges (log-rank χ2 21.5; p < 0.0001). At Cox hazard ratio analysis, GCW was the only prognostic parameter associated with cardiovascular mortality (β 1.006; 95% CI: 1.003-1.009; P < 0.0001).

CONCLUSIONS. Despite CA and LVH patients shows a similar phenotype, the systolic function differs greatly. In the present study, the GCW showed the best ability in detecting CA among other forms of LVH. Its reduction in CA seems reflect the infiltrative burden and its consequences on myocardial deformation properties, while its reduction in LVH group has been attributed elsewhere to fibrotic derangement. GCW showed to be a promising novel diagnostic and prognostic factor in this setting. Abstract Figure 1  Abstract Table 1
Right heart function in patients with viral pneumonia of varying severity caused by SARS-n-COV-2
Authors: Karasev AA , Krylova N , Poteshkina NG , Kovalevskaya EA , Nikitina TA , Svanadze AA , Beloglazova IP
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Purpose

the purpose of this study was to estimate condition of right heart in patients with COVID-19 and viral pneumonia.

Material and methods

 87 patients were included (age 53 ± 13, 58% male) with established diagnosis of COVID-19 via PСR and viral pneumonia on CT scans. Patient’s clinical condition was assessed by SHOCS-COVID and NEWS scales. Transthoracic echocardiography was performed on 12 ± 4.6 day from the first symptoms of disease. Levels of high-sense Troponin I and NT-proBNP were measured in blood samples.

Results

Patients were divided into 3 groups according to pattern of viral pneumonia severity on CT scans. Group I with CT 1 grade (involvement of the pulmonary parenchyma 0-25%) - 11(12.6%) patients; mid age- 48.9 ± 17 years; NEWS score – 1.4 ± 0.9; SHOCS-COVID score – 7.5 ± 3.7.

Group II with CT 2 grade (involvement of the pulmonary parenchyma 25-50%). 48 (55.2%) patients; mid age- 51.6 ± 13.1 years; NEWS score - 2 ± 1; SHOCS-COVID score - 9 ± 2.1.

Group III with CT 3 grade (involvement of the pulmonary parenchyma 50%-75%). 28 (32.2%) patients; mid age- 57.1 ± 10.3 years; NEWS score – 3.2 ± 1.5; SHOCS-COVID score – 12.4 ± 2. 

Groups didn’t differ in age (p-value >0.05). Highest NEWS and SHOCS-COVID scores were observed in group III (p < 0.0001 and p = 0.01, accordingly). All patients had preserved LV ejection fraction (62 ± 4.2%). Range of right heart echocardiography parameters was higher in patients with more severe grade of viral pneumonia:

- pulmonary artery systolic pressure in group I – 26,3 ± 4 mmHg, in II ­– 28.7 ± 4 mmHg, in III – 29.1 ± 13.2 mmHg (pI-III= 0.002), r = 0.4, p < 0.0001;

- myocardial systolic velocity (s’) of free tricuspid annulus site by TDI in group I–11 ± 0.5 cm/s, in II–13 ± 2 cm/s, in III –14 ± 2 cm/s (pI-III= 0.02), r = 0.4. p < 0.0001;

- GLS of right ventricle (RV) in group I -18.6 ± 3%, in II – 21.6 ± 3.9%, in III – 21 ± 3.9% (pI-III = 0.038), r = 0.4, p = 0.005;

- RV mid diameter in apical position in group I– 27 ± 2.8 mm, in II – 31 ± 5.1 mm, in III – 29 ± 4.2 mm (pI-III = 0.03), r = 0.3, p = 0.002.

TAPSE and right heart areas didn’t differ between groups (p > 0.05). Levels of high-sense Troponin I were under 0.2 ng/ml in all groups (p > 0.05). NT-proBNP level were elevated only in group III – 172 [97,7;330] ng/l (pI-III = 0,03) and correlated with SHOCS-COVID scores (r = 0.4, p = 0.04), CT grade (r = 0.3, p = 0.01) and RV Tei index from pulse-wave Doppler (r = 0.3, p = 0.02).

Conclusion

perhaps, RV hyperfunction is compensatory reaction in response to increased afterload of right heart in patients with severe viral pneumonia caused by SARS-n-COV-2. Increased level of NT-proBNP indirectly confirms presence of myocardial stress in patients with severe viral pneumonia caused by SARS-n-COV-2.
The long term prognostic value of peak left atrial strain in cardiac transplant patients
Authors: Appadurai V , Chamberlain R , Edwards NFA , Mulligan A , Platts D , Hamilton-Craig C , Chan J , Scalia GM
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial (LA) dysfunction is associated with poorer outcomes in many disease processes. Left atrial strain (LAS) is a novel two-dimensional (2D) quantitative analysis of LA function. Cardiac transplantation directly involves the LA during implantation of the donor heart. Traditional echocardiographic indices after transplantation have demonstrated value in correlating with acute cellular rejection (ACR), morbidity and mortality over short- and long-term follow-up. The prognostic value of LA strain has not been previously investigated in this cohort.

Purpose

We hypothesized that incrementally impaired LA strain in post cardiac transplant patients with varying degrees of ACR may be prognostic of poorer outcomes on long term follow-up.

Methods

87 Heart transplant patients, assessed between 2009 and 2015, underwent transthoracic echocardiography and endomyocardial biopsy. 2D strain analysis on the LV and LA were performed along with traditional echocardiographic parameters. Patients were grouped according to peak LAS (PALS) tertiles and rejection burden history was assessed and grouped according to ACR burden at a median of 12 (±5.4) months post transplantation. The primary endpoint was all-cause mortality at follow-up.

Results

12 patients met the primary endpoint over a median follow-up of 66 ± 51 months. The mean LA PALS was significantly different across the tertiles (lowest tertile 12.29 ± 2.5% vs middle tertile 17.89 ± 1.1% vs highest tertile 24.54 ± 4.2%; p <0.0001). LA strain dispersion was also significantly different between the tertiles (61.03 ± 25.8ms vs 41.8 ± 15.8ms vs 44.8 ± 18.8ms; p <0.001). All other clinical and echocardiographic parameters were non-significant between the tertiles however, there was a trend towards a lower PALS in the higher rejection burden group. Kaplan Meier curves demonstrated that survival over follow-up was significantly worse in the lower tertile LA PALS group compared to the highest tertiles LA PALS group (Log-rank test = p < 0.0001). The lowest LA PALS tertile had a significantly higher risk of reaching the primary endpoint compared with patients in the highest LA PALS tertile (hazard ratio [HR] 9.802; 95% CI 1.832-52.45; p <0.008). Higher LA PALS and LV GLS (LA PALS HR 0.610 95% CI 0.401-0.926; p 0.02; LV GLS HR 0.638 95% CI 0.418-0.972; p 0.037) were significantly associated with a reduction in reaching the primary endpoint in a multi-variate regression model including clinically relevant traditional and strain-based echocardiographic parameters.

Conclusions

Lower LA PALS is significantly associated with poorer long-term outcomes in cardiac transplant patients with ACR. Non-invasive LA PALS may be a useful predictor of long-term outcome in patients post cardiac transplantation. Abstract Figure. Survival curves for LA PALS tertiles
If echo or magnetic resonance are not enough to assess a patient with congenital heart disease, think of ECG gated computed tomography. Case series from a second level hospital
Authors: Sanz Ortega I , Sadaba Sagredo M , Armendariz Tellitu K , Velasco Del Castillo S , Ullate De La Torre A , Onaindia Gandarias JJ , Urkullu Naveda A , Salcedo Arruti A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Congenital heart disease (CHD) is evaluated by echocardiogram, and if doubts, there may be necessary other exams, generally magnetic resonance (MRI). Due to radiation concerns, computed tomography (CT) is seldom performed. Depending of different cardiac procedures, radiation exposure to the patients varies, ranged from almost 4 mSv approx. for coronariography alone to 15 mSv approx. if stenting and ventriculography are added. ECG-gated CT can be used in cases of CHD because of its better spatial resolution if other examinations are not enough. 

Methods

We reviewed ECG-gated CT performed at our institution to evaluate patients with CHD (suspected or previously known). Characteristics of the patients and the exams were reported, including other cardiovascular or extracardiac findings.

Results

There were 5 exams in 4 patients, all of them with contrast. 2 patients were women, 1 of them with two exams (cases No 4 and 5). Mean age was 45.4 years (range 17-59). CT was chosen due to better spatial resolution (including 1 patient which previous MRI was inconclusive), except in one patient, that was performed because of cardiac device that contraindicated MRI. This patient had repeated exams. All of them were in sinusal rhythm. The patient with repeated exams was previously diagnosed of CHD, whereas, in the rest of cases the final diagnosis was made by CT. 3 examinations were retrospective. Coronary arteries were also evaluated in 3 cases (in all prospective studies and one retrospective). Mean radiation exposure was 6.22 mSv (1.2 to 10.7). In prospective studies, it was 1.85 mSv (1.6 and 2.1 mSv) and in retrospective ones were 9.13 mSv (8.2 to 10.7 mSv). There were no complications. In all cases, other cardiovascular findings other than CHD were reported.

In 3 cases, other extracardiovascular findings were noted. Characteristics of patients are listed in figure 1 and images from the studies are shown in figure 2. Yellow arrows show the congenital defects.

Conclusions

Although patients with congenital heart disease are generally evaluated by other imaging techniques, they can be evaluated by ECG-gated CT if necessary, with similar radiation exposure to other cardiac interventional procedures, and coronary angiography and other cardiovascular or extravascular findings can also be assessed. Abstract Table: Characteristics of patients  Abstract Figure. Images from exams
Predictive factors of outcome in patients with Tetralogy of Fallot (TOF) after pulmonary valve replacement: preliminary data of our Centre experience (2010-2020)
Authors: Cavaliere A , Vivian LM , Puricelli F , Reffo E , Di Salvo G
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

TOF patients undergo multiple surgical procedures during their life. The improvement in surgical techniques and patient’s clinical management led to longer life expectancy, creating an adult TOF population that experiences specific adverse events, such as atrial/ventricular arrythmias, heart failure and sudden cardiac death. In selected patients, pulmonary valve replacement (PVR) is mandatory to reduce right ventricular (RV) volume; therefore, careful patients’ selection but also correct timing of PVR are crucial.

Purpose

Current guidelines are based on pre-PVR threshold values of indexed RV end-diastolic volume (RVEDVi) calculated with cardiac magnetic resonance (CMR), to achieve normalization of RV size after valve implantation, but recent studies demonstrated that post-PVR RV dilatation is not so tightly connected with adverse clinical outcomes. Therefore, our aim is to identify new possible predictive factors of post-PVR outcome to provide tailored PVR on the correct cohort of patients, at the correct time.

Methods: The inclusion criteria of this retrospective and partially prospective cohort study were

i) repaired TOF; ii) available CMR data pre- and post-PVR; iii) PVR performed between 2010 and 2020; iv) clinical and ECG available pre- and post-PVR; v) complete echocardiographic examination pre- and post-PVR. Multivariate analysis was applied. Primary outcomes were considered death, resuscitated death, atrial/ventricular arrhythmias. NYHA class was considered to evaluate patients’ clinical status. CMR Late Gadolinium Enhancement (LGE) score was calculated pre- and post-PVR.

Results

22 patients were selected (12 males, median age ± SD 28,25 ± 11,2 years). After PVR, the only primary outcome observed was sustained ventricular tachycardia in 4 patients. Multivariate analysis showed that patients with later PVR, lower Fractional Area Change (FAC) at pre-PVR echocardiogram and higher LGE score post-PVR (LGE > 3) showed higher post-PVR RVEDVi. On the contrary, patients with class I NYHA post-PVR showed lower RVEDVi.

Conclusion

Our study demonstrates that lower age at PVR and careful patient’s selection, guided by echocardiographic and CMR findings, lead to greater benefit in terms of good volumetric recovery of the RV and better performance status post-PVR (NYHA class I) in TOF patients after PVR.
Severe MAC increases shear stresses on particles traversing the mitral valve: an in vitro study
Authors: Pressman GS , Darwish A , Friend EJ , Wiener PC , Kadem L
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

  Mitral annular calcification (MAC) is a strong predictor of stroke but mechanism(s) are poorly defined.  Severe MAC can produce a gradient across the mitral valve (MV) and, when studied in vitro, disturbs normal flow across the valve resulting in increased viscous energy dissipation.

Purpose

  We hypothesized that severe MAC would increase shear stress on particles traveling across the MV into the left ventricle (LV).  Given that shear stresses cause platelet activation this might represent a mechanism by which MAC could increase stroke risk.

Methods

  A silicone model MV was created using a 3D TEE dataset. 3D printed calcium phantoms were incorporated into the valve simulate severe MAC. The valve was tested in a left heart duplicator under rest and exercise conditions and compared with a duplicate valve without the calcium phantoms. Fine particles suspended in a water/glycerol blood analogue allowed for measurement of vortex formation and shear stresses using particle image velocimetry (PIV).  Particle residence time (PRT) maps were created to assess how long blood particles would remain in the LV.  Particle residence index (PRI - ratio of remaining particles in LV/initial number of particles) is a more quantitative measure of how fast particles leave the LV.  These calculations were used to approximate viscous shear stresses on blood particles.  For each particle the induced viscous shear stress was evaluated for the entire duration of residence in the LV.

Results

  For the normal MV all released particles left the LV by the 3rd cycle; with severe MAC particles completely left the LV shortly after the 7th cycle.  PRI measurements confirmed that particles remained longer in the LV in the presence of severe MAC (figure 1).  MAC also induced a shift in the accumulated shear stress levels from the high range > 0.4 Pa.s and the low range < 0.1 towards the middle region (0.16-0.32 Pa.s, figure 2). As shear stress is reported for one cycle, one may expect MAC to lead to higher accumulated higher viscous stresses as particles reside in the LV for a longer time.

Conclusions

  In the presence of severe MAC blood particles remain longer in the LV and are exposed to greater cumulative shear stresses vs the normal situation.  Given that shear stress is known to cause platelet activation this may be a mechanism by which MAC increases risk of ischemic stroke. Abstract Figure 1  Abstract Figure 2
Global longitudinal strain and its association with quantitative and qualitative analyses of myocardial perfusion correlate in patients with abnormal SPECT results
Authors: Espinola-Zavaleta NG , Caballero-Guadarrama YCG , Guerra ECG , Antonio-Villa NAV , Garcia-Cardenas MGC , Lopez-Mendez ALM , Gonzalez-Hernandez MGH , Alexanderson-Rosas EAR
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

BACKGROUND

Global longitudinal strain (GLS) is being used more commonly in the evaluation of patients with ischemic heart disease (IHD). Even though GLS is known to be associated with infarct size, its relationship with parameters derived from myocardial perfusion studies (MPS) has not been explored enough.

AIMS

We assessed the correlation of GLS measured with echocardiography with quantitative and qualitive analyses parameters of SPECT-MPS, particularly stress and rest total perfusion deficits (TPDS and TPDR) and summed stress and summed rest scores (SSS and SRS) respectively.

METHODS

A cross-sectional cohort of patients classified with an abnormal nuclear medicine result using SPECT were tested with doppler echocardiography in a center of reference in Mexico City. Pearson correlation tests and polynomial regression models were used to extract the correlation coefficient and the explained variability for each variable.

RESULTS

122 subjects with abnormal nuclear medicine results were assessed. 87 (71.3%) were male with a mean left ventricular GLS of -16 (±5), SRS of 12.9 (±14.5), SSS of 18 (±15.8), TPDR of 12 (±14.3) and TPDS of 17.7 (±15.6). We observed a negative cubic adjusted correlation between GLS and TPDR (r = 0.501, 95% CI: 0.336-0.637, p= <0.001), TPDS (r = 0.470, 95% CI: 0.300-0.612, p= <0.001), SRS (r = 0.472, 95% CI: 0.302-0.613, p= <0.001) and SSS (r = 0.460, 95% CI: 0.288-0.603, p= <0.001).

CONCLUSION

GLS has a moderate cubic correlation with a negative leading coefficient with TPDR, TPDS, SRS and SSS. This data suggests that GLS may be an adequate parameter for assessing patients with IHD. Abstract Figure. Scatter plot with regression model
Prognostic value of the liver stiffness in patients with acute decompensated heart failure
Authors: Tereshina O
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background.

Shear wave elastography (SWE) is a novel ultrasound technique for charactering tissues stiffness and  widely used in liver diseases. In patients with heart failure (HF)  liver stiffness (LS) seems directly influenced by central venous pressure. However, clinical implication of liver SWE for prognosis in heart failure remains unknown. Study aimed to evaluate the prognostic value of assessing liver stiffness by SWE in HF.

Methods

We enrolled 214 consecutive patients with acute decompensated heart failure, but 33 of them were excluded due to the presence of other factors that could influence the LS measurement. In addition to traditional cardiac test, all patients were undergone liver stiffness measurement by point shear wave elastography at admission and at discharge. The remaining 181 patients were divided into three groups: 1. LS value > 8.8 kPa at admission and delta decrease in LS value at discharge < 4 kPa (n = 67); 2. LS value > 8.8 kPa at admission, and delta decrease in LS value at discharge > 4 kPa (n = 78); 3. LS value < 8.8 kPa at admission, and in LS value by pSWE at discharge > 4 kPa (n = 36). A median follow up period was 12 month.

Results. Adverse cardiac events, i.e., death or readmission to hospital, occurred in 54% of patients in first group, 34% of patients in second group and 15 % of patients in third group (P = 0.001). After adjusting for age, sex, left ventricle ejection fraction  a LS ≥ 8.8 kPa and lack of decrease LS during admission was still significantly associated with cardiac events.

Conclusion. Liver stiffness by SWE in patients with HF can be used as a prognostic marker to predict cardiac events.
Case report: asymptomatic pseudoaneurysm of the native coronary soon after the graft anastomosis treated with off-pump repair
Authors: Ruggerini Sara , Pavasini Rita , Quagliara Teresa A P , Fiorani Vinicio
Published: February 2022

Background

Pseudoaneurysms (PSAs) of native coronary arteries are rare but potentially lethal complications occurring after coronary artery graft anastomosis mainly secondary to median sternotomy.

Case summary

A 61-year-old man underwent coronary artery bypass grafting because of stable angina. After the surgery, the patient was asymptomatic. A routine pre-discharge transthoracic echocardiogram was performed showing a haematoma of the apex partially involving the right ventricle with systolic colour Doppler flow going from the left ventricle to the pericardium. A coronary computed tomography scan was ordered and it revealed the presence of a PSA of the left anterior descending (LAD) artery distal to the graft anastomosis with the left internal mammary artery. An off-pump direct suture of the LAD injury through a redo sternotomy was successfully performed.

Discussion

The development of a PSA of a native coronary artery after bypass grafting is a very rare and potentially fatal condition. A correct and prompt diagnosis is crucial to avoid lethal complication.
Amphetamine-induced cardiomyopathy complicated by embolic stroke: a case report
Authors: Chapman Lucy , Tahir Ismail , Sheriff Neha , Colwell Niall
Published: February 2022

Background

Amphetamine use causes cardiomyopathy via catecholamine-mediated effects such as tachycardia, hypertension, vasoconstriction, and direct cardio-toxic effects. Traditionally, an increased risk of haemorrhagic stroke is associated with amphetamine use. However, up to one-third of stimulant-associated cardiomyopathy patients have left ventricular (LV) thrombus formation leading to an increased risk of systemic embolization. We report a case of amphetamine-induced cardiomyopathy complicated by embolic stroke secondary to LV thrombus.

Case summary

A 38-year-old man with 6-month history of sustained amphetamine use presented to the emergency department with left-sided weakness, facial droop, and dysarthria. Angiography confirmed right middle cerebral artery thrombus. Prompt mechanical thrombectomy yielded full neurological recovery. Dyspnoea prompted transthoracic echocardiography showing dilated cardiomyopathy with an ejection fraction of 5% and LV thrombus. Anticoagulation was initiated with warfarin as well as pharmacological therapy for heart failure with reduced ejection fraction including bisoprolol, spironolactone, loop diuretic, and sacubitril/valsartan. He was discharged successfully following resolution of ventricular thrombus and medical management of heart failure. Clinical recovery was hampered by psychosocial factors resulting in non-adherence to medical therapy and continued amphetamine use.

Conclusion

Sustained amphetamine use can result in severe dilated cardiomyopathy with LV thrombus formation and embolic complications such as ischaemic stroke. Avoidance of amphetamines in conjunction with guideline-directed pharmacological management are key components of therapy. However, psychosocial factors can exert significant influence on recovery.
An uncommon case of congenital thoracic venous anomaly and extracardiac sinus venosus defect in an asymptomatic adult first presenting with brain abscesses: a case report
Authors: Pettersson Staffan , Trzebiatowska-Krzynska Aleksandra , Engvall Jan
Published: February 2022

Background

Congenital thoracic venous anomalies (CTVAs) with right-to-left shunt constitute an uncommon source of paradoxical embolization in adults. We present a case of a healthy and physically fit individual with a rare asymptomatic anomaly first presenting with brain abscesses after a visit to the dental office; persistent left superior vena cavae (PLSVC) without bridging vein, over-riding right-sided superior vena cavae (RSVC) connected to the left atrium (LA), and an extracardiac sinus venosus defect.

Case summary

A 29-year-old male presented to the neurosurgical unit due to intracranial abscesses requiring intervention following a visit to his dentist. The abscess cultures isolated bacteria commonly found in the normal oral flora. Transthoracic echocardiography revealed an enlarged coronary sinus consistent with PLSVC. An agitated saline study was performed and raised suspicion of simultaneous extra- and intracardiac shunting. Magnetic resonance angiography confirmed the presence of a PLSVC and revealed an RSVC connected to the LA; however, no intracardiac shunt was evident. Electrocardiogram-gated computed tomography was therefore conducted and discovered the rudimentary remains of the physiologic RSVC forming a connection to the right atrium, explaining the bilateral contrast loading seen on the agitated saline study and diagnosing an extracardiac sinus venosus defect (SVD). The patient recovered and has been referred for surgery.

Discussion

This case illustrates a CTVA and a forme fruste type SVD resulting in a severe complication in a healthy adult. We highlight the diagnostic challenges posed, suggest early usage of agitated saline studies, and discuss the rationale for surgical correction of this patient.