bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of plasma volume redistribution on outcomes in patients with heart failure with reduced ejection fraction
Authors: Skidan V I , Goda A Y , Challa A B , Pislaru C , Nkomo V T , Miller W L , Pislaru S V
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The impact of capacitance and blood volume redistribution on outcomes of patients with chronic heart failure is incompletely understood. Quantitative plasma volume (PV) measurements together with echocardiographic evaluation allow a comprehensive assessment of the interplay between volumetric overload, cardiac chamber remodelling and myocardial function.

Purpose

We hypothesize that PV expansion is associated with myocardial and renal dysfunction, right ventricular-pulmonary arterial uncoupling and unfavorable outcomes in HF patients with reduced ejection fraction (HFrEF).

Methods

Patients hospitalized at Mayo Clinic with decompensated HF and who had PV by the indicator-dilution nuclear methodology (Daxor BVA100) were included. Patients were considered hypervolemic if BV was ≥25% over expected. The primary endpoint was the composite of all-cause mortality or heart transplantation. The closest TTE to the time of PV was used to measure various indexes of myocardial performance (standard echo parameters and global chamber-specific strain parameters). Event-free survival was estimated using the Kaplan-Meier method. The relationship between PV and various parameters was evaluated with correlation coefficient (r²).

Results

A total of 65 patients were enrolled in the study. Reduced LVEF was present in 53 (81.6%) patients. There were 44 events (32 deaths, 12 heart transplants) after a median follow-up of 43 months (IQR 14–65). Results in patients with HFrEF are presented in the Table. Our main findings were: 1) PV expansion was associated with an increased risk of adverse events (Figure 1); 2) Volume redistribution correlated with various indexes of cardiac chamber function, suggesting that volume overload and associated cardiac remodeling may be responsible for altered myocardial mechanics in patients with HFrEF (Figure 2); 3) right ventricular-pulmonary arterial uncoupling was triggered by the plasma volume expansion, that causes postcapillary pulmonary hypertension; 4) PV redistribution was also associated with renal dysfunction and increasing the level of the protein catabolism (Table 1).

Conclusion

Expansion of plasma volume in HFrEF patients is associated with left atrium dilatation, abnormal filling of both atria and right ventricular dilatation / dysfunction. Plasma volume redistributions apparently became a trigger of right ventricular-pulmonary arterial uncoupling and stimulated postcapillary pulmonary hypertension, renal dysfunction with increasing the level of protein catabolism and unfavorable outcomes.
Left atrial strain is associated with the burden of symptoms in cardiac amyloidosis: a speckle tracking study
Authors: Pastore M C , Giacomin E , Marrese F , Ragazzoni G L , Mandoli G E , Susini F , Focardi M , Gozzetti A , Cavigli L , Lisi M , D'ascenzi F , Valente S , Cameli M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

cardiac amyloidosis (CA) is characterized by an impairment of cardiac diastolic and, in the severe state of the disease, systolic function, with increasing worsening of functional capacity and quality of life (QoL). Six minute walking test (6MWT) and Kansas City Cardiomyopathy Questionnaire (KCCQ) are two well-known and validated methods to assess the impact of heart failure (HF) symptoms and functional capacity. Left atrial strain by speckle tracking echocardiography has emerged as an index of left ventricular (LV) diastolic function and filing pressure, and is also associated with symptoms in HF. However, its possible association with functional capacity and QoL in CA has not yet been investigated.

Objectives

in this observational pilot study, our aim was to evaluate the relationship of left atrial strain with 6MWT and KCCQ in patients with CA (both AL and ATTR).

Methods

we enrolled consecutive patients with CA during routine follow up visits. Patients underwent clinical and echocardiographic evaluation. On the same day, 6MWT was performed and KCCQ was administered. Speckle tracking analysis was performed offline by an experienced operator blinded to the other data. Correlation analysis was conducted using Pearsons’ coefficient and linear regression analysis

Results

overall, 43 patients with CA (25 ATTR, 18 AL) were enrolled. Mean age was 74 ±11, 16% (n=7) were female. Most patients showed normal left ventricular (LV) ejection fraction (55±9) and reduced LV global longitudinal strain (GLS =−12 ± 7%), 32 of them with apical sparing pattern (Table 1). Mean global peak atrial longitudinal strain (PALS) was 14 (median[IQR]=6.5;23.5), mean 6MWT score = 382 ± 104 and mean KCCQ score= 67 ± 24.

Global PALS showed a strong direct correlation with 6MWT (Fig 1, P= 0.4, R2=0.2, p-value=0.032) and a trend towards correlation with KCCQ (R2=0.3, p-value=0.06), although not reaching statistical significance, probably due to the low sample size. The correlation between PALS and 6MWT was even stronger in patients with ATTR (p = 0.7, R2 0.4; p-value<0.0001).

Conclusions

our preliminary results show that, global PALS is associated with functional capacity and the burden of HF symptoms in ATTR and AL, suggesting its role as a more objective marker of disease severity in CA.
Abnormal origin of the coronary arteries by echocardiography. And then what?
Authors: Constantin I , Carrero M C , Denes J , Ventura A , Oestereicher C , Pessio C , De Stefano L , Mezzadra M , Jaimovich G , Masson Juarez G , Stutzbach G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The anomalous origin of the coronary arteries from the opposite sinus (AOCA) is increasingly recognized. The most frequent diagnosed by echocardiography is the circumflex artery arising from the right sinus of Valsalva with a retroaortic course. Classically is believed to be a low-risk malformation, nevertheless, whether this anomaly is associated with other high risk features (coexistence with other high-risk AOACA, acute take off angle, intramural course, etc) not easily identify by echocardiography is unknown.

Objectives

The objectives of this study are to know the prevalence of anomalies of the origin of the coronary arteries diagnosed by echocardiography, to determine the use of additional diagnostic tests and to evaluate the coexistence of the anomalous origin of the circumflex artery with other anomalies and / or risk characteristics.

Materials and methods

A retrospective search of AOCA diagnosis was performed among echocardiography reports of outpatients in a high complexity cardiology center between March 2018 and December 2021. The clinical history was investigated to identify if the AOCA diagnosis led to further testing (coronary Angio CT or Ischemia diagnosis test) and if these studies provided clinically relevant information.

Results

Of a total of 26260 echocardiogram reports investigated, 50 presented suspected AOCA (0. 2%), 49 circumflex arteries with anomalous arising from the right sinus with retroaortic course and 1 left coronary artery arising from the right sinus with a subpulmonary course. 18 coronary CT angiography (36%) and 13 stress tests (26%) were requested. In 17 of 18 patients (98%) coronary CT angiography confirmed the diagnosis of anomalous origin of circumflex artery arising from the right sinus with retroaortic course (true positive). In 4 of the 17 OAAC confirmed by CT angiography, the study provided additional important information (2 associated anomalies of the origin of the anterior descending, 1 interarterial course and 1 circumflex artery arising from the right sinus with a retroaortic course and an angle take-off from the aortic wall ‹45°).

Conclusion

The diagnosis of AOCA by echocardiography is an uncommon finding and most of them are low risk. The most frequent variant is the circumflex artery arising from the right sinus with a retroaortic course. CT angiography adds additional information by identifying associated abnormalities of other coronary arteries and evaluating the angulation of the origin of abnormal coronary arteries.
Automated measurements based on artificial intelligence software in pediatric echocardiography: a feasibility study
Authors: Vasile C M , Avesani M , Velly C , Chan C , Iriart X
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Transthoracic echocardiography is the first-line non-invasive investigation for assessing pediatric patients' cardiac anatomy, physiology, and hemodynamics, based on its accessibility and portability, but complete anatomic and hemodynamic assessment is time-consuming. The study aimed to determine the accuracy and reliability of a new automated artificial intelligence software initially developed for adults for analyzing the main echocardiographic parameters in pediatric patients.

Materials and Methods

The study was performed at the University Hospital of Bordeaux between August and September 2022 and included 45 patients who underwent a 2D transthoracic echocardiographic examination, mainly for murmur (n=8), post ASD closure evaluation(N=5), chest pain, or arrhythmia as we aimed to have a homogeneous group of patients with normal or near normal heart architecture. We compared AI automatic measurements with manual measurements performed by a senior and junior pediatric cardiologist. Pearson correlation and Bland and Altman analysis were used. As the AI software has been developed for adults, we decided to subclassify our patients into two subgroups: the first group (patients aged between 0–8 years) and the second group (patients over 8 years). The decision was made because pediatric anatomy differs from adults and to see if the dedicated artificial intelligence soft for adults has better reproducibility for pediatric patients older than 8 years.

Results

The median age was 8.9 years. Comparison between senior and junior pediatric cardiologists for all subgroups was significant (Pearson correlation >0,7 for most measurements performed). For younger patients (<8 years old), we found excellent correlations (Pearson correlation >0.8) for heart chambers measurements measured from A4CH and A2CH views (LV end-diastolic volume, LV end-systolic volume, RV end-diastolic area, and RV area) between AI software and both junior and senior pediatric cardiologist, but poor correlation for the measurements performed from parasternal long axis view (r=0.06 for STJ measurement). We achieved stronger correlations for the measurements evaluation of patients over 8 years old ( r>0.8 for aortic annulus, STJ, E, A, S waves, LV end-diastolic volume in A4CH, LV end-systolic volume in A4CH) for both junior and senior cardiologist in relation to AI measurements.

Conclusion

In this preliminary study, we found that automated artificial intelligence software provided promising results for measuring mainly volumes (LV end-diastolic volume, LV end-systolic volume) in A4CH and A2CH. The software requires improvements for automated measurements within the parasternal long-axis section to achieve better accuracy. Results obtained with the AI software for patients over 8 years old were significantly improved compared to those obtained for those under 8 years of age.
Predictive value of myocardial performance indices for the detection of significant coronary artery disease in patients with a positive ischemia test
Authors: Fraichot V , Pace N , Filippetti L , Fraix A , Metzdorf P A , Varlot J , Hennequin J , Lamiral Z , Selton-Suty C , Popovic B , Huttin O
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Echocardiography using conventional global or segmental function evaluation has low diagnostic value in detecting subclinical coronary artery disease (CAD). Deformation parameters are more informative but load-dependent. Myocardial Work (MW) based on non-invasive LV pressure-strain loops has been suggested as a new alternative tool for the early detection of CAD.

Purpose

This study aimed to determine MW diagnostic performance in patients with a positive ischemia test.

Methods

Fifty-four patients referred for a coronary angiography secondary to a positive ischemia test were included (43 men (79.6%), mean age: 64.3 ± 9.7 years). Patients were divided into two groups according to the presence (SCAD) or absence (NCAD) of significant CAD requiring revascularization. Global and segmental MW parameters were measured on top of conventional echo parameters. Territorial myocardial work index (TWI) and constructive work (TCW) were analyzed according to coronary angiogram results.

Results

All patients had normal wall motion and left ventricular ejection fraction. There were no significant differences between the two groups regarding conventional echocardiographic parameters and global myocardial deformation. Patients with SCAD had a significantly reduced Global Constructive Work (GCW) compared to NCAD group (2316 mmHg% vs. 2565 mmHg%; p = 0.012). Territorial analysis confirmed a significant decrease in TCW in myocardial segments related to SCAD. GCW is the parameter with the largest AUC to predict a SCAD (AUC = 0.706; CI 95% (0.56 – 0.84)) with a high positive predictive value (73.9%).

Conclusion

Patients with SCAD had significantly impaired global and territorial MW parameters. MW quantification allows better discrimination of patients with confirmed SCAD. The routine addition of those parameters should improve the predictive value of ischemic tests.
Normal right ventricular augmentation during stress echocardiography- A comparative study
Authors: Alborikan S
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The assessment of right ventricular (RV) contractile reserve (CR) during exercise echocardiography in healthy subjects is not well described. We aimed to describe normal RV CR in healthy cases and to compare CR to patients with defined RV compromise because of previous repair of Tetralogy of Fallot.

Methods

40 healthy individuals with satisfactory RV windows were randomly selected and retrospectively analysed from previously published study (marathon study). These cases were compared to 100 adult patients with repaired TOF. We defined RV CR by the change in tricuspid lateral annular systolic velocity (ΔRVS’), change in tricuspid annular plane systolic excursion (ΔTAPSE), and change in fractional area change (ΔFAC). All parameters were evaluated at baseline and at peak stress.

Results

During exercise, RVS’ was increased by 60±20%, followed by TAPSE 48±15%, and the lowest with FAC by 32±10%. These ranges were significantly higher than in TOF population. RV CR was greater in males than females for all RV functional measures (34±10 vs 28±10, %, p<0.05); (50±10 vs 44±11, %, p<0.05); (61±12 vs 52±11, %, p<0.05), for ΔFAC, ΔTAPSE, and ΔRVS’, respectively. There was no association between RV CR and functional capacity parameters in healthy individuals, whereas in patients with repaired TOF there was a significant association with peak absolute VO2 (ml/min) (r=.36, p<0.001, with ΔFAC).

Conclusions

We have presented normal values for RV CR parameters in healthy cases during stress echocardiography. RV CR is an important determinant of exercise capacity in patients with abnormal RV function but not in normal subjects.
Echocardiographic assessment of right ventricular function and right ventriculoarterial coupling in tricuspid regurgitation
Authors: Trousselle L T , Eggenspieler F E , Nazeyrollas P N , Faroux L F , Huttin O H , Pace N P , Filippetti L F , Fraix A F , Carquin B C , Selton-Suty C S S , Metz D M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Echocardiographic evaluation of the cardiopulmonary unit may be difficult in the presence of tricuspid regurgitation (TR) and combined echocardiographic parameters could therefore be useful in such patients.

Purpose

To assess the variation of simple and combined echocardiographic parameters analysing the cardiopulmonary unit according to the severity of TR.

Methods

Echocardiographic images were reviewed in 179 patients to assess TR grade according to Hahn’s 5 grades classification. Classical morphological (right ventricle (RV) end diastolic (ED) length and area), function (tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), S’ wave, RV free wall longitudinal strain (RVFWS)) and load (TR Time-velocity integral (TR TVI), pulmonary artery systolic pressure (PASP)) parameters analysing RV were assessed. Combined parameters of function and load (TAPSE/PASP, TR TVI x RVFWS), morphology and load (load adaptation index (LAI) = TR TVI x RVED length/area) and morphology, load, and function (myomechanical index (MMI = RV-RA mean pressure gradient x RVFWS/indexed RAED area x 10–2 ) and morphology-load-function index (MLF = RVED length/area x TR TVI x RVFWS)) were calculated. We used receiver operating characteristic (ROC) curve analysis to analyze the diagnostic value of echocardiographic parameters to predict potential high (>3) or low (<6) surgical risk of mortality according to TRISCORE.

Results

Simple parameters were significatively different among groups with a nonlinear progression between the 5 levels of severity of TR. Combined parameters were also significatively different among groups. Among them, MMI and MLF had a linear progression between the 5 groups (MMI: grade 1: 0.20±0.09; grade 2: 0.15±0.08; grade 3: 0.10±0.05, grade 4: 0.09±0.08; grade 5: 0.05±0.04 p = 0.000; MLF: grade 1: 7.56±2.06; grade 2: 6.57±2.14; grade 3: 4.85±2.29, grade 4: 4.79±3.17; grade 5: 3.06±1.82 p = 0.000) and had the best predictive value for TRISCORE high and low risk (MMI: AUC =0.889 p = 0.000 for low risk, 0.855 p = 0.000 for high risk; MLF: AUC =0.873 p = 0.000 for low risk, 0.822 p = 0.000 for high risk).

Conclusion

Combined parameters are relevant to evaluate cardiopulmonary unit in a population presenting with TR, especially when combining morphology, function and load parameters. Their good predictive value for TRISCORE risk suggests a potential role of such parameters in the prognostic assessment of TR patients and in the selection for new percutaneous repair techniques.
Acute modification of hemodynamic forces in patients with severe aortic stenosis after transcatheter aortic valve replacement
Authors: Zaccaro L , Vairo A , Alunni G , D'ascenzo F , De Ferrari G M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Transcatheter-Aortic-Valve-Implantation (TAVI) is the established first-line treatment for patient with severe aortic stenosis not suitable for surgery. Echocardiographic evaluation of hemodynamic forces (HDFs) is a growing field, holding the potential to early predict improvement in LV function.

Methods

A prospective observational study was conducted. Transthoracic echocardiography was performed before and after TAVI. HDFs were analyzed along with traditional left ventricular (LV) function parameters.

Results

25 consecutive patients undergoing TAVI were enrolled: mean age 83±5 years, 74.5% male, mean LV Ejection Fraction (LVEF) at baseline 57±8%. Post-TAVI echocardiographic evaluation was performed 2.4±1.06 days after the procedure. HDFs amplitude parameters improved significantly after the procedure: LV Longitudinal Forces (LF) apex-base [mean difference (MD) 1.79%; 95%CI 1.07–2.5; P-value <0.001]; LV systolic LF apex-base (MD 2.6%; 95%CI 1.57–3.7; P-value <0.001); LV impulse (LVim) apex-base (MD 2.9%; 95%CI 1.48–4.3; P-value <0.001). Similarly, HDFs orientation parameters improved: LVLF angle (MD 1.5°; 95%CI 0.07–2.9; P-value 0.041); LVim angle (MD 2.16°; 95%CI 0.76–3.56; P-value 0.004). Conversely, Global Longitudinal Strain and LVEF did not show any significant difference before and after the procedure. Conclusion: Echocardiographic analysis of HDFs could help differentiate patients with LV function recovery after TAVI from patients with persistent hemodynamic dysfunction.
Increased risk of coronary plaque vulnerabilization following COVID-19 infection, identified by elevated FAI index of pericoronary inflammation at coronary CT
Authors: Matyas B , Benedek I , Opincariu D , Blindu E , Rosca A , Bordi L , Benedek B , Benedek T
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This research has been funded by the research grant Intel-FAT, proposal registration code PN-III-P4-ID-PCE-2020-2861, contract number PCE 206/2021, Project funded by the European Union and the Government of Romania through the Ministry of European Funds, and the Doctoral School of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania.

Background

Inflammation plays an essential role in all stages of atherosclerosis, with stable plaques characterized by chronic inflammation and vulnerable or ruptured plaques exhibiting "active" inflammation. COVID infection may significantly increase systemic inflammation, but the role of SARS COV-2 infection on local plaque vulnerability is still not elucidated. Mapping the PCAT - FAI on routine CCTA can detect coronary artery inflammation non-invasively by measuring changes in the composition of pericoronary fat.

Purpose

The aim of this study was to assess the impact of COVID-19 infection on CAD in patients who underwent CCTA examinations for chest pain in the early stages after infection, using the new AI - powered CaRi-Heart® solution.

Methods

In our study, we included 158 patients (mean age was 61.63 ± 10.14 years) with chest pain and low to intermediate clinical likelihood of CAD, who underwent 128-slice CCTA for assessment of coronary anatomy, atherosclerosis, and determination of FAI – Score. The study population was divided into two main groups: Group 1 (n = 75) – patients who had a COVID-19 infection a few months prior to their CCTA examination, and Group 2 (n = 83) – patients adjusted for age and gender, who did not have a COVID-19 infection.

Results

The FAI - Score was consistently higher in the non COVID-19 group: LAD (11.61 ± 7.60 vs. 9.32 ± 6.00, p = 0.05), LCX (12.43 ± 6.65 vs. 10.48 ± 6.24, p = 0.05), RCA (15.40 ± 11.36 vs. 14.54 ± 12.17, p = ns), the average FAI - Score (12.81 ± 8.28 vs. 10.47 ± 7.19, p = 0.001). For the FAI-Score Centile, the overall pattern shifts significantly, as the values for all three coronary arteries are higher for the subjects in the COVID-19 positive group, as follows: LAD (0.66 ± 0.29 vs. 0.58 ± 0.28, p = 0.05), LCX (0.79 ± 0.16 vs. 0.68 ± 0.26, p = 0.03), RCA (0.83 ± 0.20 vs. 0.68 ± 0.29, p = 0.05). In both cases, the CaRi Heart® Risk (p < 0.0001) and the Duke Score (p < 0.0001) had significantly higher values for the patients in the COVID-negative group.

Conclusion

Lesions with higher pericoronary FAI - Score Centile values were more commonly found in patients who had previously been infected with COVID-19. The higher levels of inflammation in the pericoronary adipose tissue suggests that COVID-19 infection is linked to an increased risk of coronary plaque destabilization.
Evaluation of the impact of transmitral mean gradient elevation after transcatheter mitral valve implantation
Authors: Chong-Nguyen C , Duvillier P , Brochet E , Cailliau A , Delhomme C , El Beze N , Himbert D , Iung B , Ou P , Urena-Alcazar M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Transcatheter mitral valve implantation (TMVI) has emerged as an alternative to surgery in high risk patients with failing mitral bioprosthesis (valve-in-valve) or annuloplasties (valve-in-ring). The presence of an elevated mean gradient > 5mmHg after the procedure has been defined as an unsuccessful procedure but the impact and outcomes of an elevated mean gradient after TMVI have not been studied.

Materials and methods

103 patients undergoing TMVI from 2010 to 2020 were included. Patients were classified in three groups according to mean gradient after the procedure: Group 1< 5mmHg, Group 2 between 5 and 10mmHg and Group 3 > 10mmHg.

Results

The median age was 71 (52.5–81.5) years. Indications for TMVI were bioprosthesis failure in 67 patients (65%) and ring annuloplasty failure in 36 patients (35%). 84 (81.6%) patients were in NYHA class III or IV. 42 patients were in group 1, 51 in group 2 and 10 in group 3, without any difference in baseline characteristics or procedural findings. At 30 days, the rates of all-cause mortality (respectively 2,6%, 0% and 0%, p = 0,66), rehospitalization for heart failure (respectively 8,4%, 7,7% and 8,4%, p = 0,89), paravalvular leak (10,3%, 27,7%, 22,2%, p = 0,33), LVOT obstruction (respectively 6,3%, 8,2% and 10%, p = 0,99) or valve thrombosis (respectively 7,7%, 4,3% and 0%) were similar in the three groups. At a median follow up of 2 years, 27 patients have died with a cumulative rate of all-cause mortality at 1 and 2 years of 21.5% and 38.1% respectively. The presence of an elevated mean gradient was not associated with increased risk of mortality (HR=1,11, (95% CI [0,93, 1,31]), p = 0,25) An improvement of NYHA class was observed in the three groups without any difference between the groups. Median systolic pulmonary arterial pressure significantly improved in group 1 (from 53mmHg (30–90) in baseline to 45mmHg (25–60), p = 0.005) and 2 (from 55mmHg (30–112) in baseline to 40mmHg (30–75), p = 0.004)) but not in group 3.

Conclusion

An elevated mean gradient post-TMVI had no impact on cardiovascular outcomes up to 2 years. Further studies with longer follow up are necessary.
Tricuspid annulus remodelling after transcatheter edge-to-edge repair for reduction of tricuspid regurgitation
Authors: Widmann M , Nerla R , Castriota F , Squeri A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background/Introduction

Clinically relevant tricuspid regurgitation is a prevalent valvular disease that has a significant impact on survival. The remarkable progress made in cardiac imaging and in interventional cardiology in the last decades, permits today a better understanding of tricuspid valve and right ventricle morphology and pathophysiology. This allowed to develop multiple transcatheter devices for tricuspid valve interventions. Structural valve interventions are considered nowadays valuable treatment options in anatomically eligible patient at high surgical risk. Transcatheter tricuspid valve interventions are directed to increasing leaflet coaptation either directly by bringing the leaflets together (leaflet approximation devices) or indirectly by reducing the dilated annulus (annuloplasty devices). Efficacy and clinical outcome are promising, but the effect on right ventricle and tricuspid annular reverse remodelling is still under evaluation.

Purpose

Aim of the study is to evaluate the acute tricuspid annulus remodelling after percutaneous leaflet repair, using a leaflet approximation device for reduction of tricuspid regurgitation.

Methods

This is a retrospective dual-center cohort study that includes 22 consecutive patients, treated with TriClip in our Hospital. Tricuspid annulus geometry was evaluated using three-dimensional transoesophageal echocardiography examinations conducted during the procedure before and after Triclip implantation. The 3D data sets were analysed using the multiplanar reformatting method.

Results

The mean age of the study cohort was 80 years, and 90,9% were female. Tricuspid regurgitation was graded severe or greater at pre-operative examination in all patients, mostly due to annular dilation. Procedure was successfully in all patients, with at least 1-grade reduction of tricuspid regurgitation before hospital dismissal. A significative reduction of mean septal-lateral diameter (4,09 ± 0,45 cm vs 3,55 ± 0,57 cm, p = < 0,0001), mean major diameter (4,60 ± 0,56 cm vs 4,24 ± 0,58 cm, p = 0,0011), planimetric area (13,70 ± 2,68 cm2 vs 11,00 ± 2,49 cm2, p = <0,0001) and perimeter (13,50 ± 1,36 cm vs 12,40 ± 1,49 cm, p = 0,0001) of the tricuspid annulus was observed. The eccentricity index (obtained dividing septal-lateral by antero-posterior diameter) was 0,99±0,17 before TriClip implantation and 0,91± 0,19 after (p = 0,0336).

Conclusions

In this small real-world population, edge-to-edge repair using TriClip was found to be effective and safe. Tricuspid transcatheter repair with a leaflet approximation device lead also to a reduction in the tricuspidal annular dimensions. This is to date the first study that shows positive changes in tricuspid annular geometry, that could have potentially relevant therapeutic implications.
Difference in left ventricular reverse remodelling after mitral valve surgery between mitral valve prolapse subtypes: barlows disease versus fibroelastic deficiency
Authors: Pype L , Paelinck B P , De Bock D , Van Craenenbroeck E M , Van De Heyning C M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Surgical correction of severe mitral regurgitation (MR) can reverse left ventricular (LV) remodelling in patients with mitral valve prolapse (MVP), however it is currently unknown whether this process is similar in Barlow’s Disease (BD) and Fibroelastic Deficiency (FED). Particularly the recently suggested concomitant cardiomyopathy in BD could affect LV (reverse) remodelling beyond volume overload.

Purpose

Evaluate LV reverse remodelling after mitral valve surgery in patients with BD versus FED.

Methods

Retrospective analysis of all MVP patients with severe MR who underwent mitral valve surgery at a single tertiary center. We assessed MR severity, LV volumes and systolic/diastolic function by transthoracic echocardiography before surgery and 6 months post-operative.

Results

A total of 55 MVP patients with BD (n=24) or FED (n=31) were enrolled between January 2013 and July 2022. Both BD and FED showed a male predominance (58.3% and 80.6% respectively, p = 0.071) and patients with BD were generally younger (52 ± 13 vs. 63 ± 12 years old; p = 0.005). Baseline LV end-diastolic (LVEDV), end-systolic volumes (LVESV) and LVEF were similar between BD and FED. In addition, pre-operative MR severity (evaluated by a multi-integrative approach) was not significantly different between both groups. However, patients with BD presented with a larger prolapse volume (12.2 ± 8.2 ml versus 5.8 ± 4.7 ml; p = 0.004) and larger mitral annulus diameter (37 ± 6 mm versus 33 ± 5 mm; p = 0.016) compared to FED.

Overall, mitral valve repair with annuloplasty, neochord and/or triangular/quadrangular resection were the most frequent surgical interventions. Mitral valve replacement was performed in selected patients when valve repair was not feasible, mainly in BD (45.8% vs. 19.4%; p = 0.035).

After a median follow-up period of 281 days, residual MR (≥grade 2) was present in 16.1% of patients with FED versus 8.3% with BD (p = 0.390). LV reverse remodelling was present in both groups, with a similar decrease in LVEDV (19.2 ± 18.8 ml/m2 in BD versus 24.4 ± 20.0 ml/m2 in FED; p = 0.337). Interestingly, the less load-dependent LVESV showed a trend towards less reverse remodelling in BD (3.4 ± 11.0 ml/m2 versus 7.5 ± 9.0 ml/m2; p = 0.138), which resulted in a significantly lower LVEF in BD versus FED (51.7 ± 7.6% versus 56.3 ± 6.1%; p = 0.016). Of note, LVEF at follow-up was independent of sex, comorbidities, baseline LV volumes and type of surgical intervention.

Conclusions

While patients with BD and FED showed similar MR severity, LV volumes and LVEF at baseline, post-operative LVEF was significantly lower in patients with BD. These findings suggest that LV (reverse) remodelling in BD could be affected by other mechanisms beyond volume overload, like a concomitant cardiomyopathy.
Correlations between CT-assessed vascular inflammation at different levels of the coronary circulation and the risk of atrial fibrillation
Authors: Gerculy R , Benedek I , Kovacs I , Rat N , Halatiu B , Rodean I , Bordi L , Blindu E , Rosca A , Matyas B , Szabo E , Parajko Z S , Benedek T
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported by the George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Research Grant number 510/5/17.01.2022

This research has been funded by the research grant Intel-FAT, proposal registration code PN-III-P4-ID-PCE-2020-2861, contract number PCE 206/2021, Project funded by the European Union and the Government of Romania through the Ministry of European Funds, and the Doctoral School of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania.

Background

Atrial fibrillation (AF) may occur any time in the evolution of various cardiovascular diseases, most of them having an inflammatory substrate. Perivascular inflammation may be assessed nowadays using coronary computed tomography angiography (CCTA) imaging. The new pericoronary fat attenuation index (FAI HU) and the FAI Score (an individualized quantification of coronary artery inflammation adjusted for age and gender) have prognostic value for predicting future cardiovascular events.

Purpose

The aim of our study was to investigate the correlation between pericoronary fat inflammation and the presence of atrial fibrillation among patients with coronary artery disease. We also compared the CA-Ri Heart Risk derived from the FAI Score values, the plaque burden and other clinical risk factors in patients with AF versus those in sinus rhythm.

Methods

In total, 81 patients (mean age 64.75 ± 7.84 years) who performed 128- slice CCTA were included in the study and divided them in two groups: group 1: 36 patients with documented AF, and group 2: 45 patients without known history of atrial fibrillation. For each patient demographyc characteristics, comorbidities and cardiovascular risk factors, echocardiography findings and lab tests were recorded and the FAI and FAI score were calculated.

Results

The CaRI Heart Risk was not significantly different between the two groups (18.14±14.09 vs. 18.09±13.59, p = ns). There were no significant differences in the absolute value of fat attenuation between the study groups (p>0.05). However, mean FAI Score was significantly higher in patients with AF (15.53 ± 10,29 vs. 11.09±6,70, p<0.05). Regional analysis of coronary inflammation indicated higher levels of inflammation especially at the level of the left anterior descending artery (13.17 ± 7,91 in group 1 vs 8.80 ± 4,75 in group 2, p = 0.008).

Conclusions

Patients with AF present a higher level of inflammation in the epicardial fat surrounding coronary arteries especially at the level of the left coronary circulation. A high inflammation at this level seems to be associated with a higher risk of atrial fibrillation development.
Left atrial hyper-strain in dyssynchronous hearts: potential driver for adverse left atrial remodelling
Authors: Hammersboen L E R , Stugaard M , Puvrez A , Larsen C K , Remme E W , Kongsgaard E , Duchenne J , Galli E , Khan F H , Sletten O J , Penicka M , Donal E , Voigt J U , Aalen J M , Smiseth O A
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Institute for Surgical Research, Oslo University Hospital.

Introduction

It was recently shown that left bundle branch block (LBBB) is associated with risk of developing atrial fibrillation. A potential mechanism is abnormal left atrial (LA) loading caused by LA dyssynchrony.

Purpose

To investigate if LBBB is associated with abnormal LA loading as reflected in non-uniform segmental strains.

Methods

In a prospective study of 143 heart failure patients with LBBB, myocardial strain was measured by speckle-tracking echocardiography prior to and after 7±2 months on cardiac resynchronization therapy (CRT). As indicated by brackets in the lower panels in the Figure, LA strain amplitudes were calculated as the difference between minimum and peak strain during the reservoir phase.

Results

In the Figure, the upper panel shows segmental and average LA strain traces in a representative LBBB patient. This patient illustrates marked spatial non-uniformity in strain amplitude between the interatrial septum and the LA lateral wall during the reservoir phase. For the entire study population, strain amplitudes were 19±9% (mean±SD) for the interatrial septum and 24±11% for the LA lateral wall (p<0.0001). In the quartile of patients with largest differences, strain amplitudes were 16±9 and 32±12%, respectively (p<0.0001). CRT abolished these differences (p = NS).

Conclusions

Patients with LBBB showed marked spatial non-uniformity of LA strains. Potentially, the excessive LA lateral wall strain amplitudes may stimulate atrial adverse remodelling. Future studies should investigate if abnormal LA strains may be a trigger mechanism for atrial fibrillation in patients with LBBB.
Diagnostic performance of the non-invasive myocardial work indices in predicting subclinical myocardial work impairment in Fontan patients
Authors: Pozza A , Sabatino J , Cuppini E , Biffanti R , Cerutti A , Reffo E , Fumanelli J , Di Candia A , Avesani M , Castaldi B , Sirico D , Di Salvo G
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): public hospital sources.

Background

The Fontan procedure is an operation that has allowed many paediatric patients suffering from severe congenital heart disease to reach adulthood. More and more frequently we come to interface with the consequences of Fontan's circulation, such as cardiac function and exercise capacity deterioration. Recently the new non-invasive method for calculating myocardial work (MW) based on spackle tracking analysis with the estimation of left ventricular pressure and the measurement of non-invasive blood pressure has been introduced.

Purpose

Aim of this study was to evaluate the diagnostic performance of the non-invasive myocardial work indices in predicting subclinical myocardial work impairment in patients with Fontan circulation.

Methods

A total of 69 patients were included and compared with healthy age- and sex- matched controls (CTRL). Ventricular systolic function and global longitudinal strain (GLS) were assessed. Cardiopulmonary exercise test was performed. Global myocardial work index (MWI) was calculated as the area of the LV pressure strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated.

Results

The two groups were comparable for blood pressure, weight end height. Mean age of Fontan patients was 21.0±9.2 years. MWI (1162 ± 364 mmHg% vs 1777 ± 240 mmHg%, p < 0.001), MCW (1554 ± 450 mmHg% vs 2102 ± 221 mmHg%, p = 0.001) and MWE (90 ± 6% vs 96 ± 2% p = 0.001) were significantly reduced in Fontan patients compared with healthy CTRL. Moreover, GLS (−13,9± 3,1 % vs −21,2 ± 1.5%, p < 0.001) and the ejection fraction (EF) (58,9 ± 4.5% vs 63.3 ± 3.9%, p < 0.002) were significantly lower in Fontan patients. Fontan patients with normal EF showed, however, significantly reduced values of MWI compared with CTRL (p<0.05). Fontan patients with functional right ventricle showed significantly reduced MWE compared with patients with functional left ventricle (p = 0.030).In univariate analysis, peak VO2 was significantly associated with age, SatO2, MWI. In multivariate regression, lower peak VO2 was associated with older age (p = 0.003) and lower MWI (p = 0.026).

Conclusions

Fontan's physiology is associated with impaired ventricular work. Estimation of myocardial work indices may be a more sensitive indicator of impaired myocardial work compared with ejection fraction and is able to predict exercise capacity.
Accuracy of non-invasive assessment of pulmonary pressures by Doppler echocardiography versus right heart catheterisation
Authors: Lwin M T , Phetcharat S , Mano T , Arvanitaki A , Dimopoulos K , Constantine A , Seitler S , Li W
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Pulmonary hypertension (PH) is haemodynamically defined according to the latest ESC/ERS guidelines as a mean pulmonary arterial pressure (mPAP) > 20 mmHg at rest. Transthoracic echocardiography (TTE) is a non-invasive and widely available initial screening test for PH, though studies of the correlation between echo-derived estimates of systolic pulmonary artery pressure (sPAP) and right heart catheterization (RHC) measurements have provided mixed results and few studies have used estimates of mPAP utilising pulmonary regurgitation (PR), especially since the recent redefinition of PH.

Aim

1) To investigate the correlation between TTE-derived mPAP and sPAP estimates and RHC in a large contemporary cohort of patients, using the new PH definition 2) To assess the impact of potential confounding factors, such as heart rhythm, the quality of continuous wave Doppler envelopes, chronologic proximity of TTE to RHC and the severity of tricuspid and pulmonary valve regurgitation (TR and PR).

Method

A single centre database of newly diagnosed PH patients by RHC between January 2010 and December 2020 was retrospectively reviewed and analysed. Patients who had medication changes between TTE and RHC were excluded. Investigators analysed individual TR and PR Doppler tracings off-line in all eligible patients. Spearman correlation (r) was used to explore the correlation between TTE and RHC parameters.

Results

Overall, 503 patients had RHC during the study period (Table 1). All TTEs were performed within a 5-month interval from RHC. Median age was 63.2 (16.0 – 91.1) years. There was moderate-strong correlation between RHC and TTE-assessed right atrial pressure ( r=0.47, p < 0.001), mPAP ( r=0.45, p <0.001) and sPAP ( r=0.61, p <0.001), with an improved correlation when all confounding factors (rhythm, quality of Doppler envelope, valve regurgitation severity) were considered and re-analysed ( r=0.63, p <0.001 for sPAP, r=0.58, p< 0.001 for mPAP, Table 2). When only patients who had TTE within 24 hours of RHC were assessed, correlation improved significantly for sPAP (r = 0.71, p <0.001), however this could not be assessed for mPAP due to an insufficient number of patients.

Conclusion

These findings are in agreement with previously published data, suggesting that there is at least moderate correlation between TTE-derived PAP estimates and RHC, which is stronger when confounding factors were considered and the time between the two investigation was short. While RHC is the gold standard for diagnosing and assessing the severity of PH, TTE remains a very useful PH screening tool, but only if measurements are standardised and meticulous, in order to improve accuracy.
Dynamic left atrial strain by dobutamine: Evidence for relationship with both left ventricular strain and atrioventricular volumetrics
Authors: Armenis I , Christodoulou M , Tsiapras D , Kyrzopoulos S , Athanassopoulos G D
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial strain (LASR) by speckle-tracking echocardiography allows the assessment of LA function in each phase of the cardiac cycle. However, its determinants and its relation with left ventricular (LV) function have not yet been fully described. Moreover, a potential effect of the LV cavities volumes has been recently proposed.

Purpose

Purpose of the study was to assess the effect of LV functional indices to LASR in combination with LA and LV volumes both at rest (R) and during dobutamine stress echo (D).

Methods

We studied 58 consecutive patients (age 59/12, male/female 37/19) who underwent D without evidence of ischemia. Using 2-D speckle tracking in apical views, both LA and LV strain analysis was performed at R and D. The following parameters were estimated: LA volumes (max/min), LA emptying function (max-min/max), LA strain (SR: overall, reservoir, conduit, active), LV volumes (systole: LVSvol, diastole: LVDvol) stroke volume (SV), LV ejection fraction (LVEF), LV longitudinal strain (LVSR) and LA/LV max volume ratio (LA/LVvol).

Results

At R, among LA indices, LAtotalSR only was related to LVSR (r=0.31, p = 0.02). However, at D, LAcondSR, LAactive SR, LAtotalSR were related to LVSR (r=-0.25/0.36/0.3 respectively, all p<0.001).

At R, LAEF, LAactiveSR and LAtotalSR were related with La/LVvol (r=-0.40/-0.40/0.45 respectively, all p<0.002). At D, LAEF, LAreservoirSR, LAactiveSR and LAtotalSR were related with La/LVvol (r=-0.39/-0.31/-0.31/-0.42 respectively, all p<0.001).

For the determination of LAactiveSR at R, using stepwise multiple regression analysis including LVEF LVSR LVsv, LVDvol, La/LVvol, the greater contribution was provided by La/LVvol (initial R=0.41), with small improvement by LVSR (final R=0.50, p<0.001). In contrast, at D, the greater contribution for LAactiveSR was provided by LVSR (initial R=0.36) with some improvement by La/LVvol (final R=0.47 p<0.001).

For the determination of LAtotalSR at R, the greatest contribution was provided by LA/LVvol (initial R=0.45) with improvement by LVSR (R=0.57) and finally by LVDvol (final R=0.64, p<0.001). For LAtotalSR at D, the greatest contribution was provided also by LA/LVvol (initial R=0.43) with further improvement by LVSR (final R=0.54, p<0.001).

Conclusions

LA strain indices are determined partially by LV strain both at rest and mainly during inotropic stimulation. However, they are further and beyond LV strain modulated by the ratio of LV and LA volumes, which play a key role for the overall LA strain both at R and during D. The LA active component is less dependent on volumes, and it is coherent to LV strain during inotropic modulation. Nonetheless, dynamic LA strain is of interest since it integrates LV/LA function, thus providing new insights for clinical application.