bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Approach For CT-Based COVID-19 Classification and Lesion Segmentation Based On Deep Learning
Authors: Truong Hieu Minh , Huynh Hieu Trung
Published: February 2022

The coronavirus disease 2019 (COVID-19) pandemic has been a globally dangerous crisis that causes an increasingly high death rate. Applying machine learning to the computed-tomography (CT)-based COVID-19 diagnosis is essential and attracts the attention of the research community. This paper introduces an approach for simultaneously identifying COVID-19 disease and segmenting its manifestations on lung images. The proposed method is an asymmetric U-Net-like model improved with skip connections. The experiment was conducted on a light-weighted feature extractor called CRNet with a feature enhancement technique called atrous spatial pyramid pooling. Classifying between COVID-19 and non-COVID-19 cases recorded the highest mean scores of 97.1, 94.4, and 97.0% for accuracy, dice similarity coefficient (DSC) and F1 score, respectively. Alternatively, the respective highest mean scores of the classification between COVID-19 and community-acquired pneumonia were 99.89, 99.79, and 99.97%. The lesion segmentation performance was with the highest mean of 99.6 and 84.7% for, respectively, accuracy and DSC.
Performance of artificial intelligence system for prescriptive acquisition guidance of transthoracic echocardiography by novice users combined with automated quantification of ejection fraction
Authors: Singh A , Yamat M , Guile B , Mor-Avi V , Lang RM
Published: February 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Caption Health

Background

Artificial intelligence (AI) has the potential to expedite the acquisition of transthoracic echocardiograms (TTE) and provide automated quantitative data including left ventricular ejection fraction (LVEF).  Specifically, AI-based imaging systems may permit less experienced individuals to obtain quantitative measurements of LVEF, with important implications for clinical workflow. 

Purpose

We sought to evaluate the accuracy of an AI-based imaging system for the evaluation of LVEF in a spectrum of novice TTE imagers in a real-world clinical setting, and hypothesized that after appropriate training, it can perform as well as experienced sonographers. 

Methods

Consecutive exams (N = 102; BMI 29 ± 7; most common indications for TTE: heart failure, arrhythmia, valve assessment) were performed by a cohort of physician trainees (MD) and nurses (RN) with no prior TTE experience, using an AI-guided imaging system equipped with real-time prescriptive guidance software that automatically measures LVEF. Guided imaging included 3 views: parasternal long-axis (PLAX), apical 4-and apical 2-chamber (AP4, AP2), with the software recognizing when a satisfactory imaging window is obtained and then auto-capturing and automatically generating an AI based LVEF. AI-EF measurements were compared against the reference standard EF (Ref EF) measured by 2 expert sonographers according to ASE chamber quantification guidelines. Bland-Altman analysis was performed to determine inter-technique agreement.

Results

Feasibility was 80%. AI-EF and Ref EF demonstrated strong correlation when all 3 views were obtained, with a small bias (Table). In cases when <3 views were available, the combination of PLAX and AP4 views achieved comparable results, with a slight increase in bias and limits of agreement. When results were stratified by cohort (MD vs RN), MD AI-EF attempts showed greater feasibility (100%, n = 51) with stronger correlation (r = 0.93) and smaller bias (-1.9%) compared to RN (feasibility of 61%; n = 31 and r= 0.85, bias -2.1%). 

Conclusions

Use of an AI-assisted imaging system for limited TTE imaging by novices is feasible in a real-world setting, with the AI based EF in good agreement with reference standard. Acquisition of all 3 views provided optimal results, but the combination of AP4/PLAX views performed reasonably well, without the AP2 view that is more difficult to acquire for less skilled users. Untrained MD were more successful when compared to RN, suggesting additional training may be needed for specific user groups. Abstract Figure.
Effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors on left ventricular remodelling and longitudinal strain: a prospective observational study
Authors: Gonzalez Teston F , Gamaza Chulian S , Diaz Retamino E , Gaitero Reina JC , Gonzalez Caballero E , Martin Santana A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) can reduce cardiovascular events in type 2 diabetes mellitus (T2DM) patients, although the mechanisms underlying these benefits are not clearly understood.

Purpose

The aim of this study was to analyze the effects of SGLT2i on left ventricular remodelling and longitudinal strain.

Methods

Between November 2019 and April 2020 we included 52 patients ≥18 years of age with T2DM, HbA1c between 6.5% and 10.0%, and estimated glomerular filtration ≥45 ml/min/1.73 m2. Patients were classified into SGLT2i group and control group, according to prescribed treatment by their referring physician. Conventional and speckle tracking echocardiography were performed by blinded sonographers, at baseline and after 6 months of treatment.

Results

Among the 52 included patients (44% females, mean age 66.8 ± 8.6 years, mean HbA1c 7.40 ± 0.7%), 30 patients were prescribed SGLT2i and 22 patients were classified as control group. Mean change in indexed left ventricular mass (LVM) was -10.85 ± 3.31 g/m2 (p = 0.003) in the SGLT2i group, and +2.34 ± 4.13 g/m2 (p = 0.58) in the control group. Absolute value of Global Longitudinal Strain (GLS) increased by a mean of 1.29 ± 0.47 (p = 0.011) in the SGLT2i group, and 0.40 ± 0.62 (p = 0.34) in the control group. We did not find correlations between changes in LVM and GLS, and other variables like change in HbA1c.

Conclusions

In patients with T2DM, SGLT2i were associated with a significant reduction in indexed LVM and a significant increase in longitudinal strain measured by speckle tracking echocardiography, which may explain in part the clinical benefits found in clinical trials.
Correlation between the left ventricular strain and the severity of coronary atherosclerosis in patients with coronary artery disease
Authors: Alieva RB , Bekmetova FM , Fozilov KHG , Donierov SN , Mukhamedova MG , Bekmetova SI , Ilkhomova LT , Khoshimov SHU
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

The purpose of this study was to assess the properties of left ventricular myocardial deformation in patients with coronary artery disease (CAD) with various degrees of coronary lesions.

Methods and Results: The study included 74 patients with stable angina pectoris Class II-IV aged between 40 and 70 years. All patients underwent the following examinations: assessment of traditional risk factors, physical examination, general clinical and laboratory blood tests, 12-lead ECG, 24-hour ABPM, transthoracic echocardiography, two-dimensional speckle tracking echocardiography (STE), and coronary angiography (CAG). The SYNTAX score was calculated retrospectively according to

the SYNTAX score algorithm. All patients were divided into 3 groups: Group 1 included 21 patients with a low SYNTAX score (0–22), for whom standard drug therapy was recommended; Group 2 included 28 patients with an intermediate SYNTAX score (23–32), to whom PCI was recommended; Group 3 included 25 patients with a high SYNTAX score (≥33), to whom CABG was recommended.

Left ventricular ejection fraction (LVEF) obtained using the modified biplane Simpson’s method was significantly lower in Group 3 than in Groups 1 and 2 (P = 0.001); it should be noted that this indicator was within the normative values in Groups 1 and 2, and belonged to the gradation "mild dysfunction." A more objective quantitative assessment of the contractile function of the LV myocardium was obtained by assessing the GLS and SR. The comparative analysis of the LV myocardial deformation properties

in the three studied groups showed that in Group 3 the GLS and SR indicators were significantly lower than in Group 1 (P = 0.000 and P = 0.0020). Moreover, GLS (global longitudinal strain) and SR (strain rate) were significantly higher in Group 1 than in Group 2 (P = 0.0001 and P = 0.0133, respectively). GLS significantly correlated with LVEF (r = 0.57; P < 0.05), E/A (r = 0.22; P < 0.05), and SYNTAX score (r=-0.63; P < 0.05). SR significantly correlated with LVEF (r = 0.49; P < 0.05) and SYNTAX score (r=-0.37; P < 0.05)

Conclusion

The results obtained indicate the diagnostic value of STE with the determination of GLS and SR in a comprehensive assessment of the severity of CAD. GLS and SR significantly correlate with the clinical course of the disease, as well as indicators of LV remodeling and LV diastolic dysfunction. STE analysis of GLS and SR has incremental diagnostic value over transthoracic echocardiography in predicting significant CAD
Impact of surgical myectomy on electrocardiographic changes in patients of hypertrophic obstructive cardiomyopathy
Authors: Badran H , Faheem N , Galal A , Yacoub MY
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Hypertrophic cardiomyopathy (HCM) is the commonest genetically inherited cardiac condition affecting 1 in 500 of the population. [1] The amelioration of patient symptomatology and decreased morbidity after surgical myectomy is previously documented. [2]. However, no data is available regarding the associated electrocardiographic changes that may occur after surgical myectomy, especially in patients showed improvement of functional status.

Aim of study:  The study was conducted to investigate the electrocardiographic changes following surgical myectomy in hypertrophic obstructive cardiomyopathy (HOCM) patients, and its relation to cardiac mechanics

Methods

The study included 25 patients (mean age: 35.44 ± 12.3 years, 52% male) with HOCM who were subjected to successful surgical myectomy. 12-lead surface ECG and echocardiographic examination including 2D strain imaging were performed pre and post myectomy.

Results

Postoperatively, 84% of patients developed new complete left bundle branch block (LBBB), 4% developed right BBB (RBBB) and 4% developed complete AV block necessitating permanent pacing. These Changes were associated with increased QRS width and QT interval prolongation in almost all patients (p < 0.001).  Following surgery, there was significant reduction in left atrium size, left ventricle mass, LV outflow tract gradient, mitral and annular systolic & diastolic velocities (S’, E’, A’) and EF%(p < 0.001 for all) compared with its preoperative values. At segmental level only LV septal εsys% showed significant inverse correlation to QRS duration (r = 0.47, P < 0.02). No significant correlation was detected between QRS & QTc duration and any other LV wall εsys%. In contrast: QTc intervals showed inverse correlation to the magnitude of reduction in RV εsys %, r=-0.59,P < 0.001 and the magnitude of reduction in RV TTP-SD (r=-.42, P < 0.03).

Conclusion

Left bundle branch block is a common conduction abnormality after septal myectomy but it did not influence the clinical improvement or structural remodeling. Post myectomy, prolongation of QRS duration was a powerful aspect of mechanical dysfunction especially of septal mechanics than QT interval prolongation. Electrical and mechanical dysfunction is commonly associated while mechanical heterogeneity is not always coexisting.
Automated left atrial volume measurement by two-dimensional speckle-tracking echocardiography: feasibility, accuracy and reproducibility
Authors: Florescu D , Badano LP , Tomaselli M , Torlasco C , Florescu C , Tartea GC , Balseanu TA , Volpato V , Parati G , Muraru D
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction - A by-product of left atrial (LA) strain analysis is the automated measurement of LA maximal volume (LAVmax), which may decrease the time of echocardiography reporting, and increase the reproducibility of the LAVmax measurement. However, the automated measurement of LAVmax by two-dimensional speckle-tracking analysis (2DSTE) has never been validated.

Purpose – Accordingly, we sought to: i. assess the feasibility of automated LAVmax measurement by 2DSTE; ii.  compare the automated LAVmax by 2DSTE with conventional two-dimensional (2DE) biplane and three-dimensional echocardiography (3DE) measurements; and iii. evaluate the accuracy and reproducibility of the three echocardiography techniques.

Methods – LAVmax (34­-197 mL) were prospectively obtained from 198/210 (feasibility 94%) consecutive patients with various cardiac diseases (median age 67 years, 126 men) by 2DSTE, 2DE and 3DE.

Results – 2DE and 2DSTE measurements resulted in similar LAVmax values (bias = 1.5 mL, limits of agreement, LOA ± 7.5 mL), and slightly underestimated 3DE LAVmax (biases=-5 mL, LOA ± 17 mL, and -6 mL, LOA ± 16 mL, respectively). LAVmax by 2DSTE and 2DE were strongly correlated to those obtained by cardiac magnetic resonance (CMR) (r=.946, and r=.935, respectively; p<.001). However, LAVmax obtained by 2DSTE (bias=-9.5 mL, LOA ± 16 mL), and 2DE (bias=-8 mL, LOA ± 17 mL) were significantly smaller than those measured by CMR. Conversely, 3DE LAVmax were similar to CMR (bias=-2 ml, LOA ± 10 mL). Excellent intra- and inter-observer intraclass correlation coefficients were found for 3DE (0.995 and 0.995), 2DE (0.990 and 0.988), and 2DSTE (0.990 and 0.989).

Conclusion – Automated LAVmax measurement by 2DSTE is highly feasible, highly reproducible, and provided similar values to conventional 2DE calculations in consecutive patients with a wide range of LAVmax. Abstract Figure. Echocardiography and CMR correlations  Abstract Figure. Echocardiography techniques correlations
Normal values of strain in a Spanish paediatric population
Authors: Aristizabal Duque C , Fernandez Cabeza J , Blancas Sanchez IM , Delgado Ortega M , Aparicio Martinez P , Fonseca Del Pozo FJ , Romero Saldana M , Pan Alvarez-Osorio M , Ruiz Ortiz M , Mesa Rubio MD
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

The analysis of systolic-diastolic function by two-dimensional ultrasound speckle-tracking strain (2DSTE) in the paediatric population is becoming progressively more available. Its use can be helpful in the diagnosis of subclinical pathology in paediatric disease, both in acquired cardiovascular pathology, congenital heart disease and especially in cardio-oncology1-4. However, there is a lack of normal reference strain values in our paediatric population.

Purpose

To provide the normal values of strain in our paediatric population and its relationship with gender, age, and body surface area.

Methods

A cross-sectional study was carried out in a population in Andalusia, Spain. Of 265 children who agreed to participate, 156 healthy children aged 6-17 years were selected by excluding congenital or acquired heart disease. Analysis using the new auto-strain software of the left ventricle, right ventricle, and left atrium. Normal values are given for our population, stratified by age, gender and body surface area (BSA).

Results

  Tables 1,2,3 shows the strain values of the different cardiac chambers, categorized by gender, age groups and BSA.  Figure 1 presents the bivariate correlations of the strain and the different cardiac chambers with age and BSA. Average strain values were significantly higher in females, except for LALScd. We also found a significant tendency to lower mean strain values with higher age, except for LALScd.  Finally, higher BSA was also inversely related to mean strain values for most variables in bivariate correlations although these associations were only significant for right ventricle strain and LALSr when BSA was categorized in tercile groups.

Conclusions

  We provide for the first time in our region normal strain values for left ventricle, right ventricle, and left atrium in the paediatric population through the usage of new auto-strain software. A discrete positive correlation of strain values with respect to female gender and a negative correlation with respect to BSA and age was found. Abstract Figure. STRAIN VALUES CATEGORIZED  Abstract Figure. BIVARIATE CORRELATIONS
Layer-specific global longitudinal strain as predictor for arrhythmic subrogates in arrhythmic risk of arrhythmogenic cardiomyopathy: beyond ejection fraction
Authors: Segura Rodriguez D , Bermudez-Jimenez FJ , Gonzalez Camacho L , Moreno Escobar E , Bautista-Paves A , Oyonarte-Ramirez JM , Tercedor Sanchez L , Jimenez-Jaimez J
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Arrhythmogenic Cardiomyopathy (AC) is a life-threatening disease which predispose to malignant arrhythmias and sudden cardiac death (SCD) even in early stages of the disease. Risk stratification relies on electrical, genetic and imaging data. Our aim is to investigate how myocardial deformation parameters may identify subjects at risk of ventricular arrhythmias.

Methods

A cohort of 45 subjects with definite or borderline diagnosis of AC was characterized using advanced transthoracic echocardiography (TTE) and cardiac magnetic resonance and divided into groups according 

surrogates such as non-sustained ventricular tachycardia (NSVT), late gadolinium enhancement (LGE) and genetic status. Layer-specific global longitudinal strain (GLS) by TTE 2D Speckle Tracking was compared in patients with and without these arrhythmic risk markers.

Results

Twenty-three (51.1%) patients were men, mean age 43 ± 16 years. Next-generation sequencing identified a potential pathogenic mutation in 39 (86.7%) patients. Thirty-nine patients presented LGE (73.3%), mostly located at the subepicardial-to-mesocardial layers. Layer-Specific-GLS analysis showed worse GLS values at the epicardial and mesocardial layers in subjects with NSVT and LGE. Epicardial GLS values of -15.4% and -16.1% were the best cut-off values for identifying individuals with NSVT and LGE, respectively (figure 1, panel A and B, respectively) regardless of left ventricular ejection fraction.

Conclusions

Layer-specific GLS assessment identified subjects with high-risk arrhythmic features in AC such as NSVT and LGE. Epicardial GLS may emerge as potential instrument for detecting subjects at risk of SCD in AC. Abstract Figure. ROC curves.Layer-specific GLS (NSVT&LGE)
A novel sphygmomanometer for central venous pressure assessment during stress echocardiography
Authors: Campagnano E , Ciampi Q , Bortolani B , Cercenelli L , Lodi S , Marcelli E , Bologna A , Bombardini T , Villari B , Picano E
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

OnBehalf

StressEcho 2030 study group

Background. Central venous pressure (CVP) is important in the hemodynamic phenotyping of failing heart, and the usual invasive assessment can be surrogated by a sphygmomanometer for venous pressure (SVEN) which has been recently prototyped and validated.

Aim

To assess the technical success rate and correlates of CVP measurements by SVEN during stress echocardiography (SE)

Methods

We evaluated 22 consecutive patients (age 66 ±11 years, 15 men, ejection fraction 60 ±6%) referred for clinically-driven dipyridamole (n = 20, for chest pain) or treadmill (n = 2, for dyspnea) SE with ABCDE protocol (score range from 0= all steps normal, to 5= all steps abnormal). Step A assesses regional wall motion abnormalities (RWMA); step B, B-lines (diastolic function); step C, left ventricular contractile reserve based on force; step D, coronary flow velocity reserve (CFVR) in left anterior descending artery; step E, heart rate reserve (HRR). In each patient, the usual setting of echocardiographic, electrocardiographic and arterial blood pressure monitoring was integrated with CVP measurement by SVEN (right arm, contralateral to the arterial sphygmomanometer arm) with personalized cuff sizes. SVEN measurements of CVP were obtained at rest and peak stress.

Results. SVEN preparation and automated analysis required < 5 minutes for positioning, inflation-deflation, acquisition and off-line reading for single measurement. SVEN success rate was 22/22 (100%). CVP did not change during SE (rest = 2.4 ± 0.5 vs stress= 3.7 ± 0.8 mmHg, p = 0.106). Resting CVP was correlated inversely to ejection fraction at rest (r=-0.489, p = 0.021) and at peak stress (r=-0.545, p = 0.001), CFVR (r=-0.505, p = 0.023), HRR (r=-0.503, p = 0.017) and directly to RWMA (r = 0.431, p = 0.045), B-lines at peak stress (r= 0.626, p = 0.002) and left atrial volume index at rest (r= 0.552, p =0.012) and at peak stress (r = 0.648, p = 0.002). CVP was significantly higher in patients with B-Lines at peak stress (Figure). ABCDE score was directly related to CVP (r = 0.560, p = 0.007).

Conclusion. SVEN assessment is feasible at rest and during stress with extremely high success rate and only minimal increase in preparation and analysis time. Changes observed are consistent with the expected hemodynamic profile, with CVP increase associated with more B-lines (a sign of pulmonary congestion and elevated pulmonary capillary wedge pressure) and larger left atrium (an integrated barometer of left ventricular end-diastolic pressure). Abstract Figure.
Impact of an inconclusive exercise stress echocardiogram on cardiovascular outcomes
Authors: Cardoso A , Lourenco MR , Von Hafe P , Dias G , Pereira T , Tinoco M , Fernandes M , Azevedo O , Lourenco A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Exercise stress echocardiography (ESE) is used for the assessment of suspected or known coronary artery disease (CAD); however, a certain percentage of ESE studies are inconclusive. We aim to evaluate the prognostic impact of an inconclusive ESE on cardiovascular outcomes.

Methods

Single-center retrospective study of consecutive patients (pts) who performed an ESE between 2018 and 2019 for diagnosis or stratification of CAD. All pts performed a symptom-limited Bruce protocol. ESE was considered inconclusive when 85% of age-predicted maximum HR was not reached. Primary endpoint was a composite of admission for acute coronary syndrome (ACS), coronary revascularization and cardiovascular death during the follow-up.

Results

A total of 141 pts were included (76% male; mean age 60 ± 9 years). ESE was inconclusive in 51 (36%) pts, positive in 11 (8%) and negative in 79 (56%).

The mean exercise time of pts with inconclusive ESE was 7 ± 2 minutes and 76% had normal functional capacity. Fatigue (25 pts; 49%) and lower extremities pain (11 pts; 22%) were the main reasons for ESE stopping. Five pts (10%) complained of chest pain during exam.

Pts with an inconclusive ESE were more diabetic (inconclusive 43%, positive 9%, negative 13%; p=.001), had more chronic obstructive pulmonary disease (COPD) (14%, 0%, 2.5%; p=.026), performed more frequently the exam under beta blocker (BB) therapy (59%, 27%, 18%; p=.041) and had less ST-segment depression fulfilling electrocardiographic criteria for ischemia (10%, 64%, 27%, p<.001). Their functional capacity was worse than negative ESE pts (p<.001).

During a median follow up of 22 months (IQR 15-27), 13 (9.2%) pts had the primary endpoint, including 5 pts (3.5%) with ACS.

Pts with an inconclusive ESE had a lower incidence of the primary outcome than pts with a positive ESE and a higher incidence of events than pts with negative results (figure).

In multivariate analysis, after adjusting for functional capacity and electrocardiographic criteria for ischemia, an inconclusive ESE was an independent predictor of the primary endpoint (HR 9.7, IC95% 1.1-87,6 p= .042)

Conclusions

The frequency of inconclusive ESE is not negligible (36%). These pts had more diabetes and COPD and performed the exam under BB therapy more frequently, highlighting the importance of proper patient selection. An inconclusive ESE was associated to a higher risk of cardiovascular events compared to negative ESE. Abstract Figure.
Role of 3D echocardiography-determined atrial volumes in predicting elevated left ventricular filling pressure
Authors: Jenei C , Kadar R , Balogh L , Gyory F , Borbely A , Csanadi Z
Published: February 2022

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Hungarian Government Research Fund, Szív- és érkutatási kiválóságközpont (IRONHEART)

Aims

Atrial sizes are considered markers of ventricular filling pressures. The studies focused on left atrial (LA) maximum volume (LAV max), however during diastole the left ventricular (LV) diastolic pressure affects the LA minimum volume (LAV min) instead. Therefore, we aimed to test the clinical applicability of atrial volumes measured by transthoracic three-dimensional echocardiography (3DE) in predicting elevated LV filling pressure.

Methods

Eighty-eight consecutive patients with and without left-sided heart disease were prospectively examined with transthoracic 3DE who underwent right heart catheterization because of clinical indication. Elevated LV filling pressure was determined as the pulmonary artery wedge pressure was higher than 15 mm Hg. The atrial volumes were measured offline with dedicated commercial software.

Results

Thirty-eight patients (24 males, age 62 ± 8 y) had left-sided heart disease (group A) and 50 (20 males, age 62 ± 15 y) had pulmonary hypertension because of lung disease (Group B). The left atrial indexed maximum (LAVi max) and minimum (LAVi min) volumes were significantly larger in group A than in group B (LAVi max: 64 ± 31 ml/m² vs. 40 ± 22 ml/m², p = 0.001; LAVi min: 51 ± 22 ml/m² vs. 25 ± 21 ml/m², p < 0.0001). The LA minimum volume correlated with the pulmonary artery wedge pressure [r = 0.6 (p < 0.0001) for LAV min vs. r = 0.47 (p < 0.0001) for LAV max]. In the receiver operating characteristic (ROC) curves of parameters predicting the elevated LV filling pressure, the areas under the curve (AUC) for LAVi min and LAVi max were 0.86 (95% CI, 0.79-0.94), 0.79 (95% CI, 0.70-0.89), respectively. The ROC analysis indicated a possible cutoff value of 28 ml/m² for LAVi min to elevated LV filling pressure (AUC = 0.86; sensitivity = 87%, specificity = 74%).

Conclusion

The left atrial minimum volume measured by transthoracic 3DE is a useful parameter for predicting elevated left ventricular filling pressure.
Multiparametric assessment of the intraprocedural result after transcatheter mitral valve edge-to-edge repair proceduret
Authors: Melillo F , Colopi M , Falsasconi G , Ancona F , Pannone L , Stella S , Ingallina G , Castiglioni A , De Bonis M , Beneduce A , Godino C , Buzzatti N , Montorfano M , Denti P , Agricola E
Published: February 2022

Funding Acknowledgements

Type of funding sources: Private company. Main funding source(s): Research grant

OnBehalf

n/a

Background. Quantification of residual mitral regurgitation (MR) after transcatheter edge-to-edge mitral valve repair (TMVr) is challenging.

Objectives.  To evaluate the feasibility and the performance of an intraprocedural multiparametric approach based on echocardiographic and invasive hemodynamic parameters and to develop a multiparametric scoring system for MR grading after TMVr, and to compare this approach against currently recommended methods. 

Methods. Ninety-three consecutive patients treated with MitraClip (April 2019-July 2020) were enrolled. The protocol of MR evaluation included: 2D and 3D color-Doppler (3D-vena contracta area- 3D-VCA), pulsed-wave Doppler (pulmonary vein- PV flow, stroke volume), continuous-wave Doppler (jet density), morphological parameters (spontaneous echocontrast) and invasive hemodynamic (mean left atrial pressure-LAP, V-wave) at baseline and after clip implantation. A multiparametric score (M-score) was calculated by including the significant predictors (3D-VCA, dense jet on CWD, final LAP, final V wave) of primary endpoint (CV death or HF related hospitalization) at one year follow-up, weighted according to the corresponding odds ratio, to predict the clinical outcome at one-month and one-year follow-up. 

Results. The final study population included 86 pts (mean age 78.3 +8.9yrs, 54.6% primary MR). Procedural success was achieved in 78 pts (90.7%). 3D-VCA (AUC 0.808) and current method for MR grading (AUC 0.801) were comparable predictors of lack of symptom improvement (<5 point change in KCCQ-OS score) at one-month (p = 0.398, DeLong’s test). The M-score performed similarly as predictor of one-month follow-up but was a better predictor of primary endpoint at 1-year (AUC 0.919) compared to single parameters (p = 0.005 vs 3D-VCA DeLong"s test) and currently recommended methods for MR grading (p = 0.006 DeLong"s test). The optimal cut-off was 2 points with 86.7% sensitivity and 83.1% specificity.

Conclusion. We evaluated intraprocedural TMVr result in a multiparametric approach showing that 3D-VCA alone is comparable to current recommended method for MR grading. However, the integration of echocardiographic and invasive hemodynamic parameters into a multiparametric score provided a further added value for predicting clinical outcome  at one-year compared to currently recommended methods for MR grading and to 3D-VCA.
Is flow better in mL/m2 or mL/s - a practical reflection on aortic stenosis
Authors: Dias Claudio F , Santos M , Custodio P , Ferreira B , Quadrado M , Manuel A , Francisco AR , Neves B , Cruz I , Almeida AR , Fazendas P , Joao I , Pereira H
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Introduction

Severe aortic stenosis is characterized for a high mean gradient (>40mmHg) and an aortic valve area (AVA ≤1cm2). There is a population of patients with discordant findings. These patients present with a lower mean gradient (<40mmHg) and area (AVA ≤1cm2).  This states are explained by a low flow (indexed SV ≤35ml/m2). Some studies demonstrated that a flow rate (determined by dividing SV by ejection time) inferior to 200 mL/s is also associated with poor prognosis. Can this be an alternative in stratifying patients with an AVA ≤1cm2?

Purpose

This paper aims to compare flow assessment by the conventional way with flow calculated in ml/s in patients with AVA ≤1cm2

Methods

We present a retrospective study from all consecutive patients to whom an echocardiogram was performed in our hospital during the years 2017 and 2018 which meet the criteria for low gradient aortic stenosis. Comorbidities were analysed for each subgroup as well as echocardiographic variables to properly characterize aortic stenosis.

Results

A total of 118 patients met the criteria for severe aortic stenosis with a valvular area ≤1cm2. This population was made up of 18 patients with severe aortic stenosis low flow, low gradient with depressed ejection fraction and 32 patients with preserved ejection fraction. The other 68 patients represented patients with a normal flow, low gradient aortic stenosis. There is a strong correlation between the variable SVi and Flow Rate (r = 0,796, p < 0,001). A linear regression shows that the flow rate equivalent to a SVi of 35mL/m2 in our sample is 203mL/s, near the value of other studies. 10 (31.3%) patients with severe aortic stenosis low flow, low gradient with preserved ejection fraction, 3 (16.7%) patients with severe aortic stenosis low flow, low gradient with depressed ejection fraction and 53 (77.9%) patients with normal flow, low gradient aortic stenosis would have a flow superior to 200mL/s.

Conclusion

The use of flow rate systematically would downgrade the severity of valvular lesions with possible need for intervention. However, in certain dubious cases its application may identify a subpopulation with need for further study and probable treatment, such as the patients with normal flow, low gradient aortic stenosis. Further studies of this subgroup of patients are warranted to reach any final conclusions. Abstract Figure.
Increasing transvalvular flow with passive leg rise as an add-on to dobutamine in patients with paradoxical low-flow, low-gradient aortic stenosis
Authors: Buffle E , Papadis A , De Marchi SF , Seiler C
Published: February 2022

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Gottfried und Julia Bangerter-Rhyner Foundation

Background

Projected aortic valve area (AVA), used in case of low-flow, low-gradient aortic stenosis is reliable if the transvalvular flow can be substantially augmented. Moreover it depends on the calculated valve compliance, which should remain constant, irrespective of the change in transvalvular flow.

Methods

We prospectively compared 3 different stress methods to increase transvalvular flow in patients with low-flow, low-gradient aortic stenosis: maximal dobutamine infusion rate ("Dmax"), passive leg-raise ("PLR") and the combination of the two ("Dmax + PLR") with the velocity time integral (VTI) method. The primary endpoint was the percentage of patients with ΔQ ≥20%. The percentage of patients with the pseudosevere classification and the mean slope between transvalvular flow and AVA - corresponding to the valve compliance - for each stress methods were the secondary endpoints.

Results

"Dmax + PLR" yielded the highest percent of patient with Δtransvalvular flow ≥20% implying the highest validity to the projected AVA between all the stress methods. In the "Paradox" group (LVEF ≥50%, n = 25), the percentage of patients classified as pseudosevere aortic stenosis was the lowest using "Dmax + PLR". This was also the case in the "lowEF" group with the Simpson’s method (LVEF <50%, n = 20). The mean slope of Q with respect to AVA consistently decreased with higher Δtransvalvular flow.

Conclusion

Projected AVA was obtained with the highest reliability with the "Dmax + PLR" stress method. This same stress method yielded the lowest percentage of classification in pseudosevere in the "Paradox" group. This implies that the valve compliance, capturing the relationship between transvalvular flow and AVA might be non-constant and rather inversely proportional to translvalvular flow. Abstract Figure. Echo parameters and classification  Abstract Figure. Projected AVA and valve compliance
Stuck mechanical valve complication in non-COVID-19 patients during COVID-19 pandemic: single center experience
Authors: Vriz O , Fawzy N , Eltayeb A , Galzerano D , Anwar M , Mushtaq A , Shaik A , Elshaer A , Kinsara A , Feras K
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Stuck valve is a very rare and severe complication that occurs in mechanical valve replacement patients with ineffective anticoagulation. However, with COVID-19 restriction measures, it became challenging to regularly assess INR to make sure it falls within the target therapeutic range to prevent this complication.

Purpose

We wanted to explore how did the COVID-19 pandemic restrictions impacted mechanical valve replacement patients on chronic anticoagulation and the long-term consequences of limiting their access to health service.

Methods

We present a series of 10 patients on warfarin anticoagulation therapy who either underwent transthoracic echocardiography for a suspected stuck valve or were seen at the outpatient valve clinic with the residual consequences of a stuck valve during the COVID-19 restriction measures in our institute.

Results

Eight patients were female, two of whom were pregnant at the first trimester and eventually went on to receive an abortion; six patients received urgent valve replacement cardiac surgery; four patients were managed medically e.g. with heparin; none had thrombolytic therapy. Stuck prosthetic valves incident has increased significantly during this period, particularly those in the mitral position for which urgent replacement and prolonged hospitalization including intensive care admission, with high in-hospital mortality rates and high costs were necessary. Mean hospital admission time was 27.5 ± 18.5 days.  The cost of treatment, as average estimated reimbursement, was 11,000 USD for medical admission only, and 43,200 USD when surgery was required, up to 64,000 USD when ECMO was part of patient management.

Conclusion

Despite governments’ efforts to implement telemedicine and virtual clinics, COVID-19 restrictions and health-messaging affected the routine follow-up of non-COVID-19 patients. We report dramatic consequences to this drastic change in healthcare: clinical complications, lost lives and inflated healthcare costs in patients with a prosthetic valve. We believe that non-COVID-19 patients have paid, and will continue to pay in the future, a price that is much greater than those patients who have suffered from COVID-19. Active engagement of patients should be implemented in a time of emergencies, and further studies should address the efficacy and cost-effectiveness of public policies aimed to decrease the burden of avoidable complications and missed diagnoses. Abstract Figure. Fluoroscopy in a 70 years old patient
Prognostic significance of left atrial reservoir strain in patients undergoing transcatheter aortic valve implantation
Authors: Von Roeder M , Maeder M , Wahl V , Stachel G , Thiele H , Desch S , Lurz P , Abdel-Wahab M
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Left atrial reservoir strain (LARS) provides prognostic information in various patient groups and might help to detect elevated filling pressures. Patients with diastolic dysfunction experience worse outcomes after transcatheter aortic valve implantation (TAVI), but Doppler-derived measurements might be hampered by atrial fibrillation, mitral valve disease or impaired image quality. Aim of the current study is to elucidate the prognostic value of LASR in patients undergoing TAVI.

Methods

 All consecutive patients undergoing TAVI at a single tertiary care hospital between 01/2018 and 12/2018 were included if discharge echo and follow-up was available. LASR was derived from 2-D-speckle-tracking averaged apical 2- and 4-chamber view. Patients were grouped in 3 tertiles according to LASR. Primary outcome was a composite of all-cause death and readmission for worsening heart failure.

Results

Overall, 606 patients were available (Age 80 years (IQR 77-84)), including 53% woman. 

LASR was significantly impaired over tertiles (T1 21.4  (IQR 18.3-24.5), T2 13.0  (IQR 11.3-14.6), T3 7.1  (IQR 5.4-8.4), p < 0.0001). The primary outcome occurred more often with impaired LASR (T1 7,4%, T2 13.4%, T3 25,7%). 

 On multivariable Cox-regression analysis LASR was a significant factor to predict outcome (HR 0.95, CI 0.91-0.99, p = 0.02).

Conclusion

Impaired LASR is associated with impaired outcomes in patients undergoing TAVI.
Classic pattern dyssynchrony predicting outcome in patients with Fontan circulation
Authors: Rosner A , Mc Elhinney DB , Friedberg MK , Lui GK
Published: February 2022

Funding Acknowledgements

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

Background

Morbidity and mortality increase as Fontan patients age into adulthood. Limited studies have examined cardiac magnetic resonance and echocardiographic parameters to predict death and transplantation in children after Fontan operation.

Purpose

The aim of the study was to investigate echocardiographic parameters in adolescents and adults after Fontan operation including myocardial mechanics including classic pattern dyssynchrony (CPD) as predictors of transplantation or death.

Methods

In a cross-sectional retrospective study, strain analysis was performed on echocardiography studies performed between 2001 and 2014 of 110 patients with single ventricle physiology after the Fontan procedure. Strain curves were measured and visually assessed for the presence of CPD. The primary end point was death or transplantation after a follow-up period of 85 ± 35 months after echocardiography.

Results

Median age at date of echocardiography was 20, range 3 to 45 years. Of 110 patients 28 patients were transplanted. During the study-period 3 patients died after transplantation and 7 patients died without being transplanted. CPD was seen in 16 and protein losing enteropathy (PLE) in 21 of 110 patients. By multivariate-analysis, CPD (HR 9.4 CI 2.6-34.6), PLE (HR 10.6 CI 3.4-33.2); systolic blood pressure (HR 0.954 CI 0.913-0.996), systolic/diastolic duration ratio (HR 6.83 CI 1.33-35.0) and E wave deceleration time (HR 0.98 CI 0.97 - 0.99) were independently associated with the primary end point.

Conclusion

CPD, PLE, systolic and diastolic ventricular dysfunction are significantly associated with transplantation or death in Fontan operated patients. In selected patients, the presence of CPD may be a basis to investigate cardiac resynchronization therapy as a treatment strategy. Abstract Figure: Mortality in patients with CPD
Myocardial work indices and ventricular dyssynchrony in adults with aortic coarctation
Authors: Fusco F , Scognamiglio G , Merola A , Roma AS , Del Giudice C , Abbate M , Palma M , Correra A , Borrelli N , Barracano R , Grimaldi N , Colonna D , Romeo E , Sarubbi B
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

Adults with coarctation of the aorta (CoA) may present residual aortic obstruction and develop arterial vasculopathy and subclinical left ventricular (LV) dysfunction. Myocardial work (MW) is a novel non-invasive index of myocardial efficiency calculated from echocardiographic LV pressure-strain loops, which yields incremental information over ejection fraction and global longitudinal strain. (GLS)

Purpose

Aim of the present study is to analyze LVMW in a cohort of adult patients with operated aortic CoA

Methods

CoA patients aged > 18 years who underwent transthoracic echocardiography between September 2020 and July 2021 at our tertiary centre were included. Exclusion criteria were significant recoarctation, impaired LVEF, significant valvular disease and suboptimal image quality. A group of healthy individuals with no cardiac abnormalities. GLS and peak strain dispersion(PSD) were measured. MW indices were calculated using the blood pressure measured in the right arm at the time of the exam.

Results

Sixty patients (26[22-33]years, 66%male) were included. Data on previous medical history, clinical status at last assessment and Coa-related echocardiographic findings are showed in table 1. No significant differences in traditional parameters of LV systolic and diastolic function were found between groups (EF 60[57-64] vs 57[53-61],p = 0.6), however Coa patients had higher LVmass (84[75-97] vs 68[56-75]g). GLS and MW indices in the study population and in the control group  are reported in table 2. Coa group showed lower GLS values and higher PSD (p < 0.0001 for both). Global work index(GWI) and global constructive work(GCW) values were not significantly different between groups, whereas CoA group showed significant increase of global wasted work(GWW) and impaired global work efficiency(GWE,p = 0.003 and 0.0005 respectively). Spearman’s linear method illustrated that both GCW and GWI had a moderate positive relation with mean gradient across the descending aorta at continuous wave Doppler. PSD was positively related to GWW and inversely related to GWE(Figure 1). Using linear regression model with the log of GWE values as dependent variable,PSD,age(β:-0.002,p = 0.03) and LVmass(β:-0.06,p = 0.004)were related to GWE. However, only PSD retained a significant relation on multivariable analysis(β:-0.002,p > 0.0001).

Conclusion

MW indices assessment is feasible in Coa patients may provide a more comprehensive understanding of the overall myocardial mechanics and performance. In particular, MW demonstrated impaired LV efficiency, which was strongly related to increased mechanical dispersion in Coa patients. Abstract Figure.  Abstract Figure.
Ventricular mechanics in adolescents with Fontan circulation: comparison to healthy controls
Authors: Aly S , Mertens L , Friedberg M , Dragulescu A
Published: February 2022

Funding Acknowledgements

Type of funding sources: None.

Background

While preserved torsion was demonstrated in very young patients with single ventricle (SV) physiology immediately post Fontan completion, there is very limited data about the changes in univentricular mechanics during adolescence and its association with outcomes.

Objective

We aimed to a) examine changes in ventricular strain and torsion in adolescents and young adults with SV in comparison to healthy controls, and b. examine its association with markers of myocardial fibrosis on cardiac magnetic resonance (CMR).

Methods

This is a retrospective single center study of adolescents with Fontan circulation in comparison with controls. Speckle-tracking echocardiography was used to assess ventricular strain, torsion, and untwist. Torsion was measured as difference between apical and basal rotations. CMR volumetric and T1 relaxometry data closest to echocardiograms were obtained. Patients were compared to controls in 1:2 match.

Results

50 SV patients (27 LV, 17 RV, and 6 co-dominant) were compared to 100 controls. Demographics, echocardiographic, and CMR measurements are shown in table 1. Median duration from Fontan completion was 13.8 (10.6-16.6) years. Compared to controls, adolescents with SV demonstrated reduced global longitudinal strain [-17.1% (-7.4 to -20.1) vs -20.1%(-12.3 to -24.5), p = 0.01], circumferential strain [-15.2% (-9.1 to – 20.3) vs -19.2% (-12.3 to -23.7), p = 0.007], and radial strain

[25.2% (15.8 to 54.3) vs 39.4% (25.7 to 62.1), p = 0.01].  Torsion was reduced in patients compared to controls [5.2˚/cm (-4.5 to 16.1) vs 9.2˚/cm (-6.8 to 17.4) vs, p = 0.01] with decreased apical rotation [3.9˚/cm (-10.2 to 14.8) vs 5.7˚/cm (1.6 to 15.6), p = 0.001] and basal rotation [-1.5˚/cm (-7.5 to 3.7) vs -3.9˚/cm (-0.3 to -8.5), p = 0.04], respectively. T1 values were higher in SV patients compared to controls [1009 ± 36ms vs 958 ± 40ms, p = 0.004] and correlated with worse circumferential strain (r = 0.59, p = 0.04) and inversely correlated with torsion (r=−0.71, p = 0.02).

Conclusion

Adolescents with SV demonstrated a significant decrease in ventricular torsion compared to controls. The increased T1 times and its association with decreased ventricular strain and torsion in SV patients highlights a potential role for myocardial fibrosis in impairment of ventricular mechanics of these patients. Abstract Figure.