bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective cascade screening for transthyretin amyloid cardiomyopathy in patients undergoing spinal stenosis surgery: results of the CASS (Cardiac Amyloidosis in Spinal Stenosis) study
Authors: Debonnaire P , Claeys M , Trenson S , De Paepe P , Lycke M , Geerts B , De Geeter F , Hoste D , Van Meirhaeghe J , Van Droogenbroeck J , Verhoeven K , Janssens A , De Muynck S , Vantomme N , Tavernier R
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Ligamentum flavum hypertrophy due to transthyretin amyloid (ATTR) deposition is common in patients with symptomatic spinal stenosis, although prospective data on systematic screening for coinciding ATTR-cardiomyopathy (CM) are lacking.

Purpose

To evaluate a prospective screening strategy to identify de novo ATTR-CM in all-comers undergoing spinal stenosis surgery.

Methods

Patients undergoing symptomatic spinal stenosis surgery were prospectively screened for potential increased ATTR-CM risk, based on predefined criteria on electrocardiography, laboratory (hs-troponin, NT-proBNP), echocardiography and peroperative ligamentum flavum histology. ≥1 Positive criteria mandated ATTR-CM exclusion by HMDP-bonescintigraphy.

Results

In total 82 consecutive patients (mean age 68±9 years, 48% males) underwent prospective cascade screening. In 90% ≥1 positive risk criterium was noted and 4.1% of patients (n=3/74, 67% male) were identified with de novo ATTR-CM. Importantly, 59% (n=48/82) had ATTR deposition on ligamentum flavum biopsy, of which 21% (n=10/48) being <60 years old. ATTR burden on histology increased with age, the sole independent predictor of ATTR presence (HR 1.15, 95%CI 1.07–1.22, p<0.001). High ATTR burden (Westermark grade 4, ≥10% amyloid on ligamentum flavum histology) was noted in 12% (n=10/82). All 3 de novo ATTR-CM patients had high ATTR burden, translating into a prevalence and positive predictive value (PPV) of 30% (n=3/10) and 85% accuracy for ATTR-CM in Westermark grade 4 patients. Other increased risk markers with PPV>5% are hs-troponin, left ventricular wall thickness ≥12mm, global longitudinal strain >-20% and relative apical sparing.

Conclusions

High ATTR burden on ligamentum flavum histology during spinal stenosis surgery relates to high risk of coincident ATTR-CM.
Is myocardial fibrosis appropriately assessed by 2D strain derived integrated backscatter?
Authors: Lima M , Abecasis J , Reis Santos R , Maltes S , Guerreiro S , Campino Padrao C , Freitas P , Ferreira A , Ribeiras R , Andrade M J , Cardim N , Madeira M , Ramos S , Mendes M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Calibrated integrated backscatter (cIBS) may be obtained from bidimensional (2D) strain echocardiography as a quantification measurement of myocardial ultrasound reflectivity. Increased collagen content of the myocardium modifies tissue reflectivity and cIBS is suggested as a marker of left ventricular (LV) fibrosis. However, its diagnostic accuracy is not established.

Aim

To assess the correlation between cIBS by 2D strain and LV myocardial fibrosis (MF), as evaluated by non-invasive imaging and histopathology.

Methods

Correlation study from a cohort of 157 patients with severe symptomatic aortic stenosis (AS) referred for surgical aortic valve replacement (AVR). Patients with complete preoperative transthoracic echocardiography, cardiac magnetic resonance (CMR) and endomyocardial biopsy (EMB) obtained from the anterior basal septum at the time of AVR were selected. Two groups of 30 patients were evaluated, with and without late gadolinium enhancement (LGE) at CMR. IBS was obtained at QRS peak in decibels (dB) from both parasternal long axis (PLAX) and apical three chamber (A3C) cine clips at Qanalysis (Figure 1A). cIBS was calculated by subtracting the pericardial intensity from the average of the anteroseptal and basal inferolateral wall values. Correlation analysis was performed for the whole group of patients with global and segmental (anterior basal septum) values of native T1 and extracellular volume (ECV), and EMB collagen volume fraction (CVF) from Masson´s Trichrome staining. IBS values were compared in both group of patients.

Results

60 patients (73 [68–74] years, 45% male) with high gradient (mean gradient: 64±20mmHg), normal flow (45±10mL/m2), preserved ejection fraction (60±9%) AS. Basal septal cIBS was −9.2±9.5dB and −16.3±7.9dB from A3C and PLAX views, respectively. These indexes did not correlate with basal septum thickness or global LV mass. Absolute and cIBS did not correlate neither with global and regional T1 and ECV values, nor with CVF at EMB (Figure 1B). These were not significantly different in both groups of patients and there was no correlation between cIBS values and mass of replacement MF in patients with LGE.

Conclusion

In these cohort of patients with classical severe AS, there was no correlation of cIBS with imaging markers of both replacement and diffuse MF. cIBS also didn´t correlate with CVF at histopathology. These findings suggest that reflectivity indexes are not suitable for myocardial tissue characterization in this setting.
Impact of myocardial inflammation on quantitative myocardial perfusion at long-term follow-up - a descriptive hybrid PET/MR myocarditis study
Authors: Buechel R , Ciancone D , Bakula A , Schmidt G A , Patriki D , Benz D C , Giannopoulos A A , Kaufmann P A
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation (SNSF).

Background

Whether myocardial inflammation causes long-term sequelae potentially affecting myocardial blood flow (MBF) is unknown.

Objectives

To assess the effect of myocardial inflammation on quantitative MBF parameters, as assessed by 13N-ammonia positron emission tomography myocardial perfusion imaging (PET-MPI) late after myocarditis.

Methods

Fifty patients with a history of myocarditis underwent cardiac magnetic resonance (CMR) imaging at diagnosis and PET/MR imaging at follow-up at least 6 months later. Segmental MBF, myocardial flow reserve (MFR), and 13N-ammonia washout were obtained from PET, and segments with reduced 13N-ammonia retention, resembling scar, were recorded. Based on CMR, segments were classified as remote (n=469), healed (inflammation at baseline but no late gadolinium enhancement [LGE] at follow-up, n=118), and scarred (LGE at follow-up, n=72). Additionally, apparently healed segments but with scar at PET were classified as PET discordant (n=18).

Results

Compared to remote segments, healed segments showed higher stress MBF (2.71mL*min-1*g-1 [IQR 2.18–3.08] vs. 2.20 mL*min-1*g-1 [1.75–2.68], p<0.0001), MFR (3.78 [2.83–4.79] vs. 3.36 [2.60–4.03], p<0.0001) and washout (rest 0.24/min [0.18–0.31] and stress 0.53/min [0.40–0.67] vs. 0.22/min [0.16–0.27] and 0.46/min [0.32–0.63], p = 0.010 and p = 0.021, respectively). While PET discordant segments did not differ from healed segments regarding MBF and MFR, washout was higher by ∼30% (p<0.014). Finally, 10 (20%) patients were diagnosed by PET-MPI as presenting with myocardial scar but without corresponding LGE.

Conclusions

In patients with a history of myocarditis, quantitative measurements of myocardial perfusion as obtained from PET-MPI remain altered in areas initially affected by inflammation.
Right heart echocardiographic parameters and outcomes of patients with aortic stenosis after transcatheter aortic valve implantation
Authors: Brandao M , Mendes L , Diaz S , Santos-Ferreira D , Barros A , Rodrigues A , Braga P , Sampaio F , Fontes-Carvalho R
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The impact of right ventricular (RV) function and RV to pulmonary artery (RV-PA) coupling on outcomes of patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), and the early effect of the intervention, remain partly unclear.

Aim

To evaluate the impact of right heart echocardiographic (echo) parameters on the outcome of patients undergoing TAVI.

Methods

Retrospective analysis including consecutive patients submitted to TAVI at our center between 2007–2021.

Pre and postprocedural (≤96h) echo parameters were analyzed: tricuspid annular plane systolic excursion (TAPSE), S-wave tissue Doppler velocity of the tricuspid annulus (S'), pulmonary arterial systolic pressure (PASP). TAPSE/PASP ratio was used as a surrogate of RV-PA coupling; TAPSE/PASP ratio<0.31 defined RV uncoupling.

Primary endpoint (PE) was defined as all-cause death within 1-year after TAVI. Echo parameters were compared between patients according to the PE. Pairwise comparison of pre- and post-TAVI indexes was also performed, for the overall cohort and according to the primary endpoint. Statistical significance was considered if p<0.05.

Results

Of 1040 TAVI patients, 615 patients with complete echo data were included: median age 81 years, 53% female, left ventricular ejection fraction 55(45–60)%. Before TAVI, 60 patients (11%) presented RV dysfunction (TAPSE<17mm), and 30 (15%) RV-PA uncoupling.

A significant reduction in PASP was observed after TAVI (40 vs 36 mmHg, p<0.01).[image] TAPSE decreased post-TAVI (20.0 vs 19.5 mm, p = 0.04); S’ values did not differ between evaluations (11.20 vs 11.50, p = 0.08).

1-year follow up data was available for 467 patients; the primary endpoint occurred in 37 (7.9%) patients. Patients meeting the PE had higher preprocedural PASP (42 vs 39 mmHg, p = 0.036). PASP decreased after TAVI (39 vs 36 mmHg, p<0.001) in patients who survived the 1st year, but not in patients meeting the PE (p = 0.82).

Postprocedural TAPSE/PASP ratio was lower in the deceased group (0.43 vs 0.57, p = .031); persistence of RV-PA uncoupling post-TAVI was more frequent in patients who met the PE (25% vs 8.1%, p = .047).

Conclusions

In this cohort, RV longitudinal function parameters did not improve after TAVI. Contrastingly, RV-PA coupling improved after the procedure. Persistence of RV-PA uncoupling after TAVI was more frequent in patients who died during the 1st year of follow-up.
Association of strain echocardiography with cardiovascular outcomes in patients with heart failure with preserved ejection fraction
Authors: Frye J T , Tao M , Ghosalkar D , Rahman T , Tam E , Dianati-Maleki N
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Speckle Tracking Echocardiography (STE) with measurement of Left Ventricular Global Longitudinal Strain (LVGLS) is an important predictor of morbidity and mortality in Heart Failure with Reduced Ejection Fraction (HFrEF), but its prognostic importance in Heart Failure with Preserved Ejection Fraction (HFpEF) is less clear. The purpose of this meta-analysis is to analyze the association between LVGLS and Major Adverse Cardiac Events (MACE) in HFpEF.

Methods

A literature search was conducted for studies reporting on STE in patients with HFpEF and the association between LVGLS and MACE. The databases queried were Pubmed, Embase, and Web of Science. The search was not restricted to time or publication status.

Results

A total of 9 studies with 2,082 total patients met inclusion criteria. Among these, 5 studies with 944 HFpEF patients (300 with future MACE, 644 without future MACE) compared baseline mean LVGLS. Mean follow up duration was 28 months (ranging 12–48 months), mean age was 67 years old, 39.4% were male. LVGLS was significantly reduced in patients who eventually had MACE compared to those without MACE on follow-up (MD −2.09, 95% CI −2.17, −2.01, p < 0.01).

4 studies with 1,138 HFpEF patients (676 with impaired LVGLS below cutoff, 462 with unimpaired LVGLS above cutoff) compared all-cause mortality or heart failure hospitalization. Mean follow up was 35 months, mean age was 71 years old, 38.3% were male, and the average LVGLS cutoff was 14. Impaired LVGLS below cutoff was associated with significantly higher risk of MACE (OR 2.13, 95% CI 1.67, 2.72, p < 0.01). Subgroup analysis demonstrated that impaired LVGLS below cutoff was associated with significantly higher risk of both all-cause mortality (OR 2.11, 95% CI 1.40, 2.97, p < 0.01) and heart failure hospitalization (OR 2.16, 95% CI 1.53, 3.06, p < 0.01).

Conclusions

STE and measurement of LVGLS may represent a useful clinical tool in risk stratification of HFpEF patients at risk for future mortality and adverse cardiac events.
Long term prognostic value of global myocardial work in patients with heart failure with mildly reduced ejection fraction
Authors: Chang W
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Heart failure (HF) with mildly reduced ejection fraction (HFmrEF) is defined as HF with a left ventricular (LV) ejection fraction (LVEF) of 41–49%. However, the change in LV function and the subsequent prognosis in these patients remain unclear. Echocardiographic global longitudinal strain (GLS) is a useful measure for detection of myocardial function but is influenced by blood pressure changes. In contrast, myocardial work (MW), incorporating blood pressure, may overcome the limitation.

Objectives

We aimed to investigate whether LV MW could differentiate the changes of LVEF and predict the clinical outcomes in patients with HFmrEF.

Methods

In this prospective cohort study, 273 outpatients with HFmrEF underwent echocardiograms at diagnosis and one year after HF therapies. GLS, global work index (GWI), global constructive work (GCW), global wasted work, and global work efficiency were measured. The observed clinical outcome was hospitalizations for HF. Regression analysis was used to study the combined use of GLS and MW for the diagnostic and prognostic assessment of HFmrEF.

Results

Among patients with HFmrEF, the more impaired the LV GLS at baseline, the higher probability of worsening EF development. An absolute change in GLS and GWI were associated with subsequent worsening EF. Change in GWI and GCW demonstrated incremental value over GLS and clinical factors for the diagnosis of concurrent worsening EF. Regarding the clinical outcome, patients who presented with worsening EF had a higher risk of hospitalization for HF. In Cox regression, patients with more preserved GLS or lesser GLS decline during the follow-up had a lower risk of hospitalization for HF. Notably, the combined use of GLS and MW add incremental value on the prognosis in patients with HFmrEF.

Conclusions

GLS can be used for differentiating the changes of LVEF and subsequent hospitalization for HF in patients with HFmrEF while MW added predictive values.
Changes in echocardiographic parameters over time in paradoxical low-flow low-gradient aortic stenosis
Authors: Galian-Gay L , Teixido-Tura G , Casas G , Fernandez-Galera R , Ferrer-Sistach E , Mitroi C , Saura D , Vidal B , Moral S , Calvo F , Sanchez V , Gonzalez A , Rodriguez Palomares J F , Ferreira-Gonzalez I , Evangelista A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Although paradoxical low-flow low-gradient (LFLG) aortic stenosis (AS) has been considered a more severe form of AS with a worse prognosis than high-gradient (HG) AS, data on the natural history of this entity are scant.

Objectives

To assess the progression of the disease and evolution of the main echocardiographic variables for quantifying AS in patients with severe LFLG AS compared to HG and normal-flow low-gradient (NFLG) AS.

Methods

A longitudinal, observational, multicenter study including consecutive asymptomatic patients with severe AS (AVA<1.0cm²) and normal LVEF (≥50%) was conducted. Patients were classified according to baseline echocardiography into one of three groups: HG (mean gradient≥40 mmHg), NFLG (mean gradient<40 mmHg, indexed systolic volume (SVi)>35ml/m²), or LFLG (mean gradient<40mmHg, SVi≤35ml/m²). AS progression was analyzed by comparing patients’ baseline measurements and their last follow-up measurements or those taken prior to aortic valve replacement (AVR).

Results

Of the 903 included patients, 401 (44.4%) were HG, 405 (44.9%) NFLG, and 97 (10.7%) LFLG. The median total follow-up time was 60.2 months (IQR 44.7–83.4). Progression of the mean gradient in a linear mixed regression model was greater in low-gradient groups: LFLG vs. HG (regression coefficient 0.124, p = 0.005) and NFLG vs. HG (regression coefficient 0.068, p = 0.018). No differences were observed between the LFLG and NFLG groups (regression coefficient 0.056, p = 0.195). However, aortic valve area (AVA) reduction was slower in the LFLG group compared to the NFLG (p<0.001). During follow-up, 19.1% (n=9) of LFLG patients evolved to having NFLG AS and 44.7% (n=21) to having HG AS. 58.0% of patients underwent AVR with HG AS (n=29).

Conclusions

LFLG AS shows an intermediate AVA and gradient progression compared to NFLG and HG AS. The majority of patients initially classified as having LFLG AS changed over time to having other severe forms of AS, and most of them received AVR with HG AS.
Asymptomatic left ventricular systolic dysfunction in hypertensive patients with disturbed ventriculo arterial coupling
Authors: Georgieva N , Kinova E , Goudev A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Left ventricular (LV) ejection fraction (LVEF) is most commonly used validated echocardiographic parameter of systolic function estimation, but left ventricular (LV) global longitudinal strain (GLS) is an early indicator of subclinical cardiac dysfunction, even when LVEF is normal.

Purpose

To investigate ventriculo – arterial coupling (VAC) and LV function in asymptomatic hypertensive patients without target organ damage to compare different echocardiographic parameters for systolic function.

Methods

A total 110 patients (56 ± 14 years) with hypertension, were separated in two groups: 32(men, ( 59 %)) patients with normal AE/Ees ratio (Arterial elastance (AE) and ventricular elastance (Ees)) and 78 (men, ( 64%)) hypertensive patients with decrease AE/Ees ratio, marker for ventriculo – arterial coupling. All patients underwent standard two – dimentional echocardiography with Speckle tracking analysis for LV - GLS. End – systolic pressure was determined from the brachial pulse wave. Arterial elastance (AE) and ventricular elastance (Ees) were calculated as and – systolic pressure/stroke volume and end – systolic pressure/end – systolic volume.

Results

Patients with disturbed VAC had concentric hypertrophy whereas patients with normal VAC had concentric remodeling. There were no significant differences in EF, but GLS in all patients was reduced. There were no statistically significant differences in LV diastolic function parameters. Statistically significant differences in echocardiographic parameters were found in patients with normal VAC in comparison with disturbed VAC (TABL. 1), There are negative correlation between LV - GLS and AE/Ees (r = -0.327, p = 0.001) and positive with Ees (r=0.250, p = 0.015).

Conclusion

LV - GLS is a more sensitive parameter of LV systolic function than LVEF, when LV concentric hypertrophy is present in hypertensive patients. Further investigation are needed to confirm the superiority of GLS over LVEF in LV systolic function estimation and its implementation in clinical practice.
Cardiopulmonary exercise test with bicycle stress echocardiography for prediction of cardiac events in patients with stage A or B heart failure
Authors: Ahn H , Cho G Y , Yoon Y E , Hwang I C , Choi H M , Choi H J , Park J S , Kang S E
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Given the high prevalence of stage A or B heart failure (HF), screening for all these patients to development of new HF can be cost prohibitive, hence, further risk stratification may be needed to identify higher risk patients.

Purpose

This study aims to assess the prediction of adverse cardiac events using by cardiopulmonary exercise test (CPET) with bicycle stress echocardiography (BSE) in patients with stage A or B HF.

Methods

Of 688 patients who underwent CPET and BSE at the same time, 423 patients with stage A or B HF were analyzed.

Results

After median of 8 years of follow-up, 59 (13.9%) of the 423 patients had events. Cardiac events were defined as hospitalization for new HF and cardiac death. In univariate analysis, age, LV mass index, LA volume index, LA strain, baseline or exercise E/e’, TR velocity, peak oxygen consumption (VmaxO2), ventilatory sufficiency (VE/VCO2), diastolic flow reserve, and diabetes mellitus were associated with events. However, LV volume, LVEF and systolic flow reserve were not associated. In multivariate analysis, baseline E/e’ (HR 1.07, 95% CI 1.03–1.11) and VE/VCO2 (HR 1.100, 95% CI 1.04–1.16) were only independent predictors for events.

Conclusions

In patients with stage A or B HF, baseline E/e’ and ventilatory sufficiency obtained from an CPET were good predictors of future development of HF and cardiac death.
Impact of the new classification of tricuspid regurgitation on the baseline characteristics and prognosis of a wide series of "real life" patients
Authors: Fernandez Ruiz A , Ruiz Ortiz M , Resua Collazo A , Fernandez Aviles Irache C , Campos Heredia G , Rodriguez Almodovar A , Esteban Martinez F , Delgado Ortega M , Piserra Lopez De Heredia A , Cortes N , Moran Salinas A , Nistor A , Gonzalez Manzanares R , Mesa Rubio D , Pan Alvarez-Ossorio M
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Andalusian Society of Cardiology

Introduction

A new classification of severe tricuspid regurgitation (TR) has recently been described that distinguishes three subgroups: severe, massive and torrential. Our objective was to analyse the prevalence of the new categories, describe their baseline characteristics according to severity group and assess their impact on the prognosis in a large series of patients with severe TR of a tertiary care hospital in our area.

Methods

All consecutive patients ≥18 years with severe TR studied with echocardiography in a tertiary care hospital in our area from 01.01.2008 to 12.31.2017 were retrospectively included. Images were analysed off-line to measure the maximum vena contracta (VC) in any echocardiographic plane and severe TR was classified into three groups: severe (VC≥7mm), massive (VC 14–20mm) and torrential (VC≥21mm). Baseline characteristics were analysed in the different subgroups and follow-up events by univariate and multivariate techniques. The combined event of death and heart failure (HF) admission on follow-up was investigated.

Results

A total of 661 patients (69±13 years, 72% women) with severe TR were included. 81.5% (539) presented severe TR, 15.6% (103) massive TR and 2.9% (19) torrential TR. The baseline characteristics were different according to the different subgroups of severity (Table). The 5-year HF-free survival was 42%, 44% and 11% (p<0.0005), for the different subgroups, respectively (Figure). After adjusting for baseline characteristics, the severity of TR assessed by VC was independent predictor of HF-free survival, HR 0.89 [95%CI 0.70–1.15] p = 0.39, for massive TR; and HR 2.48 [95% CI 1.52–4.05] p<0.0005, for torrential TR considering severe TR as reference.

Conclusions

In this large monocentric study, severe TR measured by VC was the most frequent subgroup, followed by massive and torrential. The prognosis was significantly worse in patients with torrential TR.
Effective echocardiographic parameters for predicting cardiac tamponade in patients with large amount of pericardial effusion
Authors: Park S , Son B J , Kim H J , Choi K U , Nam J H , Lee C H , Son J W , Park J S , Shin D G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac tamponade is life-threatening medical condition that needs rapid diagnosis and pericardiocentesis. For diagnosing cardiac tamponade, comprehensive and complex doppler echocardiographic evaluation is necessary. The aim of this study was to evaluate the echocardiographic parameters for differentiating cardiac tamponade in patients with large amount of pericardial effusion.

Methods

From March 2003 to January 2020, 392 patients with large amount of PE with TTE evaluation were enrolled. We divided the patients into two groups; group A: patients performed subsequent drainage (n=197), group B: patients who are not performed drainage (n=195). Quantitative echocardiographic parameters were compared between two groups and analyzed which parameters were related with cardiac tamponade.

Results

The patients in group A showed low left ventricular end-diastolic diameter/body surface area (LVEDD/BSA) (25.44 ± 7.75 vs. 28.86 ± 6.10 mm/m2, p<0.001), left atrium volume index (LAVI) (24.08 ± 13.53 vs. 42.69 ± 28.69 ml/m2, p<0.001), early diastolic mitral inflow velocity (E velocity) (0.63 ± 0.18 vs. 0.88 ± 0.31 m/s, p<0.001), right ventricular systolic pressure (RVSP) (31.23 ± 9.47 vs. 39.16 ± 16.49 mmHg, p<0.001), early diastolic mitral inflow velocity/early diastolic mitral annular tissue velocity (E/e’) (11.62 ± 5.07 vs. 16.56 ± 7.75, p<0.001) compared with group B. In the multivariable analysis, E velocity was the most statistically significant parameter (Odds ratio=0.034, 95% CI=0.003–0.470, p = 0.012) and LAVI was the second one (Odds ratio=0.952, 95% CI=0.913–0.993, p = 0.022) related with cardiac tamponade. The ROC curve showed the cutoff value of E velocity was 0.678 m/s (sensitivity=0.675, specificity=0.673) and that of LAVI was 26.62 ml/m2 (sensitivity=0.681, specificity=0.679) for no need of pericardial drainage.

Conclusion

In patients with large amount of PE, E velocity and LAVI can be simple and useful echocardiographic parameters to differentiate the patients with cardiac tamponade who need pericardial drainage.
Prognostic role of feature tracking strain in stress cardiac magnetic eesonance (the PROGRESS study)
Authors: Guglielmo M , Fusini L , Baessato F , Baggiano A , Mushtaq S , Annoni A , Carerj M L , Fazzari F , Penso M , Volpe A , Tassetti L , Guaricci A I , Van Der Bilt I , Van Der Harst P , Pontone G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Objectives

This study aims to assess the role of feature-tracking (FT) strain in the long-term risk stratification of a large population of patients with known or suspected coronary artery disease (CAD) undergoing stress cardiac magnetic resonance (S-CMR) with dipyridamole.

Background

Recently, FT strain has been applied to S-CMR to improve risk stratification of patients with known or suspected CAD. However, no data are available on the prognostication role of FT strain in patients undergoing a S-CMR with dipyridamole.

Methods

729 consecutive patients (age: 63±10 y, male 84%) with stable symptoms suggesting possible cardiac ischemia underwent dipyridamole S-CMR and followed up for 5.8±1.2 years. CMR-FT analysis was performed in each patient to obtain 2D global peak systolic rest and stress longitudinal (GLS), circumferential (GCS), and radial strain (GRS). Major adverse cardiac events (MACE) were defined as non-fatal myocardial infarction and cardiac death.

Results

MACE occurred in 70 (9.6%) patients. At multivariate analysis, the presence of late gadolinium enhancement (LGE) (HR 2.737 [95% CI 1.534–4.884]), p <0.001, and stress GCS (HR 1.064 [95% CI 1.011–1.119]), p = 0.0164 were independently associated with MACE. By Kaplan-Meier analysis, patients with stress GCS >-15% had significantly reduced event-free survival compared with those with stress GCS ≤-15 (log-rank p = 0.007). The best predictive model of MACE included left ventricular ejection fraction (LVEF) + positive S-CMR for inducible ischemia (positive S-CMR) + LGE. A model based on LVEF + stress GCS (contrast free) showed higher performance in predicting MACE compared to LVEF alone and a similar performance compared to LVEF + positive S-CMR (p =0.05).

Conclusions

In patients with known or suspected CAD undergoing S-CMR with dipyridamole, stress GCS and LGE presence are independent predictors of MACE. Adding strain analysis of stress GCS can help define patients' risk after S-CMR on top of LVEF without needing contrast agents.
Comparison of functional tricuspid regurgitation after transcatheter closure of atrial septal defect in patients with sinus rhythm and atrial fibrillation
Authors: Noda S , Hashimoto K , Miyamoto J , Tanaka H , Kamioka N , Murakami T , Tanaka S , Ohno Y , Nagai T , Ikari Y
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Significant tricuspid regurgitation (TR) often improves during the long-term follow-up period after transcatheter atrial septal defect (ASD) closure. However, It is unknown whether ASD closure improves TR in patients with atrial fibrillation (AF).

Methods

Between 2016 and 2021, 66 consecutive patients (66% males, mean age 58 +/- 16 years, 30% with AF, 68% with severe/moderate TR) underwent transcatheter ASD closure and were evaluated with transthoracic echocardiography at baseline, 1day, 1 month and 1 year.

Results

Sinus rhythm(SR) group showed an improvement in TR one month after ASD closure, which persisted at 12 months, whereas AF group demonstrated no improvement in TR after one month and 1 year.(figure1)

Right atrial volume index improved in both groups, but tricuspid annular diameter showed no improvement in AF group.(figure2)(figure3)

Conclusion

Decrease in tricuspid annular diameter was significantly associated with TR improvement after ASD closure. Our findings suggest that TR is less likely to improve in patients with AF since ASD closure had less impact in tricuspid annular diameter.
Echocardiographic indices of right ventricular function differentiate pre- and post-capillary pulmonary hypertension
Authors: Lindqvist P , Venkateshvaran A
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Heart and Lung foundation

Background

The importance of assessing right ventricular (RV) function in heart failure is well established. Methods evaluating intrinsic RV function using Doppler echocardiography estimating RV -pulmonary coupling assessment might improve the understanding of RV response due to increase in RV afterload in different conditions.

Aim

To investigate RV function and RV-pulmonary coupling in patients with pre- and postcapillary pulmonary hypertension.

Material and Methods

We investigated 85 patients with pulmonary hypertension (PH) defined as mPAP >20mmHg from right heart catheterization (RHC). Those having PH with PCWP≤15mmHg and PVR ≥ 3WU were categorized as pre-capillary PH (preCPH, n=60) and those with PCWP>15mmHg and PVR <3WU as post-capillary PH (postCPH, n=25). Of those 25 having postCPH, 16 had HFrEF (LVEF<50%) and 9 HFpEF )LVEF≥50%). Doppler echocardiography and RHC were done simultaneously.

Results

Pulmonary artery acceleration time (<0.01), sPAP (<0.01) and regional RV strain ( p<0.05) differed between pre- and postCPH, whereas RV -pulmonary coupling did not, table 1. The indirect echocardiographic measure demonstrating strongest association with Ees/Ea (volume method= SVrhc/ESVecho) in patients with preCPH was mPAP/CO (r=0.61, fig 1A), RV s’/sPAP and RVGLS/sPAP (r=0.62, fig 1B, and 0.57 respectively). RV e’, RV segmental and global strain were lower in HFrEF compared with HFpEF but RV-pulmonary coupling did not differ between groups.

Conclusion

Right ventricular-pulmonary coupling and RV free wall strain had low accuracy to differentiate pre- from post CPH which was not the case for PAAt, sPAP and RV regional strain. mPAP/CO and RVs’/sPAP suggests promise as markers for right ventricular- pulmonary coupling, especially in pre CPH.
Right ventricular function in patients with significant tricuspid regurgitation
Authors: Bombace S , Viggiani G , Meucci M C , Esposito G , Condorelli G , Von Roeder M , Lurz P , Grayburn P A , Sannino A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Aim

The aim of this meta-analysis was to systematically investigate the prognostic value of right ventricular (RV) function in all-comers patients with significant (at least moderate, ≥ 2+) tricuspid regurgitation (TR).

Background

Chronic significant TR imposes a volume overload to the RV leading to a progressive RV dilatation and dysfunction. A comprehensive assessment of RV function is of paramount importance to guide the therapeutic management of these patients; however, it remains challenging, particularly in presence of altered loading conditions.

Methods

MEDLINE, ISI Web of Science, and SCOPUS databases were searched for studies published up to July 2022. Studies reporting data on at least one echocardiographic RV function parameter and outcome in patients with significant TR were included. This study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) requirements. The primary endpoint was all-cause long-term mortality (more than one year).

Results

Out of 3,152 studies, a total of 10 were included in the analytic synthesis, enrolling 3435 subjects. The median follow-up in our study population was 28 [22 – 70] months. All-cause long-term mortality was 40% (95% confidence interval [CI]: 32–49%, p = 0.028; Figure 1). To explore the potential impact of effect size modifiers on all-cause long-term mortality, we performed a meta-regression analysis of the baseline characteristics of the included studies. At long-term, a significant relation was found between RV fractional area change (RV-FAC), tricuspid annular plane systolic excursion (TAPSE), tricuspid annular tissue doppler imaging systolic velocity (TDI s’) and mortality. In particular, RV-FAC was associated with reduced incidence of all-cause mortality [7 studies enrolling 2,611 subjects, intercept 5.18, slope −0.15, P = 0.007; Figure 2]; whereas both TAPSE and TDI s’ were unsatisfactory to predict the outcome in these patients [TAPSE 9 studies enrolling 2,891 subjects, intercept 1.73, slope −0.12, P = 0.36; TDI s’ 5 studies enrolling 1429 subjects, intercept −2.06, slope 0.15, P = 0.78]. Interestingly, diabetes mellitus (DM) and hyperlipidaemia were associated with an increased risk of mortality [DM 9 studies enrolling 3371 subjects, intercept −2.62, slope 0.09, P = 0.004; hyperlipidaemia 6 studies enrolling 2338 subjects, intercept −2.91, slope 0.05, P = 0.01].

Conclusions

Significant TR is associated with increased risk of all-cause. To our knowledge, this is the first study to demonstrate that only RV-FAC, and not conventional echocardiographic indexes of RV longitudinal function, correlates with adverse outcomes in patients with significant TR.
Validating aortic stiffness parameters by cardiac magnetic resonance against mechanical testing of ex-vivo aortic aneurysms specimens
Authors: Guala A , Cilla M , Teixido-Tura G , Martinez M , Dux-Santoy L , Ruiz Munoz A , Garrido-Oliver J , Galian-Gay L , Morales A , Carrasco-Poves A , Ferreira-Gonzalez I , Evangelista A , Pena E , Rodriguez-Palomares J F
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Sociedad Española de Cardiología

Background

Aortic stiffness is a predictor of incident cardiovascular events and mortality in the general population (1). Cardiovascular magnetic resonance (CMR) imaging allow to compute a number of parameters, such as pulse wave velocity (PWV), distensibility (AD) and aortic longitudinal strain, theoretically related to aortic wall stiffness, but no formal validation has ever been reported.

Purpose

To test the correlation between aortic PWV, AD and longitudinal strain and aortic wall stiffness as assessed via ex-vivo mechanical testing of aortic specimens.

Methods

Patients undergoing ascending aorta (AAo) aneurysms resection underwent a CMR study which included bSSFP images and a 4D flow CMR of the thoracic aorta. At surgery 2 AAo specimens (each 15x5 mm, one oriented in the longitudinal and the other in circumferential aortic direction) were extracted, maintaining a record of their in-vivo position and orientation, and frozen. Specimens were tested under control for extension force (I5558, INSTRON) and elongation was quantifies by laser video extensometer (2663–281, INSTRON). The Young's modulus (E), i.e. tangent of the stress-strain curve, was quantified at the patient’s diastolic pressure during CMR (2). AAo PWV was extracted from 4D flow CMR study and the product of Eh (h being wall thickness) was computed via the Moens-Korteweg equation using the mean AAo diameter(3,4). AD was quantified from cine CMR at the pulmonary artery level using ARTFUN software (INSERM U678, France) while AAo longitudinal strain was assessed as mean deformation of the AAo by tracking the aortic root during the cardiac cycle (5).

Results

Twenty patients were included: age 52.5 [37.3 – 71.0] years, 13 (65%) male, BSA 1.94 [1.74 – 1.94] m2. Most of patients had AAo aneurysms of degenerative origin and a tricuspid aortic valve, while 2 patients had a bicuspid aortic valve, and 9 patients had connective tissue disorders. Due to missing data, one AD a two PWV could not have been computed while the specimen in circumferential direction of a patient could not be tested.

AAo PWV, Eh and AD were strongly associated with circumferential elastic modulus at diastolic blood pressure (R = 0.652, R = 0.602 and R = -0.502, respectively) (Figure 1). Strong association was also obtained between AAo longitudinal strain and longitudinal elastic modulus at diastolic blood pressure (R = -0.513).

Conclusion

Pulse wave velocity and the derived Eh product, aortic distensibility and aortic longitudinal strain as non-invasively assessed by CMR are reliable representation of aortic wall stiffness.
Validation and potential usefulness of the updated PROMISE Minimal Risk Tool in patients with suspected coronary artery disease undergoing coronary CT angiography
Authors: Lima M , Lopes P , Albuquerque F , Presume J , Freitas P , Silva C , Guerreiro S , Abecasis J , Saraiva C , Coutinho Santos A , Araujo Goncalves P , Mendes M , Ferreira A , Marques H
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The steady decline in test positivity among patients with suspected coronary artery disease (CAD) has raised interest in developing strategies to identify patients who may not require testing. The updated PROMISE minimal-risk tool (PMRT) was developed specifically for this purpose, but never tested in our population.

The aim of this study was to assess the diagnostic performance of this new tool, and to compare it with the guideline-recommended pre-test probability (PTP) and with the risk factor-weighted clinical likelihood (RF-CL) model in a Portuguese cohort of symptomatic patients undergoing coronary computed tomography angiography (CCTA).

Methods

We conducted a two-centre cross-sectional study of symptomatic patients undergoing CCTA for suspected CAD. Key exclusion criteria were age <30 years, known CAD, suspected acute coronary syndrome or symptoms other than chest pain or dyspnoea. A simplified version of the updated PMRT (without HDL-C), the guideline PTP, and RF-CL score were calculated for each patient. Obstructive CAD was defined as any luminal stenosis ≥ 50% on CCTA. ‘Low risk’ was defined as absence of obstructive CAD and coronary artery calcium (CAC) score < 100 (both conditions present, where CCTA results are unlikely to change patient management). The cut-off value of the PMRT with 95% positive predictive value for identifying patients with ‘Low risk’ was identified in ROC curve analysis.

Results

A total of 2162 patients (mean age 60±11years, 59% female) were included. Overall, 14.9% (N=323) of patients had obstructive CAD, and 73.5% (N=1589) fulfilled the criteria for ‘Low risk’. Patients with ‘Low risk’ were more frequently female, had higher prevalence of non-anginal chest pain and had fewer cardiovascular risk factors.

For obstructive CAD, the discriminative power of the updated PMRT was similar to the one provided by the guideline PTP and RF-CL models (Figure 1A). However, for identifying patients with ‘Low risk’, the updated PMRT showed greater discriminative power than the guideline PTP and RF-CL models (Figure1B).

The PMRT cut-off value with 95% positive predictive value for detecting patients at "Low risk" was identified as >46%. A total of 458 patients (21.2%) had a PMRT >46%.

Conclusion

In this cohort of symptomatic patients undergoing CCTA, the updated PMRT showed similar discriminative power for obstructive CAD, but greater discriminative power to identify "Low risk" than the guideline-recommended PTP and the RF-CL models. The criterion that identified "Low Risk" with 95% positive predictive value was present in roughly one fifth of patients undergoing CCTA, who would be less likely to derive benefit from testing.
Machine learning model including left ventricular strain analysis for sudden cardiac death prediction in hypertrophic cardiomyopathy
Authors: Al Wazzan A , Taconne M , Le Rolle V , Inngjerdingen Forsaa M , Hermann Haugaa K , Galli E , Hernandez A , Edvardsen T , Donal E
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The excess mortality in hypertrophic cardiomyopathy (HCM) patients is mainly attributed to the occurrence of sudden cardiac death (SCD). The prediction of ventricular arrhythmias remains challenging and could be improved.

Purpose

This study evaluated the added predictive value of a machine learning-based model combining clinical and conventional imaging parameters with information from left ventricular strain analysis to predict SCD in patients with HCM.

Methods

A total of 434 HCM patients (65% men, mean age 56 years) were retrospectively included from two referral centers from two different countries and followed longitudinally (mean duration 6 years). Strain parameters were automatically extracted from the left ventricle longitudinal strain segmental curves of each patient and included in a Ridge Regression model alongside conventional clinical and imaging data. The composite endpoint included sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator therapy, aborted cardiac arrest, or sudden cardiac death.

Results

34 patients (7.8%) met the endpoint with an incidence of ventricular arrhythmias of 0.9%/years. Among the 18 most discriminating parameters, 7 were derived from left ventricle longitudinal strain segmental curves analysis (figure 1). After n=200 rounds of cross-validation, the final model showed superior predictive performance compared to conventional models with a mean area under the curve (AUC) of 0.83 ± 0.8 compared with an AUC of 0.56 and 0.61 for the 2014 ESC risk score and the 2020 AHA/ACC model, respectively.

Conclusion

A machine learning model including automatically extracted left ventricular strain-derived parameters was superior in the prediction of sustained ventricular arrhythmias and SCD in patients with HCM compared to existing models. A machine learning model including left ventricle longitudinal strain analysis could improve SCD risk stratification in HCM patients.
T1 mapping in population ageing
Authors: Tambe' V , Esseridou A , De Simoni S , Moltrasi R , Bentivegna S , Schwarz E , Zanardo M , Secchi F
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

The world’s population is ageing: every country is experiencing growth in both the size and the proportion of older people. Common health states in older age mainly include cardiovascular disease. To ensure that our health system is ready to face this demographic shift, we investigated native and post-contrast T1 mapping as a quantitative method to appraise its clinical potential in older people.

Purpose

This article aimed to provide reference values of T1 mapping for quantification of the expansion of the extracellular matrix in older people.

Methods

We retrospectively selected subjects ranged in age from 86 to 101 years old that underwent contrast cardiac magnetic resonance (CMR). All subjects were imaged on a 1.5 T system. T1 measurements were performed with a Modified Look Lockers Inversion (MOLLI) recovery sequence. Regions of interest (ROI) were drawn in the left ventricle for blood T1 measurement and in the interventricular septum. We used T1 data obtained before and after contrast injection. We also measured the volume and function of both ventricles. Rho di Spearman was used for correlations.

Results

We analysed 29 patients (mean age 88.58±3.13 years old). Mean value of T1 in the blood pool (T1bp) was 1647.43±107.66 before contrast and 357.18±63.94 after contrast. Mean value of T1 in the septum (T1s) was 1012.86±38.41 before contrast and 488.68±69.29 after contrast. Left ventricle (LV) EDVI was 48.11±15.29 ml/m2 and ESVI 16.49±8.59 ml/m2, LV ejection fraction (EF) and stroke volume (SV) were 66.38±9.65 % and 52.39±18.84 ml respectively. Right ventricle (RV) EDVI was 46.44±13.19 ml/m2 and ESVI 16.97±5.93 ml/m2, LV ejection fraction (EF) and stroke volume (SV) were 63.46±8.65 % and 49.29±18.63 ml respectively. A significant negative correlation was found between age and T1s before contrast (r=-0.405 and p = 0.015). Positive correlations were found also between T1s before contrast and LV volumes.

Conclusions

This study shows a correlation between T1 mapping and population ageing.
Epicardial adipose tissue and subclinical incident atrial fibrillation in a population at risk of stroke - a cardiac magnetic resonance imaging study
Authors: Guldberg E , Diederichsen S , Haugan K , Brandes A , Graff C , Krieger D , Olesen M , Hoejbjerg S , Koeber L , Vejlstrup N , Bertelsen L , Svendsen J
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Innovation Fund Denmark.

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and is associated with a substantially increased risk of morbidity and mortality, including heart failure and stroke(1,2). Epicardial adipose tissue (EAT) is believed to provide both thermoregulation and mechanical protection to the heart and coronary arteries in healthy human beings(3,4), but the role of EAT in the development and severity of AF suggests deleterious effects of EAT. Since EAT shares blood circulation with the myocardium, it offers the opportunity for paracrine- and neuroendocrine signaling(5), which contributes to an arrhythmogenic- and pro-inflammatory state.

Purpose

While EAT assessed by cardiac magnetic resonance imaging (CMR) has been found predictive of clinical AF(5,6), the association with subclinical AF has not yet been established. This study aimed to investigate the association between EAT, determined by CMR, and incident AF following long-term continuous heart rhythm monitoring by implantable loop recorder (ILR) in an at-risk population.

Methods

This study is a sub-study of the LOOP study. In total, 203 participants without a history of AF received an ILR and underwent advanced CMR. All participants were at least 70 years of age at inclusion and had at least one of the following conditions: hypertension, diabetes, previous stroke, or heart failure. Volumetric measurements of atrial- and ventricular EAT were derived from CMR, as seen in Picture 1, and the time to incident AF was subsequently determined.

Results

A total of 78 patients (38%) were diagnosed with AF during a median of 40 (37–42) months of monitoring. Of these, only 7 (9%) participants reported symptoms of AF during arrhythmia episodes, i.e., 91% had subclinical AF. In multivariate Cox regression analyses adjusted for age, sex, body mass index (BMI), and comorbidities, we found EAT to be an independent marker for time to AF with hazard ratios (95% confidence intervals) up to 1.66 (1.17–2.36; p = 0.005) when analyzing the risk of new-onset AF episodes lasting ≥ 24 hours. The Cox regression analyses are presented in Picture 2, where we furthermore have adjusted for left atrial size (LAMIN) and left atrial function (LATEF).

Conclusion

Atrial EAT assessed by volumetric measurements on CMR images was significantly associated with the incident AF episodes as detected by ILR.