bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance of fully automated AI-based left ventricular strain measurement in cancer patients treated with immune checkpoint inhibitors
Authors: Tzuberi M , Laufer-Perl M , Merin R , Khoury S , Ben-Shoshan J , Kapusta L , Topilsky Y , Flint N
Published: January 2025

Background

Immune checkpoint inhibitors (ICIs) have improved clinical outcomes for various types of cancer. However, their use is associated with cardiotoxicity. Left ventricular global longitudinal strain (LV-GLS) is considered the standard of care for detecting early myocardial damage in patients treated with anti-cancer drugs. However, the routine use of LV-GLS is limited by its time-consuming nature, and the need for expert cardiologists. AI-based LV-GLS applications may offer a cost-effective alternative to conventional methods.

Purpose

To compare standard, semi-automated LV-GLS analysis to a fully-automated AI-based LV-GLS software, and to evaluate its performance in predicting cardiovascular (CV) events in patients treated with ICIs.

Methods

We retrospectively analyzed consecutive cancer patients who underwent baseline transthoracic echocardiography before the initiation ICIs therapy. All echocardiographic studies were performed by experienced sonographers. LV-GLS analysis was conducted using both standard semi-automated, vendor-independent software (TomTec) and fully-automated AI-based software (Us2.AI). CV events were defined as a composite of myocarditis, acute coronary syndrome, heart failure and arrhythmia. We examined the correlation between the two techniques and their ability to predict future CV events using logistic regression and receiver operating characteristic (ROC) curves. For simplicity, we report LV-GLS as a positive value.

Results

Out of 183 patients (mean age 65±12 years, 43% females) who underwent echocardiography assessment, 157 (86%) had adequate image quality for strain analysis. During a median follow up period of 48 months (IQR: 34-61), 23 (13%) patients experienced CV events. A significant difference was observed between the baseline mean standard LV-GLS and AI-based LV-GLS (18±2.9 vs. 20±2.9, P<0.001), with a moderate positive correlation between the two techniques (r=0.38, P<0.001). Lower standard LV-GLS was predictive of CV events (OR = 0.83, 95% CI 0.71-0.98, P=0.03), whereas AI-based LV-GLS did not (OR = 0.96, 95% CI 0.82-1.14, P=0.686). In ROC analysis, standard LV-GLS showed superior area under the curve compared to AI-based measurements, but the difference was not statistically significant (AUC 0.62 vs. 0.53, P=0.275).

Conclusions

Among cancer patients treated with ICIs, fully automated AI-based LV-GLS provided higher values compared to standard, semi-automated LV-GLS, with a moderate correlation between the two techniques. Only standard LV-GLS was predictive of future CV events. Further validation and specific cut-offs are required to enhance the predictive accuracy of AI-based LV-GLS.
Correlation between atrial strain and outcome in brugada syndrome
Authors: Diomede D , Conte G , Santoro F , Bergonti M , Ragnatela I , D'alessandro D , Niglio F P , Margaglione A , Leo L A
Published: January 2025

Introduction

Brugada Syndrome (BrS) is an hereditary channelopathy which can induce malignant arrhythmias that may lead to syncope or sudden cardiac death. The electrical substrate can be studied with an electrophysiological study in order to assess the risk of ventricular arrhythmias, but the role of echocardiography in this setting is still unclear.

Purpose

The primary aim of this study is to assess peculiar echocardiographic features in BrS patients vs healthy controls and their correlation with an high risk clinical setting.

Methods

We enrolled 153 patients affected by BrS (95 outpatients from Institute Cardiocentro Ticino of Lugano, and 58 outpatients from the arrhythmology clinic of Ospedali Riuniti of Foggia). The control group was composed of 57 healthy subjects with a negative provocative drug test. 100 out of the 153 affected patients have received a genetic testing for BrS associated genes. All patients have undergone a complete cardiologic examination, EKG, and echocardiography. The gathered data comprehend medical history, basal EKG, Shangai Score, clinical evaluation, genetic test, response to provocative test, 24-hrs holter EKG and ecocardiographic parameters: chambers quantification, ejection fraction, transmitralic doppler parameters, right ventricle function parameters, and longitudinal strain values.

Results

Atrial fibrillation (AF) was reported in 16 out of 153 (10.5%) BrS patients and in 2 out of 57 (3.5%) healthy controls. Among BrS patients, 15 (9.8%) reported major ventricular arrhythmias (VA). The analysis showed a significant divergence in BrS patients compared to healthy controls with regard to the following measurements: RAVI (23.8 ± 6.6 vs 20.7 ± 6.7); E/A (1.2 ± 0.4 vs 1.6 ±0.6); A wave (64.6 ± 18.7 vs 53.4 ± 16.9); DTE (215.4 ± 49.7 vs 190.4 ± 43.5); LASr-ED (44.5 ± 12.6 vs 50.8 ± 13.8); LAScd-ED (-27.5 ± 10.7 vs -33.8 ± 11.4); RASr-ED (39.5 ± 10.6 vs 47.9 ± 9.5); RAScd-ED ( -25.1 ± 8.7 vs -31.9 ± 8.3). Among BrS patients, at the univariate analysis the onset of atrial fibrillation was correlated to the following parameters: LAVI (p 0.001); RAVI (p 0.015); LASr-ED (p 0.013); LASct-ED (p 0.029). LAVI was also correlated to atrial fibrillation at the multivariate analysis (p 0.02). Ventricular arrhythmic episodes were correlated, among BrS patients, to RASct-ED (p 0.004) and LV-GLS (p 0.042) at the univariate analysis. RASct-ED was also correlated to ventricular arrhythmias at the multivariate analysis (p 0.011) and could predict VAs with a cut-off value of -10.85% (sensibility 0.75; specificity 0.79).

Conclusions

When compared to healthy controls, atrial reservoir and conduit phase are altered in BrS for both left and right atrium. AF episodes are correlated with atrial volumes and LA strain. VA episodes correlate with RASct-ED, which may be helpful as a prediction parameter (cut-off -10.85%). These features could help to better stratify high risk patients.
Left atrial mechanics and left ventricular function in cardiac amyloidosis patients treated with tafamidis
Authors: Carvalheiro R , Marques Antunes M , Cardoso I , Ferreira A , Viegas J , Bras P , Almeida I , Galrinho A , Cruz Ferreira R , Aguiar Rosa S
Published: January 2025

Introduction and aims

Patients with amyloid cardiomyopathy (ATTR-CM) present with a restrictive phenotype characterized by decreased ventricular compliance and increased filling pressures, with progressive loss of atrial function and increased stiffness, which are associated with poor clinical outcomes. Tafamidis improves clinical outcomes and slows disease progression but its effects in left ventricle (LV) and atrium (LA) mechanics are still unclear, with recent studies (reference 1.) suggesting improvement of LA function (as assesses by LA strain [LAS]) in patients with sinus rythm (SR). Our study aimed to characterize the 1-year evolution of LV function and LA mechanics in ATTR-CM patients treated with tafamidis.

Methods

We prospectively evaluated a cohort of patients with ATTR-CM treated with tafamidis in a single-centre.

Results

Out of 41 patients treated, 13 were excluded due to incomplete follow-up or poor quality of echocardiographic images that precluded LAS analysis. A total of 28 patients (75% male) were included, with a mean age of 80 ± 10 years at the start of treatment and a median follow up of 14 months. 11 pts (39%) were in sinus rhythm (SR group) and 17 (61%) were not (non-SR group). At the start of the treatment with tafamidis, mean LV ejection fraction (LVEF) was 55.5 ± 11.4%, GLS was -10.7 ± 4.3%, E/e’ 17.2 ± 5.4 and indexed LA volume (LAVi) 47.4 ± 15.3 mL/m2. Median NTproBNP was 2031 (3143) pg/mL and pts walked 313 ± 121m on the 6-minute walk test (6MWT). Regarding LAS, there was significant reduction in all atrial functional components in both SR (LAS reservoir 13.1 ± 12, LAS conduit -6.5 ± 4.2, LA contraction -6.6 ± 3.6) and non-SR groups (LAS reservoir 5.1 ± 3.6) as well as significantly increased LA stiffness (SR – 1.4 ± 0.9, non-SR – 6.1 ±6.0). Our analysis showed stabilization, with no statistically significant differences in LVEF, GLS, diastolic function parameters, LAS or LA stiffness, as well as NTproBNP and 6MWT after 1-year treatment with tafamidis (tables 1 and 2). We found a moderate correlation between LAS contraction and NTproBNP in the SR group (r=0.650, p=0.031) – meaning that worse (less negative) LAS contraction associated with higher NTproBNP values – despite there being no correlation between other echocardiographic variables ante NTproBNP or 6MWT.

Conclusions

In our cohort of patients, patients presented with significantly reduced atrial function and increased stiffness. 12-month treatment with tafamidis allowed stabilization of LA and LV performance, as well as of NTproBNP and 6MWT. We found a moderate correlation between LA contraction objectively evaluated by strain analysis and NTproBNP in SR patients, highlighting the importance of LA mechanical contraction preservation in patients with a restrictive cardiomyopathy phenotype.
Atrial strain assessment in elite athletes: unveiling physiologic adaptation
Authors: Baptista Carvalho A , Mendes L
Published: January 2025

Background

Left atrial (LA) strain, measured by speckle-tracking echocardiography, provides insights into cardiac function beyond traditional volumetric assessments. In athletes, the effects of chronic exercise on LA strain are unclear, with conflicting findings on whether it reflects physiological adaptation or potential dysfunction.

Aims

This study aimed to comprehensively assess LA remodeling and function in professional soccer players compared to controls. We hypothesized that while athletes would exhibit LA enlargement, their atrial function would remain preserved due to the physiological nature of cardiac remodeling in this population.

Methods

A retrospective analysis of echocardiographic parameters, namely left atrial strain, was carried out in a group of professional male athletes compared to a control group of healthy male individuals. A GE Vivid E95 echocardiographic ultrasound system and EchoPAC V.206 software (GE Vingmed Ultrasound AS, Horten, Norway) were used. Shapiro-Wilk test was used to test data distribution, ANOVA and t-test were used as a parametric tests, and Man-Whitney as a non-parametric Test (SPSS v.27).

Results

The study analyzed 111 athletes with a median age of 24 (21-31) years and 70 healthy male individuals from the control group with a median age of 27 (23-32) years.

Athletes had a significantly higher indexed left atrial end-systolic volume compared to the control group (41 ± 9 ml/m² vs. 31 ± 7 ml/m², p<0.001). Despite the difference in volume, the early and late diastolic tissue velocities were similar in both groups and E/E’ was lower (4.4 ± 0.9 vs. 5.0 (4.5-5.8), p<0.001). There were no significant differences between athletes and the control group in Left Atrial Reservoir Strain (LASr) and Left Atrial Conduit Strain (LAScd). The active contraction of the left atrium during atrial systole is reduced in athletes, which had a significantly lower left atrial contraction strain compared to the control group (-9 (-11 – -8)% vs. -12 ± 4%, p<0.001).

Conclusion

The data suggests that athletes' hearts have undergone specific adaptations, particularly in terms of increased left atrial size and altered contraction patterns. Maintaining atrial reservoir strain (the most validated parameter for normality) and atrial conduit strain within normal ranges may indicate that morphological changes are merely normal adaptations to the high cardiac output demands during exercise.

Descriptive analysis

LA strain example
Long COVID echocardiography, cardiac MRIi, and endomyocardial biopsy findings in previously healthy individuals
Authors: Gomez Monterrosas O G M , Martinez Juarez D M , Loyola G L , Jimenez Cisneros G J , Miro J M
Published: January 2025

Aims

There are many possible causes of myocardial injury in long COVID patients. The aim of the study was to search by endomyocardial biopsy EMB in patients with not previous comorbidities histopathological causes.

Material and Methods

This is part of a single center registry, 209 patients with chest pain due to long COVID without previous known comorbidities, all patients have had positive COVID polymerase chain reaction (PCR) or rapid antigen test. The median of 32.56 weeks following diagnosis, due to lack of improvement of symptoms with medical treatment, according with clinical, laboratory results, echocardiography, and cardiac magnetic resonance (CMR), the endomyocardial biopsy (EMB) was performed, a total of 16 patients from January 2021 to January 2024 were included.

Results

Of the 16 patients included,7 (43%) had persistent high-sensitive I troponin (HS-TnT) and 8 (50%) HS-CRP, all patients have low vitamin D level. 5 of them 31% evidenced myocardial injury in CMR, elevated T1 or T2 mappings, anormal extracellular Volume (ECV), or late gadolinium enhancement (LGE).

The main findings in histopathology, immunohistochemistry staining, and PCR proof of viral genome. 12 (75%) patients had had diffuse ischemic necrosis with loss of general myocardial architecture, and interstitial edema, early cellular degeneration in the presence of intracytoplasmic lipofuscin 2 patients have lymphocytic myocarditis criteria, from this 2, 1 had immunoperoxidase for SARS-Cov2 (Bio&Sb), where nuclei with uptake evidenced with diaminobenzidine favors virus infection (Sars-Cov2), 1 patient thrombotic microangiopathy and 1 AA amyloidosis.

Conclusion

Most of patients have diffuse ischemic necrosis instead, inflammatory changes, also it is possible to find AA amyloidosis and thrombotic microangiopathy

table 1 and 2
Left atrial stiffness index in patients with cryptogenic ischemic stroke: a clue of atrial fibrillation?
Authors: Gabrielli F A , Bencardino G , Abruzzese S , Di Renzo A , Colo' F , Lanza G A , Lombardo A , Pelargonio G , Burzotta F , Broccolini A
Published: January 2025

Introduction

About 25% of cryptogenic ischemic stroke are due to undiagnosed atrial fibrillation. New echocardiographic markers derived from left atrial strain analysis could be useful to early identify patients candidates to oral anticoagulation.

Purpose

Aim of our study was to investigate the relationship between left atrial strain parameters assessed by speckle tracking echocardiography (STE) and the new documentation of atrial fibrillation at follow-up in patients admitted for acute cryptogenic ischemic stroke.

Methods

From 2020 to 2023 consecutive patients admitted to Stroke Unit of our Hospital for cryptogenic ischemic stroke undergoing loop-recorder implantation were retrospectively enrolled in our study. Main exclusion criteria were previous diagnosis of atrial fibrillation and poor image quality. All patients underwent full echocardiographic examination, including left atrial strain analysis with STE by dedicated software.

Results

Sixty-nine patients were finally selected, divided in patients with and without atrial fibrillation at follow-up (26 and 43 pts, respectively). No clinically significant differences were found between the two groups at baseline. Analysing echocardiographic parameters, significant differences were found in patients with and without diagnosis of atrial fibrillation at follow-up, respectively, with regard to left atrial volume index (LAVi, 44.26 ± 10.58 vs 34.54 ± 11.03 ml/m2, p 0.005), peak atrial longitudinal strain of reservoir phase (PALSr 19.50 ± 8.48 vs 26.22 ± 9.11%, p 0.01) and contraction phase (PALSct 5.70 (0; 20.92) vs 11.23 (5.98; 16), p 0.017). Left atrial stiffness index was defined as the ratio between E/E’ (expression of left ventricular filling pressures) and PALSr. Using a cut-point of 0.55, identified with ROC analysis, a significant difference was found between the two groups (10/26 (38.4%) vs 4/43 (9.3%), p 0.002). Among all these parameters, at the multivariate logistic regression analysis only left atrial stiffness index showed a trend to the significance (p 0.06).

Conclusions

Left atrial strain analysis can be useful to better select patients with cryptogenic stroke who need loop-recorder implantation and a closer follow-up to prompt recognize atrial fibrillation. In particular, Left atrial stiffness index seems to be the most useful parameter to stratify patients at higher risk of atrial fibrillation.
Acute alterations in blood lactate in the setting of transient stress induced myocardial ischaemia
Authors: O'driscoll J , Smith E , Bibat M , Edwards J , Compton C L A I R E , Kipourou K , Coleman D , Wiles J , Cunliffe E , Marciniak A , Sharma R
Published: January 2025

Background

An elevation in resting venous blood lactate levels ([La-]b) in conditions of myocardial hypoperfusion is associated with adverse prognosis and survival. This investigation aimed to assess changes in venous [La-]b levels induced by dobutamine stress in the presence and absence of myocardial ischaemia and adverse outcomes at 1-year.

Methods

404 consecutive patients (mean age 70±10 years, 243 male) reporting chest pain underwent dobutamine stress echocardiography and were categorised as ischaemic (IS) or non-ischaemic (NI) responders. Conventional and global longitudinal strain (GLS) echocardiographic measures were recorded at rest. Venous [La-]b samples were acquired at rest, peak stress and 1, 3, 5 and 10-minutes into recovery using a commercially available Lactate Pro 2 device.

Results

There were no significant differences in [La-]b concentrations between IS (1.75±0.76 mmol×L-1) and NI (1.73±0.60 mmol×L-1) responders at baseline (p=0.592). However, [La-]b concentrations were significantly greater at peak stress (1.83±0.57 vs. 1.68±0.60 mmol×L-1), 1 (1.90±0.56 vs. 1.73±0.71 mmol×L-1), 3 (1.97±0.56 vs. 1.73±0.71 mmol×L-1), 5 (1.98±0.60 vs. 1.74±0.70 mmol×L-1), and 10-minutes (2.01±0.63 vs. 1.76±0.71 mmol×L-1) into recovery between IS and NI responders (all p<0.001), respectfully. GLS was significantly lower in IS compared to NI responders (-15.5±2.9 vs -16.2±2.7%, p=0.02) at baseline. In patients who experienced an adverse cardiac event during 1-year of follow-up, GLS (-14.4±2.7 vs -16.1±2.8%, p<0.001) and [La-]b concentrations were significantly lower at baseline (1.54±0.55 mmol×L-1 vs. 1.78±0.70 mmol×L-1, p=0.02), as were [La-]b concentrations at 5 (1.68±0.55 mmol×L-1 vs. 1.88±0.68 mmol×L-1, p=0.04) and 10-minutes (1.70±0.56 mmol×L-1 vs. 1.93±0.71 mmol×L-1, p=0.02) into recovery compared to patients who did not experience an adverse event, respectively. GLS (HR 1.21; 95% CI 1.11 to 1.33, p<0.001) and [La-]b concentrations at 10-minutes into recovery (HR 0.54; 95% CI 0.33 to 0.85, p=0.01) were significant independent predictors of an adverse event.

Conclusions

Transient myocardial ischaemia is associated with a significant elevation in [La-]b concentrations, which extends into the recovery period, compared to NI responders. A blunted metabolic response to dobutamine stress and attenuated longitudinal myocardial mechanics are independently associated with short-term adverse events.
Mean pulmonary arterial pressure over cardiac output slope for risk stratification in patients with unexplained dyspnea: does the math matter?
Authors: Bekhuis Y G , Falter M , Milani M , Hoedemakers S , Moura-Ferreira S , Verbrugge F , Gevaert A B , Debonnaire P , Dhont S , Van De Bruaene A , Stassen J , Herbots L , Jasaityte R , Claessen G , Verwerft J
Published: January 2025

Background

Pulmonary artery pressure corrected for cardiac output (mPAP/CO) assessed by exercise echocardiography and calculated as the mPAP/CO slope improves risk stratification in various populations. However, it is unclear whether simplified alternatives have a similar predictive ability for outcomes.

Purpose

To evaluate whether the methodology employed to calculate the mPAP/CO slope affects prognostic assessment.

Methods

This is a secondary analysis of a multicenter cohort study that included patients with unexplained dyspnea who underwent exercise echocardiography. The primary analysis evaluated the additional prognostic value of the mPAP/CO slope. The mPAP was derived from the colloid-enhanced peak tricuspid regurgitation velocity using the Chemla formula. Cardiac output was calculated by multiplying heart rate by stroke volume, determined by the velocity time integral of the left ventricular outflow tract. The mPAP and CO were measured at rest, intermediate, and peak effort. The mPAP/CO relationship was calculated in six different ways: (1) linear regression based on three points, (2) delta from rest to peak, (3) delta from rest to intermediate, (4) delta from intermediate to peak effort, (5) mPAP/CO at intermediate effort and (6) mPAP/CO at peak effort. The primary outcome was the composite endpoint of all-cause mortality or non-elective cardiovascular hospitalizations. Receiver Operating Characteristic (ROC) curve analysis was used to assess the diagnostic performance of the different calculation methods, and the DeLong approach was used to compare differences in the area under the curve (AUC).

Results

Out of 2538 exercise echocardiography exams performed between January 2016 and March 2023, 2022 exams were included (age 62±15 years, 53% women) The patients' characteristics are shown in Figure 1. After 19 (11-36) months of follow-up, the overall event rate was 11.23%. Five of the six methods performed equally (Figure 2; AUC between 0.603 and 0.615, p> 0.05 for comparisons). The delta from intermediate to peak effort method was significantly less accurate than the other methods (Figure 2; AUC: 0.543; 95% CI: 0.521, 0.565; p-values ranging from 0.03 to < 0.001).

Conclusion

For risk stratification of patients with unexplained dyspnea, the 3-point linear regression method is not superior to more straightforward methods such as a 2-point slope (rest to peak; rest to intermediate effort) or a single-point mPAP/CO ratio during intermediate or peak effort. These findings can enhance the implementation of the mPAP/CO relationship in clinical practice.

Figure 1. Patient characteristics

Figure 2. ROC curves for each calculatio
Quantifying right ventricular function in tetralogy of fallot: 3D echo into longitudinal, radial, and anteroposterior directions
Authors: Schneijdenberg J W , Zwaan R R , Chen Y , Bowen D J , Van Burken G , Bosch J G , Van Den Bosch A E
Published: January 2025

Introduction

Tetralogy of Fallot (ToF) is a congenital heart disease requiring surgical correction in early childhood. Despite high surgical success rates, patients cope with severe morbidity during adulthood predominantly originating from the right ventricle (RV). Pathophysiological processes underlying these conditions remain largely unknown, but are mostly attributed to RV remodelling. Improved understanding of remodelling patterns is essential for advancements in clinical decision making and treatment planning.

Purpose

To gain better insight in RV remodelling in patients with ToF, a method for detailed quantification of directional components of RV function was developed using three-dimensional echocardiography (3DE).

Methods

From RV-focused 3DE studies of 50 ToF patients and 50 healthy controls, three-dimensional dynamic RV meshes were obtained using commercially available software (TomTec 4D RV-Function). Within an in-house developed software application (RV-Dynamics), a technique was realized to decompose RV contraction in longitudinal (LT), radial (RD), and anteroposterior (AP) motion directions (Figure 1). Their relative contributions to RV ejection fraction (RVEF) were calculated as measure for RV function, analysed, and statistically compared within and between ToF patients and healthy controls.

Results

Decomposed RVEF in the AP motion direction was identified as the largest relative contributor to RVEF in both ToF patients (38% [31 – 42]) and healthy controls (40% [37 – 44]). Moreover, the AP component was significantly reduced in ToF patients compared to healthy controls (p=0.004). Deterioration in AP direction was complemented by a significant increase of the LT RVEF component (p=0.009), with 28% [26 – 33] in ToF patients compared to 26% [23 – 31] in healthy controls. Relative contribution of RD motion remained the same between both groups (p=0.649) (Figure 2).

Conclusion

RV-Dynamics allowed for effective directional decomposition of RVEF, enabling detailed quantification of RV function in patients with ToF. The AP component proved to be the largest relative contributor to RVEF in both ToF patients and healthy controls, disputing currently applied parameters focussing on LT wall motion for RV function assessment. Deterioration of RV function in ToF patients was mostly assigned to decreased contribution of AP wall motion to RVEF. We hypothesised this relates to the crucial involvement of left ventricular function in RV function, as RV motion in AP direction is largely attributed to left ventricular systolic function. A compensatory increase in LT contraction was observed, suggesting RV remodelling in LT direction in ToF patients.
3D echocardiographic assessment of permanent pacemaker ventricular lead position according to the type of ventricular pacing
Authors: Fusini L , Maranzano G , Marongiu A , Arcudi A , Provenzano E , Rondinara G , Dell'era G , Tundo F , Erbetta R , Garlasche A , Pepi M , Muratori M , Pontone G , Patti G
Published: January 2025

Introduction

In recent years, there has been a significant increase in the use of permanent pacemakers (PPM). Endocardial leads can induce or worsen tricuspid regurgitation (TR) when they interfere with tricuspid valve (TV) leaflets motion. Additionally, right ventricular pacing can also worsen TR and mitral regurgitation (MR).

Purpose

We aimed to assess: 1) the feasibility of utilizing 3D transthoracic echocardiography (TTE) to visualize PPM lead position, 2) the prevalence of different lead positions relative to the TV leaflets, and 3) the short-term echocardiographic outcomes based on the type of ventricular pacing (right ventricular apical pacing, RVAP, and left bundle branch area pacing, LBBAP).

Methods

We prospectively enrolled 48 consecutive patients who underwent PPM implantation with RVAP and LBBAP. Both 2D and 3D TTE were obtained from all patients at baseline and at a 3-month follow-up.

Results

3D TTE was feasible in 94% of patients. The most common lead location was the posteroseptal commissure, regardless of the ventricular pacing types (65% RVAP vs 60% LBBAP, p = 0.761). TV diameters were similar in both groups (TV maximum diameter: RVAP 37±3 mm vs LBBAP 38±4 mm, p=0.248; TV minimum diameter: RVAP: 27±5 mm vs LBBAP 29±5 mm, p=0.143). However, a greater distance between the TV plane and lead tip insertion was found in RVAP compared to LBBAP. No differences were detected in the biventricular size/function and the severity of MR and TR based on the type of ventricular pacing at the 3-month follow-up (Table). High agreement was observed between two operators in identifying the lead localization by 3DTTE (Cohen K = 0.63, p < 0.001).

Conclusions

3D TTE enables precise localization of PPM leads at the tricuspid valve level. Therefore, 3D TTE should be routinely employed, in particular to facilitate the detection of TV interference and the progression of TR after PPM implantation.

Table. Echocardiographic characteristics
Associations between systolic left ventricular rotational mechanics and peak left atrial reservoir strains - a three-dimensional speckle-tracking echocardiographic study
Authors: Nemes A , Kormanyos A , Ambrus N , Lengyel C
Published: January 2025

Introduction

In systole, during left ventricular (LV) twist, the left atrium (LA) acts as a reservoir, its volume is the largest. In this phase of LA function, the direction of its wall movement is opposite to that of the LV wall, and can be quantitatively characterized using strains.

Purpose

The objective of the present study was to investigate the relationship between LV twist and LA strains as assessed simultaneously by three-dimensional speckle-tracking echocardiography (3DSTE) under healthy conditions by examining what happens when the above parameters are smaller or greater than the average.

Methods

In the present study, 157 healthy adults (mean age: 33.2 ± 12.7 years, 73 men) were involved. Complete two-dimensional Doppler echocardiography with 3DSTE-derived data acquisition were performed in all cases. 3DSTE-derived LA strains and LV rotational parameters were determined at a later date.

Results

Increased basal LV rotation was associated with a decreasing tendency of apical LV rotation and increased LV twist. Increased apical LV rotation was associated with a decreasing tendency of basal LV rotation and increased LV twist. Peak LA global circumferential (GCS) and area (GAS) strains proved to be reduced in case of the highest basal LV rotation, other peak LA strains did not show association with increasing basal LV rotation. Peak LA global radial strain (GRS) was highest in case of the lowest apical LV rotation. Peak LA global 3D strain (G3DS) was lowest in case of the highest apical LV rotation. All peak LA strains showed an increasing tendency of other strains but to different extent. With increasing peak LA-GRS, increasing peak LA global longitudinal strain (GLS), LA-GCS and LA-GAS could be detected, but only up to a point, beyond which further increase cannot be detected (except peak LA-G3DS). Increasing peak LA-GCS was associated with increase of all other strain values except for peak LA-G3DS. Increase of all peak LA strains could be seen with increasing peak LA-GLS, except for peak LA-GRS. From complex strains, with increasing peak LA-G3DS, increasing peak LA-GLS, LA-GCS and LA-GAS could be detected, but only up to a point, beyond which further increase cannot be detected (except peak LA-GRS). Increase of all peak LA strains could be detected with increasing peak LA-GAS, but only up to a point, beyond which further increase in peak LA strains cannot be detected. Only apical LV rotation proved to be significantly reduced in case of the highest peak LA-G3DS. Other peak global LA strains did not show any associations with basal and apical LV rotations.

Conclusions

In LV systole, LV rotational mechanics are associated with LA deformation represented by peak reservoir LA strains even in healthy circumstances.
Three-dimensional speckle-tracking echocardiography-derived deformation analysis of the morphologic left ventricle in adults with corrected dextro-transposition of the great arteries
Authors: Kormanyos A , Gyenes N , Ambrus N , Lengyel C , Havasi K , Nemes A
Published: January 2025

Introduction

Dextro-transposition of the great arteries (dTGA) stands out as a prevalent cyanotic congenital heart defect, characterized by an intricate reversal in the arrangement of the major arteries. In the past, surgical interventions, including atrial redirection (switch), were embraced, with survivors from those pioneering procedures still living today. Recent advancements in cardiovascular imaging have led to the emergence of several novel echocardiographic techniques, notably three-dimensional (3D) and/or speckle-tracking echocardiography (STE).

Purpose

The present study aimed to employ 3DSTE to determine morphologic left ventricle (mLV) strain parameters in adults with dTGA who underwent Senning’s and Mustard’s procedures at infancy. Furthermore, it was also aimed to assess whether the type of correction procedure had any impact on mLV deformation parameters.

Methods

Eleven dTGA patients, with a mean age of 28.8 ± 8.5 years (6 males, 6 Senning- and 5 Mustard-operated patients) were enrolled. They were compared to 34 healthy controls matched for age and gender (age: 35.7 ± 12.8 years, 21 males). All subjects underwent complete 2D Doppler echocardiography with 3DSTE data acquisition as per recent guidelines.

Results

Comparing all dTGA patients to the control group no mean segmental or global mLV strains showed significant differences, however out of the regional strains, midventricular longitudinal strain was significantly higher in dTGA compared to the healthy group (-6.8±7.4 % vs. -13.3±2.5 %, p<0.05). The Mustard-operated patients showed significantly lower global LV-CS compared to that of controls (-22.1±12.4 % vs. -28.9±4.7 %, p<0.05). Out of the regional strains the Mustard’s group had a significantly lower apical V-CS (-24.8±11.9 % vs. -28.9±4.7 %, p<0.05), higher midventricular LV-LS (-20.1±9.2 % vs. -13.3±2.5 %, p<0.05) and a lower apical LV-AS (-36.3±17.0 % vs. -48.8±9.7 %, p<0.05).

Conclusions

Significant mLV strain abnormalities are present in dTGA late after atrial switch procedures. These differences are more pronounced in the Mustard operated subgroup.
Characteristics and results of edge-to-edge transcatheter repair of the mitral valve depending on the mechanism causing mitral regurgitation
Authors: Aguayo Cano N , Barreiro Mesa L J , Urbano Sanchez C , Roldan Guerra A , Rodriguez Almodovar A , Ruiz Ortiz M , Delgado Ortega M , Esteban Martinez F , Ojeda Pineda S , Gonzalez Manzanares R , Moran Salinas A , Alvarado Ruiz M , Suarez De Lezo J , Pan Alvarez-Osorio M , Mesa Rubio D
Published: January 2025

Background

Transcatheter edge-to-edge repair (TEER) has been increasingly used for selected patients with mitral regurgitation (MR), but limited data are available regarding clinical outcomes in patients with varied mechanisms of MR. Studies usually identify two types of MR: degenerative mitral regurgitation (DMR) and functional mitral regurgitation (FMR). However, patients with mixed MR etiology (MMR) are usually excluded from studies.

Objective

We investigated baseline echocardiographic data and clinical characteristics of three groups. Additionally, we analized the long-term prognostic impact of TEER in patients with clinically significant MR depending on the mechanism causing MR.

Method

Patients (n=191) who had severe MR and underwent TEER between November 2011 and Janury 2024 were included in the study. 116 patients with structurally normal mitral leaflets were classified as FMR, while 42 patients with valvular abnormalities were classified as having DMR. 33 patients with both structural and functional deformation were classified as having MMR.

Results

Baseline echocardiographic and clinical characteristics are summarized in Table 1. Patients with FMR were younger, had fewer comorbidities and had a larger left ventricular size than patients with DMR. Patients with MMR presented intermediate characteristics between patients with FMR and DMR. The median (p25-75) follow-up of patients was 24 (9-50) months. Time-to-event curves of survival in patients with FMR, DMR, MMR was 75% vs. 80% vs. 82%, respectively, and time event-free survival for heart failure hospitalization and all-cause mortality according to severe MR for patients with FMR, DMR, and MMR were 60% vs. 74% vs. 71% (Figure 1). In the follow up, no differences were found in terms of survival and survival free of heart failure admission or all-cause death.

Conclusions

The baseline characteristics of patients with FMR, DMR and MMR treated with TEER are different. Despite this, the prognosis after treatment is similar in the three groups of patients.

Baseline characteristics of patients

Kaplan-Meier curves
Is mitral annular disjunction always dangerous - the brighter side of MAD
Authors: Wabich E , Sienkiewicz K , Fijalkowska J , Zienciuk-Krajka A , Fijalkowski M , Danilowicz-Szymanowicz L
Published: January 2025

Background

Mitral valve prolapse (MVP) is a common problem affecting 1 - 3% of the adults. There have been published several reports of life-threatening ventricular arrhythmias (VA) in patients with MVP (known as arrhythmogenic MVP – AMVP), in which the presence, severity, and possible consequences of mitral annular disjunction (MAD) could have an adverse arrhythmogenic effect. However, the unequivocal arrhythmic potential of MAD is controversial, while MAD presence is described even in healthy hearts without MVP. The purpose of our study was to assess the relationship between MAD and potentially arrhythmogenic morphological parameters of the left ventricle in the non-selected patients referred for CMR examination.

Methods

Sixty-two patients with MAD detection in CMR (Siemens Magnetom 1.5T Sola i Area; Siemens Syngovia, Medviso Segment Classic) were enrolled into the study. In every patient late gadolinium enhancement (LGE), extracellular volume (ECV) and darkPAP presence (a relatively hypointensive systolic signal of papillary muscles) as potentially arrhythmogenic substrates of VA were analyzed. Additionally, all patients underwent echocardiography (VIVID E94 GE Healthcare) with particular assessment of tissue doppler and speckle tracking analysis parameters.

Results

Patients with MVP (+) were characterized by higher mitral annular S' velocity, post systolic dispersion (PSD) index, bigger size of MAD in posterior, inferior and lateral walls, and significantly more frequent occurrence of darkPAP (known as modern, intensively studied potentially arrhythmogenic parameter); however, they did not differ in global longitudinal strain (GLS) and LGE presence from MVP (-) patients (Table 1). Patients with darkPAP apperance were significantly more likely to have MVP, Pickelhaube sign occurence, and greater walls covered by MAD, but also a higher level of general ECV. LGE in papillary muscles did not differ both of those groups (Table 2).

Conclusions

The process of formation of arrhythmia foci in AMVP patients seems to be gradual and consists of many stages. In patients with MVP and MAD occurence, formation of arrhythmogenic substrate precede discrete changes which could be observed in CMR examination.
Artificial intelligence-assisted left ventricular global longitudinal strain assessment in patients with acute myocardial infarction: a sub-study of RESUS-AMI trial
Authors: Ren C B , Brandenburg H J , Mekonnen D , Mrevlje B , Mcfadden E P , Caplice N M , Spitzer E
Published: January 2025

Background

Data on the use of global longitudinal strain (GLS) for assessing patients who had undergone primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) remains scarce.

Purpose

The aim of this sub-analysis of the RESUS AMI trial was to evaluate the feasibility and reproducibility of artificial intelligence (AI)-assisted echocardiographic assessments in STEMI patients after primary PCI and the correlation with the left ventricular ejection fraction (LVEF), volumes, and infarct size assessed with cardiac magnetic resonance (CMR) imaging.

Methods

Echocardiographic datasets were analysed with an AI-assisted software (CAAS Qardia 2.0) using fully automated and semi-automated (i.e. manual correction on the automated contours) methods to determine the LVEF, dimensions and GLS. CMR datasets were analysed with an off-line workstation (CAAS MRV 4.1) in a CMR core lab for the LVEF, dimensions and infarct size. Inter and intra-observer reproducibility of echocardiographic assessments were also assessed in 40 echocardiograms selected with completed views and sufficient acoustic window.

Results

In total 169 echocardiograms were analysed and the GLS was -11.7±3.0% (automated) and -12.2±3.0% (semi-automated) and showed moderately high correlation with the LVEF (r=-0.51 automated and -0.67 semi-automated, both p<0.0001). When compared with the cardiac measurements from 81 CMR recordings, the GLS showed moderately high correlation with the infarct size (r=0.58 automated and 0.64 semi-automated, both p<0.0001) and LVEF (r=-0.63 automated and -0.65 semi-automated, both p<0.0001). The inter-observer reproducibility was excellent in GLS from both the automated (ICC=0.94, bias=0.08, LoA=1.75) and semi-automated analysis (ICC=0.95, bias=-0.38, LoA=1.49); excellent in LVEF from the automated (ICC=0.98, bias=0, LoA=5.3) and moderate-high from the semi-automated (ICC=0.73, bias=3.6, LoA=10.43) groups. LV volumes had very good to excellent interobserver reproducibility. The interobserver reproducibility was excellent in all echocardiographic measures in both automated and semi-automated groups.

Conclusion

GLS derived from the AI-assisted software (either automated or semi-automated) appears to be an accurate marker of LV systolic function as it correlates well the infarct size and LVEF assessed with CMR and LVEF with echocardiography.
Exploring new dimensions: cardiac tomography advances in left atrial appendage wall thickness assessment
Authors: Urgiles Ortiz M , Silva Garcia E , Garcia Gamez A F , Garcia Benitez J C , Perez Martin A , Tey Aguilera M J , Grez Gutierrez T A , Mariscal Vazquez S , Lubian Esplugues J I , Villar Ruiz A , Jimenez Mendez C , Perez Asensio A , Pesantez Salinas P E , Gheorge L L
Published: January 2025

Background/Introduction

The left atrial appendage (LAA) is a finger-like extension originating from the main body of the left atrium, characterized by a neck and one or multiple lobes. Closure devices for the LAA are typically implanted at the neck level. Peri-device leaks during LAA closure have different causes, and the LAA thickness and stiffness may play a role in them.

Aim

This study aimed to assess the feasibility of utilizing a novel software tool, based on cardiac computer tomography (CCT), for measurement of left atrial appendage (LAA) wall thickness.

Methods

In fifteen patients, ten with a history of atrial fibrillation undergoing LAA closure (study group) and five without structural heart disease (control group), CCT synchronized with ECG-triggered at 75% of the RR cycle was acquired to capture the maximum volume of the left atrium. Using ADAS 3D software (Adas3D Medical S.L., Barcelona, Spain), LAA was segmented into two structures: neck and lobes. The thickness of the neck was analyzed using a novel tool within the software that allows the measurement of thickness of the left atrium wall and may be applicable also for LAA (figure 1). The thickness is represented using a color-coded system (red <1 mm, yellow 1-2 mm, green 2-3 mm, blue 3-4 mm, violet >4 mm).

Results

Among the 15 patients analyzed, those who underwent LAA closure were significantly older, more hypertensive, and diabetic with a mean history of atrial fibrillation of 7.1 ± 3.2 years. Analyzing a total of 681±177 points per patient, the mean neck wall thickness in the control group was significantly greater than in the group that underwent LAA closure (1.29±0.61 mm vs. 1.18±0.49 mm, p<0.001). (Table 1). Conclusion: Through the use of myocardial thickness quantification software, the feasibility of measuring the left atrial appendage (LAA) wall thickness has been demonstrated. With proof of concept established, further studies with larger sample sizes are needed to determine the clinical implications of LAA wall thickness in optimizing the outcomes of closure procedures.
Branch pulmonary artery flows calculated using velocity time integral correlate with MRI in pediatric pulmonary vein stenosis
Authors: Pradhan S , Aldana Aguirre J , Mertens L , Vanderlaan R D , Yoo S J , Dragulescu A
Published: January 2025

Background/Introduction

In pulmonary vein stenosis (PVS), serial echocardiograms are the mainstay in assessment of pulmonary vein disease. Development of gradients in stenotic pulmonary veins indicate progression of disease and influences timing of intervention. However, pulmonary vein gradients should be interpreted in the context of relative branch pulmonary artery (PA) flows to avoid misinterpretation of worsening PVS. To date, the comparison of branch PA flows derived from echocardiography compared to gold-standard from MRI has not been described.

Purpose

To determine if branch PA flows calculated using velocity time integral (VTI) correlate with MRI.

Methods

Single-center retrospective assessment of cardiac MRIs and echocardiograms in pediatric patients with pulmonary vein stenosis between February 2019 to May 2022. Cardiac MRIs and echocardiograms obtained within a 6-month period were compared. All causes and severity of PVS were included. Patients were excluded if echocardiographic assessment did not adequately visualize either branch PA or pulse wave Dopplers in the PAs were not performed. 20 patients with a mean age of 7.72 ± 5.93 years were included. Branch PA flows were derived using PA diameter in systole from the high parasternal view from which cross-sectional area (CSA) was calculated using CSA = pi(radius)^2. Using pulse wave Doppler in the branch PAs, VTI was measured as an averaged area under the curves over 3 beats. Relative branch PA flows were calculated using a product of CSA and VTI. We present branch PA flows indexed to body surface area.

Results

Mean RPA flows by VTI and MRI were 2.18 ± 1.36L/min/m2 and 2.34 ± 1.29L/min/m2, respectively. Mean LPA flows by VTI and MRI were 1.64±0.77L/min/m2 and 1.94±1.13L/min/m2, respectively. There were statistically significant correlations in branch PA flows comparing VTI to MRI (RPA correlation coefficient 0.549, p=0.02, LPA correlation coefficient 0.621, p=0.01).

Conclusion

Relative branch PA flows calculated using VTI correlate significantly with gold-standard from MRI. Lower correlation in the RPA may be due to Doppler angle. This is a feasible, complementary tool easily integrated as part of the standard echocardiographic assessment of PVS, that allows early detection of disease progression while decreasing the frequency of general anesthesia required for MRIs in young children. Expansion to a larger cohort is necessary to strengthen demonstrated correlations. Future work includes integration of branch PA flows in addition to pulmonary vein gradients to develop a PVS severity score in pediatrics to guide management.