bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-invasive assessment of right ventriculo-arterial coupling in dilated cardiomyopathy – insights from 3D echocardiography
Authors: Vijiiac A.E , Guzu C , Scarlatescu A , Onciul S , Iancovici S , Petre I , Zamfir D , Pascal A.M , Onut R , Stoian M , Dorobantu M 
Published: November 2020

Abstract

Background
Right ventricular-pulmonary artery coupling (RVPAC) reflects the mechanical efficiency of the interaction between the right ventricle (RV) and the pulmonary circulation unit. Although it has been traditionally assessed with right heart catheterisation (RHC), modern imaging techniques enable the non-invasive estimation of the RVPAC, which proved to correlate well with measurements derived from RHC.

Methods
We used three-dimensional (3D) echocardiography to study 88 consecutive patients (60.4±13.4 years, 69 men) with dilated cardiomyopathy (DCM) and left ventricular ejection fraction&lt;40% and we measured the RV volumes and RV ejection fraction (RVEF) using dedicated software. 15 healthy individuals served as controls. RVPAC was estimated non-invasively as the ratio between the RV end-systolic volume and stroke volume. Right-sided heart failure was defined as either elevated jugular venous pressure, pedal oedema or congestive hepatomegaly.

Results
Patients with DCM showed larger RV end-diastolic volume (163±60.9 ml vs. 91.3±13.2 ml; p&lt;0.0001), as well as larger RV end-systolic volume (97.3±43.2 ml vs. 39.8±7.2 ml; p&lt;0.0001) than healthy controls. The patients in the study group showed lower RVEF: 41.5±8.5% vs. 56.5±3.6% (p&lt;0.0001). Non-invasive RVPAC was 1.53±0.60 in DCM patients vs. 0.78±0.11 in controls (p&lt;0.0001). RVPAC had an excellent negative correlation with RVEF, both in DCM patients (r=−0.96, p&lt;0.0001) and in controls (r=−0.99, p&lt;0.0001). Patients with no signs of right-sided heart failure had lower RVPAC (1.38±0.45) than patients with at least one sign of right heart failure (1.90±0.72, p=0.03). Patients with mild symptoms of heart failure (NYHA classes 1 or 2) showed lower RVPAC (1.37±0.48) than DCM patients with severe heart failure (NYHA classes 3 or 4): 1.79±0.68 (p=0.003).

Conclusions
3D echocardiography provides useful insights in the functional assessment of the cardiopulmonary unit. Non-invasive RVPAC is impaired in patients with DCM, and it is more impaired when signs of right-sided heart failure are present. Severe symptoms are associated with more pronounced decoupling of the RV and the pulmonary circulation. The prognostic significance of non-invasive RVPAC in a disease primarily involving the left ventricle remains to be clarified.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF
Mechanical systolic dyssynchrony assessed with 3-D echocardiography and its association with global strain
Authors: Espinola-Zavaleta N.G , Antonio-Villa N.E , Garcia-Diaz J.A , Escudero-Salamanca M , Alvarez-Santana R , Alexanderson-Rosas E 
Published: November 2020

Abstract

Background
The evaluation of global longitudinal strain using 2-D velocity vector imaging, is an accurate automatized tool for assessment of ventricular function, nevertheless its correlation with systolic synchrony by 3D echocardiography, remains unclear.

Aims
To evaluate the correlation between global longitudinal strain and systolic synchrony index (SSI). In addition, identify which ventricle has the global longitudinal strain with the best odds ratio for detecting systolic dyssynchrony (SSI ≥6.0 ms).

Methods
We evaluate left (LV-GS, LA-GS) and right (RV-GS; RA-GS) global longitudinal strain using automatized 2-D velocity vector imaging. SSI was measured using 17 segments according to guidelines.

Results
We included 420 subjects. Characteristics of study population are presented in table 1. We found a positive and significant correlation with LV-GS (r=0.152, 95% CI: 0.052–0.247), RV-GS (r=0.119, 95% CI: 0.02–0.215), LA-GS (r=0.160, 95% CI: 0.290,0.212) and RA-GS (r=0.249, 95% CI: 0.355,-0.136) (Figure 1). Decreased values of RV-GS (OR: 1.06, 95% CI: 1.01–1.10) had the better association with mechanical systolic dyssynchrony after adjusted for covariates.

Conclusion
Automated measurement of the global longitudinal deformation of the left and right chambers correlates with the systolic synchrony index. The quantification of RV-GS could be an ideal tool to detect systolic dyssynchrony using an automated approach

Funding Acknowledgement
Type of funding source: None
Hemodynamic heterogeneity of inadequate cardiac output increase identified by 2-dimensional volumetric exercise echocardiography: slow, stiff or weak heart?
Authors: Bombardini T , Zagatina A , Ciampi Q , Cortigiani L , D'Andrea A , Borguezan Daros C , Zhuravskaya N , Wierzbowska-Drabik K , Kasprzak J.D , De Castro E Silva Pretto J.L , Djordjevic-Dikic A , Beleslin B , Ostojic M , Kovacevic-Preradovic T , Picano E 
Published: November 2020

Abstract

Background
Two-dimensional (2-D) volumetric exercise stress echocardiography (ESE) provides an integrated view of preload reserve through end-diastolic volume (EDV) and left ventricular contractile reserve (LVCR) through end-systolic volume (ESV) changes.

Purpose
To assess the dependence of stroke volume (SV) and cardiac output (CO) upon LVCR EDV changes and heart rate (HR) during ESE.

Methods
We prospectively performed semi-supine bicycle or treadmill ESE in 1,344 patients (age 59.8±11.4 years; 550 female; ejection fraction = 62.5±8%) referred for known or suspected coronary artery disease in 20 quality controlled laboratories of 16 countries from 2016 to 2019. SV was calculated at rest and peak stress from raw measurement of LV EDV and ESV by biplane Simpson rule, 2-D echo. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values &lt;2.0 identify a “weak” heart). Preload reserve was defined by an increase in LV EDV. Abnormal values (lack of EDV increase, peak EDV ≤ rest EDV) identify a “stiff” heart. Cardiac output was calculated as SV * HR (measured with standard EKG). HR reserve (stress/rest ratio) &lt;1.85 identifies a “slow” heart with chronotropic incompetence.

Results
By selection, all patients had negative SE by wall motion criteria. Of the 1,344 patients included in the study, 448 belonged to the lowest tertile of CO increase. Of them 326 (73%) achieved HR reserve &lt;1.85; 220 (49%) had a blunted LVCR and 374 (83%) a reduction of preload reserve, with 348 patients (78%) showing ≥2 abnormalities. The more the abnormal criteria, the worse the CO response, which was lowest in slow, stiff and weak hearts: see figure.

Conclusion
Patients with normal CO reserve during exercise usually have a fast, compliant and strong heart. Abnormal CO reserve is associated with heterogeneous hemodynamic responses, with slow, stiff and/or weak hearts. The clarification of underlying hemodynamic heterogeneity is the prerequisite for a personalized treatment, and can be easily extracted from a standard 2-D volumetric SE. Hearts with normal CO are all alike; every heart with abnormal CO is abnormal in its own way.
CO % changes in subsets (*p&lt;0.001)

Funding Acknowledgement
Type of funding source: None
Better diastolic function in CRT candidates is associated with improved survival after CRT implantation
Authors: Galli E , Smiseth O.A , Aalen J , Duchenne J , Larsen C , Sade E , Hubert A , Anilkumar S , Penicka M , Hernandez A , Leclercq C , Voigt J.-U , Donal E 
Published: November 2020

Abstract

Background
The relationship between diastolic dysfunction (DD) and outcome after CRT is debated.

Purpose
Purpose of this study was to evaluate the role of DD in predicting all-cause mortality in heart failure patients undergoing CRT.

Methods
One-hundred ninety-three patients (age: 67±11 years, QRS width: 167±21 ms, LVEF 28±8%) were included in this multicentre prospective study. Mitral filling pattern, mitral tissue Doppler velocity, tricuspid regurgitation velocity, and indexed left atrial volume were used to classify DD from grade I to III according to the 2016 recommendations of the American Society of Echocardiography/European Association of Cardiovascular Imaging. A reduction of LV end-systolic volume &gt;15% at 6-month follow-up (FU) identified CRT-responders and was observed in 132 (68%) patients.

Results
During a median 35 months FU, 29 (15%) patients died. Through multivariable analysis, coronary artery disease, NYHA functional class and grade I DD were shown to be independent predictors of prognosis (Table 1). Grade I DD was associated with a longer survival rate in both responders and non responders (Figure 1). Non responders with grade II-III DD had the worse outcome (HR 12.5 [3.56–44.04], p&lt;0.0001).

Conclusions
Better diastolic function at baseline is associated with an improved survival after CRT implantation, independently of CRT-response.

Funding Acknowledgement
Type of funding source: None
Obstructive and restrictive ventilatory patterns are differentially associated with cardiac structure and function in late-life
Authors: Ramalho S , Claggett B.L , Kitzman D.W , Chang P.P , Cipriano Junior G , Solomon S.D , Skali H.L , Shah A.M 
Published: November 2020

Abstract

Background
Pulmonary and cardiac function both decline with age. However, few data exist regarding the associations of obstructive and restrictive spirometric patterns with cardiac structure and function in late-life.

Purpose
Determine the associations of reduced percent predicted forced vital capacity (ppFVC) and forced expired volume in 1 second (FEV1)/FVC with cardiac structure and function in late life.

Methods
In the Atherosclerosis Risk in Communities longitudinal cohort study, 3,854 heart failure free participants underwent echocardiography and spirometry at the fifth study visit (2011–2013). Relationships were examined using multivariable linear regression. Models adjusted for demographics and clinical risk factors (Table legend).

Results
Mean age was 75±5 years, 40% were male, 19% black, and 6% current smokers. Mean FEV1/FVC was 72±8, and ppFVC was 98±17%. In adjusted analyses, lower FEV1/FVC was associated with higher pulmonary arterial pressure (PASP) but not with measures of left ventricular (LV) structure or function (Table). In contrast, lower ppFVC, was associated with greater LV mass, worse LV strain, higher E/e' ratio, greater left atrial volume index, and higher PASP (all p&lt;0.01; Table).

Conclusion
In late life, reductions in both FEV1/FVC and ppFVC are associated with higher pulmonary pressure, but only ppFVC was associated with worse LV structure and function.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services
New expectations for diastolic function assessment in TTE based on a semi-automated computing of strain-volume loops
Authors: Hubert A , Le Rolle V , Galli E , Bidaut A , Hernandez A.I , Donal E 
Published: November 2020

Abstract

Background
Early diagnosis of heart failure with preserved ejection fraction (HFpEF) by determination of diastolic dysfunction is challenging. Strain-volume loop (SVL) is a new tool to analyze left ventricular function.

Purpose
We propose a new semi-automated method to calculate SVL area and explore the added value of this index for diastolic function assessment.

Methods
50 patients (25 amyloidosis, 25 HFpEF) were included in the study and compared with 25 healthy control subjects. All patients underwent standard echocardiography. SVL area were also assessed.

Results
Left ventricular ejection fraction was preserved and similar between groups. Classical indices of diastolic function were pathological in HFpEF and amyloidosis groups with greater left atrial volume index, greater mitral average E/e' ratio, faster tricuspid regurgitation (p&lt;0.0001 compared with controls). SVL analysis demonstrated a significant difference of the global area between groups, with the smaller area in amyloidosis group, the greater in controls and a mid-range value in HFpEF group (37 vs 120 vs 72 ml.%, respectively, p&lt;0.0001) (Table 1). Applying a Linear Discriminant Analysis (LDA) classifier, results show a mean area under the curve (AUC) of 0.89 for the comparison between HFpEF and amyloidosis groups (Figure 1).

Conclusion
Strain-volume loops area is efficient to identify patients with a diastolic dysfunction. This new semi-automated tool is very promising for future development of automated diagnosis with machine-learning algorithms.
Figure 1

Funding Acknowledgement
Type of funding source: None
Assessment of left ventricular filling pressure: left atrial reservoir strain is an excellent replacement for missing tricuspid regurgitation velocity
Authors: Khan F , Inoue K , Remme E.W , Andersen O.S , Gude E , Skulstad H , Chetrit M , Garcia-Izquierdo Jaen E , Ha J.W , Klein A.L , Kikuchi S , Ohte N , Nagueh S.F , Smiseth O.A 
Published: November 2020

Abstract

Background
When evaluating left ventricular filling pressure (LVFP) according to current guidelines, tricuspid regurgitation (TR) velocity is often not available.

Purpose
In the present study we investigate if left atrial (LA) reservoir strain may be used instead of TR velocity for evaluation of LVFP.

Methods
We performed a prospective, multicenter, multinational and multivendor study in an all comer population of 322 patients with suspected heart failure or other cardiovascular disease where LVFP was measured by right- or left heart catheterization, as pulmonary capillary wedge pressure or pre-A LV diastolic pressure, respectively. Echocardiography was performed within 1 day of catheterization.
101 patients classified as special populations in the 2016 ASE/EACVI recommendations (i.e. non-cardiac pulmonary hypertension, atrial fibrillation, hypertrophic and restrictive cardiomyopathies) were excluded. Of the remaining 221 patients, 118 patients had EF ≥50% and 103 patients had EF &lt;50%. Regression analysis was performed for LA reservoir strain and TR velocity against LVFP. LA reservoir strain at a cut-off value of &lt;18% was applied instead of TR velocity in the 2016 ASE/EACVI algorithm and compared with the current algorithm.

Results
LA reservoir strain correlated better with LVFP than TR velocity, r=0.62 vs 0.40 (p&lt;0.01) (Figure 1). When replacing TR velocity with LA reservoir strain, the feasibility of the ASE/EACVI 2016 algorithm increased from 91.8% to 98.1%. The accuracy of the algorithm was not significantly altered (80% vs 79%).
An accuracy of 80% for the algorithm is lower than what has been reported in earlier publications, this may be due to inclusion of patients without suspected heart failure and no assessment of clinical data, which in turn may have influenced the accuracy of the algorithm.

Conclusion
LA reservoir strain has better correlation to LVFP than TR velocity, and can be used in the ASE/EACVI 2016 algorithm for estimation of LVFP as a replacement when TR velocity is missing.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority
Identification of the intermittent nature of trace mitral and/or aortic regurgitation: long-term longitudinal echocardiogram study in children with Dravet syndrome treated with fenfluramine
Authors: Agarwal A , Galer B , Wong P , Farfel G , Keane M.G , Lai W.W 
Published: November 2020

Abstract

Background
Previous studies have identified the presence of trace valvular regurgitation; however, these studies are typically cross-sectional assessments at a single point in time and provide no information regarding the natural history of trace aortic or mitral regurgitation (AR, MR). To our knowledge no study has assessed valve function in growing children with longitudinal echocardiogram (ECHO) assessments.

Purpose
To monitor cardiac valve function with regular, standardized ECHOs in patients with Dravet syndrome (DS) treated with fenfluramine for up to 3 years.

Methods
Patients with DS who completed either of two double-blind Phase 3 clinical trials were eligible to enroll in the open label extension (OLE) study. Patients were to be excluded from entry into the double-blind trials if they exhibited any degree of AR or MR, including trace; or pulmonary artery hypertension (PAH). However, trace MR or AR were not exclusion criteria for continuation into the OLE study. All patients had an ECHO prior to initiation of treatment in the double-blind study, after 6 to 8 weeks of treatment, and at the end of that study. In the OLE study, ECHOs were performed at study week 4, 5, or 6, and every 3 months thereafter. Valve morphology was also examined.

Results
As of September 1, 2019 a total of 330 patients had enrolled in the OLE study and received at least one dose of fenfluramine. The average age of patients at enrollment was 9.0±4.6 years, 27.6% were &lt;6 years old, and 54.5% were male. The median duration of treatment with fenfluramine in the OLE study was 631 days (min, max; 7, 1086 days), and a total of 2,691 ECHOs had been performed. The point prevalence of trace MR was 10.6% at OLE study entry and ranged from 2.8% to 12.9% thereafter. All instances of trace MR were transient events that reverted to absent or oscillated between trace and absent at later study visits. Four patients demonstrated trace AR at one or more visits and all had reverted to absent at their most recent examination. No changes in valve morphology were observed.

Conclusions
In this long-term longitudinal ECHO study in DS children treated with fenfluramine, we identified that trace MR and AR were intermittent and not predictive of future valve disease. In all cases trace reverted to absent regurgitation at subsequent ECHOs. No valve morphological changes were seen. The intermittent and transient nature of trace regurgitation observed in this study is consistent with current ECHO guidelines, which consider trace regurgitation to be a normal physiologic phenomenon.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Zogenix, Inc.
Demographic characteristics, aortic valve intervention rates and all-cause mortality in 4 flow-gradient sub-types of severe aortic stenosis
Authors: Saeed S , Vamvakidou A , Yakupoglu H.Y , Senior R , Khattar R.S 
Published: November 2020

Abstract

Introduction
Severe aortic stenosis (AS), defined as aortic valve area (AVA) &lt;1.0 cm2, can be divided into 4 categories based on flow status and mean gradient. Stroke volume index &lt;35 ml/m2 has classically been used to define low flow, but recent data suggest that flow rate (FR) &lt;200ml/sec may be a more accurate and robust marker of low flow.

Methods
We prospectively collected demographic, echocardiographic, aortic valve intervention (AVI) and all-cause mortality data on 1562 patients with symptomatic severe AS from 2010 to 2017 with a mean follow up period of 35±22 months. Patients were divided into 4 flow-gradient sub-groups based on a FR threshold of 200ml/s and mean pressure gradient of 40mmHg. Comparative analyses were performed among the 4 groups using analysis of variance.

Results
The prevalence of normal flow high gradient (NFHG) severe AS was 30%, NF low gradient (NFLG) 21%, low flow HG (LFHG) 18% and LFLG 31% (Table). Across these 4 sub-groups, there was a graded reduction in LVEF and FR, and an increase in age and all–cause mortality.

Conclusions
Classification of aortic stenosis based on flow-gradient patterns, shows important differences in the demographic profile and clinical outcome among the 4 groups. Classical NFHG AS was associated with the highest rate of AVI and lowest all-cause mortality compared to the 3 discordant flow-gradient subtypes. The LFLG group had the lowest AVI rates and worst outcome.

Funding Acknowledgement
Type of funding source: None
Flow rate and stroke volume index as predictors of mortality in patients undergoing transcatheter aortic valve implantation
Authors: Abdelrazek S , Hein M , Sopira M , Neumann F.-J , Jander N , Minners J 
Published: November 2020

Abstract

Background
Reduced flow rate and stroke volume are a common finding in patients with severe aortic stenosis. The aim of this study was to assess their impact on mortality in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods
A total of 1080 patients with severe aortic stenosis who underwent TAVI between 2007 and 2017 were followed for a mean of 2.4±1.6 years. Patients were allocated into two groups according to flow rate (cut-off 200mL/s), 805 patients had a normal flow rate and 275 patients had reduced flow rate. Long-term survival was summarized using Kaplan-Meier curves and Cox-regression models.

Results
Patients with reduced flow rate were older (83.8±5.5 years; P&lt;0.01) with more diabetics (36.7% P=0.02). Kaplan-Meier survival curves demonstrated inferior survival for patients with reduced flow rate (global log rank, P&lt;0.01), Multivariable Cox-regression analysis (adjusted for age, creatinine, diabetes, hemoglobin and presence of atrial fibrillation) confirmed flow rate as an independent risk factor of all-cause mortality (HR: 0.998; 95%-CI: 0.997–0.999; P&lt;0.01). Similar results were obtained for stroke volume index (SVI).

Conclusion
Patients with a reduced flow rate exhibit an increased mortality even after TAVI (similar to patients with reduced SVI) and should therefore be carefully evaluated in the heart-team.
PostTAVI survival according to flow rate

Funding Acknowledgement
Type of funding source: None
The prognostic value of novel myocardial deformation parameters for sudden events in hypertrophic cardiomyopathy
Authors: Zegkos T , Parcharidou D , Panagiotidis T , Ntelios D , Katranas S , Rouskas P , Vassilikos V , Karvounis H , Efthimiadis G 
Published: November 2020

Abstract

Background
Data about the implications of two-dimensional (2D) speckle tracking myocardial deformation parameter for predicting sudden arrhythmic events in hypertrophic cardiomyopathy (HCM) are limited.

Purpose
The aim of our study was to prospectively evaluate the predictive value of novel myocardial deformation parameters with regard to 2D speckle tracking echocardiography in patients with HCM.

Methods
This was a prospective study that included HCM patients without concomitant severe valvular heart disease, without prior myocardial infarction and with sinus rhythm at index evaluation. A total of 317 patients were screened and 67 subjects were excluded. Finally, the study sample consisted of 250 patients (mean age 50.8±15.8, 67.2% male). Global longitudinal strain (GLS), left atrial (LA) strain, radial strain, circumferential strain, and mechanical dispersion of the left ventricle ((MD)-the standard deviation of time to peak negative strain in 18 left ventricular segments) were examined. The primary outcome of the study was sudden arrhythmic events including sudden cardiac death, sustained ventricular tachycardia, resuscitated cardiac arrest and appropriate impantable cardioverter defibrillator discharges.

Results
During a mean follow-up of 2.4±1.2 years, 19 patients suffered a sudden arrhythmic event. GLS, LA strain, MD and radial strain significantly predicted sudden events among our cohort. The optimal cut-off values obtained from receiver-operator characteristic curves were for GLS &gt;−14%, for LA strain &lt;12%, for radial strain &lt;21% and for MD &gt;67ms. However, only GLS &gt;−14% and LA strain &lt;12% displayed a significant additive predictive value on top of the European Society Of Cardiology risk score (HCMRisk-SCD) (C statistic from 0.757 to 0.831, p=0.03 including GLS &gt;−14% in the survival model and to 0.839, p=0.009 including LA strain &lt;12% in the model). (Table)

Conclusion
GLS and LA strain conferred a significant additional prognostic value to HCMRisc-SCD score for predicting sudden arrhythmic events in HCM patients.

Funding Acknowledgement
Type of funding source: None