bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship between pulmonary edema development and left atrium mechanical functions in patients with left ventricular hypertrophy
Authors: Aggul B , Korkmaz B , Vatanoglu E , Yuksel G , Avci I , Zeren G , Simsek B , Keles N , Tanboga H , Karabay C 
Published: November 2020

Abstract

Background
Since there is no proven treatment to reduce mortality in heart failure with preserved ejection fraction patients, to identify the predictors of decompensation are important in these patients.

Purpose
In this study, we aimed to evaluate the left atrium (LA) mechanical functions in patients with left ventricular hypertrophy (LVH) presenting with dyspnea and to investigate the predictors of pulmonary edema (PE).

Methods
This study was designed as a single-center cross-sectional study. Patients with LVH who presented to the emergency department with dyspnea were divided into two groups as PE (n=30) and non-PE (n=100). Mechanical functions of the LA were evaluated by speckle-tracking echocardiography. As a statistical method, diagnostic modelling was performed to demonstrate the relationship between demographic and echocardiographic features with the diagnosis of the patient (with or without PE). First, a basal model was created consisting of age, gender, body mass index (BMI), left ventricular mass index (LVMI), creatinine (Model 0). Then, different models were created by adding reservoir strain (S) (Model 1), conduit S, pump S, reservoir strain rate (SR), conduit SR and pump SR to the basal model, respectively. It was analyzed how each model made changes in performance criteria compared to the basal model.

Results
When the relationship between left atrial strain parameters and PE were analyzed, LA reservoir S (OR: 1.74 (1.14–2.64); p: 0.003) and LA pump SR (OR: 1.69 (1.07–2.64); p: 0.023) had found to be significantly associated with the development of PE. Another parameter associated with PE was admission creatinine value (OR: 1.52 (1.08–2.15), p-value: 0.016). In our study, LVMI is not a predictor for PE but, when the interaction of LA reservoir S and LVMI was considered, it is observed that decreased LA reservoir S is associated with more PE, especially in individuals with higher LVMI.

Conclusion
In this study, we found that the LA reservoir S is significantly associated with the development of PE in patients with LVH, especially in individuals with higher LVMI.
Interaction of reservoir S and LVMI

Funding Acknowledgement
Type of funding source: None
Comparison of global left ventricular myocardial work indices at baseline and after 3 months of st-segment elevation myocardial infarction
Authors: De Paula Lustosa R , Van Der Bijl P , Goedemans L , El Mahdiui M , Montero-Cabezas J.M , Kostyukevich M , Ajmone Marsan N , Bax J.J , Delgado V 
Published: November 2020

Abstract

Background
Global left ventricular myocardial work indices (GLVMWI) are derived from speckle tracking echocardiographic strain data in combination with non-invasive blood pressure recordings. Global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) are derived from these measures. GLVMWI in ST-segment elevation myocardial infarction (STEMI) remains unexplored and comparison between measures of GLVMWI at index event (baseline) and follow-up is unknown.

Purpose
To assess the evolution in GLVMWI in STEMI patients from baseline (index infarct) to 3 months' follow-up.

Methods
This retrospective study included 350 patients (265 men, mean age: 61±10 years) with STEMI treated with primary percutaneous coronary intervention and optimal, guideline-based medical therapy. Clinical variables, echocardiographic measures and GLVMWI were recorded at baseline and 3 months follow-up.

Results
Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), GWI, GCW and GWE improved significantly at 3 months follow-up with no significant difference in GWW (Table). These findings suggest that the impaired values of GLVMWI at baseline are related to stunning after STEMI and they recover at 3 months follow-up without further deterioration in GWW, which probably reflects irreversible myocardial damage.

Conclusions
In STEMI patients treated with primary percutaneous coronary intervention and optimal guideline-based medical therapy, GLVMWI assessed by speckle tracking strain echocardiography are significantly improved at 3 months follow-up, without significant changes in GWW. GLVMWI therefore have the potential to identify reversible and irreversible components of post-infarct myocardial damage.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): European Society of Cardiology Research Grant
Prognostic value of global longitudinal layer specific strain for patients with heart failure with reduced ejection fraction
Authors: Johnsen C , Sengeloev M , Joergensen P , Bruun N , Modin D , Alhakak A , Schou M , Gislason G , Fritz-Hansen T , Shah A , Biering-Soerensen T 
Published: November 2020

Abstract

Background
Novel echocardiographic software allows for layer-specific evaluation of myocardial deformation by 2-dimensional speckle tracking echocardiography. Endocardial, epicardial- and whole wall global longitudinal strain (GLS) may be superior to conventional echocardiographic parameters in predicting all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF).

Purpose
The purpose of this study was to investigate the prognostic value of endocardial-, epicardial- and whole wall GLS in patients with HFrEF in relation to all-cause mortality.

Methods
We included and analyzed transthoracic echocardiographic examinations from 1,015 patients with HFrEF. The echocardiographic images were analyzed, and conventional and novel echocardiographic parameters were obtained. A p value in a 2-sided test &lt;0.05 was considered statistically significant. Cox proportional hazards regression models were constructed, and both univariable and multivariable hazard ratios (HRs) were calculated.

Results
During a median follow-up time of 40 months, 171 patients (16.8%) died. A lower endocardial (HR 1.17; 95% CI (1.11–1.23), per 1% decrease, p&lt;0.001), epicardial (HR 1.20; 95% CI (1.13–1.27), per 1% decrease, p&lt;0.001), and whole wall (HR 1.20; 95% CI (1.14–1.27), per 1% decrease, p&lt;0.001) GLS were all associated with higher risk of death (Figure 1). Both endocardial (HR 1.12; 95% CI (1.01–1.23), p=0.027), epicardial (HR 1.13; 95% CI (1.01–1.26), p=0.040) and whole wall (HR 1.13; 95% CI (1.01–1.27), p=0.030) GLS remained independent predictors of mortality in the multivariable models after adjusting for significant clinical parameters (age, sex, total cholesterol, mean arterial pressure, heart rate, ischemic cardiomyopathy, percutaneous transluminal coronary angioplasty and diabetes) and conventional echocardiographic parameters (left ventricular (LV) ejection fraction, LV mass index, left atrial volume index, deceleration time, E/e', E-velocity, E/A ratio and tricuspid annular plane systolic excursion). No other echocardiographic parameters remained an independent predictors after adjusting. Furthermore, endocardial, epicardial and whole wall GLS had the highest C-statistics of all the echocardiographic parameters.

Conclusion
Endocardial, epicardial and whole wall GLS are independent predictors of all-cause mortality in patients with HFrEF. Furthermore, endocardial, epicardial and whole wall GLS were superior prognosticators of all-cause mortality compared with all other echocardiographic parameters.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Herlev and Gentofte Hospital
The behaviour of natural shear waves under different loading conditions
Authors: Bezy S , Duchenne J , Orlowska M , Wouters L , Caenen A , Keijzer L.B.H , Cvijic M , D'hooge J , Voigt J.-U 
Published: November 2020

Abstract

Background
Shear wave imaging (SWI) is a novel ultrasound technique based on the detection of transverse waves traveling through the myocardium using high frame rate echocardiography. These waves can be naturally induced e.g. by mitral valve closure (MVC). Their propagation velocity is dependent on the stiffness of the myocardium. Previous studies have shown the potential of SWI for the non-invasive assessment of myocardial stiffness. So far, the influence of loading on shear wave propagation velocities has not been extensively investigated.

Purpose
The aim of this study was to explore how loading changes affect shear wave propagation velocities after MVC.

Methods
Until now, 5 pigs (weight: 33.5±6.9 kg) were included. Echocardiographic images and left ventricular pressure recordings were simultaneously acquired during acute loading alterations: 1) preload was reduced by balloon occlusion of the vena cava inferior, 2) afterload was increased by balloon occlusion of the descending aorta and 3) preload was increased by intra-venous administration of 500 ml of saline. Left ventricular parasternal long-axis views were acquired with an experimental high frame rate ultrasound scanner (average frame rate: 1247±179 Hz). Shear waves were visualized on tissue acceleration maps by drawing an M-mode line along the interventricular septum. Shear wave propagation velocities after MVC were calculated by measuring the slope of the wave front on the acceleration maps (Figure A).

Results
The changes in left ventricular end-diastolic pressures (LV EDP) between baseline and each intervention are shown in Figure B. Preload reduction resulted in significantly reduced LV EDP (p&lt;0.01). The shear wave propagation velocities after MVC dropped with preload reduction and increased significantly by increasing afterload as well as preload (both p&lt;0.05) (Figure C). There was a good positive correlation between the change in LV EDP and the change in shear wave velocities (r=0.83; p&lt;0.001) (Figure D).

Conclusion
The shear wave propagation velocity after MVC was significantly influenced by alterations in left ventricular loading conditions and changes in these velocities were related to changes in LV EDP. These results indicate that shear wave measurements at MVC might be a potential novel parameter for the estimation of left ventricular filling pressures. More pigs will be included in the future to further confirm these findings.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fonds Wetenschappelijk Onderzoek - Vlaanderen
Inflammation and fibrosis biomarkers are related to atrial dysfunction in patients at risk of atrial fibrillation
Authors: Mimbrero Guillamon M , Loncaric F , Loncaric F , Nunno L , Nunno L , Tirapu L , Tirapu L , Montserrat M , Montserrat M , Sanchis L , Sanchis L , Doltra A , Doltra A , Bijnens B , Bijnens B , Sitges M , Sitges M 
Published: November 2020

Abstract

Introduction
Arterial hypertension mitral regurgitation and endurance training are risks factors for incidental atrial fibrillation (AF). Left atrial (LA) remodeling in the context of volume and pressure overload may be the substrate for AF development. Inflammation and subsequent fibrosis may be related to the development of this atrial remodeling. Our aim was to analyze if there is any correlation between inflammation and fibrosis biomarkers and left atrial dysfunction in blood samples of subjects with hypertension or mitral regurgitation and in endurance athletes.

Methods
A population of 478 subjects at risk of atrial fibrillation were enrolled to this study. The cohort was composed by 275 endurance athletes, 185 patients with arterial hypertension and 32 with moderate to severe mitral regurgitation. All patients underwent 2D (two-dimensional) echocardiography with speckle-tracking analysis (LA strain and LA strain-rate) and 3D (three-dimensional) echocardiography to assess LA volume and volume-based function. Furthermore, blood samples were obtained to measure plasma levels of BNP, troponin-I and the following fibrosis and inflammatory biomarkers: MMP-9 (Matrix Metalloproteinase 9), CXCL16 (CXC chemokine), CXCL6, FABP3, PIGF, OSM, endocan-1.
The whole cohort was divided into quartiles according to their reservoir strain value (surrogate of atrial relaxation impairment), and correlation between biomarkers, atrial 2D volumes and 3D volumes was calculated.

Results
Quartile ranges regarding reservoir strain (RS) were: 1st quartile (&lt;28.9%), 2nd quartile (28,9%-32,1%), 3rd quartile (32,95–35,4), 4th quartile (&gt;35,4%).
The first quartile (worse left atrial reservoir function) was mainly composed by hypertensive and mitral regurgitation subjects while the 4th quartile (with larger left atrium but better reservoir function) was mostly integrated by athletes. The 1st quartile (worse atrial function) showed higher levels of fibrotic (MMP-9) and inflammatory biomarkers (CXCL16, FABP3, PIGF, BNP, Troponin-I and PIGF) as compared to the other quartiles.

Conclusions
Inflammation and fibrosis biomarkers (CXCL16, FABP3, PIGF and MMP-9) are higher in subjects with worse LA reservoir function. This suggests a correlation among inflammation (fibrosis) and atrial dysfunction in a population at risk for AF development.
Biomarkers according RS quartiles

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Fundaciό La Maratό de TV3
Electromechanical delay by speckle-tracking echocardiography: a novel tool for distinguishing between Brugada syndrome and isolated right bundle branch block
Authors: D'Ascenzi F , Sanz De La Garza M , Anselmi F , Nunno L , Arbelo E , Jorda P , Marzotti T , Aprile F , Natali B.M , Brugada J , Sitges M , Mondillo S 
Published: November 2020

Abstract

Background
The electrocardiographic (ECG) definition of Brugada syndrome (BS) can be challenging because benign ECG abnormalities, such as right bundle branch block (RBBB), may mimic pathological ECG characteristics of BrS. However, although myocardial delay and deformation can be quantified by advanced imaging, it has not yet been used to differentiate between BrS and RBBB.

Purpose
The aim of this study was to characterize the electro-mechanical behavior of the heart of patients with type-1 BrS and subjects with isolated complete RBBB in order to differentiate these conditions.

Methods
In this two-center study, 66 subjects were analyzed by standard and speckle-tracking echocardiography (STE): 22 type-1 BrS, 24 isolated complete RBBB, and 20 healthy subjects. The participants were not treated by any drug potentially influencing myocardial conduction.

Results
Standard echocardiographic parameters did not differ among the groups. STE demonstrated that right ventricular (RV) mechanical dispersion (MD) was greater in RBBB as compared to BrS and controls (p&lt;0.05). In patients with isolated RBBB, the greatest delay of RV time-to-peak longitudinal strain (TTP) was found in RV free-wall basal segments. Mean absolute deviations of TTP calculated for each left ventricular (LV) region were greater in patients with RBBB as compared to those with BrS and to controls with a localisation of the delay in LV antero-septal, anterior, lateral, and infero-septal basal segments (figure 1).

Conclusions
Advanced echocardiographic techniques may help to differentiate between BrS and RBBB. Indeed, STE allows to identify an electro-mechanical conduction delay in RBBB patients that is not found in patients affected by type-1 BrS.
Electromechanical delay by STE

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Italian Society of Cardiology
Prognostic role of left ventricular diastolic function assessed by speckle tracking echocardiography in patients after surgical ventricular repair
Authors: Nemchyna O , Solowjowa N , Dandel M , Hrytsyna Y , Stein J , Soltani S , Knierim J , Schoenrath F , Falk V , Knosalla C 
Published: November 2020

Abstract

Background
Assessment of left ventricular (LV) diastolic function brings important prognostic information for patients with heart failure and could be evaluated by speckle tracking echocardiography (STE). Less known about its role in patients planned for surgical ventricular repair due to LV aneurysm.

Purpose
The aim of this study was to evaluate the prognostic role of STE parameters of LV diastolic function for prediction of all-cause mortality in patients after surgical ventricular repair.

Methods
We retrospectively evaluated data of 163 consecutive pts (mean age 62.3±11.5 years, 74.8% males) with anteroapical LV aneurysm who underwent surgical ventricular repair combined with coronary artery bypass surgery (71.8%) Prognostic role for prediction of all-cause mortality was assessed for various STE parameters, including left atrial strain (LAS) measured as peak reservoir strain and for the ratio of early to late global longitudinal strain rate (GLSRe/GLSRa).

Results
During a median follow-up of 4.7 years (IQR: 1.6–8.9 years) there were 65 deaths, 5 year survival rate was 73.8 (95% CI 67–79%). Baseline ejection fraction, end-diastolic and end-systolic volumes of LV did not differ between pts who died and survived at 5 year after the surgery, whereas LAS was significantly higher and GLSRe/GLSRa was significantly lower in survivors. Cox proportional hazard model adjusted to demographic and clinical variables demonstrated that LAS and GLSRe/GLSRa were independent predictors of all-cause death, with HR of 0.79 (95% CI 0.66–0.95, p=0.012) for each 5% increase of LAS and HR of 1.24 (95% CI 1.1–1.4, p=0.001) for each 0.5 increase of GLSRe/GLSRa. Moreover, GLSRe/GLSRa remained an independent predictor after additional adjustment for LV end-systolic volume, sphericity index and presence of mitral insufficiency of grade 2 and higher. A significant difference in median survival time was demonstrated according to the following cut-offs: LAS ≥16.7% (12.1 vs. 6.4 years, p=0.01), GLSRe/GLSRa ratio ≥2.3 (3.3 years vs. 10.2 years, p=0.0005) (Figure). The classification and regression tree analysis with the application of all two-dimensional, Doppler and various speckle-tracking echocardiographic parameters revealed that GLSRe/GLSRa and LAS were the most important echocardiographic variables for risk stratification for 5-year mortality.

Conclusion
This study demonstrates that STE parameters of LV diastolic function are important predictors of all-cause mortality after surgical ventricular repair due to anteroapical aneurysm of LV and could be used in the preoperative decision-making process.

Funding Acknowledgement
Type of funding source: None
Prognostic value of peri-coronary adipose tissue attenuation and whole vessel and lesion plaque quantification on Coronary Computed Tomography Angiography
Authors: Hoshino M , Yang S , Sugiyama T , Zhang J , Kanaji Y , Yamaguchi M , Hada M , Sumino Y , Nogami K , Ueno H , Misawa T , Yonetsu T , Koo B , Kakuta T 
Published: November 2020

Abstract

Background
Peri-coronary adipose tissue attenuation expressed by fat attenuation index (FAI) on coronary CT angiography (CCTA) reflects peri-coronary inflammation and is associated with cardiac mortality. CCTA also provides two-dimensional and three-dimensional quantification of the individual component of atherosclerotic plaque and entire vessel. The atherosclerotic burden or disease extent in entire epicardial coronary arteries provides prognostic information in patients with coronary artery disease.

Purpose
This study sought to explore the prognostic significance of FAI values and whole vessel and lesion plaque quantification on CCTA in stable patients with intermediate epicardial stenosis evaluated by fractional flow reserve (FFR).

Methods
A total of 277 patients (277 lesions) with intermediate coronary stenosis who underwent FFR measurement and CCTA were studied. FAI was assessed by the crude analysis of the mean CT attenuation value (−190 to −30 Hounsfield units; higher values indicating inflammation) on CCTA. CT findings including whole vessel and lesion plaque quantification, and target vessel myocardial mass were investigated. Major adverse cardiovascular outcome (MACE) was defined as all cause death, cardiac death, myocardial infarction, unplanned revascularization, and heart failure requiring admission. Survivals from MACE were assessed.

Results
The mean FAI and the median FFR values were −71.6 and 0.77, respectively. FFR values were weakly albeit significantly correlated with FAI values. (r=−0.016, P=0.008.) MACE was occurred 43 (15.5%) patients during 5 years F-up. ROC analyses revealed that best cut-off value of FAI to predict MACE was −73.1. Kaplan-Meier analysis revealed that lesions with FAI ≥−73.1 had a significantly higher risk of MACE. (Chi-square 5.5, P=0.019) FFR values and the percutaneous coronary intervention were not predictive of MACE. Multivariate COX proportional hazards regression analysis revealed that age, remodeling index, and lesions with FAI ≥−73.1 were independent predictors of MACE.

Conclusion
The peri-coronary inflammation evaluated by FAI and CT remodeling index enhances cardiac risk prediction in chronic coronary syndrome patients with intermediate lesions. Non-invasive comprehensive CT assessment may help identify high risk patients of subsequent clinical events and provide enhanced patient management.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): This study was supported in part by an unrestricted research grant from St. Jude Medical (Abbot Vascular, Santa Clara, CA, USA). The company had no role in study design, conduct, data analysis or manuscript preparation.
Meta-analysis of computed tomography and magnetic resonance imaging for diagnosing mycotic aneurysms
Authors: Wang T.K.M , Griffin B.P , Cremer P.C , Gamble G.D , Unai S , Shrestha N , Gordon S , Pettersson G , Desai M.Y 
Published: November 2020

Abstract

Background
Mycotic aneurysms are a serious complication of infective endocarditis and bloodstream infection with high mortality and morbidity. Computed tomography (CT) and magnetic resonance (MRI) play major roles in detecting mycotic aneurysms, but their accuracy is not well established warranting this meta-analysis.

Purpose
We aimed to assess the diagnostic performance of CT and MRI for mycotic aneurysms in this meta-analysis.

Methods
Pubmed, Cochrane and Embase were searched from 1 January 1980–30 June 2019 for diagnostic studies reporting both sensitivity and specificity of CT and/or MRI for detecting mycotic aneurysms, and pooled using random effects models and Meta-DiSc 1.4 software.

Results
Amongst 1507 articles searched, 15 studies with 622 scans for 249 mycotic aneurysms included. CT was performed in 13 studies and MRI in 5 studies, looking at aortic and cerebral mycotic aneurysm in 12 and 3 studies respectively. The pooled sensitivities and specificities for all mycotic aneurysms with 95% confidence intervals were for CT 0.82 (0.77–0.87) and 0.93 (0.89–0.95) respectively, and for MRI 0.79 (0.61–0.91) and 0.89 (0.81–0.95) (Figure). CT or MRI had pooled sensitivities and specificities of 0.84 (0.78–0.89) and 0.92 (0.89–0.95) for aortic and 0.71 (0.54–0.85) and 0.90 (0.83–0.95) for cerebral mycotic aneurysms. Heterogeneity and publication bias was observed in some pooled analysis.

Conclusion
CT and MRI had moderately high diagnostic accuracy for mycotic aneurysms. Sensitivity was numerically higher for detecting aortic than cerebral mycotic aneurysms, with similar specificity. Study heterogeneity, publication bias and modest sample size from the literature were important limitations, warranting larger and higher quality studies.
Forrest plots for CT and MRI pooled data

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): National Heart Foundation of New Zealand - Overseas Clinical and Research Fellowship