bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of the MitraClip on right heart function and tricuspid valve regurgitation
Authors: Ahmed A 
Published: November 2020

Abstract

The MitraClip has been established as a therapeutic option for patients with symptomatic mitral regurgitation (MR) and increased risk of Surgery. MR is often combined with a decrease in right heart function due to the volume and pressure overload it leads to. The effects of MR reduction by MitraClip on right heart function is currently not adequately determined. The study further addresses the question of whether and when it makes sense to correct combined tricuspid regurgitation (TR).

Methods
All Patients that took part in this study underwent 2D and 3D Echocardiography before MitraClip implantation as well as six months afterwards. RV Function was evaluated through 4 Parameters: Tricuspid annular plane systolic excursion (TAPSE) in mm, tricuspid annular systolic velocity (TASV) in cm/s, right ventricular fractional area change (RVFAC) in % and myocardial performance index (MPI). Estimated right ventricular systolic pressure (RVSP) in mmHg was used as evidence for the presence of pulmonic Hypertension. Further Parameters determined the severity of TR and the dimensions of the right ventricle (RV) and atrium (RA) in cm respectively the volume in ml.

Results
60 Patients were recruited (63% male, Age 81.4±7.1). Six Months (±3) after MitraClip implantation a significant improvement in right heart parameters was noticed. Most of the parameters used in this study showed a significant change. (TASV 9.3±2.4 vs. 10.5±2.6, p=0.01), (RVFAC 33.1±10.9 vs. 39.0±9.6, p&lt;0.05). TAPSE showed an improvement by trend (16.1±4.6 vs. 17.4±4.8, p=0.06). RVSP showed a significant decrease (51.9±12.3 vs. 44.6±13.4, P&lt;0.05). However, Dimensions and Volume of the right atrium and ventricle showed no significant change. On the other hand, the average TR severity has noticeably declined after 6 months (2.1±0.7 vs. 1.6±0.6, p&lt;0.05). Flow Convergence and Vena contracta of Tricuspid regurgitation also demonstrated a significant reduction (Flow Convergence 7.6±4.5 vs. 5.9±2.5, P=0.01), (Vena contracta 6.8±2.5 vs. 5.4±1.9, p&lt;0.05).

Conclusion
MitralClip leads to a reduction in Mitral regurgitation which leads to a significant improvement in the right heart parameters, especially the RV Function. A noticeable decrease in the TR severity was often seen as an accompanying effect. An initially wait-and-see approach to a residual TR appears justified.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Heart Center University Clinic Dresden, Germany
Value of a comprehensive exercise echocardiography assessment for patients with hypertrophic cardiomyopathy
Authors: Peteiro Vazquez J.C , Peteiro J , Barriales-Villa R , Larranaga-Moreira J , Martinez-Veira C , Martinez-Veira C , Castro-Dios D , Fernandez-Fernandez X , Monserrat L 
Published: November 2020

Abstract

Background
Exercise echocardiography (ExE) may assess left ventricular (LV) systolic and diastolic function, LV outflow tract (LVOT) obstruction and mitral regurgitation (MR). We aimed to assess the feasibility and prognostic value of the assessment of all these issues during exercise in patients with hypertrophic cardiomyopathy (HCM).

Methods
LV systolic and diastolic function, LVOT gradients, and MR were evaluated during ExE in 285 patients with HCM (age 60±14 years, 168 men) and preserved LVEF (≥50%). Recordings were obtained at rest and peak exercise for regional/global LV systolic function and at rest and within 1.5 min after exercise for the rest of assessments: LVOT gradients, MR and ratio of early LV inflow velocity to early tissue Doppler septal annulus velocity (E/e').

Results
Feasibility was 100%, 97%, 98% and 98% for LV systolic function, E/e', LVOT gradients, and MR assessments at exercise, respectively. Thirty-seven patients (13%) had LVOT obstruction at rest, and 76 (27%) developed exercise-induced LVOT obstruction. Mean resting LVEF was 63±3%. New wall motion abnormalities (WMAs) were detected in 38 patients (13%). E/e'&gt;15 was observed in 108 patients at rest (38%) and in 119 at exercise (42%). Corresponding figures for significant MR (moderate or severe) were 20 (7%) and 17 (6%). During follow-up of 3.9±2.5 years, 21 patients had a hard event (cardiac death or transplantation, appropriate discharge of a defibrillator, stroke, myocardial infarction, hospitalization for heart failure), 33 a combined event (hard plus new atrial fibrillation or syncope), and 53 a combined event plus any interventionism.
After adjustment, LV wall thickness, resting LVEF, maximal workload in Metabolic Equivalents (METs), and E/e' post-exercise resulted independent predictors of hard events (HR=1.45, 95% CI: 1.21–1.74, p&lt;0.001; HR=0.80, CI: 0.71–0.89, p&lt;0.001; HR=0.73, 95% CI: 0.62–0.86, p&lt;0.001; HR=1.08, 95% CI: 1.02–1.14, p&lt;0.009, respectively). Independent predictors of combined events included also LV wall thickness, resting LVEF, and METs, along with therapy with beta-blockers at the time of ExE (HR=1.29, 95% CI: 1.12–1.50, p=0.001; HR=0.89, CI: 0.81–0.97, p=0.012; HR=0.83, 95% CI: 0.74–0.93, p=0.001; HR=2.51, 95% CI: 1.20–5.25, p=0.015), whereas the model for combined events+any interventionism consisted of beta-blockers, LV wall thickness, LA dimension, METs and new WMAs. (HR=2.15, 95% CI: 1.20–3.86, p=0.01; HR=1.17, 95% CI: 1.03–1.32, p=0.02; HR=1.07, CI: 1.02–1.11, p=0.005; HR=0.90, 95% CI: 0.82–0.98, p=0.01; HR=2.33, 95% CI: 1.17–4.63, p=0.016)

Conclusions
A comprehensive assessment during ExE is feasible for patients with HCM and provides significant incremental prognostic information

Funding Acknowledgement
Type of funding source: None
Beat-to-beat variability in the tricuspid annulus dimensions and dynamics is markedly increased in atrial fibrillation
Authors: Naser J , Ciobanu A , Wen S , Thaden J , Nkomo V , Pislaru C , Eleid M , Pellikka P , Pislaru S 
Published: November 2020

Abstract

Background
Atrial fibrillation (Afib) leads to beat-to-beat variability in cycle length; however, whether there is associated beat-to-beat variability in the tricuspid annulus (TA) dimensions or variability in the time in cardiac cycle when TA reaches maximal size is unknown.

Purpose
We aim to assess the beat-to-beat variability in the TA dimensions in Afib compared with sinus rhythm (SR).

Methods
Images were obtained from 58 patients (29 in Afib, 29 in SR) undergoing either 3D TTE or TEE examination. We measured TA in 3–6 cardiac cycles per patient using commercially available software (TomTec 4MV).

Results
Median absolute difference in maximal TA area over 3–6 cardiac cycles was 1.60 cm2 (range 0.35 cm2 to 4.08 cm2) in Afib vs. 1.17 cm2 (range 0.32 cm2 to 2.19 cm2) in SR, p=0.0063. Median absolute difference in the maximal circumference was 0.79 cm (range 0.09 cm to 2.2 cm) in Afib vs 0.54 cm (range 0.12 cm to 1.43 cm) in SR, p=0.0175. A total of 118 cardiac cycles were analyzed in patients in SR and 147 in Afib. Timing of maximal TA area was most commonly recorded at end-diastole (80–100% of the R-R interval) in 62% of cycles in SR; however, it was distributed over a broad range in Afib, p&lt;0.0001, [Figure].

Conclusion
Afib leads to significant beat-to-beat variability in the maximal TA area, minimal TA area, maximal TA circumference, and in the time of maximal TA area. These findings suggest that accurate assessment of TA dimensions should be based on continuous tracking of the TA over several cardiac cycles, especially in patients with Afib. These observations have significant implications for device sizing in percutaneous tricuspid valve interventions.
Timing of Maximal TA Area

Funding Acknowledgement
Type of funding source: None
Sex, body size and right atrial volume are the main determinants of tricuspid annulus geometry in healthy volunteers. A 3D echo study using a novel, commercially-available dedicated software package
Authors: Mihalcea D , Guta A.C , Caravita S , Parati G , Vinereanu D , Badano L.P , Muraru D 
Published: November 2020

Abstract

Tricuspid annulus (TA) sizing is essential for percutaneous and surgical procedures. Guidelines recommend to assess TA size by 2D echo (2DE) linear dimension; but TA is a complex 3D structure.

Aim
To identify physiological determinants of TA geometry parameters and their reference values using 3D echo (3DE) and a novel, commercially-available software in healthy volunteers.

Methods
254 healthy volunteers (113 men, mean age 47±11 years) were evaluated by 2D and 3DE. 3DE TA analysis was made in 228 of them (feasibility=90%). TA 3DE area, perimeter, diameters, sphericity index and coaptation (Figure) were assessed at mid-systole using a dedicated software package (4D AutoTVQ, GE Healthcare, Horton, N). 3D right atrial (RA) and ventricular (RV) volumes were measured.

Results
Normal values of 3D TA geometry parameters, RV and RA volumes are presented in table. 3D TA area, perimeter and diameters correlated with BSA (r=0.33 to 0.5, p&lt;0.001) and were larger in men, independently of BSA (p&lt;0.0001). There were no age-related changes in TA parameters (r&lt;0.25, p=0.0001). 2D TA diameters measured in apical 4ch and RV focused views were significantly smaller than 3DE 4ch diameter (16±2 and 16±3 vs 17±3, p&lt;0.0001). RA maximal volumes had the strongest correlation with 3D TA area (r=0.65), compared with RV end-diastolic (r=0.55) and end-systolic (r=0.51) volumes (p&lt;0.0001). By multivariable linear regression, RA maximal volume, sex and BSA, but not RV volumes, were independent predictors of 3D TA area (R2=0.46, p&lt;0.0001).

Conclusions
Reference values for TA metrics should be sex-specific and indexed to BSA. 2DE underestimates TA dimensions. Even if both RA and RV volumes correlate significantly with TA area, only RA maximum volume was an independent predictor of its size at mid-systole.
3D tricuspid annulus parameters

Funding Acknowledgement
Type of funding source: None
Intraprocedural mean mitral pressure gradient predicts mortality in percutaneous edge-to-edge mitral repair for functional mitral regurgitation
Authors: M-Labbe B , Rajakulasingam R , Davies A , Connolly L , Rajani P , Jiliu P , Di Mario C , Smith R , Vazir A 
Published: November 2020

Abstract

Introduction
Percutaneous edge-to-edge mitral repair is a safe treatment method for functional (FMR) and degenerative (DMR) mitral regurgitation. Iatrogenic mitral stenosis remains a concern and periprocedural transoesophageal echocardiography is essential for real-time monitoring of mean mitral pressure gradient (intra-MMPG) and to guide clip deployment.

Purpose
Published data suggests intra-MMPG predicts clinical outcome and mortality only in DMR patients. We sought to validate these findings in a large high-volume UK center cohort with prolonged follow-up and further explore its use to predict mortality in functional MR patients.

Methods
All consecutive patients who underwent edge-to-edge mitral repair between 2010 and 2020 were analysed. The intra-MMPG and the severity of MR grade from the transoesophageal echocardiogram post-clip deployment (intra-MRgrade) were collected. Statistical analysis using covariates before and after edge-to-edge repair were compared using paired tests and cox regression models were used to assess the relationship of covariates with all-cause mortality. p&lt;0.05 was deemed as statistically significant.

Results
We analysed data from 246 consecutive patients, 65% were men and mean age was 76±11 years. Pre-procedure LVEF was 49±15%, TAPSE was 16±6 mm, severity of MR was 3.8±0.5, 80% had NYHA III/IV and 45% had FMR. Post procedure, there was a significant reduction in severity of MR grade (3.8±0.5 to 1.7±0.8; p&lt;0.001) and a reduction in LVEF (49±15 to 45±15%; p&lt;0.001). There were significant improvements in NYHA class (3.2±0.6 to 2.0±0.6; P&lt;0.0001) and LV outflow tract VTI (15±5 to 17±4 cm; p&lt;0.001).
Patients were followed-up for a median of 1021 days (inter-quartile range 289 to 1555) during which 76 patients died. Multivariate survival analysis (see table) showed that the increase in intra-MMPG was independently associated with mortality for FMR, but not for DMR. Furthermore, higher intra-MRgrade was associated with mortality for FMR patients only.

Conclusion
Intraprocedural mean mitral pressure gradient (intra-MMPG) predicts mortality in percutaneous mitral edge-to-edge repair for FMR, but not for DMR, herby challenging previously published data.

Funding Acknowledgement
Type of funding source: None
Effect of age and parity on maternal diastolic function in middle trimester pregnant women with normal left ventricular ejection fraction and potential link of diastolic function to pre-eclampsia
Authors: Zhu D , Chen W.Y , Pan Y.C , Cui M 
Published: November 2020

Abstract

Background
It has been suggested that maternal cardiac adaptations during pregnancy differ between nulliparous and multipara women and also vary according to the age. Impaired cardiac function precedes pre-eclampsia.

Purpose
To evaluate effect of age and parity on maternal cardiac diastolic function in middle trimester among pregnant women with normal left ventricular ejection fraction as well as correlation between impaired diastolic function and pre-eclampsia.

Methods
Pregnant women with singleton pregnancies carried from 13 weeks to 20 weeks and left ventricular ejection fraction (LVEF) ≥50% were identified. Diastolic function parameters were assessed using transthoracic echocardiography. Pre-eclampsia was identified from medical records.

Results
376 pregnant women were included (median age: 30 years; median gestational age: 14 weeks; 171 multiparous women). LVEF was 66%. Impaired cardiac diastolic function was seen in 7.8% of pregnant women &lt;35 years compared with 28.6% of those ≥35 years (p=0.000). ROC curve showed women with maternal age over 32 began to have a higher rate of impaired cardiac diastolic function (AUC=0.704, p=0.000, sensitivity=54.5%, specificity=75.3%). There was no difference in diastolic function indices between maternal women grouped by parity. After adjustment for confounders, maternal age can be independent effect factor of Em declined (P&lt;0.05). Em&lt;13cm/s was significantly associated with pre-eclampsia occurrence (HR 8.56; 95% CI: 3.40–21.57) after adjusting for the confounders.

Conclusion
Maternal age is an independent impact factor for diastolic function decline. There is no difference in cardiac diastolic function between nullipara and multipara. Pre-eclampsia occurrence is significantly higher in patients with diastolic function decline at mid-gestation. The utility of risk stratification using diastolic function at mid-gestation may improve the survival outcomes of pregnant women.
Association between Em and PE risk

Funding Acknowledgement
Type of funding source: None
Right ventricular morphology and function undergo complex changes after cardiac surgery
Authors: Wejner-Mik P , Kasprzak J.D , Szymczyk E , Wdowiak-Okrojek K , Ammer A , Religa G , Kaszczynski T , Lipiec P 
Published: November 2020

Abstract

Background
An impairment of certain echocardiographic parameters of right ventricular (RV) function, such as tricuspid annular peak systolic excursion (TAPSE), is a known phenomenon in patients undergoing cardiac surgery. However, little is known about significance of these alterations with regard to other aspects of RV function. The aim of our study was to clarify this issue using parameters based on 3D echocardiography and speckle tracking technique.

Methods
The study population comprised 122 patients (92 men, mean age 65±11 years), referred for coronary artery bypass grafting and/or replacement of mitral or aortic valve. Patients undergoing tricuspid annuloplasty and with baseline suboptimal image quality were excluded from the study group. Transthoracic echocardiographic examination was performed on average 2±2 days prior to surgery (TTE1), and 7±4 days after surgery (TTE2), whereas follow-up TTE (TTE3) was performed on average 12±2months after the surgery. Parameters measured during these examinations included both standard and advanced indices of RV size and function (such as TAPSE, systolic velocity of tricuspid annulus (S'), fractional area change (FAC), RV ejection fraction (EF) and RV global longitudinal systolic strain (GLS), as well as a new parameter introduced by our team - RV shortening fraction (RV SF), calculated as the change in mid RV transverse diameter.

Results
Echocardiographic measurements were completed for TTE1, TTE2 and TTE3 in 95% of patients. We noticed a significant postoperative (TTE2) impairment of parameters of RV longitudinal function (TAPSE, S' and GLS; p&lt;0,0001). However, neither RV size assessed by both 2D and 3D technique changed, nor the global RV function measured with the use of FAC and EF. Additionally during the postoperative period an increase in the value of a RV SF by 12.85% was observed. After 12 months (TTE3) we observed an improvement in the parameters of the longitudinal RV function.

Conclusion
Cardiac surgery results in an impairment of the longitudinal systolic RV function, with no influence on the global RV function. The preservation of global function results from increased RV SF. After 12 months, an improvement of the longitudinal function can be observed.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Grant Polish Cardiac Society
Restoration of normal sinus rhythm in atrial fibrillation: impact of reverse remodelling of right chambers on tricuspid regurgitation severity
Authors: Soulat-Dufour L , Benhamou-Tarallo I , Lang S , Ederhy S , Ancedy Y , Adavane-Scheuble S , Chauvet-Droit M , Nhan P , Jean M , Ben Said R , Scheuble A , Boccara F , Addetia K , Lang R , Cohen A 
Published: November 2020

Abstract

Background
The severity of tricuspid regurgitation (TR) in patients with restored normal sinus rhythm (SR) after atrial fibrillation (AF) has been poorly assessed.

Purpose
Our study aimed to assess (1) right chamber remodelling and (2) TR severity in patients with AF who have had their rhythms restored to normal sinus.

Methods
We prospectively evaluated 94 consecutive patients hospitalized for AF who received either ablation, direct current cardioversion, or pharmacological therapy. Patients were divided into two groups according to their cardiac rhythm at 6 months follow up (6M): restoration to SR (SR group, n=54), persistence of AF (AF group, n=40). TR vena contracta (VC), TR grade severity was divided into 4 grades using an integrated approach (0: none or trace; 1: mild; 2: moderate; 3: severe TR). Two dimensional (2D) end diastolic (ED) tricuspid annulus (TA) diameter in the apical 4 chambers view, three-dimensional (3D) indexed volumes (3D Vi) of the right atrium (RA) and right ventricle (RV) in end systole (ES) and ED were acquired using transthoracic echocardiography at admission and at 6M.

Results
At 6M, in the SR group a significant improvement in TR VC (Figure A) and TR grade (Figure B) were noted, whereas there was no differences in the AF group (0.41 vs. 0.42cm, p=0.24 for TR VC; 1.70 vs. 1.76, p=0.16 for mean TR grade). In the SR group a significant reduction in 3D ES RV Vi, 2D ED TA diameter, 3D ES and ED Vi of the RA (Table) were observed. Regression of TR VC was correlated with regression of right cavities parameters (ρ=0.47, p&lt;0.001 for 2D ED TA diameter; ρ=0.34, p&lt;0.005 for 3D ES RA Vi; ρ=0.33, p&lt;0.005 for 3D ED RV Vi; ρ=0.29, p&lt;0.005 for 3D ES RV Vi).

Conclusion
Restoration of normal SR in patients with AF results in beneficial remodelling of right cavities at 6M of follow-up which were associated with a significant decrease in TR severity. Strategies for normal SR restoration in patients with AF and TR should be vigorously attempted.
TR Evolution

Funding Acknowledgement
Type of funding source: None
Association betweenLeft Atrial Appendage function assessed by speckle-tracking echocardiography and the presence ofLeft Atrial Appendage stasis in patients with atrial fibrillation
Authors: Mao Y , Chan C , Ma M.M , Jiang R.H , Yang Y , Wang Y.H , Jiang C.Y 
Published: November 2020

Abstract

Objectives
The aim of this study was to determine the association of LAA left atrial appendage funtion as assessed by speckle-tracking imaging with LAA stasis and thrombus in patients with nonvalvular atrial fibrillation (AF).

Methods
A total of 154 consecutive patients with AF referred for transesophageal echocardiography (TEE) were prospectively enrolled. Of these, 29 (18.8%) patients had LAA dense spontaneous echo contrast (SEC) and/or thrombus. Besides standard echocardiography we assessed global, basal, middle and apical LAA longitudinal strain (LS) in mid-esophageal TEE views obtained at 0°, 45°, 90° and 135° by using speckle-tracking echocardiography (STE).

Results
Patients were comparable with regard to the clinical data. A subgroup with LAA stasis or thrombus had enlarged LAA size, impaired LAA emptying fraction (LAAEF) and reduced LAA emptying velocity than control group.LAA global and segmental LS were significantly decreased in patients with dense SEC or thrombus. Receiver operating characteristic curve analysis revealed that the LAAEF of 61.5%, the LAA GLS of 8.02%, LAA segmental LS of (basal) 8.07%, (middle) 9.08%, (apical) 8.43% (P&lt;0.0001) were the optimal cutoff values for distinguishing both subgroups. All the LAA strain parameters as well as LAAEF were independently associated with the presence of LAA stasis or thrombus in multivariate analyses, with additional significance over the CHA2DS2-VASc score.

Conclusion
Speckle-tracking echocardiography may be used to describe LAA function during AF, allowing identification of patients with higher risk of LAA stasis or thrombus and providing incremental value over the CH2ADS2-VASc Score.
Figure 1

Funding Acknowledgement
Type of funding source: None
Myocardial work: a new way to predict fibrosis in patients with hypertrophic cardiomyopathy
Authors: Valentim Goncalves A , Aguiar Rosa S , Moura Branco L , Galrinho A , Fiarresga A , Rocha Lopes L , Thomas B , Baquero L , Mota Carmo M , Cruz Ferreira R 
Published: November 2020

Abstract

Aims
Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) adds prognostic information in patients with hypertrophic cardiomyopathy (HCM). Whether Myocardial work (MW), a new parameter on transthoracic echocardiographic (TTE), can predict significant fibrosis in HCM patients is unknown.

Methods
Single-centre evaluation of consecutively recruited HCM patients in which TTE and CMR were performed. MW and related indices were calculated from global longitudinal strain (GLS) and from estimated left ventricular pressure curves. The extent of LGE was quantitatively assessed. LGE ≥15% was chosen to define significant fibrosis.
Logistic regression analysis was used to find the variables associated with LGE ≥15% and cut-off values were determined.

Results
Among the thirty-two patients analysed mean age was 57±16 years, 18 (56%) were male patients and the mean left ventricular ejection fraction by TTE was 67±8%.
Global constructive work (GCW), global work index and GLS were significant predictors of LGE ≥15%. A cut-off ≤1550 mmHg% of GCW was able to predict significant fibrosis with a sensitivity of 92% and a specificity of 79%, while the best cut-off for GLS (&gt;−15%) had a sensitivity of 86% and a specificity of 72%.

Conclusion
GCW was the best parameter to predict significant left ventricular myocardial fibrosis in CMR, suggesting its utility in patients who may not be able to have a CMR study.
Myocardial Work and LGE in CMR in HCM

Funding Acknowledgement
Type of funding source: None