bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic role of coronary flow velocity reserve in hypertrophic cardiomyopathy
Authors: Tesic M , Ciampi Q , Djordjevic-Dikic A , Beleslin B , Cortigiani L , Palinkas A , Palinkas E , Nemes A , Rigo F , Borguezan-Daros C , Varga A , Agoston G , Villari B , Carpeggiani C , Picano E 
Published: November 2020

Abstract

Background
A reduction in coronary flow velocity reserve (CFVR) related to coronary microvascular dysfunction is a major mechanism for ischemia in hypertrophic cardiomyopathy (HCM).

Hypothesis
To assess the functional correlates and prognostic value of CFVR during stress echocardiography (SE) in HCM.

Methods
We enrolled 201 HCM patients (age 51±14 years, 105 male, 52%; maximal wall thickness: 18±3 mm) studied with CFVR during exercise (n=33, 16.4%), dipyridamole (n=89, 44.3%) or adenosine (n=79, 39.3%) SE in 6 certified centers. CFVR was assessed using pulsed wave Doppler sampling in left anterior descending coronary artery. All patients completed the clinical follow-up.

Results
During SE mean value of CFVR was 2.11±0.46. No patients showed regional wall motion abnormalities during stress. LV outflow tract obstruction (LVOTO) was present in 34 (16.9%) patients at rest and in 47 (23.4%) at peak stress. CFVR was inversely related to age (r=−0.229, p=0.001) and maximal wall thickness (r=−0.197, p=0.031). During a median follow-up of 26 months (IQ range: 12–48 months), 75 events in 63 patients occurred: 10 deaths, 33 new hospital admission for acute heart failure, 8 sustained ventricular tachycardias and 24 atrial fibrillations. Patients in the lowest tertile (≤1.88) showed the worse prognosis with higher incidence of follow-up events compared to median tertile (1.89–2.29) and highest tertile (≥2.30) (see figure). At multivariable analysis, NYHA functional class (HR: 2.234, 95% CI: 1.398–3.517, p=0.001), presence of LVOTO at rest (HR: 2.958, 95% CI: 1.074–3.570, p=0.028) and lowest tertile of CFVR (HR: 2.144, 95% CI: 1.126–4.081, p=0.011) were the independent predictors of follow-up events.

Conclusions
In HCM patients, reduction in CFVR is associated to a clearly worse outcome. The spectrum of prognostic stratification is expanded if the response is titrated according to a continuous scale.
Figure 1

Funding Acknowledgement
Type of funding source: None
Quantitative analysis of mitral annulus morphology in aortic stenosis using real time 3-dimentional transesophageal echocardiography
Authors: Suzuki W , Nakano Y , Ohashi H , Ando H , Waseda K , Takashima H , Uchida Y , Amano T 
Published: November 2020

Abstract

Background
Normal mitral annulus morphology is known to be saddle shape. There are a few reports regarding the relationship between flattening of the mitral annular saddle shape and mitral regurgitation. However, the relationship between aortic stenosis (AS) and mitral annulus morphology is unknown.

Purpose
To assess the impact of AS on mitral annular saddle shape using 3-dimentional transesophageal echocardiography.

Methods
A total of consecutive 83 subjects including 44 patients with severe AS (AS group) and 39 patients without AS (control group), who underwent real-time 3-dimentional transesophageal echocardiography of the mitral valve, were enrolled. The 3-dimentional geometry of the mitral annulus apparatus was evaluated by the parameters analyzed using dedicated quantification software such as anteroposterior diameter (APD), commissural width (CW), annular height (AH), mitral annulus (MA) area and annular height to commissural width ratio (AHCWR) as shown in Figure. We assessed the impact of severe AS on AHCWR, which is the key parameter showing flattening of the mitral annular saddle shape. These parameters were adjusted by body surface area (BSA). Exclusion criteria included left ventricular ejection fraction &lt;50%, the presence of aortic regurgitation, mitral valve disease, pericardial or congenital diseases, endocarditis, cardiomyopathy, prior myocardial infarction, and paroxysmal or persistent atrial fibrillation.

Results
Comparisons of mitral valve geometry between AS group and control group are summarized in Table. AH/BSA and AHCWR were significantly lower in AS group compared with control group. Multiple linear regression analysis revealed severe AS to be a significant and independent predictor of lowering AHCWR (β=−0.39, t=−4.04, p&lt;0.001) (adjusted with MA area, selected by stepwise analysis).

Conclusions
Severe AS might contribute to flattening of the mitral annular saddle shape, lead to the mitral annular structural remodeling. Assessment of the mitral annulus morphology might help evaluating severe AS.
Mitral annulus 3-dimensional geometry

Funding Acknowledgement
Type of funding source: None
Risk stratification on echocardiography and outcome in ischaemic mitral regurgitation
Authors: Sharma H , Radhakrishnan A , Brown S , May J , Zia N , Joshi R , Nightingale P , Ludman P.F , Townend J.N , Doshi S.N , Khan S.Q , Zaphiriou A , George S , Nadir A , Steeds R.P 
Published: November 2020

Abstract

Background
Ischaemic mitral regurgitation (IMR) confers a poor prognosis. Transcatheter intervention may improve survival but benefit is likely to depend on severity of IMR relative to LV remodelling following myocardial infarction (MI). In theory, those with “discordant” IMR (significant regurgitant volume without severe LV dilatation or impairment), are expected to benefit most from mitral intervention. While subcategorization may help to inform treatment, there are no data on post-MI patients in this respect.

Purpose
To determine the incidence of discordant & concordant IMR categorised on echocardiography post-MI and impact on outcomes.

Methods
1000 consecutive patients admitted to our hospital with myocardial infarction who underwent coronary angioplasty were included. Early inpatient TTE was performed by accredited echocardiographers using standard multiparametric quantification.
Using TTE parameters, 4 subgroups were identified (figure) according to the degree of MR relative to LV remodelling. Thresholds were based on European guidelines (± 2SD from normal) and median value among survivors for vena contracta (VC):
– LVEF: 52% (♂), 54% (♀)
– Indexed LV end diastolic volume (LVEDVi): 74ml/m2 (♂), 61ml/m2 (♀)
– Effective regurgitant orifice area (EROA) ≥0.2cm2
– Regurgitant volume (RVol) ≥30ml
– VC ≥0.5cm

Results
MR was seen in 294/1000 patients (29.4%) with a severity of mild (76%), moderate (21%) and severe (3%). Concordant and discordant IMR were each seen in 16/294 (5%) of IMR patients post-MI.
After a mean follow up of 3.2 years, IMR patients had a 3% rate of heart failure (HF) within 1 year and 19% mortality. Non-survivors had significantly worse IMR (PISA 0.65±0.25cm vs 0.54±0.19cm; p=0.033; VC 0.63±0.25cm vs 0.49±0.18cm; p=0.014), worse LV function (LVEF 44±17% vs 51±13%; p&lt;0.001), larger LV (LVEDVi 67±23ml/m2 vs 60±22ml/m2; p=0.032) and larger indexed LA volume (LAVi) (44±22ml vs 35±15ml; p&lt;0.001). Those with concordant IMR had the worst survival (50%) although almost 1 in 5 of those with discordant MR died within the follow up period (19%). Using multivariable Cox regression, significant predictors of mortality included LVEF (p&lt;0.001; HR 0.96, 0.94–0.98) and LAVi (p&lt;0.001; HR 1.02, 1.01–1.03) but not LVEDVi.

Conclusion
1) Significant predictors of mortality in IMR include LA dilatation and decline in LVEF, but not LV dilatation.
2) Although discordant severe IMR is uncommon following MI, mortality if left untreated remains high. Attention should be paid to early selection of this cohort for intervention.

Funding Acknowledgement
Type of funding source: None
One-year echocardiographic outcomes of transcatheter aortic valve implantation with or without predilatation of the aortic valve: insights from the multicenter, randomized DIRECT trial
Authors: Karmpalioti M , Benetos G , Drakopoulou M , Xanthopoulou M , Stathogiannis K , Latsios G , Synetos A , Kalantzis C , Voudris V , Kosmas E , Mastrokostopoulos A , Katsimagklis G , Danenberg H , Tousoulis D , Toutouzas K 
Published: November 2020

Abstract

Introduction
Transcatheter aortic valve implantation (TAVI) has become the standard of care for high-risk and inoperable surgical patients and a valid alternative in intermediate-risk patients with severe aortic stenosis.The DIRECT trial (Predilatation in Transcatheter Aortic Valve Implantation Trial) was a multicenter, randomized, clinical trial designed to evaluate the safety and efficacy of TAVI with or without balloon aortic valvuloplasty (BAV) in patients with symptomatic, severe aortic valve stenosis.

Purpose
To compare the one year echocardiographic findings among patients, who underwent TAVI using a self-expanding valve with or without BAV.

Methods
A total of 171 patients with severe aortic stenosis were randomly assigned at 4 tertiary centers to undergo TAVI with the use of self-expanding prostheses with (pre-BAV) or without pre-dilatation (no-BAV). Follow up transthoracic echocardiography was performed 1 year after TAVI.

Results
Of 171 patients, 86 patients were randomized to pre-BAV group and 85 to no-BAV group. One year echocardiographic follow up was available in 146 patients. In one year follow up there was no significant difference between pre-BAV and no-BAV group in aortic valve area (1.84±0.39cm2 vs. 1.85±0.44cm2, p=0.79), peak aortic valve gradient (15.95±9.97 mmHg vs. 14.51±6.60 mmHg, p=0.35), mean aortic valve gradient (8.37±5.01 mmHg vs. 7.99±4.04 mmHg, p=0.64), aortic valve peak velocity (1.90±0.51 m/s vs. 1.80±0.42m/s, p=0.24), ejection fraction (54.19±8.36% vs. 53.19±9.58%, p=0.52) and pulmonary artery systolic pressure (41.86±14.34 mmHg vs. 40.71±12.40 mmHg, p=0.64). The incidence of moderate or severe paravalvular regurgitation (PVL) in 1 year follow up was 6.2% without significant difference between the 2 study groups (5.7% in the no-BAV group vs. 6.6% in the pre-BAV group, p=0.83).

Conclusions
Direct transcatheter aortic valve implantation has no impact on one-year prosthesis function and PVL in patients undergoing TAVI with self-expanding valve

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Medtronic
Beyond effective regurgitant orifice in quantitative assessment of tricuspid regurgitation: impact on clinical outcomes
Authors: Hinojar Baydes R , De Angelis V , Gonzalez-Gomez A , Garcia-Martin A , Monteagudo J.M , Pascual M , Lorente A , Jimenez-Nacher J.J , Zamorano J.L , Fernandez-Golfin C 
Published: November 2020

Abstract

Background
Quantification in tricuspid regurgitation has been poorly investigated. Recommended methods and thresholds are directly translated from mitral regurgitation; however, the anatomy, hemodynamics, and regurgitant orifice geometry are different in TR. Effective regurgitant orifice (ERO) calculation may be incorrect in very severe TR when right atrial and ventricular pressures could get equalized resulting in typically very low TR velocities.

Purpose
Our aim was to compare the prognostic value of different parameters for the evaluation of the tricuspid regurgitation (TR).

Methods
Consecutive patients with significant TR (≥ moderate echocardiographic grade) evaluated in the Heart Valve Clinic were included. TR severity was evaluated by TR radius, TR flow rate, ERO and TR regurgitant volume by PISA method and biplane vena contracta (VC) width using EPIQ system. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure.

Results
A total of 100 patients were included (mean age: 76±10 years, 65% females, 86% functional TR, 84% in NYHA I/II). During a mean follow up of 24±10 months 36% of the patients reached the combined end-point. Patients with events showed more severe TR independently of the parameter applied (table). In univariate analysis, TR radius, TR flow rate, ERO and TR regurgitant volume were predictors of the combined endpoint (p&lt;0.05 for all). Among all parameters, TR flow rate was the strongest and independent predictor of outcomes in multivariate and ROC analysis (HR per 1 ml/seg 1.02 [1.003–1.026], p=0.01). A value of TR flow rate of 109 ml/sec reached the best accuracy to predicted poor outcomes (p&lt;0.01).

Conclusion
Among different parameters to graduate TR severity, TR flow rate was the strongest predictor of outcomes. Since it does not include the TR velocity in the calculation, its incremental benefit may be related to very severe cases of TR. In this scenario, right atrial and ventricular pressures are equalized and TR velocity calculation is not longer possible. New grading schemes for TR may include this parameter in the classification.

Funding Acknowledgement
Type of funding source: None
Usefulness of non-invasive myocardial work to predict left ventricular recovery and acute complications after acute anterior myocardial infarction treated by primary angioplasty
Authors: Meimoun P , Abdani S , Gannem M , Stracchi V , Elmkies F , Boulanger J , Zemir H , Clerc J 
Published: November 2020

Abstract

Background
Predicting left ventricular (LV) recovery after acute ST-elevation myocardial infarction (STEMI) is challenging and of prognostic importance.

Objective
To evaluate the usefulness of non-invasive myocardial work (MW), a new index of global and regional myocardial performance, to predict LV recovery and in-hospital complications after STEMI.

Methods
Ninety-three consecutive patients with anterior STEMI (mean age, 59±12 years) treated by primary angioplasty underwent transthoracic echocardiography (TTE) within 24–48 hours after angioplasty and a median of 92 days at follow-up. MW is derived from the non-invasive strain-pressure loop obtained from the 2D strain data, integrating in its calculation the non-invasive brachial arterial pressure. Segmental LV recovery was defined as a normalization of segmental wall motion abnormalities of the affected segments and global recovery as an absolute improvement of left ventricular ejection fraction (LVEF) greater than 5% in patients with baseline LVEF &lt;50%. In-hospital complications were defined as a composite of death, reinfarction, heart failure, and LV apical thrombus.

Results
1642 segments were studied and MW was impaired in infarct segments, more severely in no recovery versus recovery segments (MW index, constructive MW, MW efficiency, all, p&lt;0.01). Furthermore, global MW was significantly correlated to acute and follow-up LVEF and global longitudinal strain (GLS) (all, p&lt;0.01). Constructive MW was the best indice to predict segmental (p&lt;0.01 versus MW index, MW efficiency, and wasted work), and global recovery (p&lt;0.05 versus GLS) with an independent association (all, p&lt;0.01). Moreover, global constructive MW was independently associated to in-hospital complications which occurred in 18 patients (p&lt;0.01).

Conclusion
In patients with anterior STEMI treated by primary angioplasty, acute constructive MW is an independent predictor of segmental and global LV recovery, as well as in-hospital complications.

Funding Acknowledgement
Type of funding source: None
Myocardial work analysis in screening of familial dilated cardiomyopathy
Authors: Triantafyllou M , Monteiro R , Protonotarios A , Gossios T , Elliott P , Lloyd G , Savvatis K 
Published: November 2020

Abstract

Introduction
Early detection of affected family relatives of patients with dilated cardiomyopathy (DCM) is essential in order to guide follow up, outcomes and initiate early treatment. Myocardial work analysis is a novel method which integrated strain imaging and blood pressure and has the potential to identify patients with subclinical disease.

Purpose
We analysed myocardial work in family relatives of DCM patients with positive genotype but negative phenotype in order to identify whether myocardial work can identify early changes.

Methods
Seventy-four family relatives of DCM patients attending for screening were examined. All individuals were asymptomatic with either positive (45/74, G+) or negative (29/74, G-) genotype and no echocardiographic evidence of left ventricular dilatation or systolic impairment. Non-invasive myocardial work analysis using two-dimensional (2D) speckle tracking echocardiography was analysed. Global longitudinal strain (GLS) was measured by the same vendor specific software used for myocardial work analysis. Left ventricular (LV) ejection fraction (EF) was measured with the Simpson's biplane method. The peak systolic arm cuff blood pressure (BP) measurement at the time of echocardiography was used for the myocardial work study.

Results
In total we included 74 individuals (37±15 years old, 50.7% women) with mean systolic and diastolic BP of 121.3±14 and 73.2±10 mmHg respectively, mean EF was 58±5% and mean GLS at 18.4±2.5%.
G+ individuals had pathogenic and very likely pathogenic mutations in 8 different genes (TTN, BAG3, DSP, FLNC, LMNA, DMD, RBM20, TPM1). There was no difference in age, systemic hypertension, diabetes or medical treatment between the 2 groups.
No significant difference was found among G+ and G- individuals in mean systolic and diastolic BP (121.2±14.7 vs 121.2±15.2 mmHg), mean EF (57.3±5 vs 59.1±4%), GLS (−18.2±1.5 vs −18.6±2.9%), mean global work index (1818±403 vs 1928±295 mmHg%) and global constructive work (2192±464 vs 2260±318 mmHg%).
However, we found significant reduction of the global work efficiency (GWE) with a GWE of 94.4±2.7% in the G+ versus 95.9±1.6% in the G- individuals (p 0.02). Moreover, the global wasted work (GWW) was increased in the G+ with a GWW of 111±58 mmHg% versus 82±41 mmHg% in the G- individuals (p 0.03).

Conclusion
DCM gene carriers show, early on, decreased myocardial work efficiency and increased wasted work compared to unaffected family members, which appears to be earlier than other parameters such as EF and GLS. Myocardial work analysis could potentially recognize individuals showing early cardiac involvement and guide closer follow up and early initiation of treatment.

Funding Acknowledgement
Type of funding source: None
Relationship between cardiac structure and function and atrial fibrillation related hospitalizations following catheter ablation
Authors: Olsen F.J , Darkner S , Chen X , Pehrson S , Johannessen A , Hansen J , Gislason G , Svendsen J.H , Biering-Sorensen T 
Published: November 2020

Abstract

Background
Even though catheter ablation (CA) is an effective treatment for atrial fibrillation (AF), AF-related hospitalizations and cardioversions are common following this procedure.

Purpose
To investigate whether echocardiographic measures of left atrial (LA) function could predict AF-related hospitalizations and cardioversions.

Methods
This was a substudy of a trial that randomized patients to amiodarone vs place to reduce AF recurrence following CA. Transthoracic echocardiography was performed prior to CA and included assessment of: end-systolic and end-diastolic LA volumes, emptying fraction (LAEF), atrial strain, and global longitudinal strain (GLS). Poisson regression was used to assess predictive value for AF-related hospitalizations and cardioversions. Multivariable adjustments were made for: age, gender, ejection fraction, AF burden, AF subtype, dyspnea, and class 1c antiarrhythmics.

Results
Of the 212 patients, 80 were hospitalized for AF (206 times), and 77 were cardioverted (192 times) within the 6 months follow-up period. Mean age was 60 years, 83% were men, and mean LVEF was 50%. In univariable analyses, LA volumes, LAEF and GLS were predictors of the outcomes but did not remain significant predictors after multivariable adjustments. During echocardiography 162 patients were in sinus rhythm and 50 had AF rhythm. Rhythm during the echocardiogram modified the association between GLS and outcomes (p for interaction &lt;0.05 for both endpoints), such that GLS predicted both AF-related hospitalizations and cardioversions in patients with sinus rhythm but not AF during the echocardiogram (figure).

Conclusion
Global longitudinal strain predicts AF-related hospitalizations and cardioversions after CA, but only in patients presenting in sinus rhythm during the echocardiogram. Patients presenting with impaired global longitudinal strain should be considered high-risk patients following CA who may benefit from close follow-up.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Danish Heart Foundation
Mechanical Dispersion as a powerful echocardiographic predictor of outcomes after Myocardial Infarction
Authors: De Sousa Bispo J.P , Azevedo P , Freitas P , Marques N , Reis C , Horta E , Trabulo M , Abecasis J , Canada M , Ribeiras R , Andrade M.J 
Published: November 2020

Abstract

Introduction
Several studies have addressed the importance of transthoracic echocardiography (TTE) in risk prediction of subsequent adverse events after ST elevation myocardial infarction (STEMI). While several traditional echo parameters have a well-established prognostic value, data derived from 2D-Speckle Tracking Echocardiography (2DSTE) needs further investigation.

Objectives
To determine if 2DSTE parameters provide additional information beyond conventional echocardiography to predict long-term adverse outcomes in patients admitted with STEMI

Methods
Retrospective, single-center study, that included all patients without previous cardiovascular events admitted with STEMI (who underwent primary coronary angioplasty) between 2015 and 2017. Patients with poor acoustic windows, severe valvular disease, irregular heart rhythm, and those who died during hospital stay were excluded. We reviewed all pre-discharge TTE to assess conventional parameters of LV systolic and diastolic function and data obtained by 2DSTE: global longitudinal strain (GLS) and peak strain dispersion (PSD), an index that is the standard deviation from time to peak strain of all segments over the entire cardiac cycle. Demographic and clinical data was obtained through electronic hospital records. Minimum follow-up was 2 years. The primary endpoint was a composite of all-cause mortality and cardiovascular re-admission at follow-up. Survival analysis was used to determine independent predictors of the primary endpoint.

Results
377 patients were included, mean age 62±13 years, 72% male. Mean LVEF was 50±10% with 19% of patients having LVEF &lt;40%. Mean indexed left atrium volume (LAVi) was 33±10 ml/m2, mean GLS was −14±4%, and PSD was 60±22 msec. Average follow-up was 36±11 months, with a combined endpoint of mortality and hospitalization of 27% (n=102)
Univariate analysis of echocardiographic variables revealed an association between heart rate, LVEF, indexed LV end-systolic volume, indexed stroke volume, LAVi, GLS and PSD with the endpoint. However, on multivariate analysis only LAVi [HR 1.030 (95% CI 1.009 - 1.051), p-value = 0.005] and PSD [HR 1.011 (95% CI 1.002 - 1.020), p-value = 0.012] remained independent predictors of the primary endpoint.
We determined that a PSD value higher than 52 msec has a sensitivity of 76% and a negative predictive value of 83% for mortality and hospitalization, and that this cut-off point discriminates patients at a higher risk of events in Kaplan-Meier Survival analysis with a Log-Rank p-value=0.001.

Conclusion
PSD derived by longitudinal strain analysis is a promising prognostic predictor after STEMI. PSD outperformed conventional echocardiographic parameters in the risk stratification of STEMI patients at discharge.
Kaplan-Meier Survival Curves

Funding Acknowledgement
Type of funding source: None