bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1468Non-invasive myocardial work indices in ischemic heart disease
Authors: Manganaro R , Cusma' Piccione M , Longobardo L , Carvelli A , Fimiani L , Casile C , Bracco A , Campisi M P , Di Bella G , Costa F , Ando' G , Carerj S , Zito C 
Published: October 2019

Abstract

Background
Myocardial work (MW) is a parameter of myocardial function which takes into account deformation as well as afterload. LV pressure-strain loops (PSLs) are a novel and reliable tool for the non-invasive assessment of MW.

Purpose
To evaluate MW indices in ischemic heart disease and their changes according to ejection fraction (EF) and type of myocardial infarction (MI) namely no-ST-segment elevation MI (NSTEMI) or ST-segment elevation MI (STEMI).

Methods
A total of 61 patients (mean age: 64.4±12 years) since at least 30 days from acute STEMI or NSTEMI treated with primary PTCA and 31 healthy subjects (controls) were enrolled. Patients with MI were divided into three groups according to the EF-based heart failure (HF) classification: a) group 1, HF preserved EF (HFpEF, EF >50%); 2) group 2, HF mid-range EF (HFmrEF, EF 40–49%); 3) group 3, HF reduced EF (HFrEF, EF <40%). Global Work Index (GWI), Global Constructive Work (GCW), Global Work Waste (GWW) and Global Work Efficiency (GWE), were estimated by LV PSLs using custom software.

Results
As shown in Table 1, GWE was significantly reduced in HFmrEF and HFrEF group (p=0.001) compared to both the controls and HFpEF group, while GWW was significantly higher (p<0.001) in the HFmEF group compared to controls and in the HFrEF group (p<0.001) vs all the other groups. GWI mmHg and GCW mmHg showed significantly compromised values in patients of HFmrEF and HFrEF groups compared to patients in HFpEF group and controls (p=0.001 and p<0.001 respectively). NSTEMI patients showed higher values of GCW compared to STEMI patients (p=0.003), and a trend towards better values of GWI, although not statistical significant. No significant differences were found about GWE and GWW. A strong correlation was found between indices of MW and LV volumes and EF (Table 2)

Conclusions
The non-invasive MW indices show a good correlation with traditional 2D parameters of myocardial systolic function in patients with ischemic heart disease. In addition, STEMI patients have lower constructive work than those with previous NSTEMI.
P1469Comparison prognostic values of coronary flow velocity assessment and ejection fraction during routine echocardiography
Authors: Zagatina A , Zhuravskaya N , Guseva O , Kalinina E , Shmatov D 
Published: October 2019

Abstract

Background
Ejection fraction (EF) is a parameter that has traditionally been used for prognostic aims during echocardiography. However, it is known that its prognostic role is accurate only if EF has clearly decreased. So, in the large group of patients who had no prior myocardial infarction, with normal EF but with severe narrowing of main coronary arteries, it is impossible to predict a high risk of adverse coronary events in the near future with transthoracic echocardiography at rest. The aim of the study was to compare prognostic values of coronary flow velocity assessment and EF during transthoracic echocardiography.

Methods
A prospective cohort study comprises 747 patients (380 males; age 58+13 years) referred for echocardiography. Left side coronary artery (left main - LM, left descending – LAD, and circumflex arteries -LCx) flows were scanned in addition to conventional echocardiography. Cardiac death, nonfatal myocardial infarction (MI), acute coronary syndrome and revascularization were defined as major adverse cardiac events (MACE). The period of follow-up was 3 years.

Results
During a median follow-up of 36 months, 192 patients experienced 224 MACE. Twenty-six deaths, 16 non-fatal MI, 2 acute coronary syndromes, 180 revascularizations were observed. EF and maximal velocity in proximal segments of coronary arteries were independents predictors of death/MI/acute coronary syndromes. The maximal velocity had a significantly higher predictive value (p<0.004) in the whole group (Figure 1A) as well as among the patients with near normal/normal EF (Figure 1B, 1C). The maximal velocity had a significantly higher predictive value (p<0.0001) of MACE (Figure 1D).

Conclusion
Coronary artery scan assessment had the statistically significantly higher predictive accuracy of MACE in comparison with traditional EF in the whole group and in the subgroups with different degrees of decreasing EF.
P1476Global longitudinal strain assessed by 2-D speckle tracking echocardiography identifies myocardial viability and predicts LV function and remodeling after acute MI with systolic dysfunction
Authors: Ben Driss A , Ben Driss Lepage C , Sfaxi A , Hakim M , Tabet J Y , Salhi A , Brandao Carreira V , Hattab M , Elhadad S , Ou P , Quignodon J F , Jondeau G , Laissy J P 
Published: October 2019

Abstract

Aims
To assess whether two-dimensional speckle-tracking echocardiography (2D-STE) could (1) identify myocardial viability in comparison with late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR); (2) predict global left ventricular (LV) functional recovery and remodeling and (3) assess prognosis after acute myocardial infarction (MI) with LV systolic dysfunction.

Methods
Seventy one first STEMI patients with LVEF ≤45%, treated with acute percutaneous coronary intervention, underwent 2D-echocardiography for 2D-STE analysis and LGE CMR between 2 and 45 days after STEMI. Segments were defined as viable when transmural LGE extension was <50% and non viable when transmural LGE extension was ≥50%. At 8-month follow-up, transthoracic echocardiography was repeated to determine global LV functional recovery (increase in LVEF ≥5%) and LV remodeling (increase in end-systolic volume >15%) (n=30) and clinical outcomes were obtained (n=46).

Results
Global longitudinal strain (GLS) was lower in non viable than in viable infarct segments (−6.6±6.1% vs −10.3±5.9%, p<0.0001) and in viable infarct segments than in normal segments (−10.3±5.9% vs −14.5±6.4%, p<0.0001). GLS >−12% had sensitivity of 78% and specificity of 69% to identify non viable segments (area under the curve (AUC), 0.79; 95% confidence interval (CI), 0.77–0.81, p<0.0001). GLS >−11.3% had sensitivity of 53% and specificity of 100% to predict the absence of global functional improvement (AUC=0.73 (CI: 0.55–0.87) p=0.01) at 8-month follow-up. GLS <−12.5% predicted the absence of adverse LV remodeling at 8-month follow-up with a sensitivity of 100% and a specificity of 54% (AUC=0.83 (CI: 0.66–0.94) p<0.0001). GLS >−11.5% was associated with a poor prognosis.

Conclusions
In patients with recent first acute MI with LV systolic dysfunction, GLS assessed by 2D-STE: (1) is able to identify non viable segments in comparison with LGE CMR, (2) allows prediction of LV global functional recovery and LV remodeling at 8-month follow-up and (3) provides strong prognostic information, independently of LVEF.
P1477Right atrial and ventricular function assessed by speckle tracking in patients with inferior wall myocardial infarction
Authors: Gonzalez-Velasquez P , Gopar-Nieto R , Flores-Garcia A , Alexanderson-Rosas E , Espinola-Zavaleta N 
Published: October 2019

Abstract

Background
Right chambers involvement in left ventricular inferior wall myocardial infarction (LVIWMI) has a prognostic impact.

Purpose
To evaluate the influence of LVIWMI in right atrium (RA) and right ventricular (RV) mechanics.

Methods
We included 60 consecutive patients who underwent myocardial perfusion (MP) gated-SPECT for chest pain. We identify 30 patients with LVIWMI and 30 control individuals with normal MP. Comprehensive echocardiography was performed in all patients. RV free wall longitudinal strain (RVFWLS) and RA reservoir (RAr), contraction (RAct) and conduit (RAcd) phase strain were analyzed by 2D speckle tracking echocardiography (STE).

Results
RVFWLS (−26.1 vs 30.3, p<0.01), RAr (peak strain) (31.5 vs 56.2, p<0.01) and RAcd strain (12.5 vs 35, p=0.01) were significantly lower in the LVIWMI patients vs control individuals. In a logistic regression model, LVIWMI, reduced 3D LV and RV ejection fraction, mitral regurgitation and pulmonary hypertension were associated with reduction in RV an RA strain.
Echocardiographic parameters LV inferior wall MI patients (n=30) Control subjects (n=30) p value 3D LV EDV (ml) (median, IQR) 121 (99.7–150) 89.5 (73–99) <0.01 3D LV EF (%) (median, IQR) 46 (37–53) 60 (58–63) <0.01 Mitral E/A (median, IQR) 0.82 (0.7–1.2) 1.21 (0.97–1.44) <0.01 Medial E/e' (median, IQR) 9.59 (7.9–13) 7.7 (6.9–10.5) 0.01 RV EDD (mm) (mean, SD) 36.7±7.4 34.7±4.39 0.12 TAPSE (mm) (mean, SD) 18.6±5.05 21.7±4.1 <0.01 RV FAC (%) (mean, SD) 37±9 46.8±7.24 <0.01 RV S' (cm/s) (mean, SD) 9.9±2.7 11.8±1.85 <0.01 3D RV EF (%) (median, IQR) 47.5 (42–52) 54 (49–57) <0.01 RIMP (mean, SD) 0.49±0.2 0.46±0.12 0.60 SPAP (mmHg) (median, IQR) 31.5 (27–37) 29.5 (26–33) 0.07 Peak global LV LS (%) (median IQR) −13.35 (−17.6–9.3) −22 (−23.2–20.4) <0.01 RV free wall LS (%) (median, IQR) −26.1 (−32.1–17.8) −30.3 (−36.6–27.5) <0.01 RA peak strain (reservoir phase) (%) (median, IQR) 31.5 (25.2–43) 56.2 (47–66.4) <0.01 RA contraction phase strain (%) (mean, SD) 20.17±10.4 24.4±10.36 0.07 RA conduit phase strain (%) (median, IQR) 12.5 (5.9–15.6) 35 (21–47.6) 0.01
Normal RVFW (A) and RA strain (B)

Conclusion
STE is a feasible technique for assessment of RVFW and RA deformation. Subclinical extension to RV in LVIWMI and its influence in RA mechanics could be assess by 2D-STE.
P1478Pilot study to predict future cardio-vascular events by novel 3D-echocardiography global area strain in STEMI patients managed by primary PCI
Authors: Al Ashry A , Esmail Y , Fahim M , Adel W , Fiky A 
Published: October 2019

Abstract

Background
Three-dimensional speckle tracking echocardiography (STE) is an ideal modality for accurate assessment of myocardial deformation, the Novel 4D-Global Area strain (GAS) is a very sensitive parameter in detection of subtle changes involving the myocardium as it encompasses both global longitudinal and global circumferential strains.

Objectives
To investigate the predictive value of four dimensional (4D) strain echocardiography for major adverse cardio-vascular events (MACE) in ST-elevation acute myocardial infarction (STEMI) after successful reperfusion by primary PCI.

Methods
One hundred seventy one patients who underwent successful primary PCI were enrolled and properly examined by 2D and 4D echocardiography with 4D strain parameters evaluation then followed up all-over a year for the occurrence of Major adverse Cardiovascular Events (MACE).

Results
Thirty two MACE were recorded in 170 patients who completed the follow-up period for one year, compared with those without MACE, patients with MACE had PTCA done during the index Primary PCI intervention, had multi-vessel CAD affection, higher LVEDD, higher LVESD, lower 2D- LVEF, higher WMSI, higher baseline HR, higher EDV and ESV, lower 3D- LVEF, higher 3D-GLS, 3D-GCS and 3D-GAS with lower 3D-GRS, all with p-values <0.005. Multi-variant logistic regression analysis showed that GAS was the most powerful predictor for MACE among our study population with the best cut-off value of 3D-GAS >−17, with p-value of (0.008) OR (20.668), CI (2.227–191.827) with relative risk of adverse events of 18.205 (95% CI 6.976–47.506, P value <0.001).

Conclusion
Our data supports the superiority of 4D strain echocardiography parameters specially GAS for prediction of adverse clinical events among patients managed by successful primary PCI.
P1484Exploring the grey zone of E/e' ratio: does left atrial strain help?
Authors: Cerrito L F , Inciardi R M , Benfari G , Bergamini C , Ribichini F L , Rossi A 
Published: October 2019

Abstract

Background
The combination of early trans-mitral inflow and mitral annular tissue Doppler velocities (E/e' ratio) is widely applied to noninvasively estimate left ventricular (LV) filling pressures. However E/e' ratio has a significant gray zone that restrict its accuracy and left atrial (LA) deformation analysis by speckle tracking echocardiography (STE) was recently proposed as an alternative approach to estimate LV filling pressures, but the clinical application of LA strain in the subgroup of patients with E/E' between 8 and 14 has been under-investigated.

Aims
This study aimed to analyze the role of LA longitudinal function by STE (PALS) to estimate intra-cardiac pressures as assessed by systolic pulmonary artery pressure (sPAP), measured by Doppler, specifically in patients with an E/e' ratio >8 and ≤14.

Methods
We enrolled 142 consecutive, non-selected patients, referred to our echocardiography laboratory for a comprehensive transthoracic echocardiography. Exclusion criteria were: organic mitral valve disease or prosthesis and presence of disease possibly associated with pre-capillary pulmonary hypertension. Particular care was used for accurate measurement of maximal tricuspid regurgitation velocity and of right atrial pressure and consequently sPAP estimation. PALS values were obtained by averaging all segments, and by separately averaging segments measured in the 4-chamber and 2-chamber views.

Results
Seventy-four patients (52% of total) showed an E/e' ratio >8 and ≤14, with the following characteristics: mean age 65.5±11.9 years, LVEF 54.5±11.2, E/e' 11.2±1.9, sPAP 33±7 mmHg, PALS 31.6±11.7%. A negative correlation between PALS and sPAP was found (r=−0.55, p<0.0001). From receiver operating characteristic (ROC) curves, PALS demonstrated a high diagnostic accuracy (AUC 0.78 (95% CI: 66%–90%)); the cutoff value of 23% showed an excellent specificity of 90% with a sensibility of 60%, to predict sPAP higher than 35 mmHg.
Correlation between sPAP and PALS

Conclusions
LA function measured by STE is a simple parameter able to predict increased intra-cardiac pressure even in the intermediate E/E' group. This parameters might help in improving the diagnostic algorithm of diastolic function.
P1500Effects of empagliflozin on cardiac function in patients with type 2 diabetes mellitus: echocardiographic substudy of the EMPA-HEART cardiolink-6 trial
Authors: Bami K , Gandhi S , Leong-Poi H , Yan A , Ho E , Zahrani M , Garg V , Teoh H , Quan A , Mazer D , Verma S , Ong G , Connelly K 
Published: October 2019

Abstract

Background
The EMPA-HEART trial showed a reduction in left ventricular (LV) mass index by cardiac MRI at 6 months in patients treated with Empagliflozin vs placebo. A secondary analysis of key echocardiographic parameters was performed to provide further insight into the mechanism of LV remodeling.

Methods
All patients enrolled prospectively underwent transthoracic echocardiography (TTE) at baseline and at 6 months. Measurements were performed according to the American Society of Echocardiography guidelines. Key outcomes of interest included changes in diastolic function and right ventricle parameters at 6 months in patients treated with Empagliflozin vs placebo.

Results
A total of 97 patients were enrolled (49 treated with Empagliflozin and 48 in the placebo group). There was no significant difference in the change in average E/E' at 6-months in the Empagliflozin group vs placebo (−0.4 vs +0.2, adjusted difference −0.2, 95% CI [−1.3 to 0.82], p=0.7) Similarly, there was no difference between the groups in secondary TTE parameters (Table 1). Subgroup analyses showed no benefit among patients with baseline LVEF >50% vs. ≤50%, and baseline LV mass index ≥60 g/m2 vs <60 g/m2.
Echocardiographic Parameter Placebo (n=48) Empagliflozin (n=49) Adjusted Difference Between Groups 95% CI P-Value Baseline 6 months Change Baseline 6 months Change LVEF (%)* 55.5 (8.7) 54.3 (8.9) −1.0 (6.5) 58.0 (7.5) 59.1 (8.57) 0.72 (5.1) 2.2 (−0.2, 4.7) 0.1 Diastolic Parameters:   Average E/e' 10.1 (3.1) 10.3 (2.5) 0.2 (3.0) 10.6 (3.0) 10.5 (3.6) −0.4 (2.5) −0.2 (−1.3, 0.8) 0.7   Medial E/e' 12.3 (3.9) 12.5 (3.6) 0.1 (3.7) 12.6 (4.2) 12.6 (5.2) −0.3 (3.3) −0.3 (−1.7, 1.1) 0.7   Lateral E/e' 8.0 (2.8) 8.2 (2.2) 0.2 (2.7) 8.7 (2.6) 8.4 (2.5) −0.4 (2.7) −0.1 (−1.0, 0.8) 0.8   E velocity (cm/sec) 68.6 (15.2) 70.6 (14.7) 1.8 (15.4) 74.4 (18.2) 71.2 (16.8) −3.2 (15.1) −2.3 (−7.9, 3.3) 0.4   A velocity (cm/sec) 74.7 (17.9) 77.9 (18.8) 2.9 (15.9) 76.2 (16.5) 75.8 (14.5) −1.4 (11.7) −3.5 (−8.9, 1.6) 0.2   LA volume index (mL/m2) 32.7 (7.9) 30.8 (8.1) −2.0 (6.7) 30.2 (6.7) 28.7 (5.5) −1.6 (6.5) −0.9 (−3.4, 1.6) 0.5 RV Parameters:   TAPSE (cm) 1.8 (0.5) 1.8 (0.4) 0.1 (0.4) 2.0 (1.2) 1.8 (0.4) −0.3 (1.4) −0.1 (−0.3, 0.1) 0.3   RV S' TDI (cm/sec) 10.9 (2.9) 10.6 (2.5) −0.1 (2.2) 10.4 (2.7) 10.2 (2.6) −0.4 (2.0) −0.3 (−1.2, 0.5) 0.4 *Measured by cardiac MRI. LA, left atrium; LVEF, left ventricular ejection fraction; RV, right ventricle; TAPSE, tricuspid annular plane systolic excursion; TDI, tissue Doppler imaging. Data expressed as mean (standard deviation).

Conclusion
This study showed no significant change in key echocardiographic parameters in patients treated with Empagliflozin, suggesting that changes in loading conditions induced by empagliflozin (i.e. preload) do not mediate the reduction in LV mass.
P1502Age- and gender-specific prognostic cutoff values of coronary flow velocity reserve in vasodilator stress echocardiography
Authors: Lombardo A , Cortigiani L , Ciampi Q , Rigo F , Bovenzi F , Picano E 
Published: October 2019

Abstract

Background
Coronary flow velocity reserve (CFVR) of left anterior descending artery is useful for risk stratification during stress echocardiography (SE) as an add-on to regional wall motion abnormalities (RWMA), but the age-and sex-dependence of prognostic cutoff values remains unclear.

Purpose
To provide sex and age-specific prognostic cut-off values which may be needed to account for the physiologic decline of CFVR with age, and sex-related differences in resting flow.

Methods
In an observational, prospective, multicenter, registry study design, we enrolled from August 2003 to August 2017 in 4 Italian cardiology referral centers with accredited, quality-controlled stress echo laboratory a consecutive sample of 5,577 patients (of them, 2,284 women and 110 aged ≥85 years) referred to the SE lab for known or suspected coronary artery disease, after exclusion of patients with inadequate acoustic window (n=295), premature test interruption (n=105), and lost to follow-up (n=173).All underwent dual imaging (RWMA and CFVR) dipyridamole SE (0.84 mg/kg over 6') and were followed-up. All-cause death and non-fatal myocardial infarction were the main outcome measures. Median follow-up of 20 months (1st quartile 8, 3rd quartile 43 months),

Results
There were 649 hard events (236 deaths and 413 non-fatal myocardial infarctions), 288 of which occurred in women and 38 in patients ≥85 years. With a ROC analysis, the best prognostic cut-off value for CFVR was almost the same for men (2.03) and women (2.02) and consistent across all age strata (<45 years: 2.03; 45–54 years: 2.04; 45–64 years: 2.03; 65–74 and 75–84 years: 2.0) except for the very elderly (>85 years) who showed an optimal value of 1.90. Independent prognostic indicators were RWMA (HR=5.42, 95% CI=2.42–12.15; p<0.0001) and reduced CFVR (HR=3.26, 95% CI 2.27–3.90; p<0.0001) in patients aged <85 years, and RWMA (HR=5.42, 95% CI=2.42–12.15; p<0.0001) in patients aged >85 years.
Best prognostic cut-off value of CFVR

Conclusion
A sex-independent cut-off value of CFVR ≤2.0 provides the optimal risk stratification across all age groups, except those >85 years in whom a lower cut-off <1.90 is needed. Risk stratification is more effective for all age groups when CFVR is combined with RWMA.
P1504Impact of myocardial ischemia induced by exercise stress echocardiography on the QT dispersion in patients with the left bundle branch block
Authors: Stoickov V , Deljanin Ilic M , Tasic I , Nikolic L J , Marinkovic D , Stoickov M , Simonovic D , Saric S , Stoickov I 
Published: October 2019

Abstract

Background/Introduction
ECG has always provided very useful information that can be used to diagnosis, treatment and prevention of cardiovascular events, but ECG changes is not useful to the detection of myocardial ischemia in patients with left bundle branch block (LBBB). QT dispersion (QTd) is a measure of inhomogeneous repolarization of myocardium. Abnormally high QTd has been correlated with risk of cardiac death in coronary patients.

Purpose
The aim of this study was to establish the impact of myocardial ischemia induced by exercise stress echocardiography on the QT dispersion in patients with the left bundle branch block.

Methods
The study involved 123 patients with LBBB, average age 52.7 years. In all subjects clinical examination, standard ECG and exercise stress echocardiography, were performed. The criterion for myocardial ischemia was the appearance of transient segmental wall motion abnormality. The first ECG was done before the exercise stress echocardiography and the second one was done immediately after exercise, with calculation of corrected QT dispersion (QTdc).

Results
During exercise stress echocardiography, in 45 (36.6%) subjects wall motion abnormality occurred (group with myocardial ischemia: MI), and 78 (63.4%) subjects were without ischemia (group without myocardial ischemia: NMI). Before starting the exercise stress echocardiography, MI group patients had significantly higher values of QTdc (61.2±17.6 vs 43.6±15.4 ms; p<0.001) in comparison to NMI group patients. During the exercise stress echocardiography, the QTdc significantly increased in MI group from 61.2±17.6 to 87.4±20.3 ms (p<0.001). In the NMI group there were no significant changes in the values QTdc during exercise stress echocardiography (from 43.6±15.4 to 46.5±19.8 ms (p - NS).

Conclusions
Significant increase of QT dispersion is associated with the occurrence of myocardial ischemia during exercise stress echocardiography in patients with LBBB. This new diagnostic approach, of using QT dispersion, significantly improves the clinical usefulness of exercise stress echocardiography in detecting myocardial ischemia in patients with LBBB.