bluuebunny/crossref_metadata_2025_split huggingface dataset:
Technical details of the abdominal part during full robotic-assisted minimally invasive esophagectomy
Authors: Berlth Felix , Mann Carolina , Uzun Eren , Tagkalos Evangelos , Hadzijusufovic Edin , Hillegersberg Richard , Li Hecheng , Egberts Jan Hendrik , Lang Hauke , Grimminger Peter Philipp 
Published: November 2020

Abstract
The full robotic-assisted minimally invasive esophagectomy (RAMIE) is an upcoming approach in the treatment of esophageal and junctional cancer. Potential benefits are seen in angulated precise maneuvers in the abdominal part as well as in the thoracic part, but due to the novelty of this approach the optimal setting of the trocars, the instruments and the operating setting is still under debate. Hereafter, we present a technical description of the ‘Mainz technique’ of the abdominal part of RAMIE carried out as Ivor Lewis procedure. Postoperative complication rate and duration of the abdominal part of 100 consecutive patients from University Medical Center in Mainz are illustrated. In addition, the abdominal phase of the full RAMIE is discussed in general.
Left atrial volume stress echocardiography in chronic coronary syndromes
Authors: Morrone D , Arbucci R , Wierzbowska-Drabik K , Ciampi Q , Peteiro J , Agoston G , Varga A , Camorazano A.C , Boshchenko A , Dekleva M , Simova I , Citro R , Colonna P , Lowenstein J , Picano E 
Published: November 2020

Abstract

Background
An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify LAVI within minutes.

Purpose
To assess the feasibility and functional correlates of LAVI-stress echocardiography (SE)

Methods
Out of 514 subjects referred to 10 quality-controlled labs, LAVI-SE was completed in 490 (359 male, age 67±12 yrs, ejection fraction 60±10%) with suspected or known chronic coronary syndromes (n=462) or asymptomatic controls (n=28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAVI was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. In a single center sub-study in 50 subjects, including 28 controls and 22 patients, also peak longitudinal atrial strain (PALS, %) was measured as an index of LA reservoir function.

Results
The intra-observer and inter-observer LAVI variability were 5% and 8%, respectively. Δ-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r=−0.271, p&lt;0.001), heart rate reserve (r=−0.239, p&lt;0.001), and Δ-PALS (n=50, r=−0.374, p=0.007).LAVI-dilators were defined as those with stress-rest increase ≥6.8 ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAVI dilation (see figure) occurred in 56 patients (11%). At multivariable logistic regression analysis, B-lines ≥2 (OR: 2.586, 95% CI =1.1293–5.169, p=0.007) and abnormal left ventricular contractile reserve (OR: 2.207, 95% CI=1.111–4.386, p=0.024) were associated with LAVI dilation.

Conclusion
LAVI-SE is feasible, with high success rate and low variability, in patients with chronic coronary syndromes. A wet (increased B-lines) and weak (reduced LV contractile reserve and LA reservoir function) heart frequently portends LAVI dilation during stress.
Figure 1

Funding Acknowledgement
Type of funding source: None
Functional correlates of left atrial volume dilatation during vasodilator stress echocardiography
Authors: Prota C , Ciampi Q , Cortigiani L , Campagnano E , Morrone D , D'Andrea A , Manganelli F , Colonna P , Wierzbowska-Drabik K , Rodriguez Zanella H , Djordjevic-Dikic A , Citro R , Villari B , Carpeggiani C , Picano E 
Published: November 2020

Abstract

Background
Exercise and dobutamine stress may induce acute left atrial volume index (LAVI) dilatation in 1 out 10 patients. The effect of vasodilator stress in LAVI remains unknown.

Purpose
To assess the feasibility and functional correlates of LAVI change during dipyridamole stress echocardiography (SE).

Methods
We studied 149 patients (99 male, age 66±10 years, ejection fraction 59±8%, 64 with previous myocardial infarction), who underwent dipyridamole ABCDE-SE. LAVI was measured with the biplane disk summation method at rest and peak stress: LAVI-dilators were defined as those with stress-rest increase ≥6.8 ml/m2. Criteria for abnormal response of ABCDE-SE were: stress-induced changes in regional wall motion abnormalities (RWMA) for step A; B-lines at peak stress ≥2 for step B (4-site simplified scan, each site scored from 0= A-lines or black lung to 10= white lung for coalescing B-lines); reduced left ventricular contractile reserve (LVCR, peak/ rest based on force) ≤1.1 for step C; abnormal coronary flow velocity reserve (CFVR) ≤2.0, assessed by pulsed wave Doppler sampling in left anterior descending coronary artery for step D; abnormal heart rate reserve (HRR, peak/rest heart rate) ≤1.22 for step E.

Results
LAVI dilation occurred in 13 patients (9%). The positivity was for step A: RWMA in 6 pts (4%); step B: presence of peak B-lines in 12 pts (8%); step C: abnormal LCVR in 14 pts (9%); step D: reduced CFVR in 17 pts (11%) and step E: abnormal HRR in 46 pts (31%). LAVI dilators showed significantly higher incidence of positivity of steps A-B-C-D (see figure) compared to patients without LAVI dilatation.

Conclusion
Evaluation of LAVI change during vasodilator SE is feasible, and LAVI dilatation is more frequently found with ischemic (step A), wet (step B), weak (step C) and cold (step D) heart.
Figure 1

Funding Acknowledgement
Type of funding source: None
Long term perspective with LBBB: role of stress echocardiography
Authors: Dedic S , Boskovic N , Giga V , Tesic M , Aleksandric S , Jovanovic I , Hadzi Tanovic L , Mihajlovic Varbusova I , Stojicic M , Beleslin B , Djordjevic Dikic A 
Published: November 2020

Abstract

Background
Previous studies have shown that left bundle branch block (LBBB), as a relatively common electrocardiographic (ECG) abnormality, represents the condition with often non benign and sometimes adverse outcome.

Purpose
The Aim of our study was to determine the predictive value of a stress echocardiography test in patients with LBBB.

Methods
Our study population included 189 patients (88 male, 46.6%, mean age 63.08±9.65) with diagnosed left bundle branch block who performed stress echocardiography (SECHO) according to Bruce protocol. Median follow-up of the patients was 56 months (IQR 48–71 months) for the occurrence of cardiovascular death and non-fatal myocardial infarction, repeat revascularization (coronary artery bypass grafting-CABG or percutaneous coronary intervention-PCI).

Results
Out of 189 patients, 32 (16.9%) patients had positive, while 157 (83.1%) patients had negative SECHO test. During the follow up period 28 patients had major adverse cardiac event: 1 nonfatal myocardial infarction, 6 heart failure hospitalizations, 5 CABGs, 8 PCIs, while 8 patients had cardiac death. Using the Cox regression analysis, univariate predictors of adverse cardiac events were diabetes mellitus (HR 4.530 [95% CI 1.355–15.141], p=0.014), PCI (HR 4.288 [95% [95% CI 2.010–9.144], p&lt;0.001) and positive SECHO test (HR 2.289 [95% CI 1.006–5207], p=0.048). In the multivariate analysis only previous PCI remained independent predictor of adverse events (HR 3.650 [95% CI 1.665–8.003], p=0.001). p=0.048). Using the Kaplan-Meier survival curve the patients with negative SECHO had better outcome compared to patients with positive SECHO (140/160; 87,5% vs 21/29; 72.4%, p=0.035) and much longer event-free time (77.4±1.6 months vs 67.1±5.4 months, Log Rank 4.136, p=0.042)

Conclusion
Patients with LBBB and negative SEHO test have good prognosis. Patients with history of CAD and diabetes mellitus and LBBB are at increased risk for future events and need periodical reassessment.

Funding Acknowledgement
Type of funding source: None
Speckle-tracking during dipyridamole stress echocardiography in the detection of myocardial ischemia in patients with suspected coronary artery disease
Authors: Moderato L , Pastorini G , Lazzeroni D , Monello A , Rusticali G , Piepoli M.F , Villani G.Q , Binno S 
Published: November 2020

Abstract

Background
The aim of this study was to investigate the incremental value of global longitudinal strain (GLS), postsystolic strain index (PSI) and prestretch (PSE) by automated function imaging with respect to wall motion (WM) and coronary flow reserve (CFR) for the diagnosis of significant coronary artery disease (CAD) during dipyridamole stress echocardiography.

Methods
We retrospectibely enrolled 227 patients with known or suspected CAD, approaching our echo lab to perform a DSE; all patient underwent coronary angiography within 1 month for clinical reasons. Obstructive CAD was defined as the evidence of &gt;70% stenosis during coronary angiogram. Obstructive CAD was detected in 143 (63%) patients, while 84 (37%) had no significant CAD.
Global longitudinal strain, PSI and PSE were measured at rest and peak of the stress (after 6 minutes of 0,84mg/kg of dipyridamole infusion).

Results
Patient with CAD showed a significantly lower GLS at rest (−16.9±4.2 vs −18.6±3.4; p&lt;0.01) and peak (14.9±3.8 vs −21.50±3.3; p&lt;0.01) Figure A; the behavior of GLS was opposite, in patient with CAD showed an increase while in patient without CAD a significant decrease after dipyridamole infusion. There was also a significant difference between groups for Delta PSI (PSIpeak − PSIrest) and Delta PSE (PSEpeak − PSErest), respectively 126±145 vs −40±97, (p&lt;0.01) and 108±163 vs −41±106 (p&lt;0.01) Figure C. ROC analyses produced a statistically valid model: Average GLS at peak (p 0.001; AUC=0.906, cut-off value −18%, sensitivity 83% and specificity 82%); on the basis of these results, we compared WM and myocardial deformation analysis and GLS was superior to CFR LAD, Delta EF, Delta ESV and Delta WMI (Figure B).

Conclusions
GLS, PSE and PSI show an opposite response to dipyridamole, in patients with CAD in patient without CAD and show much higher sensitivity and specificity compared to the conventional parameters like WMI, EF and CFR in detecting CAD

Funding Acknowledgement
Type of funding source: None
Impact of 2016 ASE/EACVI recommendations on evaluation of left ventricular diastolic function and clinical outcomes in patients with diabetes and hypertension without prior adverse cardiac events
Authors: Foo D , Lam K.H , Igo M , Bujang M.A , Ku M.Y , King T.L , Yeo L.S , Ahip S.S , Sahiran M.F , Mustapha M , Michael J , Abdullah A , Fong A.Y.Y 
Published: November 2020

Abstract

Background
Left ventricular diastolic dysfunction (LVDD) has been shown to be more prevalent in patients with diabetes, and once progress to overt heart failure, carry worse clinical outcomes, compared to those without diabetes. The complexity of previous 2009 ASE/EACVI algorithms makes diastolic function (DF) assessment challenging. Hence, prognostic value of LVDD estimates in clinical setting is not well-established.

Objective
To evaluate the impact of 2016 recommendations in estimates of LVDD and predicting cardiovascular outcomes in patients with diabetes and hypertension.

Materials and methods
A total of 111 patients with diabetes and hypertension who attended diabetic clinic follow-up at the primary healthcare settings were enrolled. All patients were clinically NYHA Class I, had no prior adverse cardiac events, and had preserved left ventricular (LV) ejection fraction on echocardiography at screening. Echocardiography was performed to obtain parameters of LV dimensions, LV volumes and LVDD. Both 2009 and 2016 algorithms were applied in DF assessment. All patients follow-up at 1 year to assess clinical outcomes.

Results
There were 65 (58.6%) female patients. Mean age was 59.86 (7.45); mean duration of diabetes was 10.5 (5.41). 55 (50.5%) patients had LV hypertrophy on echocardiography.
Prevalence of LVDD (14.4% vs 55.0%) and elevated LV filling pressure (9.0% vs 26.1%) were lower with 2016 compared with 2009 recommendations. Prevalence of indeterminate DF was 18.0% and 12.6% according to 2016 and 2009 recommendations respectively. Concordance between 2016 and 2009 recommendations was fair (k=0.29, p&lt;0.001), with a reclassification rate of 45.9%.
None out of 45 patients who were diagnosed with indeterminate and normal DF according to 2016 and LVDD with 2009 algorithms developed MACE at 1 year. Out of 12 patients diagnosed with LVDD based on both 2016 and 2009 recommendations, 4 patients developed MACE at 1 year. 2016 recommendations showed better accuracy (sensitivity=80.0%; specificity=88.68%) than 2009 recommendations (sensitivity=80.0%; specificity= 45.28%) in predicting MACE at 1 year.

Conclusions
The application of 2016 recommendations results in lower prevalence of LVDD. The 2016 criteria detect more advanced cases and predict 1 year cardiovascular outcomes better. Further studies are warranted to investigate the prognostic impact of this criteria.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health (NIH), Ministry of Health Malaysia
Non-invasive estimation of myocardial work in aortic stenosis from modelling approach
Authors: Owashi K.P , Hubert A , Galli E , Donal E , Hernandez A.I , Le Rolle V 
Published: November 2020

Abstract

Background
The noninvasive assessment of myocardial work by pressure-strain loops (PSL) analysis is a recently introduced tool to estimate myocardial performance. PSL analysis cannot be applied to patients having an obstacle to LV ejection, as in the case of aortic stenosis (AS), because of the difficulty to estimate left ventricular (LV) pressure.
The purpose of this work is to propose a non-invasive model-based estimation of the left ventricular pressure curve in AS patients in order to evaluate myocardial work indices.

Methods
Twelve patients with moderate-to-severe AS underwent cardiac catheterization to acquire the LV pressure (Pexp-LV). All patients underwent a standard trans-thoracic echocardiography to extract regional myocardial strain curves and estimate the aortic valve area (AVA). Systolic and diastolic arterial pressures were also measured. The proposed cardiovascular system (CVS) model is composed of four main coupled sub-models simulating: i) cardiac electrical activities, ii) cardiac cavity, iii) the systemic and pulmonary circulation, and iv) cardiac valves (Figure 1, upper panel). A 2-step parameter identification strategy, based evolutionary algorithms, was implemented to learn LV parameters from Pexp-LV and to estimate patient-specific model-based LV pressure curves (Pmodel-LV) starting from parameters obtained from non-invasive hemodynamics. Global myocardial constructive work (GCW) and myocardial wasted work (GWW) were calculated using Pexp-LV and Pmodel-LV.

Results
A close match was observed between Pexp-LV and Pmodel-LV, with a mean total relative error of 12.27% (range 5.9% to 17.40%). When considering GCW and GWW, global correlation was equal to 0.92 (p&lt;0.0001). In BA analysis, mean bias was −2.9 mmHg.%, which corresponds to relative bias equal to 0.11% with respect to the mean value of work indices (Figure 1, lower panel).

Conclusions
A model-based approach can be used to estimate LV pressure and myocardial work indices in patients with AS, and be provide a promising tool for the assessment of myocardial performance in patients with AS

Funding Acknowledgement
Type of funding source: None
Asymptomatic aortic regurgitation: diastolic function and type-B natriuretic peptide as prognostic factors
Authors: Abellas Sequeiros M , Garcia Martin A , Gonzalez A , Hinojar Baydes R , Rincon Diaz L.M , Vieitez Florez J.M , Lorente Ros A , Pardo Sanz A , Manjon Rubio H , Pascual Izco M , Moya Mur J.L , Casas E , Jimenez Nacher J.J , Zamorano J.L , Fernandez Golfin C 
Published: November 2020

Abstract

Introduction
The indication of valve replacement surgery in patients with severe aortic regurgitation (AR) is mainly based on the presence of symptoms or dilatation/dysfunction of the left ventricle (LV). However, diastolic function and natriuretic peptides have not been related to adverse outcomes in these patients. The aim of this study was to evaluate the prognosis impact of different diastolic function parameters as well as type-B natriuretic peptide (BNP).

Methods
Patients with moderate to severe or severe AR evaluated in the Heart Valve Clinic between 2013–2019 were evaluated. Those patients with classical indications for surgical aortic valve replacement (SAVR) at the moment of inclusion were excluded, as well as those patients with atrial fibrillation. Echocardiographic and analytical data were obtained from the medical history. End-point included cardiovascular mortality, SAVR and heart failure.

Results
A total of 126 patients were included. Median age was 65.0±17.7 years. Among them, 75 (59.5%) were men, 78 (62.4%) hypertensive, 44 (35.3%) suffered from dyslipidemia and 11 (9,6%) had ischaemic cardiomyopathy. During a median follow up of 31±17 months, 24.6% of the patients reached the combined end-point (n=5 developed heart failure, n=28 underwent SAVR, and n=4 died).
Among the diastolic parameters [E wave, A wave, E/A, E/e', left atrial volume and diameter, tricuspid regurgitation (TR) degree and pulmonary systolic pressure (PSP)], only TR degree and PSP were associated with a higher incidence of the combined endpoint: TR degree HR=2,08, p=0,039 and PSP HR= 1,1, p=0,007. BNP also showed prognostic impact for the combined endpoint (HR= 1,002, p=0,011).

Conclusions
In patients with asymptomatic significant AR, severity of TR, PSP and BNP levels are associated with worst prognosis. However, classical echocardiographic diastolic parameters do not show prognosis impact, probably due to the limitations of such parameters to identify diastolic dysfunction and high filling pressures in this population. Our findings support the use of PSP and TR over diastolic function parameters to better stratify left valvular patient risk in clinical practice.

Funding Acknowledgement
Type of funding source: None
Regurgitant fraction as a load-dependent parameter in tricuspid regurgitation quantitation
Authors: Liu Y , Dong L.L , Chen B.Q , Zuo W.X , Shu X.H , Ge J.B 
Published: November 2020

Abstract

Background
Regurgitant fraction (RF) is an accepted tool for valvular lesion quantitation in the left heart, while its role in tricuspid regurgitation (TR) is less studied.

Purpose
The aim of this study was to examine the determinants of RF in TR and its diagnostic utility for TR severity grading in comparison with regurgitant volume (RVol) using guideline recommended integrated algorithm as the reference standard.

Methods
114 pts with more-than-mild TR in the absence of pulmonary regurgitation or intracardiac shunt prospectively underwent 2D and 3D transthoracic echocardiography. 3D data sets of the right ventricle (RV) were obtained during breath hold. 3D RVol was calculated through subtracting the right ventricular outflow tract forward stroke volume (SV) from RV SV, where the outflow tract cross-sectional area was derived from single-view measured diameter. 3D RF was calculated by dividing 3D RVol with RV SV. 3D EROA was derived dividing 3D RVol with the velocity-time integral of TR.

Results
104 pts were included in the final analysis. 3D RF correlated well with 3D RVol (r=0.80, P&lt;0.0001). Factors encompassing aetiology (organic/functional), heart rate, systolic pulmonary arterial pressure (sPAP), cardiac output, 3D EROA and RV end-diastolic volume index were included in multiple linear regression (R2=0.85), which demonstrated that RF was associated with sPAP (P&lt;0.0001) but not RV end-diastolic volume index (P=0.116). Receiver operator characteristic analysis revealed significant difference in area under the curve between 3D RVol and 3D RF (Z=2.873, P=0.004). Such difference diminished in pts with elevated sPAP (Z=1.226, P=0.220), while remained in those with normal range sPAP (Z=2.897, P=0.004).

Conclusions
3D RF is less dependent on volume load but is significantly influenced by pressure load in TR quantitation. The diagnostic power of 3D RF in differentiating severe TR is comparable with 3D RVol in pts with elevated sPAP but is limited in pts with normal range sPAP.

Funding Acknowledgement
Type of funding source: None
Clinical significance of late diastolic tissue doppler parameters after onset of STEMI: from the view point of the timing of the echocardipography
Authors: Iwahashi N , Kirigaya J , Horii M , Abe T , Akiyama E , Okada K , Matsuzawa Y , Maejima N , Hibi K , Kosuge M , Ebina T , Tamura K , Kimura K 
Published: November 2020

Abstract

Background
The early transmitral flow velocity (E) divided by the early diastolic velocity of the mitral valve annulus (e') is referred to as the “E/e' ratio,” is useful even for ST elevation acute myocardial infarction (STEMI). However, the role of late diastolic velocity (a') which reveals the atrial function for STEMI is still unclear.

Objectives
We evaluated the clinical usefulness of tissue Doppler including atrial function for a first-time STEMI by long time follow up. Furthermore, we evaluated the meaning of each parameters by performing immediately after PCI or 2 weeks later.

Methods
We treated consecutive 571 first-time STEMI patients by immediate PCI within 12 hours after onset, and we examined 270 patients at immediately after PCI (GroupA, 65 years, 250 male) and 301 patients at 2 weeks after onset (GroupB, 64 years, 243 male). We examined trans mitral flow and TDI, then defined E/e' as LV filling pressure and A/a' as left atrial function. We followed them for a long time (&gt;5 years). The primary end point (PE) was cardiac death or re-admission for heart failure (HF).

Results
We followed the patients in Group A for 10 years, Group B for 5 years. PE occurred in 64 patients in GroupA during 10 years, and 45 patients in GroupB during 5 years. We analyzed the univariate and multivariate Cox hazard analyses and we compared e' and a', E/e' and A/a' (Table). In GroupA, a' and A/a' were the independent predictors, on the other hand neither a' nor A/a' were the predictors in GroupB. E/e' was an independent predictor both in GroupA and B.

Conclusion
TDI parameters have different meanings by the timing of echocardiography after onset of a first-time STEMI. These results demonstrated that atrial dysfunction immediately after onset of STEMI suggests the poor prognosis after STEMI.
Cox Hazard Proportional Analysis

Funding Acknowledgement
Type of funding source: None