bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis of heart failure with preserved ejection fraction in patients with dyspnea and paroxysmal atrial fibrillation: a role of left atrial strain
Authors: Katbeh A , De Potter T , Geelen P , Di Gioia G , Kodeboina M , Balogh Z , Albano M , Vanderheyden M , Bartunek J , Barbato E , Van Camp G , Penicka M 
Published: November 2020

Abstract

Background
Diagnosis of heart failure with preserved ejection fraction (HFpEF) in patients with dyspnea and paroxysmal atrial fibrillation (AF) is challenging. Speckle tracking-derived left atrial strain (LAS) provides an accurate estimate of left ventricular filling pressures and left atrial phasic function. However, data on clinical utility of LAS in patients with dyspnea and AF are scarce.

Objective
To assess relationship between LAS and probability of HFpEF in patients with dyspnea and paroxysmal AF.

Methods
The study included 205 consecutive patients (62±10 years, 58% males) with limiting dyspnea (NYHA ≥ II), paroxysmal AF and preserved LVEF (≥50%), who underwent speckle tracking echocardiography and natriuretic peptide (NT-proBNP) assessment during sinus rhythm. Patients with manifest ischemic heart or valve disease, and cardiomyopathy were excluded. Probability of HFpEF was estimated using H2FPEF and HFA-PEFF scores, which combine clinical characteristics, echocardiographic parameters and natriuretic peptides.

Results
A total of 61 (30%), 115 (56%) and 29 (14%) had respectively high, intermediate and low probability of HFpEF. Patients with high probability of HFpEF were significantly older, had higher body mass index, NT-proBNP, E/e', pulmonary artery pressure and larger LA volume index than patients in low-to-intermediate probability groups (all p&lt;0.05). Two distinct patterns of LA phasic function were observed. Firstly, reservoir LAS showed close inverse association with increasing probability of HFpEF. Secondly, contractile LAS showed initial decrease with subsequent compensatory increase in intermediate probability category with final decrease in patients with high HFpEF probability. In contrast, LV global longitudinal strain was similar between groups (NS). In multivariable regression analysis, reservoir LAS emerged as the strongest independent predictor of HFpEF defined by using both scores. Reservoir LAS with optimal cut off value of 24% showed sensitivity of 86% and specificity of 70% to identify high probability of HFpEF. Combination of LAS with NT-proBNP did not increase the accuracy of each parameter alone.

Conclusions
Reservoir LAS shows a strong independent association with probability of HFpEF in patients with dyspnea and paroxysmal AF. This advocates for more liberal use of LAS assessment to distinguish cardiac from non-cardiac dyspnea in patients with history of AF.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): International PhD programme in Cardiovascular Pathophysiology and Therapeutics (CardioPaTh).
Prognostic role of right ventricular and atrial mechanics in systemic sclerosis
Authors: Nogradi A.B , Varga Z , Szebenyi D , Porpaczy A , Vertes V , Czirjak L , Komocsi A , Faludi R 
Published: November 2020

Abstract

Background
Left ventricular diastolic dysfunction implies a worse prognosis in systemic sclerosis (SSc). Little is known, however, about the prognostic value of right ventricular (RV) and right atrial (RA) mechanics in this disease. Thus we aimed to investigate the long term prognostic value of the traditional and modern echocardiographic parameters of the RV and RA function as well as N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in SSc patients.

Patients and methods
Seventy SSc patients (age: 57±12 years) were enrolled into the study. They underwent echocardiography in the years 2014–15. Parameters of the RV systolic function (tricuspid annular plane systolic excursion /TAPSE/, RV fractional area change /RVFAC/), inferior vena cava, collapsibility index, RV wall thickness were measured. Doppler data were collected: tricuspid E and A, peak velocity of tricuspid regurgitation (TR), tricuspid annular myocardial systolic (S), early- (e') and late- (a') diastolic velocities, tricuspid E/e' ratio. Maximal RA volume index as well as RA reservoir (εR), conduit (εCD) and contractile (εCT) strain were measured with the speckle tracking method. RA stiffness was calculated as ratio of E/e' to εR. Survival was assessed after 5 years. Since in some cases the cause of death was unknown, all-cause mortality was chosen as outcome.

Results
During the follow-up period of 4.7±0.9 years, 6 patients (8.6%) died. In univariate Cox regression analysis TAPSE, peak velocity of TR, tricuspid annular a' and S, tricuspid E/e' ratio, maximal RA volume index, RA stiffness and lnNT-proBNP were significantly associated with outcome. In multivariate Cox regression analysis RA stiffness was proved to be the only independent predictor of mortality (p=0.013). Using ROC analysis, RA stiffness ≥0.156 was the strongest predictor of the mortality (sensitivity=83.3%, specificity =89.1%, AUC=0.859).

Conclusion
Our results suggest that RA stiffness is an independent predictor of all-cause mortality in SSc. Larger prospective validation studies are required to prove our findings.
ROC and Kaplan-Meier survival curve

Funding Acknowledgement
Type of funding source: None
Prognostic utility of routine assessment of left ventricular global longitudinal strain and peak atrial reservoir strain in stable heart disease patients
Authors: Bolog M.I , Dumitrescu M , Pacuraru E , Romanoschi F , Rapa A 
Published: November 2020

Abstract

Background
Left ventricular ejection fraction above 40% is a poor predictor of cardiac outcomes. Strain imaging seems to add incremental prognostic value in various heart conditions.

Purpose
The aim of the study is to investigate whether assessment of both left ventricular global longitudinal strain (LVGLS) and peak atrial reservoir strain (PARS) in routine daily practice is useful in predicting cardiac events.

Methods
We prospectively enrolled 300 patients (212 men, mean age 64.8±10.9 years old) with stable cardiac disease, referred for echocardiographic examination and eligible for strain imaging. Conventional and speckle tracking 2D rest echocardiography were performed and clinical variables were recorded. We excluded patients with acute coronary syndromes, severe valvular disease, cardiomyopathies, arrhythmia and class IV NYHA.

Results
During a median follow up of 30 months, there were 111 cardiac events (CE) recorded including: 7 cardiac deaths (CD), 25 acute coronary syndromes (ACS), 45 hospitalisations for worsening heart failure (WHF), 23 episodes of atrial fibrillation (AF), 11 stroke (S). Average EF, LVGLS and PARS in patients with CE were significantly lower than in patients without CE (55.8±8.4%, −17.3±3.9% and 16.3±9.8% vs. 60.4±8.4%, −20.1±3.7% and 28.4±8.2%; p&lt;0.05, p&lt;0.01, p&lt;0.01). In univariate analysis, lower LVGLS, respectively lower PARS were associated with a higher risk of cardiac events [Hazard Ratio (HR)1.26; 95% CI (confidence interval): 1.08–1.34; p&lt;0.01 per 1% decrease, respectively HR 1.38; 95% CI: 1.16–1.42; p&lt;0.01 per 1% decrease]. On multivariate analysis this association was independent after adjustment for age, gender, hypertension, diabetes, ejection fraction, left atrial indexed volume. Lower LVGLS was a better predictor of a composite of ACS and CD (HR 1.38 per 1% decrease 95% CI: 1.16–1.48; p&lt;0.01). Lower PARS had a stronger association with AF, S and WHF (HR 1.49 per 1% decrease 95% CI: 1.19–1.58; p&lt;0.01). In a model defined by depressed LVGLS (more positive than −18%) adding lower PALS, with a cut off point of 20%, significantly improved prediction of CE (C-statistic increased from 0.68 to 0.83, p&lt;0.001).

Conclusions
Left ventricular global longitudinal strain and peak atrial reservoir strain are independent predictors of cardiac events patients with stable heart disease. Acute coronary syndromes and death were better predicted by depressed LVGLS and onset of atrial fibrillation, stroke and worsening heart failure were better predicted by lower PARS. Routine assessment of both parameters improves significantly prediction of cardiac events and helps clinical decision making.

Funding Acknowledgement
Type of funding source: None
Evaluation of the local atrial function by regional speckle tracking imaging using intracardiac echocardiography
Authors: Inoue K , Ohnishi T , Iwakura K , Tanaka K , Oka T , Hirao Y , Tanaka N , Okada M , Kitagaki R , Yoshimoto I , Koyama Y , Okamura A , Fujii K 
Published: November 2020

Abstract

Background
It has been reported that low voltage areas and conduction abnormalities detected by electrophysiology catheters in the left atrium (LA) represent regional degeneration and fibrosis of the atrium and are related to a poor atrial fibrillation (AF) ablation outcome. Assessment of the local atrial function is clinically useful because atrial degeneration does not occur uniformly throughout the atrium. Though evaluating the global atrial function using speckle tracking imaging (STI) by transthoracic echocardiography (TTE) has been attempted, TTE does not have a sufficient image quality to assess local atrial STI.

Purpose
To evaluate the local atrial function by STI using intracardiac echocardiography (ICE) and to elucidate the characteristics of the STI in normal and abnormal voltage regions in the LA.

Methods
We included 9 patients undergoing AF ablation with written informed consent for this prospective observational study. After pulmonary vein isolation, we performed voltage mapping of the LA in sinus rhythm using a CARTO system (Biosense). Abnormal regions and normal regions were defined as those with low voltage areas (&lt;0.5 mV) and those with normal voltages, respectively. Echo images were recorded by an ACUSON SC2000 (Siemens) and SOUNDSTAR catheter (Biosense). We inserted the SOUNDSTAR catheter into the LA to obtain clear images, recorded the STI of the anterior and inferior wall, and performed an offline analysis of the atrial strain with an eSie VVI work station (Siemens) and the LA voltage data with CARTO system at each site simultaneously (left figure). We compared the strain during the atrial contraction phase (Sct) between the normal and abnormal regions.

Results
Among the study population, 5 patients had low voltage areas in the LA. We evaluated the STI at 26 normal regions and 44 abnormal regions. The typical regional speckle tracking waveform in the normal region was similar to a jugular vein pressure waveform (right figure). There was a difference in the amplitude of the Sct between the groups; it was significantly smaller in the abnormal regions (normal and abnormal regions, 9.8±5.0% and 5.6±3.8%, p=0.0001). The duration of the Sct was significantly more prolonged in the abnormal regions than normal regions (98.8±26.3ms and 118.2±33.9ms, p=0.015).

Conclusions
This pilot study demonstrated that the local atrial function was evaluable by STI using ICE and that the regional strain tracking waveform during the atrial contraction phase in abnormal voltage regions was smaller and more prolonged than that in normal regions. An evaluation of the regional STI with an ICE may be useful to detect regional abnormalities of the atrium.
Representative case

Funding Acknowledgement
Type of funding source: None
Very low birth weight is associated with reduced right ventricular function detected by strain imaging in early adulthood – findings from a prospective matched cohort study
Authors: Greer C , Adamson P , Harris S , Horwood J , Troughton R , Darlow B 
Published: November 2020

Abstract

Introduction
Being born at very low birth weight (VLBW, &lt;1500g) is associated with increased rates of cardiopulmonary disorders in childhood. As survivors age, late cardiac effects, including right ventricular (RV) remodelling and occult pulmonary hypertension are emerging. Strain imaging provides prognostically important information regarding RV dysfunction in diverse cardiopulmonary conditions however, these indices have not previously been described within VLBW cohorts.

Purpose
To assess differences in right heart function using strain in young adults born at VLBW, compared to normal weight term born controls.

Methods
The New Zealand Very Low Birth Weight Study has followed all infants born in 1986 with birth weight &lt;1500g. Of 323 survivors to adulthood, 228 (71%) had echocardiograms at 26–30 years which were compared to age and sex-matched term-born, normal-weight controls (n=100). RV global longitudinal strain (GLS) was measured by speckle tracking echocardiography by an investigator blinded to group allocation. Established measures of RV function (fractional area change (FAC), tricuspid annular systolic velocity (RV S') and tricuspid regurgitation velocities) were also obtained.

Results
VLBW subjects were smaller than their peers as young adults (Table 1). Strain measurement showed reduced myocardial deformation among VLBW subjects (RV myocardial GLS: −22.4% vs −23.5%, p=0.008; RV endocardial GLS: −23.6% vs −24.9%, p=0.005; free wall myocardial GLS −25.2% vs −26.1%, p=0.039; free wall endocardial GLS −26.7% vs −27.9%, p=0.009). TR velocity was higher in VLBW: 224 cm/s v 210 cm/s (p=0.002). RV S', and FAC were not different.

Conclusion
Young adults born at VLBW have impaired myocardial strain despite preserved RV function as assessed by standard techniques. Echocardiographic strain imaging may be an important tool to detect subclinical RV dysfunction.
Graph 1

Funding Acknowledgement
Type of funding source: None
The future of cardiac prognostication: supervised machine learning to predict mortality in patients with acute pulmonary embolism
Authors: Hasani A , Mustehsan M.H , Taub C 
Published: November 2020

Abstract

Background
Pulmonary embolism (PE) is a significant cause of morbidity and hospitalization worldwide with Right Ventricular (RV) dysfunction identified in association with morality. Two-dimensional speckle tracking echocardiography is an imaging modality used to calculate cardiac strain which can be used to identify early mechanical stress in the RV.

Purpose
Combining imaging techniques with patient demographics, comorbidities, and clinical parameters, we aim to create a supervised machine learning model to predict mortality within one year after PE and identify important variables.

Methods
A retrospective cohort of 74 patients who presented with acute PE, confirmed by contrast CT or V/Q scanning, to our hospital system in 2017 who had a transthoracic echocardiogram within 48 hours after the event. STE was used to calculate Endocardial Global Longitudinal Strain (Endo-GLS), End-Diastolic Area (EDA), End-Systolic Area (ESA), and Fractional Area Change (FAC). These parameters were taken along with Size/location of PE, RV size, RV Function, RV Systolic Pressure (RVSP), and TR Velocity. A supervised machine learning model was created using logistic regression and random forest classifier algorithm 100 trees with bootstrapping using Python version 3.7.2. The data was randomly sampled and run through our classifier 50 times which our outcome measurements averaged.

Results
We identified Endo-GLS as the parameter with the highest weight (30.9%) followed by, FAC (14.0%), and ESA (10.8%). Non-echocardiographic variables that had high importance were patients BMI and Intervention at time of event. We found an Accuracy of 84.3%, Sensitivity of 57.1%, and Specificity of 91.5%. The AUC for our model was 0.87.

Conclusion
The use of novel imaging methods and supervised machine learning can help identify important variables such as Endo-GLS and help predict mortality in patients with PE. Extrapolated, strain patterns can be sensitively measured in the acute setting of diseases and be used to help predict clinical outcomes. Our next steps are to obtain larger sample size in to create a more robust classifier and to prospectively validate our model.
Random Forest Model

Funding Acknowledgement
Type of funding source: None
Exercise induced reduction in myocardial work predicts significant coronary artery disease in patients with false negative stress echocardiography
Authors: Chilingaryan A.L , Tunyan L.G , Adamyan K.G , Zelveyan P.H , Tumasyan L.R , Kzhdryan H.K 
Published: November 2020

Abstract

Stress echocardiography (SE) is a reliable technique for the diagnosis of coronary artery disease (CAD) with high sensitivity and specificity. However in patients with small left ventricular (LV) cavity caused by marked concentric hypertrophy the sensitivity of SE is low. We assumed that in patients with false negative SE evaluation of global myocardial work (GW) might detect significant CAD.

Methods
238 patents with chest pain (98 female, mean age 61±5 years) without history of CAD were referred to SE for CAD confirmation. 94 (39.5%) patients had negative SE and were enrolled in our study for re-examination. Age and gender matched 50 healthy subjects served as controls. GW index (GWI) was obtained from pressure-strain loops composed from speckle tracking analysis indexed to brachial systolic blood pressure. Global constructive work (GCW) as the sum of positive work due to myocardial shortening during systole and negative work due to lengthening during isovolumic relaxation, global wasted work (GWW) as energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation, and GW efficiency (GWE) as the percentage ratio of constructive work to the sum of constructive work and wasted work were measured after submaximal treadmill SE at the heart rate of 100–110 beats per minute (109±11 s after SE) using EchoPac software by blinded experienced echocardiographer. All patients were referred to coronary angiography after re-examination.

Results
42 (44.7%) patients had lower GWI values than the lowest limit of GWI value in controls. These patients had significant reduction in GWI, compared with remaining 52 patients in whom GWI did not differ from those of controls (GWI 1897±112 mmHg% vs 2518±243 mmHg%, p&lt;0.01). GCW, GWE and GWW were comparable between patients with or without reduced GWI (GCW 2283±107mmHg% vs 2321±110 mmHg%, p=NS; GWE 96.9±1.1% vs 97.4±1.2%, p=NS; GWW 57±3 mmHg% vs 53±4 mmHg%, p=NS). 28 (66.7%) of 42 patients with GWI reduction and 8 (15.0%) of 52 patients without GWI reduction had at least one vessel significant CAD. GWI had sensitivity, specificity, and accuracy in detection of CAD 78%, 76%, 77% respectively with 67% positive predictive value, and 85% negative predictive value. 29 (80.5%) patients out of 36 with significant CAD had concentric increase in LVMi compared with true negative SE patients (83±6 g/m2 vs 71±4 g/m2, p&lt;0.01). GWI was the predictor of significant CAD (area under the curve 0.793).

Conclusion
GWI extends diagnostic power of conventional SE in detection of CAD, especially in patients with smaller LV cavity due to concentric hypertrophy when sensitivity of conventional SE is low.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Committee of Sience at Ministry of Education of Republic of Armenia
The value of regional myocardial function assessment in patients with acute myocarditis at baseline and mid term follow-up
Authors: Boidol J , Koziel M , Miszalski-Jamka K , Klys J , Kalarus Z , Kukulski T 
Published: November 2020

Abstract

Background
The clinical course and ventricular remodeling in inflammatory myocardial disease could be unpredictable. No single functional parameter has been confirmed as a powerful predictor of clinical course and functional recovery assessment in patients with acute inflammatory myocardial disease.

Purpose
The aim of the study was to assess the mechanical properties of the myocardium in patients with active myocarditis at baseline and follow-up.

Methods
Database from a high volume, tertiary cardiology center was analysed to identify patients with active myocarditis, based on clinical presentation and ≥1 diagnostic criteria from different categories (including electrocardiography/holter, elevated troponin T/I levels, functional or structural abnormalities on cardiac imaging or tissue characterization by cardiac magnetic resonance) between 2016 and 2019. Conventional and speckle tracking echocardiography including global longitudinal strain (GLS) mechanical dispersion (MD) was completed at baseline and at 17±13 months follow-up. MD was calculated as a standard deviation of time to peak longitudinal strain derived from all left ventricle segments in 3 apical views.

Results
61 consecutive patients [50 M, 11F, end-diastolic volume 212±84 ml, end-systolic volume 130±90ml, ejection fraction (EF) 42±16%] were enrolled. During the entire follow-up 1 patient died at early observation. Implantable cardioverter-defibrillator was implanted in 5 patients (primary prevention 4, secondary 1), cardiac resynchronization therapy pacemaker in 1 patient. Despite of significant global improvement (EF 42±16% vs 52±10%, p&lt;0.001) the limited regional improvement was noticed (GLS 14±6% vs 15±4%, p = NS; MD 47±18 ms vs 45±20 ms, p=NS) in all patients at 17±13 months follow-up. There was a strong negative association between GLS and MD at baseline (Figure 1), and slightly weaker at follow-up (R=0.47, Pearson's correlation). Moreover, the GLS correlated well the change of MD in each individual patient.

Conclusions
Mechanical dispersion and global longitudinal strain may serve as an additional markers of myocardial damage and potential predictive markers in non ischemic cardiomyopathy patients with proven inflammatory origin.

Funding Acknowledgement
Type of funding source: None
A two year echocardiographic follow-up of patients with chronic total occlusion treated with percutaneous coronary intervention or receiving only medical therapy
Authors: Juricic S , Petrovic O , Tesic M , Dobric M , Dikic M , Mehmedbegovic Z , Zivkovic M , Vukcevic V , Aleksandric S , Milasinovic D , Tomasevic M , Orlic D , Stankovic G , Beleslin B , Stojkovic S 
Published: November 2020

Abstract

Background
Percutaneous coronary intervention of chronic total occlusion (PCI CTO) can reduce angina and the need for bypass surgery, however, it is still not clear how it effects the myocardial function. Conventional echocardiography is subjective and experience-dependent while tissue Doppler imaging together with strain imaging provides a more objective assessment of myocardial contractility.

Purpose
Our aim was to access the effectiveness of percutaneous coronary intervention (PCI) along with optimal medical therapy (OMT) on myocardial function.

Methods
We compared two groups of patients. The first group of patients underwent PCI CTO with OMT while the second group of patients only received OMT (control group). The echocardiographic exam was performed before randomization and after 24 months of follow-up. Doppler time intervals- isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVCT) and ejection time (ET) were measured from mitral inflow and left ventricular outflow Doppler tracings. Myocardial performance index (MPI) is equal to the sum of the IVRT and IVCT divided by the ET. Velocity of early mitral filling wave (E) was measured and divided by average peak early diastolic annular velocity (e'). Peak longitudinal strain was assessed in 17 left ventricular segments. Time intervals from start Q/R on electrocardiogram to peak negative strain during the cardiac cycle were assessed. Mechanical dispersion was defined as the standard deviation of this time interval from 17 left ventricular segments, reflecting myocardial contraction heterogeneity

Results
Comparing the groups at follow up, there was no significant change in ejection fraction (EF), diastolic function, and mechanical dispersion, however, there was improvement in GLS and MPI (Table 1).

Conclusion
Global longitudinal strain as a parameter of systolic function and Myocardial performance index as a parametar of global systolic and diastolic function are sensitive markers that can detect subtle improvement in myocardial function after recanalisation of CTO.

Funding Acknowledgement
Type of funding source: None