bluuebunny/crossref_metadata_2025_split huggingface dataset:
Carotid intima-media thickness and subclinical left heart dysfunction in the general population
Authors: Nakanishi K , Daimon M , Yoshida Y , Ishiwata J , Sawada N , Hirokawa M , Kaneko H , Nakao T , Mizuno Y , Morita H , Di Tullio M , Homma S , Komuro I 
Published: November 2020

Abstract

Background
Although carotid intima-media thickness (IMT) is an established marker of atherosclerosis and carries independent risk for cardiovascular disease, its possible association with subclinical cardiac dysfunction has not been extensively evaluated. Left ventricular global longitudinal strain (LVGLS) and peak left atrial longitudinal systolic strain (PALS) can detect subclinical left heart dysfunction.

Purpose
This study aimed to investigate the association between carotid IMT and subclinical left heart dysfunction in a large sample of the general population without overt cardiac disease.

Methods
We examined 1,161 participants who underwent extensive cardiovascular examination. Ultrasonography of common carotid artery was performed for the measurement of maximal carotid IMT. LVGLS and PALS were assessed by 2-dimensional speckle-tracking echocardiography.

Results
Mean age was 62±12 years, and 56% were male. The prevalence of abnormal LVGLS (&gt;−18.6%) and PALS (&lt;31.4%) was greatest in the upper quartile of carotid IMT (both p&lt;0.001; Figure). In multivariable analyses, carotid IMT was associated with abnormal LVGLS (adjusted odds ratio = 1.33 per 1SD increase of IMT, p=0.003) as well as PALS (adjusted odds ratio = 1.33 per 1SD increase of IMT, p=0.005) independent of traditional cardiovascular risk factors, echocardiographic parameters including LV ejection fraction, LV mass index and diastolic dysfunction, and pertinent laboratory parameters. The independent association between carotid IMT and PALS persisted even after adjustment for LVGLS. When carotid IMT was examined as a categorical variable, the upper quartile of carotid IMT carried a significant risk of abnormal LVGLS and PALS in a fully-adjusted model including echocardiographic and laboratory parameters (adjusted odds ratio 2.27 and 3.03 vs. lower quartile, both p&lt;0.01).

Conclusion
Participants with increased IMT had significantly impaired LV and LA function in an unselected community-based cohort. This association may be involved in the higher incidence of cardiovascular disease in individuals with increased carotid IMT.

Funding Acknowledgement
Type of funding source: None
Regional left ventricular myocardial work index in culprit territory predicts early left ventricular remodelling in patients with st-segment elevation myocardial infarction
Authors: De Paula Lustosa R , Van Der Bijl P , Knuuti J , Goedemans L , El Mahdiui M , Montero-Cabezas J , Kostyukevich M , Fortuni F , Ajmone Marsan N , Bax J.J , Delgado V 
Published: November 2020

Abstract

Background
The association between left ventricular (LV) myocardial work index (LVMWI) derived from speckle tracking echocardiographic strain data in combination with non-invasive blood pressure recordings and adverse LV dilatation i.e. remodelling has not been evaluated.

Purpose
To assess the predictive value of regional LVMWI for LV remodelling at baseline echocardiography in patients with ST-segment elevation myocardial infarction (STEMI).

Methods
This retrospective study included 350 patients (265 men, mean age: 61±10 years) with STEMI treated with primary percutaneous coronary intervention and optimal medical therapy. Clinical variables, conventional echocardiographic parameters, global and segmental measures of LVMWI were recorded at baseline. The primary endpoint was early LV remodelling defined as increase in LV end-diastolic volume (LVEDV) ≥20% at 3 months after the index event.

Results
Eighty-seven patients (24.9%) presented with early LV remodelling. The global and regional LVMWI in the culprit territory were significantly lower in patients with early LV remodelling. Univariate and multivariate logistic regression analyses were performed to identify predictors of early LV remodelling. At the index event, troponin I peak, LVEDV and LVMWI in the culprit territory were independently associated with early LV remodelling (Table).

Conclusions
In STEMI patients treated with primary percutaneous coronary intervention and optimal medical therapy, the regional LVMWI in the culprit territory at echocardiography before discharge is independently associated with troponin I peak and LVEDV in predicting early LV remodelling.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): European Society of Cardiology
Predictors of left ventricular remodelling in patients after active myocarditis
Authors: Koziel M , Boidol J , Klys J , Miszalski-Jamka K , Kalarus Z , Kukulski T 
Published: November 2020

Abstract

Background
Myocarditis may be a challenging diagnosis because of diversity of clinical presentations. Thus, the clinical course and ventricular remodelling in this disease seems to be unpredictable.

Aims
To assess predictors of left ventricular remodelling in patients after active myocarditis.

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. Left ventricle global longitudinal strain (GLS), mechanical dispersion (standard deviation of time to peak longitudinal strain derived from all left ventricle segments in 3 apical views) were calculated. Response (left ventricular positive remodeling measured by transthoracic echocardiography) was defined as end-systolic volume (ESV) reduction ≥15% from a baseline value or end-diastolic volume (EDV) reduction ≥15%.

Results
61 consecutive patients were enrolled. The median follow-up was 1.4 years (range: 0.3–4.0). During entire follow-up period mortality rate in patients was 1.6%. Multivariate Cox regression model including significant baseline differences as covariates reported that QRS durations (HR 1.31, 95% CI 1.17–1.57, P=0.049) and mechanical dispersion (HR 1.03, 95% CI 1.01–1.07, P=0.036) were independently associated with left ventricular positive remodelling with ESV reduction. Mechanical dispersion (HR 1.04, 95% CI 1.02–1.06, P=0.040) was independently associated with left ventricular positive remodelling with EDV reduction.

Conclusions
Mechanical dispersion and QRS duration are independent predictors of left ventricular remodelling in patients after active myocarditis.

Funding Acknowledgement
Type of funding source: None
Left atrial adaptation to different overloads: is atrial enlargement always related to atrial dysfunction?
Authors: Mimbrero Guillamon M , Loncaric F , Nunno L , Tirapu L , Sanchis L , Montserrat S , Doltra A , Bijnens B , Sitges M 
Published: November 2020

Abstract

Introduction
The adaptative response to different loading conditions of the left atrium (LA) has been scarcely studied. This might have clinical implication in terms of risk of emboli and atrial fibrillation development. Our aim is to assess function in enlarged LA with 3-dimensional (3D) echocardiographic volume assessment and speckle-tracking deformation analysis, and compare findings between patients with arterial hypertension (HTN), mitral regurgitation (MR) and endurance athletes (EA).

Methods
A population of 478 subjects were enrolled: 57% (n=273) EA, 37% (n=176) patients with well-controlled HTN and 6% (n=29) with moderate-to-severe MR. From this cohort, we selected the patients with enlarged atriums defining a 2D cut-off value of ≥34 mL/m2. These patients underwent 2D and 3D echocardiography. LA function was assessed with speckle-tracking analysis and phasic volume indices.

Results
LA enlargement was seen in 63% (n=299) of the cohort: 80% (n=219) of EA, 30% (n=53) of HTN and 93% (n=27) of MR patients. Analysis of LA function in these patients is shown in Table 1. As expected, MR was related to the largest LA volumes, followed by athletes - which had significantly larger volumes than HTN patients. LA reservoir strain and LA ejection fraction, as well as LA conduit strain and LA passive Ejection Fraction, were preserved in the athletes group while reduced in HTN and MR, whereas the LA contractile strain and LA active Ejection Fraction were reduced only in the MR subgroup.

Conclusions
These findings suggest that LA adapts differently to pressure and volume overload and also influenced by the amount of overload. Additionally, LA enlargement may not be associated with the same degree of LA dysfunction in different at-risk populations.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Fundaciό La Maratό de TV3
Clinical usefulness of relative apical sparing pattern for predicting functional recovery after transcatheter aortic valve implantation in patients with severe aortic stenosis
Authors: Matsuda K , Okayama H , Kazatani T , Okabe H , Kido S , Aono T , Tanaka Y , Kosaki T , Kawamura G , Shigematsu T , Kawata Y , Hiasa G , Yamada T , Kazatani Y 
Published: November 2020

Abstract

Background
Relative apical sparing pattern (RASP) is thought to be associated with prognosis in patients with cardiac amyloidosis or left ventricular hypertrophy (LVH). Although almost all patients with severe aortic stenosis (AS) have LVH, little is known about the effect of transcatheter aortic valve implantation (TAVI) in patients with severe AS exhibiting a RASP.

Purpose
This study aimed to elucidate the effect of TAVI on left ventricular global longitudinal strain (LS; LVGLS) in patients with severe AS exhibiting a RASP.

Methods
Eighty-four patients who underwent transfemoral or subclavian TAVI were evaluated. They were divided into the RASP and non-RASP groups. The average apical LS divided by the sum of the average mid and basal LS values of &gt;1.0 was defined as the RASP. We analyzed the difference between pre- and post-TAVI LVGLS (ΔGLS = post-TAVI LVGLS − pre-TAVI LVGLS).

Results
Of the 84 patients (mean age, 84.5±3.9 years; 24 men), 15 (17.9%) exhibited a RASP. No significant difference in mean pre-TAVI LVGLS was found between the RASP and non-RASP groups (−16.6% ± 3.8% vs. −15.8% ± 3.9%). The ΔGLS in the RASP group was significantly higher than that in the non-RASP group (−0.97% ± 2.5% vs. −2.6% ± 3.0%; P&lt;0.05). Multivariate analysis revealed that relative apical longitudinal strain was an independent predictor of ΔGLS (β = 0.35, p=0.002).

Conclusion
Relative apical longitudinal strain was associated with LVGLS recovery. The effect of TAVI on LVGLS in patients with a RASP is inferior to that in patients without a RASP.

Funding Acknowledgement
Type of funding source: None
Echocardiographic assessment of the impact of percutaneous revascularisation of chronic total occlusion on myocardial function and electrical stability, two-year follow up period
Authors: Petrovic O , Juricic S , Arnautovic N , Paunovic I , Trifunovic-Zamaklar D , Rakocevic I , Boricic-Kostic M , Aleksandric S , Milasinovic D , Dobric M , Tesic M , Ivanovic B , Stankovic G , Stojkovic S 
Published: November 2020

Abstract

Background
Chronic total coronary occlusion (CTO) is frequent finding in patients with ischaemic heart disease, but it is not clear yet how it affects myocardial function, especially electrical stability. Myocardial strain by echocardiography can objectively quantify extent and timing of myocardial deformation. Echocardiographically derived dyssynchrony, mechanical dispersion, is good predictive tool for patients at risk of ventricular arrhythmias.

Purpose
The purpose of this study was to evaluate the influence of chronic total occlusion percutaneous coronary intervention (CTO PCI) on myocardial contractility and arrhythmogenicity.

Methods
We analysed total of 35 CTO patients (age 56±9, 86% male). Convectional echocardiographic exam with two dimensional speckle tracking echocardiography (2D STE) was performed before CTO PCI and after 24 months of follow-up. Peak longitudinal strain was assessed in 17 left ventricular segments. 2D STE computed global longitudinal strain (GLS). Time intervals from start of 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
24 months after CTO PCI patients showed no change in ejection fraction (EF) (55.75±7.56% vs. 56.03±6.29%, p=0.622). There was slight improvement in GLS (−14.89±2.81% vs. −15.93±2.64%, p&lt;0.05), Mechanical dispersion was significantly reduced (62.78±23.44ms vs 47.96±12.10ms, p&lt;0.001)

Conclusion
CTO recanalization improved GLS without changes in left ventricular EF after 24 months. Mechanical dispersion as a surrogate for arrhythmogenic substrate was reduced by CTO PCI.

Funding Acknowledgement
Type of funding source: None
Right ventricular speckle tracking in patients with heart failure – a comparison of right ventricular measures
Authors: Lundorff I.J , Sengeloev M , Pedersen S , Modin D , Bruun N.E , Hansen T.F , Biering-Soerensen T , Godsk Joergensen P 
Published: November 2020

Abstract

Background
RV dysfunction is associated with increased mortality and morbidity in patients with heart failure. Due to the complex shape and position of the RV, assessing RV function from echocardiographic images remains a challenge.

Purpose
We have previously found that global longitudinal strain from 2DSTE is superior to left ventricular ejection fraction (LVEF) in identifying HFrEF patients with high risk of mortality. In this study we wanted to examine RV 2DSTE in patients with HFrEF and compare its prognostic value to conventional RV measures.

Methods and results
Echocardiographic examinations were retrieved from 701 patients with HFrEF. RV estimates were analysed offline, and end point was all-cause mortality. During follow-up (median 39 months) 118 patients (16.8%) died. RV GLS and RV FWS remained associated with mortality after multivariable adjustment, independent of TAPSE (RV GLS: HR 1.07, 95% CI 1.02–1.13, p=0.010, per 1% decrease) (RV FWS: HR 1.05, 95% CI 1.01–1.09, p=0.010, per 1% decrease). This seemed to be caused by significant associations in men as TAPSE remained as the only independent prognosticator in women. All RV estimates provided prognostic information incremental to established risk factors and significantly increased C-statistics (TAPSE: 0.74 to 0.75; RVFAC: 0.74 to 0.75; RVFWS: 0.74 to 0.77; RVGLS: 0.74 to 0.77).

Conclusions
RV strain from 2DSTE was associated with mortality in patients with HFrEF, independent of TAPSE and established risk factors. Our results indicate that RV strain is particularly valuable in male patients, whereas in women TAPSE remains a stronger prognosticator.
RV GLS and the risk of mortality

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): PGJ reports receiving lecture fee from Novo Nordisk.
Evidence for abnormal deformational reserve in hypertrophic obstructive cardiomyopathy on exercise: is this a true fingerprint?
Authors: Halmai L , Ward M , Kardos A , Nemes A , Neubauer S , Wong J , Pantazis A 
Published: November 2020

Abstract

Hypertrophic obstructive cardiomyopathy (HOCM) is characterized by muscle hypertrophy and fibrosis, interfering with force generation and relaxation. Abnormal ventricular (LV) myocardial deformation have been demonstrated in patients with HOCM at rest, but there is lack of data regarding the deformational mechanics in exercise in obstructive HCM.

Aims
To assess the adaptability of LV deformational behaviour to physical exercise in HOCM patients as compared to healthy controls and to examine if Deformational Imaging (DMI) can provide additional information.

Methods
28 obstructive HOCM (age 51.2±14.2yrs; 16 men, LVOT-obstruction 56±19mmHg at rest or on Valsalva maneuver) and 32 control subjects (50.9±6.8 yrs, 19 men from the MAGYAR-PATH Registry) underwent bicycle stress Echo (ESE) with full conventional 2D- and Doppler TTE, 2D- and 3D-Speckle Tracking Analysis (DMI) and 3D-Full Volume assessment both at rest and on submaximal ESE.

Results
At rest, the HOCM group had lower GLS (−14.6±4.5 vs 18.4±2.6%, p&lt;0.01) but higher CS (−32.9±5.1 vs 28.8±2.3%) and Twist (9.9±2.6 vs 6.1±2.2°) than in control subjects. Exercise induced an increase in all strains in control subjects but less in HOCM (GLS: −21.4±3.5 vs 15.1±3.0% and CS: −33.9±3.6 vs 34.1±4.2% in controls). The increase of LV twist was blunted in HOCM (Δ1.2 vs Δ3.6° in controls). The PSS was more pronounced in HOCM on ESE (46.6±12.0 vs 21.2±9.6%, AUC: 0.71 for predicting HOCM), the UTR was slower (118±2.1 vs 133.1±14.1°/s) and occurred later in HOCM. The MD of Strain increased in HOCM on ESE (Δ85.1 vs Δ8.1ms in controls). The Twist had positive correlation with LVOT-obstruction (R2=0.54, p&lt;0.01) and inverse correlation with UTR (R2=−0.72, p&lt;0.02). The UTR/Twist ratio diminished only in HOCM on exercise (−6.0±0.8 vs −13.1±2.5 1/s). The MD, the PSS on ESE and the UTR/Twist ratio predicted the HOCM deformation phenotype accurately (AUC: 0.72, cut-off 6.0 1/s).

Conclusions
The HOCM patients had attenuated Strain and Rotational response on exercise implying impaired deformational adaptability with post-systolic shortening and pronounced mechanical dispersion of peak Strain on exercise which was more accurate to identify the HOCM phenotype than other Echo-indices. These findings support evidence for reduced systolic-diastolic coupling efficiency in HOCM patients on exercise which can contribute to the development of exercise-related breathlessness, dynamic LVOT-obstruction and arrhythmias in patients with HOCM. These distinct deformational patterns on exercise can help in the differential diagnosis of patients with LV hypertrophy of unknown aetiology with good sensitivity and specificity and can also aid in the risk stratification workup in HOCM.
DMI Predictors for HOCM

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Milton Keynes University Hospital Research Founding
Influence of lesion location on the accuracy of CT derived FFR: head-to-head comparison with invasive FFR
Authors: Moshage M , Smolka S , Achenbach S , Ammon F , Ferstl P , Goeller M , Bittner D.O , Uehlein S , Bal Z , Marwan M 
Published: November 2020

Abstract

Background
The accuracy of CT-derived FFR (FFRCT) has been repeatedly reported. However, the influence of lesion location on accuracy is unknown. Therefore, we evaluated the diagnostic accuracy of FFRCT to detect lesion-specific ischemia and determined the influence of lesion location (proximal vs. distal vessel segments) compared to invasively measured FFR in patients with suspected CAD.

Methods
A total of 136 vessels in which “Dual-Source”-CT coronary angiography had been performed due to suspected CAD and who were further referred for invasive coronary angiography with invasive FFR measurement within three months of the index CT examination were retrospectively identified and screened for inclusion in this analysis. Patients with either left main coronary artery stenoses, bifurcation or ostial stenoses were excluded. Invasive FFR was measured using a pressure wire (CERTUS®, St. Jude Medical, Minnesota, USA or Verrata®, Volcano, San Diego, USA). FFRCT was calculated using an on-site prototype (cFFR Version 3.0, Siemens Healthineers, Forchheim, Germany). All vessels were analyzed by an experienced observer blinded to the results of invasive FFR. Stenoses with invasively measured FFR ≤0.80 were classified as hemodynamically significant. We evaluated the diagnostic accuracy of FFRCT in proximal vs. non-proximal vessel segments. Proximal lesions included stenoses located in segment one, six, eleven and twelve. All other stenoses were categorized as distal lesions.

Results
Out of 136 coronary stenoses, 47 (35%) were located in proximal segments and 89 (65%) lesions were located in distal segments. Compared to invasive FFR, the sensitivity of FFRCT to correctly identify/exclude hemodynamically significant stenoses in proximal vessel segments was 93% (95% CI: 68–99.8%) and the specificity was 100% (95% CI: 89–100%), compared to a sensitivity of 72% (95% CI: 46.5–90%) and a specificity of 87% (95% CI: 77–94%) for FFRCT in distal lesions. The positive predictive value was 100% and the negative predictive value was 97% (95% CI: 82.8–99.5%) compared to a positive predictive value of 59% (95% CI: 42–93.9%) and a negative predictive value of 93% (95% CI: 85.4–96.3%) for proximal vs. distal vessel segment, respectively. This corresponds to an accuracy of 98% vs. 84%, respectively (p=0.02). ROC-Curve analysis showed a slightly higher – albeit non-significant – area under the curve for FFRCT to detect hemodynamic relevance in proximal lesions compared to distal lesions (AUC 0.95, p&lt;0.001 vs. AUC: 0.86, p&lt;0.001, respectively, p=0.2).

Conclusion
FFRCT obtained using an on-site prototype shows overall a high diagnostic accuracy for detecting lesions causing ischemia as compared to invasive FFR with a trend towards better diagnostic performance in proximal vessel segments.

Funding Acknowledgement
Type of funding source: None
Characteristics of aortic root and vascular anatomy in bicuspid versus tricuspid aortic valve stenosis in patients undergoing transcatheter aortic valve implantation
Authors: Arow Z , Yaron A , Nassar M , Perlman G , Lessick J , Brodov Y , Vaknin-Assa H , Steinvil A , Kornowski R , Hamdan A 
Published: November 2020

Abstract

Background
Transcatheter aortic valve implantation (TAVI) is being increasingly performed in patients with bicuspid aortic valve stenosis (AS).

Objectives
This study sought to compare aortic root and ilio-femoral artery characteristics and clinical outcomes in patients with bicuspid versus tricuspid AS from the Bicuspid AS TAVI multicenter registry.

Methods
88 patients with bicuspid AS and 213 matched patients with tricuspid AS were referred for pre-procedural computed tomography (CT) evaluation before TAVI. We performed a detailed assessment of aortic root anatomy: size of the annulus, sinus of Valsalva (SoV), sino-tubular junction (STJ); we also determined the dimensions of aorta, left subclavian, and ilio-femoral arteries.

Results
Patients with bicuspid AS had significantly larger aortic root dimensions, (annulus mean diameter: 25.5±2.9 mm vs. 23.7±2.4 mm, SoV mean diameter: 35.3±4.7 mm vs. 32±4.4mm, STJ mean diameter: 31.5±4.9 mm vs. 27.6±3.5 mm; respectively) than patients with tricuspid AS (P value for all &lt;0.001), even after adjustment for their larger BSA and height. Dimensions of ascending aorta, left subclavian artery, and ilio-femoral arteries were also consistently larger in bicuspid than in tricuspid AS morphology.

Conclusions
Patients with bicuspid AS had significantly larger aortic root dimensions, larger ascending aorta, subclavian artery and ilio-femoral arteries even after adjustment for their BSA and height.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Rabin Medical Center