bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic role of myocardial work in patients with heart failure and reduced ejection fraction treated by sacubitril/valsartan
Authors: Galli E , Bouali Y , Laurin C , Gallard A , Hubert A , Bidaut A , Leclercq C , Donal E 
Published: November 2020

Abstract

Background
The non-invasive assessment of myocardial work (MW) by pressure-strain loops analysis (PSL) is a relative new tool for the evaluation of myocardial performance. Sacubitril/Valsartan is a treatment for heart failure with reduced ejection fraction (HFrEF) which has a spectacular effect on the reduction of cardiovascular events (MACEs).
Purposes of this study were to evaluate 1) the short and medium term effect of Sacubitril/Valsartan treatment on MW parameters; 2) the prognostic value of MW in this specific group of patients.

Methods
79 patients with HFrEF (mean age: 66±12 years; LV ejection fraction: 28±9%) were prospectively included in the study and treated with Sacubitril/Valsartan. Echocardiographic examination was performed at baseline, and after 6- and 12-month of therapy with Sacubitril/Valsartan.

Results
Sacubitril/Valsartan significantly increased global myocardial constructive work (CW) (1023±449 vs 1424±484 mmHg%, p&lt;0.0001) and myocardial work efficiency (WE) [87 (78–90) vs 90 (86–95), p&lt;0.0001]. During FU (2.6±0.9 years), MACEs occurred in 13 (16%) patients. After correction for LV size, LVEF and WE, CW was the only predictor of MACEs (Table 1). A CW&lt;910 mmHg (AUC=0.81, p&lt;0.0001, Figure 1A) identified patients at particularly increase risk of MACEs [HR 11.09 (1.45–98.94), p=0.002, log-rank test p&lt;0.0001] (Figure 1 B).

Conclusions
In patients with HFrEF who receive a comprehensive background beta-blocker and mineral-corticoid receptor antagonist therapy, Sacubitril/Valsartan induces a significant improvement of myocardial CW and WE. In this population, the estimation of CW before the initiation of Sacubitril/Valsartan therapy allows the prediction of MACEs.

Funding Acknowledgement
Type of funding source: None
Non-invasive myocardial work reference ranges in healthy children
Authors: Sabatino J , Borrelli N , Leo I , Avesani M , Piccinelli E , Josen M , Paredes J , La Bella S , Indolfi C , Di Salvo G 
Published: November 2020

Abstract

Background
Myocardial work (MW) estimation by pressure-strain loops (PSL) allows a non-invasive assessment of myocardial performance, as recently demonstrated in adult patients.

Aim
Aim of this study is to provide the reference values for global myocardial work index (MWI), constructive work (MCW), wasted work (MWW), and work efficiency (MWE) in a group of healthy children.

Methods
Assessment of MW was performed using a commercially available software package. MW was measured from PSLs areas, derived from non-invasive LVP curves combined with strain acquired speckle tracking echocardiography (STE).
After calculating GLS, values of brachial blood pressure were inserted and the time of valvular events by echocardiography were indicated, then the software was able to measure non-invasive PSLs.

Results
Two-dimensional (2D) standard and speckle-tracking echocardiography were performed in 90 healthy children (mean age 9.9±4.9 [1–17] years, females: 57%) together with the assessment of MW by means of PSLs.
Mean ± standard deviation, 5° and 95° percentile values for global MWI, MCW, MWW, and MWE in the whole population were 1769±254 mm Hg, (1354–2193); 2201±290 mm Hg, (1657–2658); 78±47 (29–163) mm Hg%; 96±1.8 (92–99)%, respectively.

Conclusions
The assessment of MW is feasible in healthy children. This study provides useful 2-dimensional echocardiographic reference ranges for novel indices of non-invasive MW.

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): ESC Training Grant 2019
Flow mapping of Intraventricular velocity behaviour along the early diastolic filling streamline in patients with atrial fibrillation: implication for HFpEF
Authors: Berlot B , Jug B , Moya Mur J.L , Rodriguez Munoz D , Fernandez Golfin C , Zamorano J.L 
Published: November 2020

Abstract

Aims
Intraventricular velocity distribution reflects left ventricular (LV) diastolic function and can be measured non-invasively by flow mapping technologies. We sought to compare intraventricular velocity gradient during early diastole – obtained by vector flow mapping (VFM) technology – in consecutive patients with normal ejection fraction (EF &gt;55%) and atrial fibrillation (AF) with and without clinical evidence of heart failure (HFpEF), and controls in sinus rhythm. We hypothesised that the VFM-derived Intraventricular Velocity Gradient over e' ratio (GrIV/e') would discriminate between the groups beyond conventional echocardiographic markers of elevated LV filling pressure.

Methods and results
Two-dimensional streamline fields were obtained using VFM technology in 120 subjects, i) 60 in sinus rhythm with normal systolic and diastolic function, ii) 29 out-patients with AF and no signs or symptoms of heart failure, and iii) 31 patients in AF hospitalized with signs of HFpEF. We compared the intraventricular gradient along the early diastolic streamline between groups, and correlated it with conventional echocardiographic parameters. GrIV/e' was the lowest in control group, followed by AF without HFpEF and the highest in AF HFpEF groups (GrIV/e' = 0.5±0.2, vs 0.9±0.4 vs. 2.0±1.2, p&lt;0.001, Figure, left). Conversely, LV filling pressure as determined by E/e', while lowest in the control group, failed to discriminate between patients with AF with and without (E/e' = 10.0±3.7 vs. 9.5±2.1, p=0.456, Figure, right).

Conclusion
The novel VFM parameter – reflecting early-diastole intraventricular dynamics – may discriminate between patients with AF with and without HFpEF beyond conventional echocardiography. While further studies are need to validate its clinical impact, GrIV/e' has the potential to become a novel parameter for diastolic function assessment in this population.
VFM vs. Conventional echo parameter

Funding Acknowledgement
Type of funding source: None
Which single echo parameter is the best marker of left ventricular filling pressure?
Authors: Khan F , Inoue K , Remme E.W , Andersen O.S , Gude E , Skulstad H , Chetrit M , Garcia-Izquierdo Jaen E , Ha J.W , Klein A.L , Kikuchi S , Ohte N , Nagueh S.F , Smiseth O.A 
Published: November 2020

Abstract

Background
Estimation of left ventricular filling pressure (LVFP) is highly relevant in clinical practice. Invasive pressure remains the gold standard, but a number of echocardiographic parameters that correlate with LVFP are used as non-invasive markers of pressure.

Purpose
We investigated how different echocardiographic parameters correlated with invasively measured LVFP, and how accurately those parameters could differentiate between normal or elevated LVFP.

Method
We performed a prospective, multicenter, multinational and multivendor study in an all comer population of 322 patients with suspected heart failure or other cardiovascular disease. 194 patients had EF ≥50% and 129 had EF &lt;50%. LVFP was measured by right- or left heart catheterization, as pulmonary capillary wedge pressure or pre-A LV diastolic pressure, respectively.
When excluding all special patient populations defined in the 2016 recommendations for echocardiographic evaluation of LV diastolic function, 213 patients remained. Of these 135 had EF ≥50% and 74 had EF &lt;50%.
Echocardiography was performed within 1 day of catheterization. Previously recommended cut-off values for established parameters were used to determine the accuracy of classifying LVFP as normal or elevated. For left atrial (LA) reservoir strain, based on ROC analysis, a cut-off value of &lt;18% was used as marker of elevated LVFP.

Results
LA reservoir strain and the ratio of peak mitral early flow velocity (E) and LA reservoir strain (E/LA strain) showed the best correlations to LVFP (Table 1, Figure 1). They also had the highest accuracy, 75% for both, in classifying LVFP as normal or elevated in the whole patient population. E/LA reservoir strain provided no additional diagnostic value to using LA reservoir strain alone.
In HFpEF patients accuracy was essentially similar for LA strain, E/LA strain and E/e', whereas in HFrEF patients the two former tended to be better than E/e'.

Conclusion
Parameters containing LA reservoir strain showed the best correlation to LVFP. This indicates that LA reservoir strain may have a role in evaluation of LVFP.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority
Aortic regurgitation is not created equal: outcomes of bicuspid versus tricuspid aortic valve regurgitation
Authors: Yang L.T , Benfari G , Nkomo V.T , Enriquez-Sarano M , Pellikka P.A , Michelena H.I 
Published: November 2020

Abstract

Background
Bicuspid aortic valve (BAV) is an important cause of AR; these patients belong to a young and male predominant population and are distinctively different from tricuspid aortic valve (TAV). However, the differences between BAV and TAV in AR have not been completely explored.

Purpose
To explore differences between patients with BAV and TAV in hemodynamically significant aortic regurgitation (AR).

Methods
Consecutive patients with ≥moderate-severe AR were retrospectively identified from 2006 to 2017.

Results
Of 798 patients (502 with TAV, mean age 67±14 years; 296 with BAV, mean age 46±14 years) followed for 6.1±3.6 years, 403 underwent AV surgery (AVS); 154 died during follow-up.
BAV men (94%) tended to become symptomatic when left ventricle enlarged; TAV patients became symptomatic before left ventricular (LV) enlargement. During follow-up, BAV patients had lower mortality (hazard ratio [HR], 0.19; P&lt;0.0001) and higher incidence of AVS (HR, 1.28; P=0.01) than TAV, which attenuated after adjusted on age, sex, comorbidities, LV ejection fraction (LVEF), functional class, and time-dependent AVS. In a propensity-matched cohort, differences of survival and incidence of AVS between BAV and TAV were not demonstrated. After a median of 6.3 (IQR: 3.3–9.3) years, 53 patients died post-AVS; TAV patients having class I surgical triggers had poor survival than TAV-non-class I patients and BAV patients with and without class I triggers (Figure). Class I triggers had no effect on BAV patients regarding post-AVS survival. LVEF&lt;60% was associated with increased mortality in both TAV and BAV.

Conclusions
The correlation between larger LV size and symptomatic status only applied in BAV men. Patients with BAV and significant AR tended to have better survival and higher incidence of AVS, likely driven by inherent younger age and less comorbidity than patients with TAV. Class I surgical triggers had heavier negative impact on poor survival in TAV patients. The cutoff of LV dysfunction in AR may be LVEF 60%.
Figure 1. Kaplan-Meier curves post-AVS

Funding Acknowledgement
Type of funding source: None
Left atrial strain as a pre-operative prognostic marker for patients with severe primary mitral regurgitation
Authors: Mandoli G.E , Pastore M.C , Benfari G , Maccherini M , Lisi G , Cameli P , Lisi M , Lisi E , Tsioulpas C , Carrucola C , Vigna M , Montesi G , Valente S , Mondillo S , Cameli M 
Published: November 2020

Abstract

Background
For patients with severe mitral regurgitation (MR), new indices are needed to optimize surgical timing before irreversible myocardial dysfunction.

Purpose
We investigated the prognostic role of left atrial (LA) strain by speckle tracking echocardiography after mitral surgery for severe MR, and its association with LA fibrosis.

Methods
70 patients with primary severe MR undergoing echocardiography before mitral surgery were enrolled. Patients with other valvular disease &gt; moderate, left bundle branch block, coronary artery disease, heart failure (HF), pacemaker implantation, heart transplantation, poor acoustic window, were excluded. The primary composite endpoint included HF and mortality; the secondary endpoint was post-operative functional capacity (NYHA and Borg CR10). LA fibrosis was assessed by atrial biopsy specimens.

Results
Of 62 patients eligible, 32 had composite events (medium follow-up: 3.3±2.5 years for event-group, 7.6±1 years for non-event group). Characteristics of our study population are summarized in Table 1. With Kaplan-Meier analysis (Fig. 1), PALS provided a good risk stratification; it also was an independent and incremental predictor of outcome in four multivariate Cox adjusted models. There was a strong association between PALS and secondary endpoint (NYHA: r2=0.11, p=0.04; Borg CR10: r2=0.10, p=0.02) and an inverse correlation between PALS &lt;21% and LA fibrosis (r2=0.80; 76.6±20.7% vs 31.9±20.8%; p&lt;0.0001).

Conclusions
Global PALS emerged as a reliable predictor of outcome and functional capacity for severe primary MR, and as a marker of LA fibrosis.
Figure 1

Funding Acknowledgement
Type of funding source: None
Is 3D analysis of longitudinal strain useful to predict long-term cardiac events in patients undergoing early mitral valve surgery?
Authors: Volpato V , Mantegazza V , Tamborini G , Gripari P , Muratori M , Alamanni F , Zanobini M , Fusini L , Pepi M 
Published: November 2020

Abstract

Background
In patients with mitral valve prolapse (MVP) and significant mitral regurgitation (MR), the presence of reduced 3D left ventricular (LV) global longitudinal strain (GLS) has already been described. However, precise data about this finding in predicting long-term cardiac events are lacking, especially in patients after MV surgery. Particularly, few data are available about the role of 3D GLS in events prediction in patients diagnosed with Barlow or Fibro-Elastic-Deficiency (FED) disease.

Aim
To determinate whether 3D LV GLS may identify a subgroup of patients with MVP and severe MR at higher risk for cardiac events after MV surgery.

Methods
We studied 143 patients diagnosed with MVP with normal LV function, who underwent isolated MV surgery between 2011 and 2017 for severe MR. A comprehensive 2D transthoracic echocardiography (TTE) analysis was performed, degree of MR was obtained using the PISA method (Proximal Isovelocity Surface Area), degree of tricuspid regurgitation was visually estimated. 3D analysis using custom software provided measurement of left atrial (LA) and right atrial (RA) dimension, right ventricular (RV) dimension and function and LV size and function including global longitudinal strain (GLS). Cardiac events (including cardiac death, arrhythmia, hospitalization for heart failure, embolic events or arrhythmia) were recorded during a follow-up of 4.6±2 years.

Results
Study patients were diagnosed with Barlow or FED in 92 (65%) and 51 (35%) of cases, respectively. The baseline 3D analysis showed left chambers dilatation with normal LV function and normal GLS, normal right chambers and systolic pulmonary artery pressure (sPAP). Based on 3D GLS, patients were divided in Group 1 (N=84, 59%, normal GLS ≥−21%) and Group 2 (N=59, 41%, reduced GLS ≤−20%). No differences were noted at baseline between groups (Table 1). At the follow-up, 43 events were recorded, including 1 death, 12 hospitalizations (3 for heart failure, 3 for embolic events and 6 for atrial fibrillation – AF) and 30 minor arrhythmic events, mostly premature ventricular complex (PVCs) and AF. The Kaplan Meier analysis showed no differences in cardiac events between groups (Figure 1, A). Among patients with Barlow, a significant difference in events was detected between patients with reduced and normal GLS at the Kaplan Meier analysis (Figure 1, B). This finding was not found in FED patients.

Conclusions
Patients undergoing MV surgery for MVP with initial LV remodeling and normal function, seem to be characterized by a low rate of major cardiac events. Interestingly, only in the Barlow population, a reduced 3D LV GLS strain may detect cases at higher risk of minor cardiac events, mostly minor arrhythmia.

Funding Acknowledgement
Type of funding source: None
Right ventricle to pulmonary artery coupling improves early after transcatheter aortic valve implantation and this is related to improved left atrial function
Authors: Calin A , Cadil D , Parasca C.A , Mateescu A.D , Rosca M , Enache R , Beladan C.C , Ginghina C , Deleanu D , Chioncel O , Bubenek S , Iliescu V , Popescu B.A 
Published: November 2020

Abstract

Background
Transcatheter aortic valve implantation (TAVI) improves not only left heart remodeling but also has an upstream effect on the right ventricle and pulmonary vasculature. Right ventricle (RV) to pulmonary artery (PA) coupling, a parameter which integrates RV systolic performance at a given degree of afterload, was associated with all-cause mortality in these patients (pts). Our aim was to evaluate the short-term effect of TAVI on RV-PA coupling and the main determinants of RV-PA coupling in pts with aortic stenosis (AS) undergoing transfemoral TAVI.

Methods
We have prospectively enrolled 102 consecutive pts (76±8 years, 57 men) with severe AS undergoing TAVI. All pts underwent a comprehensive echocardiogram both before and 30 days after TAVI, including speckle tracking echocardiography (STE) for myocardial deformation analysis. Peak values of global longitudinal left ventricular strain (GLS), left atrial strain (LAε, reservoir function), and late diastolic LA strain rate (ASr, contractile function) were measured. The ratio of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP) was used as an estimate of RV-PA coupling.

Results
Compared with baseline, there was a significant increase in LV ejection fraction after TAVI (54±12% vs 50±13%, p=0.04), a significant reduction in LV mass (147±35 vs 171±44 g/m2, p&lt;0.001) and increase in absolute GLS values (14±3% vs 12±5%, p=0.007). Indexed LA volumes decreased (49±19 vs 55±19 ml/m2, p=0.03) while both global LAε and ASr improved significantly after TAVI (16±8% vs 13±7%, p=0.01 and −1.2±0.6 vs −0.9±0.6%, p=0.01). A significant improvement of TAPSE/PASP values (0.069±0.026 vs 0.057±0.025 cm/mm Hg, p&lt;0.001) was found after TAVI, indicating an enhanced RV-PA coupling. In multivariable regression analysis global LAε was independently related to RV-PA coupling, both before and after TAVI (R=0.54, p=0.003 and R= 0.39, p&lt;0.001). The increase in RV-PA coupling was significantly related to the increase in LAε (p=0.005).

Conclusions
Our results confirm that relief of aortic valve obstruction by TAVI has beneficial effects on the RV-PA coupling, that occur early after intervention. This is accompanied by a significant improvement in LV and LA deformation. Moreover, there is a significant correlation between LA function and RV-PA coupling both before and after TAVI. Enhanced RV-PA coupling after TAVI is related to improved LA strain, suggesting the contribution of LA function in modulating right heart function in this setting.

Funding Acknowledgement
Type of funding source: None
Left atrial dysfunction and dyssynchrony in paroxysmal atrial fibrillation: data from the akershus cardiac examination 1950 study
Authors: Solberg M.G , Aagaard E.N , Berge T , Roenningen P.S , Enger S , Nygaard S , Pervez O , Orstad E.B , Kvisvik B.A , Lyngbakken M.N , Rosjo H , Steine K , Tveit A 
Published: November 2020

Abstract

Background
Left atrial (LA) strain measurements by speckle tracking echocardiography (STE) are predictive markers of cardiovascular morbidity, including atrial fibrillation (AF). LA mechanical dispersion (LA MD) is a new parameter derived from STE. A reduction of LA strain is considered to reflect LA dysfunction, while increased LA MD may reflect LA dyssynchrony.

Purpose
To assess LA dysfunction and dyssynchrony, as measured by STE, in patients with paroxysmal AF (pAF).

Methods
A subset of 616 participants in the Akershus Cardiac Examination 1950 Study were divided into three groups: (1) A healthy group (n=179) defined by excluding AF, coronary artery disease, stroke, hypertension, chronic obstructive pulmonary disease, body mass index &gt;30, left ventricular ejection fraction &lt;50%, transmitral E/e' &gt;14 or E/A &gt;2.0, (2) A non-healthy group (n=350) of participants without pAF, but with any of the above conditions, (3) A group with pAF, but in sinus rhythm at examination (n=87). LA reservoir strain (LASr), conduit strain (LAScd) and contractile strain (LASct), as well as LA MD were assessed by STE. MD was defined as the standard deviation (SD) of time from ECG R to peak atrial longitudinal strain (SD-TPS), and corrected by RR-interval (SD-TPS/RR), expressing LA MD as a percentage of the cardiac cycle. Comparisons were made by Mann-Whitney U-test due to non-normal distributions.

Results
Mean age was 63.5±0.5 years and 46.6% were women. LASr, LAScd and LASct were significantly lower, and LA MD significantly higher in the pAF group compared to the healthy and non-healthy groups (Table; Figure).

Conclusion
The present study has demonstrated LA dysfunction and dyssynchrony in patients with pAF, which may reflect LA remodeling and increased fibrosis.
Figure 1

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority