bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decreased layer specific longitudinal strain in myocardial segments supplied by stenosed LAD coronary artery: analysis for baseline, peak and recovery phase of stress echocardiography
Authors: Kowalczyk E , Kasprzak J.D , Hamala P , Nowak B , Nowakowski R , Trzos E , Lipiec P , Wierzbowska-Drabik K 
Published: November 2020

Abstract

Background
Despite wide utility of global longitudinal strain in the assessment of left ventricular function up to now little is known about layer specific quantification of myocardial function during stress tests and its potential for ischemia detection.

Purpose
To investigate diagnostic utility of layer specific LS during stress echocardiography using marker segments in patients with established Left Anterior Descending (LAD) coronary artery status.

Methods
We retrospectively analyzed 63 patients (mean age 62.5±9.9 years, 62% males) with suspected coronary artery disease, who had performed dobutamine stress echocardiography (DSE). Layer specific speckle tracking LS analyses were performed during rest, maximal stress and recovery. As a marker for LAD (segment most probably supplied by this artery) we used mid-anterior left ventricle segments. LAD status were established with coronary angiography or angioCT and consider as significant if ≥70% stenosis was present.

Results
In our study group 14 patients had significantly stenosed LAD (group 1) and 24 had normal coronaries (group 2). We detected significantly lowered absolute values of strain in endocardial and mid-myocardial layers of segments supplied by stenosed LAD at rest for endocardium −8.6% (group 1) vs −13.4% (group 2); p=0.045; and mid-myocardium −7.3% (group 1) vs −11.2% (group 2); p=0.044. Moreover, we observed similar trend at recovery, however without reaching statistical significance.

Conclusions
Longitudinal strain analysis focused on segments supplied by assessed coronary artery my provide quantitative data confirming ischemia in the settings of rest and stress echocardiography. Our pilot study suggest that for inotropic agents like dobutamine the potential ischemic dysfunction may be however masked at peak stage of the test.

Funding Acknowledgement
Type of funding source: None
Layer-specific strain and the degree of left ventricular thickness in patients with hypertrophic cardiomyopathy
Authors: Tsugu T , Nagatomo Y , Dulgheru R , Marchetta S , Postolache A , Tridetti J , Nguyen M.L , Piette C , Lancellotti P 
Published: November 2020

Abstract

Background
Left ventricular (LV) wall thickness is an important parameter for the diagnosis of hypertrophic cardiomyopathy (HCM) and is also associated with long-term clinical outcome in HCM patients. However, conventional tools have failed to analyze the mechanisms of structural and functional abnormalities that occur at the cellular level in hypertrophied myocardial tissue. Recently, technological progression of 2D-speckle tracking echocardiography (2D-STE) has enabled the estimation of layer-specific strain (LSS), such as epicardial, mid-myocardial, and endocardial longitudinal strain, respectively. LSS may have the potential to elucidate the detailed mechanisms of myocardial dysfunction.

Purpose
The aim of this study was (i) to clarify the detailed mechanisms of structural and functional abnormalities of myocardial tissue in HCM using LSS (ii) to investigate the diagnostic accuracy of LSS for HCM.

Methods
Forty-one patients with HCM and preserved LV ejection fraction (LVEF) (66% male, 52±18 years, LVEF 62.9±3.7%) and 41 controls matched for age and sex (66% male, 52±20 years, LVEF 63.5±8.2%) underwent 2D-STE (GE-Healthcare, Vivid-E9). Quantitative strain values of epicardial, mid-myocardial, and endocardial layers were measured.

Results
LV wall thickness including interventricular septum thickness (HCM vs. Controls; 18.9±5.0 vs. 9.1±1.8, p&lt;0.001), posterior wall thickness (11.5±2.5 vs. 8.8±1.9, p&lt;0.001), and maximum wall thickness (20.1±4.3 vs. 9.4±0.4, p&lt;0.001) were significantly lower in HCM than in Controls. Absolute values of LSS for all layers were lower in HCM than in Controls (HCM vs. Controls; epicardial; −13.1±3.3 vs. −19.5±1.6, p&lt;0.001; mid-myocardial; −15.8±3.3 vs. −21.4±1.7, p&lt;0.001; endocardial; −18.9±3.9 vs. −23.6±1.9, p&lt;0.001). End/Epi ratio was higher in HCM than in Controls (HCM vs. Controls; 1.5±0.2 vs. 1.2±0.0, p&lt;0.001). Next, we investigated the echocardiographic parameters that correlated with LV maximal wall thickness (MWT). End/Epi ratio was an independent predictor of LV MWT (β=0.96, p&lt;0.001). Receiver operating characteristic analysis revealed that a higher End/Epi ratio (≥1.3) was the strongest predictor of diagnostic criteria for HCM (LV wall thickness ≥15 mm) (area under the curve 0.99, p&lt;0.001, sensitivity 98%, specificity 97%).

Conclusions
In HCM patients with preserved LVEF, (i) LSS was lower and End/Epi ratio was higher than in controls. (ii) End/Epi ratio (≥1.3) was the strongest predictor of abnormal wall thickness of HCM. The mechanism of higher End/Epi ratio in HCM might be attributable to the more common myofibrillar disarray in mid- and epicardial layers. Variations of LSS represented by End/Epi ratio might have the potential to accurately detect HCM and to elucidate the pathophysiology of impaired LV wall motion at cellular level in HCM.

Funding Acknowledgement
Type of funding source: None
Prognostic value of reduced heart rate reserve during exercise stress-echocardiography in hypertrophic cardiomyopathy
Authors: Ciampi Q , Olivotto I , D'Alfonso M.A , Tassetti L , Milazzo A , Peteiro J , Monserrat L , Palinkas A , Palinkas E , Tesic M , Djordjevic-Dikic A , Losi M.A , Canciello G , Re F , Picano E 
Published: November 2020

Abstract

Background
Heart rate reserve (HRR) during exercise evaluates chronotropic incompetence and is a prognostically important marker of cardiac autonomic dysfunction, additive to regional wall motion abnormalities (RWMA) in patients with coronary artery disease.

Objectives
To assess determinants and prognostic value of HRR in patients with hypertrophic cardiomyopathy (HCM).

Methods
From 1998 to 2019, we enrolled 774 HCM patients (age = 48.8±15.9 years, 410 men) with exercise stress echocardiography (ESE) in 10 certified centres of the international stress echo network. During ESE we assessed: left ventricular outflow tract obstruction (LVOTO, significant when &gt;50 mmHg); RWMA; HRR (peak/ rest heart rate), 344 in beta-blockers therapy (44.4%). Patients were followed for a median 49 months (IQ range, 25–78 months). The study end-point was all-cause mortality.

Results
During ESE, we observed stress-induced RWMA in 42 (5.4%) and LVOTO in 248 (33%); HRR was 1.92.±0.41. There were no difference in patients with normal and abnormal HRR with and without beta-blockers therapy (147, 41.1% vs 211, 58.9%, p=0.079). During follow-up, 43 deaths occurred. Beta blockers therapy in univariate analysis did not have prognostic role (HR 1.105, 95% CI 0.602–2.028, p=0.768). The lowest HRR quartile (≤1.62) had a 10-fold higher 6-year death rate (10.9%) than the highest quartile (&gt;2.16, 1.04%): see figure. At multivariable analysis, lowest HRR quartile (HR 2.074, 95% CI 1.082–6.773, p=0.034), age (HR 1.045, 95% CI 1.014–1.077, p=0.004), maximal wall thickness (HR 1.137, 95% CI 1.054–1.226, p=0.001), stress-induced RWMA s(HR 4.289, 95% CI 1.733–10.615, p=0.002) and ≥ moderate mitral regurgitation at rest (HR 3.127, 95% CI 1.507–6.488, p=0.002) predicted death.

Conclusions
A blunted HRR during ESE predicts adverse outcome independent of inducible RWMA in HCM patients. Autonomic dysfunction deserves consideration as a potential therapeutic target in this disease.
Figure 1

Funding Acknowledgement
Type of funding source: None
Hyperventilation echocardiography in INOCA: the HEROIC study
Authors: Boskovic N , Djordjevic-Dikic A , Dedic S , Giga V , Nedeljkovic I , Tesic M , Jovanovic I , Aleksandric S , Beleslin B , Picano E 
Published: November 2020

Abstract

Background
Patients with ischemia and no obstructive coronary artery disease (INOCA) are a heterogeneous group and an unmet diagnostic challenge. Noninvasive Doppler is a feasible tool to assess coronary flow velocity (CFV) in left anterior descending coronary artery (LAD) during stress echocardiography (SE).

Aim
To assess CFV response during coronary vasoconstrictor and vasodilator stimuli in INOCA patients.

Methods
In a prospective single center study, we enrolled 16 INOCA patients (age 60±12 years, 15 females) with previously normal angiograms. All underwent SE testing with hyperventilation (HYP, respiratory rate of 30 per min for 5') followed by supine bicycle exercise (HYP+EXE); and adenosine CFV evaluation (ADO, 0.84 mg/kg in 1 min) on the other day. The ratio of peak/rest changes of CFV during HYP in LAD was taken as an index of vasoconstriction, and CFV reserve was evaluated after EXE. An abnormal response to HYP was a CFV ratio &lt;1.0 (vasoconstrictor response). An abnormal response to ADO was a CFV reserve &lt;2.0 (blunted vasodilatory response). CFVR at peak HYP+ EXE was an indicator of endothelial dependent vasodilatation.

Results
The double product increased during HYP, in comparison to rest (13 337 vs 9858, p&lt;0.001), and further increase with EXE (21 118 vs HYP, p&lt;0.001). Chest pain or dyspnea were present in 2/16 pts during HYP, and in 5/16 patients during HYP+EXE (12.5% vs 31.25%, p=0.083). ST segment depression (≥1mm) was present in 1/16 patients during HYP, and 3/16 during HYP+EXE. Two patients showed regional wall motion abnormalities with HYP+EXE. CFVR response was blunted in 9/16 patients during HYP+EXE, and abnormal for vasoconstriction during HYP in 6. Vasodilation during ADO was preserved in all patients. There was significant difference between CFVR response during HYP+EXE and ADO (1.9±0.5 vs 2.4±0.4 respectively, p=0.039), and between CFVR HYP and ADO (1.2±0.3 vs 2.4±0.4, p&lt;0.001).

Conclusion
In INOCA patients, HYP+EXE is a more powerful ischemic stress than HYP alone and unmasks abnormalities in regional wall motion and/or CFV response in over one- half of patients, likely unmasking the underlying abnormal coronary vasomotor response of large epicardial and/ or small coronary vessels. INOCA patients show profound heterogeneity of coronary vasomotor responses which can be detected with a combined vasodilator - vasoconstrictor SE approach with CFV assessment. The clarification of underlying coronary microcirculatory heterogeneity is the prerequisite for a personalized treatment, and can be easily extracted from CFV-SE. Normal INOCA hearts are all alike, every abnormal heart is abnormal in its own way.

Funding Acknowledgement
Type of funding source: None
The prognostic value of coronary flow reserve of left anterior descending artery in non-diagnostic or inconclusive stress echocardiography tests
Authors: Kotevska Angjushev M , Dedic S , Boskovic N , Giga V , Tesic M , Jovanovic I , Aleksandric S , Beleslin B , Djordjevic Dikic A 
Published: November 2020

Abstract

Background
Relevant number of all stress echocardiography results are non-diagnostic or inconclusive. Such importance cannot be ignored as previous studies have shown that these patients have higher risk for adverse events. Non-invasive transthoracic Doppler derived coronary flow reserve (CFR) of left anterior descending (LAD) artery, as additional test, is an effective tool to predict adverse cardiac events in various clinical settings.

Purpose
The aim of this study was to investigate the value of CFR of LAD in predicting outcome.

Methods
122 patients, (35,8% with previous MI) with nondiagnostic stress echocardiography results (target heart rate not reached, chest pain without ECG and echo changes) and with inconclusive stress echocardiography results (target heart rate reached, chest pain with ECG changes and without echo changes) were referred for transthoracic
Doppler echocardiographic CFR assessment of LAD. CFR was calculated as the ratio between maximal hyperemic and baseline coronary flow velocity. CFR ≤2 was considered abnormal. All patients were followed for major adverse cardiac events (MACE): nonfatal myocardial infarction, hospitalization, revascularization (CABG or PCI) and death.

Results
Measured values of CFR LAD were in the range 1,52- 4,00 (mean: 2,4±0.44). CFR LAD was abnormal in 22 (18%), and preserved in 100 patients (82%). During median follow-up of 23 months (interquartile range 9–35), 14 patients underwent revascularization (2 had CABG, 12 had PCI). There were no myocardial infarctions, hospitalizations or cardiovascular deaths in the follow-up period. Patients with lower CFR values (CFR≤2) had a higher event rate and shorter event free survival time compared to those with CFR&gt;2, event rate (9/22, 40,9% vs 5/98 5,1%; p&lt;0.0001) and event free time (22±3 vs 33±1 months; p&lt;0.0001) by Kaplan Maier analyses, (Log Rank 24.42; p&lt;0.001).

Conclusions
Preserved CFR of LAD (&gt;2.0) predicts excellent survival in patients with non-diagnostic and inconclusive stress echocardiography.

Funding Acknowledgement
Type of funding source: None
Prognostic relevance of exercise pulmonary hypertension for new-onset atrial fibrillation in primary mitral regurgitation
Authors: Teramoto K , Izumo M , Kuwata S , Kamijima R , Suzuki T , Nishikawa H , Mizukoshi K , Takai M , Ohara H , Harada T , Akashi Y.J 
Published: November 2020

Abstract

Background/Introduction
New-onset of atrial fibrillation (AF) portends poor prognosis in patients with primary mitral regurgitation (MR). However less is known about prognostic indicator for new-onset AF.

Purpose
The purpose of this study was to identify the prognostic relevance of exercise pulmonary hypertension for the new-onset AF in patients with primary MR.

Methods
Total of 114 consecutive patients with primary MR who underwent symptom-limited exercise echocardiography using supine-cycle ergometer were followed for new-onset AF over mean follow-up time of 3.6±2.6 years. Those with prevalent AF and pulmonary hypertension (estimated systolic pulmonary artery pressure ≥50mmHg) prior to exercise echocardiography were excluded from our analysis. We defined exercise-induced pulmonary hypertension (ExPHT) as those with peak estimated systolic pulmonary artery pressure (SPAP) ≥60mmHg or delta SPAP defined as differences between rest and peak SPAP ≥20mmHg.

Results
The mean age was 61±15 years old and 70 (61%) were male. Of those, 8 (7.8%) had mild MR, 32 (31.1%) had moderate MR, and 63 (61.2%) had severe MR. 60 (52.2%) patients had ExPHT. A total of 27 cases of new-onset AF were found during follow-up where the ExPHT group had higher prevalence of new-onset AF than the non-ExPHT group (35% vs. 11%, p=0.002). Those with ExPHT had significantly stronger association with shorter event-free survival time of new-onset AF (log-rank p&lt;0.001, Figure). When adjusted for age, sex, body surface area, the American Society of Echocardiography MR grade, left atrial dimension, peak systolic blood pressure and heart rate, the multivariable Cox regression analysis showed that those with ExPHT had a hazard risk of 3.1 ([95% CI 1.1–9.1], p=0.039) for new-onset of AF.

Conclusions
Exercise-induced pulmonary hypertension predicted incident of new-onset AF in those with primary MR. Exercise echocardiography is expected to play an important role in decision making with regards to the optimal timing for surgical intervention in primary MR.
Figure 1

Funding Acknowledgement
Type of funding source: None
The value of 3D-speckle tracking longitudinal strain for the assessment of left ventricular function recovery in ischemic heart failure patients undergoing surgical remodeling:the RECOVERY-IN study
Authors: Castelvecchio S , Frigelli M , Sturla F , Citarella M , Pappalardo O.A , Milani V , Guastafierro F , Menicanti L , Votta E 
Published: November 2020

Abstract

Background
Three-dimensional (3D) speckle-tracking echocardiography is largely employed to evaluate left ventricle (LV) morphology and function.

Purpose
To investigate LV function before and after surgical ventricular reconstruction (SVR) through the analysis of global (GLS) and segmental (SLS) longitudinal strain, and the derived mechanical dispersion (MD).

Methods
Twenty patients eligible for SVR, with previous LV remodelling and ischemic heart failure (HF), received 3D echocardiographic evaluation before SVR and at 6-months follow-up; 15 normal controls, matched by age and BSA, were enrolled. Standard off-line GLS analysis was performed with 4D LV-ANALYSIS©; advanced segmental analysis was accomplished automatically through in-house numerical post-processing.

Results
Before SVR, GLS deteriorated compared to normal subjects (−6.7% vs. −19.6%, P&lt;0.0001) as confirmed by SLS at each LV segment basal, mid and apical level (P&lt;0.0001); MD was higher than in controls (P&lt;0.001) and markedly increased from basal to apical LV segment. After SVR, GLS significantly improved from −6.7% to −11.3% (P&lt;0.0001). Analysis of variance showed that SLS recovery was higher in the basal region (7.25%) than in both mid (4.06%, P=0.001) and apical (1.92%, P&lt;0.0001) segments, respectively, with adjustment for baseline values.

Conclusions
After SVR, LV longitudinal strain mostly improves in the basal segments, outlining the role of the remote myocardium in enhancing LV function through an extensive volume reduction; post-surgical MD reduction indicates a more homogeneous myocardial contraction.
Heath map of longitudinal strain (%)

Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): IRCCS Policlinico San Donato is a clinical research hospital partially funded by the Italian Ministry of Health.
Model-based analysis of myocardial strain in left bundle branch block patients
Authors: Owashi K.P , Galli E , Hubert A , Donal E , Hernandez A.I , Le Rolle V 
Published: November 2020

Abstract

Background
Although patients with typical left bundle branch block (LBBB) show greater efficacy of cardiac resynchronization therapy (CRT), there is a wide range of responses to CRT with a subset of patients showing little or no improvement. Recently, it has been shown that combination of echo-based parameters of LV dyssynchrony and QRS duration helped to improve the prediction of the response to CRT. However, the interpretation of features extracted from echocardiography could be difficult due the complexity of mechanisms involved in cardiac contraction. Computational modelling could help to improve the interpretation of myocardial strains in LBBB patients before implantation.

Purpose
Purpose of the study is to propose a patient-specific model-based approach in order to assist the analysis of myocardial strains and to improve the interpretability of echo-based parameters.

Methods
The proposed model of the cardiovascular system integrates four main sub-models: 1) cardiac electrical system, 2) right and left atrium, 3) multi-segment right and left ventricles and 4) systemic and pulmonary circulations. Patient-specific simulations of myocardial strains were obtained by coupling the computational model and the clinical data to a parameter identification algorithm (Figure 1, upper panel). The proposed approach was evaluated on data obtained from 10 LBBB patients, including ischaemic (n=5) and non-ischaemic (n=5) cardiomyopathy. The localisation of scar was determined by cardiac MRI. Bull's-eye representations of the electrical activation time and contractility levels were analysed.

Results
The comparison between simulated and experimental strains for the 10 subjects reflects a satisfying adaptation of the model to different strain morphologies. The mean errors between real and synthesized signals are equal to 3.72±0.91. The lower panel of Figure 1 presents simulated (black line) and experimental (red line) myocardial strain signals for selected LBBB patients with a lateral ischaemia, anterior ischaemia and non-ischaemia. The bull's-eye representations of electrical activation delay and contractility levels, estimated from the model-based approach, for ischemic and non-ischemic LBBB is included in the figure. Contractility bull's-eye results allow ischaemic and non-ischaemic cases distinction, where low levels of contractility could be associated with damaged tissues.

Conclusion
Identified parameters show significant electrical conduction, mechanical activation delays for the LBBB patient. Hypocontractile myocardial segments were successfully localized from the model-based approach in both ischemic and non-ischemic patients.

Funding Acknowledgement
Type of funding source: None
Effects of aging on coronary flow reserve in patients with no evidence of myocardial perfusion abnormality
Authors: Ramandika E , Kurisu S , Nitta K , Hidaka T , Utsunomiya H , Ishibashi K , Ikenaga H , Fukuda Y , Kihara Y 
Published: November 2020

Abstract

Background
Coronary flow reserve (CFR) reflects the functional capacity of microcirculation to adapt to blood demand during increased cardiac work.

Purpose
We tested the hypothesis that aging had impacts on coronary flow velocities and CFR in patients with no evidence of myocardial perfusion abnormality on single photon emission computed tomography (SPECT).

Methods and results
Seventy-six patients with no evidence of myocardial perfusion abnormality on SPECT undergoing transthoracic Doppler echocardiography were enrolled in this study. Patients were divided into three age groups: 17 patients aged &lt;70 years (Group I), 38 patients aged 70–79 years (Group II), and 21 patients aged ≥80 years (Group III). Compared with Group I, CFR was significantly lower in Group II (P&lt;0.01) and Group III (P&lt;0.01). Multivariate analysis showed that female (P=0.03), cigarette smoking (P=0.004), hemoglobin level (P=0.001) and LV mass index (P=0.03) were determinants for resting coronary flow velocity. On the other hand, age (P=0.008), hemoglobin level (P&lt;0.001) and LV mass index (P=0.04) were determinants for hyperemic coronary flow velocity. Age was only independent determinant for CFR (β=−0.48 P&lt;0.001).

Conclusions
Our data suggested that aging impaired CFR in patients with no evidence of myocardial perfusion abnormality primarily due to the decrease in hyperemic coronary flow velocity.
Comparison of coronary flow reserve amon

Funding Acknowledgement
Type of funding source: None
Incidence and predictors of left atrium thrombus in acute ischemic stroke patients without atrial fibrillation: a single center cohort study
Authors: Cinar T , Hayiroglu M.I , Cicek V , Asal S , Atmaca M.M , Keser N , Orhan A.L 
Published: November 2020

Abstract

Introduction
The present study aimed to determine independent predictors of left atrial thrombus (LAT) in acute ischemic stroke patients without atrial fibrillation (AF) using transesophageal echocardiography (TEE).

Material and methods
In this single center, retrospective cohort study, we enrolled 149 consecutive acute ischemic stroke patients. All of the patients underwent TEE examination to detect LAT within 10 days following admission. Multivariate logistic regression analysis was performed to assess independent predictors of LAT.

Results
Among all cases, 14 patients (9.3%) had a diagnosis of LAT on TEE examination. In a multivariate analysis; a previous diagnosis of cerebrovascular accident, elevated mean platelet volume (MPV), low left ventricle ejection fraction (EF) and a reduced left atrium appendix (LAA) peak emptying velocity were independent predictors of LAT. The area of MPV under the receiver operating characteristic curve analysis was 0.70 (95% CI: 0.57–0.83; p=0.011). With the optimal cut-off value of 9.45, MPV had a sensitivity of 71.4% and a specificity of 63% to predict LAT.

Conclusion
Patients with low ventricle EF and elevated MPV should undergo further TEE examination for the possibility of cardio-embolic source. In addition, this research may provide novel information with respect to the applicability of MPV to predict LAT in acute ischemic stroke patients without AF.
Figure 1

Funding Acknowledgement
Type of funding source: None