bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic implications of myocardial work in patients with reduced left ventricular ejection fraction: a preliminary study
Authors: Strada S , Casas Masnou G , Gonzalez Fernandez V , Lozano Torres J , La Mura L , Cinque A , Pisaniello M , Valente F , Fernandez Galera R , Gutierrez Garcia Moreno L , Galian Gay L , Teixido Tura G , Gonzalez Alujas T , Ferreira Gonzalez I , Rodriguez Palomares JF 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Myocardial work (MW) is a new imaging technique to assess left ventricular (LV) systolic function. It incorporates both deformation parameters (global longitudinal strain -GLS-) and loading conditions and gives information on global constructive work (GCW), global wasted work (GWW), global LV myocardial work index (GWI) and global LV myocardial work efﬁciency (GWE).
Purpose. The aim of this study was to describe the prognostic role of MW in predicting major adverse cardiovascular events (MACE) in patients with reduced LV ejection fraction (LVEF), and to compare it with GLS and LVEF.
Methods. We retrospectively included consecutive patients from 2012 to 2019 with dilated LV and LVEF &lt; 50% of any aetiology. Clinical variables were collected and LVEF, GLS and MW were evaluated from baseline echocardiogram. MACE was defined as heart failure (HF) and/or ventricular arrhythmia (VA) and/or cardiac arrest and/or all cause death.
Results. 99 patients were included, 26 were women (26.3%), mean age at diagnosis was 57 years (SD 23). Mean LVEF was 32.5% (SD 10.3). Baseline patients characteristics are described in Table 1. During a median follow-up of 25 months (IQR 12), 24 MACE were recorded (24.4%). Patients with MACE had worse MW parameters: significantly lower MWI (805 ± 360 % vs 638 ± 277 %, p = 0.04) and lower GCW (1116 ± 535 mmHg vs 874 ± 458 mmHg, p = 0.05), and a tendency to lower GWE (83 ± 11 % vs 77 ± 16 %, p = 0.084). Of note, both LVEF (33 ± 10% vs 29 ± 9%, p = 0.123) and GLS (-9.99 ± 3.7% vs -8.8 ± 3.0, p = 0.170) showed a trend but were not significantly associated with outcomes. This might suggest that MW variables are stronger prognostic predictors than traditional imaging parameters.
Conclusions. In patients with reduced LVEF, MW parameters including global MWI and GCW were associated with major adverse cardiovascular events. Of note, both EF and GLS seem to have less prognostic implications in this cohort when compared with MW. Our results are preliminary and larger studies are needed in order to fully understand the clinical utility of MW beyond traditional parameters.
Baseline patient characteristics GLOBAL EVENTS NO EVENTS p Hypertension, % 41 67 29 0.014 Ischaemic etiology, % 14 20 12 0.448 Creatinine, mean (SD) - mg/dL 0.96 (0.04) 1.11 (0.09) 0.90 (0.04) 0.021 Bblockers, % 98 100 97 0.514 Nitrates, % 4 13 0 0.025 Diuretics, % 65 93 53 0.006 SD standard deviation Abstract Figure. Results
Echocardiographic speckle tracking provides incremental value for left atrial function in patients with paroxysmal atrial fibrillation
Authors: Bastos L , Al-Khalili F , Back M , Manouras A , Engdahl J , Shahgaldi K 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Danderyds Hospital

Background
Atrial fibrillation (AF) is associated with progression of left atrial (LA) structural and functional changes. It is well acknowledged that AF over time promotes LA enlargement. Transthoracic echocardiography (TTE) is important in decision making for further treatment. Initially, new onset of AF such as paroxysmal AF can occur in the absence of LA enlargement. Therefore assessment of LA volume index (LAVI) as follow-up can mislead LA evaluation. LA global longitudinal strain (LA-GLS) is a novel parameter assessed with two-dimensional (2D) speckle tracking (ST). LA-GLS allows quantification of LA myocardial deformation by measuring reservoir function which reflects LA compliance during left ventricular systole.

Purpose
Our aim is to study potential differences in LA myocardial deformation as assessed by LA-GLS in paroxysmal AF patients compared with aged-matched control group.

Methods
A total of 75 paroxysmal AF patients and 99 control aged-matched patients (mean age, 77 ± 0.4) were enrolled from STROKESTOP2 study. Patients with paroxysmal AF were included from a subgroup of newly screened-diagnosed AF. TTE examinations were analyzed retrospectively offline using dedicated software. NT-proBNP ≤ 900 ng/L was an inclusion criteria. Besides conventional echocardiographic parameters, LA-GLS was measured using 2D-ST in biplane during systole.

Results
There was a significant LA-GLS reduction in the paroxysmal AF group compared to the control group (19 ± 6.1 % vs. 28 ± 7.2 %, P &lt; 0.001) with a feasibility of 70 %. In the AF group, 45 patients (60 %) expressed normal LAVI &lt;34 ml/m2. No significant difference was revealed concerning LAVI (P &gt; 0.05) between the groups (AF group with normal LAVI), yet LA-GLS remained significant reduced in the AF group (P &lt; 0.001). No significant difference was shown regarding NT-proBNP levels (P &gt; 0.05) between the AF group 243 (179-420) ng/L and the control group 219 (160-317) ng/L.

Conclusion
LA-GLS allows early detection of LA myocardial deformation dysfunction before LA enlargement in patients with paroxysmal AF. This findig provides incremental information to conventional echocardiographic parameters of LA. Whether early detection of LA dysfunction using LA-GLS can contribute to better risk stratification and cardiac therapy improvement requires to be further investigated.
Role of global longitudinal strain to identify and monitor left ventricular dysfunction over time in Becker muscular dystrophy
Authors: Gegenava T , Velde N , Koeks Z , Spitali P , Niks E , Ajmone Marsan N 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Myocardial involvement is a frequent manifestation of Becker muscular dystrophy (BMD) representing one of the main causes of death; however, it has been shown that left ventricular (LV) systolic function is not specifically related to the degree of skeletal myopathy and therefore each patient should be screened for myocardial involvement. Advanced echocardiographic measures of LV function, such as global longitudinal strain (GLS), have not been studied in BMD patients and might help in identifying myocardial involvement at an early stage. Aim of this study was therefore to perform a longitudinal assessment of LV function but using LV ejection fraction (EF) and GLS in a relatively large cohort of BMD patients (Fig 1). Methods: A total of 40 BMD patients (39 ± 13 years) were analyzed including standard and advanced echocardiography at the time of their first visit and at 24 months (IQR 23-25) follow-up. A control group consisted of 22 age- and gender-matched healthy subjects. Results: BMD patients showed significantly impaired LV systolic function as compared to controls both by LVEF (47 ± 11% vs. 61 ± 8%, p &lt; 0.001) and LV GLS (-16% (-17%-12%) vs. -19% (-21%-18%), p &lt; 0.001). However, a total of 32 (80%) BMD patients showed impaired LV GLS (based on a reference value -18%) and only 24 (60%) BMD patients showed reduced LVEF (based on reference value 52%) suggesting at the important role of LV GLS to identify early myocardial involvement. Furthermore at the follow-up assessment (available in n = 29 patients), LV GLS showed significant deterioration in BMD patients (from -15%±3 to -14%±4, p = 0.004), while LVEF and LV volumes did not show significant changes over time. Conclusion: LV GLS is significantly impaired in BMD patients and shows progressive deterioration over time, while LVEF remains unchanged. LV GLS might therefore represents a new tool to improve identification of early myocardial involvement and subclinical changes in these patients.
Abstract Figure. LV systolic function in Becker disease
Segmental and global longitudinal strain differences between children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 pandemic and Kawasaki disease
Authors: Piccinelli E , Herberg J , Kang H , Fraisse A , Krupickova S , Altamar IB , Sabatino J , Singh Y , Bautista-Rodriguez C , Di Salvo G 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and Kawasaki disease (KD) have overlapping features. This study aimed to describe the strain segmental analysis among both entities.

Methods
Retrospective review of strain segmental analysis within 4 weeks of presentation of symptoms among children diagnosed with PIMS-TS between April and June 2020 and a historic cohort of typical KD from the Royal Brompton Hospital, London.

Results
We included 33 PIMS-TS patients (23 males, 69.7%) at a mean age of 8 ± 4,9 years old and 45 KD patients (31 males, 68,9%) at a mean age of 5,8 ± 4,5 years old. PIMS-TS patients were older at presentation (p = 0.038). Left ventricle ejection fraction (LVEF) was normal in both groups (63,3% vs 63,5%; p= 0,89), 4/33 PIMS-TS children (12,1%) had coronary arteries abnormalities (CAA), whereas 100% of KD cohort had CAA. Both groups had a normal global longitudinal strain (GLS),but in PIMS-TS it was significantly reduced compared to the KD group (-20% vs -22%; p = 0,008). Basal segments were the most affected in PIMS-TS with significant difference in the basal anterior and anterolateral strain compared to KD (respectively -18,2% vs -23,4%; p &lt; 0,001 and - 16,7% vs -22,7%; p &lt; 0,001). PIMS-TS had a greater anterior, anterolateral and posterior segments involvement with a significant reduction in the anterolateral mid-wall longitudinal strain (-18,3% vs -22%; p = 0,002). Apical segments were less involved, with significant difference only in the septal and inferior apical strain (respectively p = 0.001 and p = 0,032).

Conclusions
These preliminary data showed that after 4 weeks from the onset of symptoms, all PIMS-TS patients had a normal LVEF but they had a significant reduction in GLS and different segmental involvement compared to KD cohort. We hypothesize that these findings may be related to direct myocardial damage in PIMS-TS rather than caused by coronaries perfusion abnormalities.
Abstract Figure. Bull"s eye
Relationship between sporting discipline and aortic dimensions in middle-aged sportsmen
Authors: Hol ME , Aengevaeren VL , Mosterd A , Eijsvogels TMH , Velthuis BK 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background
A previous study reported a high prevalence (21%) of clinically relevant aortic dilatation (≥40 mm) in competitive veteran runners and rowers. It is uncertain whether this also applies to middle-aged sportsmen performing other sporting disciplines.
Purpose
To relate aortic dimensions to sporting disciplines in middle-aged sportsmen.
Methods
Middle-aged sportsmen, ≥45 years of age, underwent coronary CT angiography. Aortic size was measured at the sinus of Valsalva (cusp-cusp) and the ascending aorta (at the height of the pulmonary trunk). Dominant sporting discipline was categorized as running, cycling or other. Analysis of variance was used to compare baseline characteristics and aortic dimensions across sporting disciplines. Multivariable linear regression was used to adjust for baseline characteristics.
Results
A total of 260 sportsmen (mean age 55.1 ± 6.4 years; 64 runners, 75 cyclists and 121 other sporting disciplines) were included (Table). Clinically relevant aortic dilatation was found in 5.0% (n = 13). Aortic size or presence of aortic dilatation did not differ across sporting disciplines. Ascending aorta and aortic root size were significantly related to age, body surface area, diastolic blood pressure and exercise tolerance, but not sporting disciplines.
Conclusions
We found clinically relevant aortic dilatation in 5% of middle-aged sportsmen. Aortic size was not different between sporting disciplines. Aortic size may be more related to level of exercise performance rather than sporting discipline.
Running (n = 64) Cycling (n = 75) Other (n = 121) p value Participant characteristics Age, yrs 54.6 ± 6.4 56.1 ± 6.8 54.8 ± 6.2 0.30 Systolic BP, mmHg 129 ± 12 128 ± 13 129 ± 12 0.95 Diastolic BP, mmHg 80 ± 8 79 ± 8 80 ± 9 0.32 Body surface area, m2 2.03 ± 0.14 2.02 ± 0.15 2.07 ± 0.15 0.08 Exercise tolerance, Watt 310 ± 42* 329 ± 47 307 ± 48 0.003 Aortic dimensions Ascending aorta maximum diameter, mm 32.5 ± 3.1 33.0 ± 3.8 32.5 ± 3.6 0.64 SoV mean diameter, mm 34.3 ± 2.8 34.1 ± 2.8 33.7 ± 3.2 0.46 SoV, NCC-RCC diameter, mm 34.2 ± 2.9 34.0 ± 2.9 33.7 ± 3.4 0.61 Any aortic diameter ≥40 mm, n (%) 3 (4.7) 2 (2.7) 8 (6.6) 0.46 Values are mean SD or n (%). *significantly different from cycling and other. BP = blood pressure; SoV = sinus of Valsalva; NCC = non-coronary cusp; RCC = right coronary cusp
Self-navigated 3D whole-heart MRA for non-enhanced surveillance of thoracic aortic dilation: a comparison to CTA
Authors: Poskaite P , Pamminger M , Kranewitter C , Kremser C , Reindl M , Reinstadler SJ , Reiter G , Piccini D , Tiller C , Holzknecht M , Klug G , Metzler B , Mayr A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The natural history of thoracic aortic aneurysm (TAA) is one of progressive expansion. Asymptomatic patients who do not meet criteria for repair require conservative management including ongoing aneurysm surveillance, mostly carried out by contrast-enhanced computed tomography angiography (CTA).

Purpose
To prospectively compare image quality and reliability of a prototype non-contrast, self-navigated 3D whole-heart magnetic resonance angiography (MRA) with contrast-enhanced computed tomography angiography (CTA) for sizing of thoracic aortic aneurysm (TAA).

Methods
Self-navigated 3D whole-heart 1.5 T MRA was performed in 20 patients (aged 67 ± 8.6 years, 75% male) for sizing of TAA; a subgroup of 18 (90%) patients underwent additional contrast-enhanced CTA on the same day. Subjective image quality was scored according to a 4-point Likert scale and ratings between observers were compared by Cohen’s Kappa statistics. Continuous MRA and CTA measurements were analyzed with regression and Bland-Altman analysis.

Results
Overall subjective image quality as rated by two observers was 1 [interquartile range (IQR) 1-2] for self-navigated MRA and 1.5 [IQR 1-2] for CTA (p = 0.717). For MRA a perfect inter-observer agreement was found for presence of artefacts and subjective image sharpness (κ=1). Subjective signal inhomogeneity correlated highly with objectively quantified inhomogeneity of the blood pool signal (r = 0.78-0.824, all p &lt;0.0001). Maximum diameters of TAA as measured by self-navigated MRA and CTA showed excellent correlation (r = 0.997, p &lt; 0.0001) without significant inter-method bias (bias -0.0278, lower and upper limit of agreement -0.74 and 0.68, p = 0.749). Inter- and intraobserver correlation of aortic aneurysm as measured by MRA was excellent (r = 0.963 and 0.967, respectively) without significant bias (all p ≤ 0.05).

Conclusion
Self-navigated 3D whole-heart MRA enables reliable contrast- and radiation free aortic dilation surveillance without significant difference to standardized CTA while providing predictable acquisition time and by offering excellent image quality.
Abstract Figure.
Low-gradient aortic stenosis in patients with concomitant mitral regurgitation - a subgroup analysis from the German aortic valve registry (GARY)
Authors: Alushi B , Ensminger S , Balaban U , Frerker C , Falk V , Lauten A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by German Cardiac Society, German Society for Thoracic and Cardiovascular Surgery, and German Heart Foundation. Statistical funding support by the German Center for Cardiovascular Research/Deutsches Zentrum für Herz-Kreislauf Forschung (DZHK).

Background
Patients with severe aortic stenosis (AS) frequently present concomitant mitral regurgitation (MR), which may interfere with echocardiographic measurement of mean pressure gradient (MPG), maximal flow velocity and aortic valve area (AVA).

Purpose
We therefore, aimed to investigate the impact of different grades of MR on parameters of AS severity in a large cohort of all-comer patients with severe AS, prospectively included in the national German Aortic Registry (GARY).

Methods
All patients undergoing transcatheter or surgical aortic valve replacement for severe AS enrolled in GARY between 2011 and 2017 were considered for this analysis. After excluding cases with mitral stenosis and unknown causes of MR, 119,641 patients were considered for the present study. Based on LVEF, the study population was divided into the following subgroups: group 1 (LVEF &lt; 30%, n = 7545), group 2 (LVEF 30-50%, n = 30,116), and group 3 (LVEF &gt; 50%, n = 81,980). Differences in the values of the mPG were explored in each group and in relation to the decremental values of aortic valve area (AVA).

Results
Overall, 37,489 (31.3%) patients had no MR, 77,890 (65.1%) had MR grade I-II, and 4262 (3.6%) had MR grade III-IV.
In group 1, 2 and 3, no MR was reported in 1339 (17.7%), 7612 (25.3%) and 28,538 (34.8%) patients respectively. MR grade I-II was more frequently observed (group 1 5621 [74.5%] vs. group 2 20,972 [69.6%] vs. group 3 51,297 [62.6%]), whereas MR grade III-IV was observed less frequently and present only in 585 (7.7%), 1532 (5.1%) and 2145 (2.6%) patients in subgroups 1, 2 and 3, respectively.
The aortic mPG was significantly lower in subgroup 1 compared to 2 and 3 (33.74 ± 14.93 versus 41.4 ± 16.47 and 46 ± 16.19mmHg respectively, p &lt; 0.001). With increasing severity of MR, there was a significant reduction of the aortic mPG in each LVEF subgroup (Figure 1). This pattern was maintained irrespective of the AVA value.

Conclusions
In patients with severe AS, concomitant MR may potentially affect diagnostic accuracy of echocardiographic AS evaluation. In this first GARY analysis of patients with severe AS and concomitant MR, we observed that increasing MR severity affects transvalvular aortic mPG and results in a low-gradient AS pattern. In contrast, AVA is a robust diagnostic parameter for the diagnosis of true severe AS that maintains its validity independently of LVEF and severity of concomitant MR.
Abstract Figure 1
Mechanical contraction patterns of the systemic right ventricle: a 3D echocardiography study
Authors: Surkova E , Kovacs A , Bispo D , Flick C , Lakatos BK , Tokodi M , Liptai C , Fabian A , Merkely B , Senior R , Gatzoulis M , Li W 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. In patients with transposition of great arteries (TGA) post atrial switch operation or with congenitally corrected TGA (ccTGA), the morphologically right ventricle (RV) has to adapt to the chronically increased systemic pressure.
Purpose. To investigate the functional adaptation of the systemic RV in patients with TGA post Mustard repair or ccTGA.
Methods. RV volumes and EF were measured by 3D echocardiography in 33 patients with the systemic RV (21 TGA and 12 ccTGA; 45 ± 13y, 61% male), and in 33 healthy volunteers (44 ± 13y, 61% male).
The 3D RV model was postprocessed by the ReVISION software and its contraction was decomposed along the longitudinal, radial and anteroposterior directions (Fig.A, Systemic RV in TGA) providing longitudinal, radial and anteroposterior EF (LEF, REF and AEF). Relative contribution of each component was measured as the ratio between LEF, REF and AEF to the global RVEF (LEFi, REFi and AEFi).
Results. Systemic RV was significantly larger with reduced function compared to controls (Tab). 3D RVEF demonstrated stronger correlation with BNP (Rho -0.76, p &lt; 0.0001) compared to other parameters of RV function (free wall strain 0.55, p = 0.0083; FAC -0.47, p = 0.024; S’ -0.39 and TAPSE 0.06, p &gt; 0.05).
While in healthy volunteers, all 3 components of RV systolic function contributed equally to the global RV EF, in patients with TGA the relative contribution of the anteroposterior component was dominant and differed significantly from longitudinal and radial components (AEFi 0.48 ± 0.06 vs LEFi 0.31 ± 0.07 vs REFi 0.36 ± 0.09, p &lt; 0.0001)(Fig. B,C). In patients with ccTGA the longitudinal component was dominant and provided a relative compensation for the reduced anteroposterior and radial components (LEFi 0.47 ± 0.07 vs AEFi 0.34 ± 0.07, p = 0.0002 and vs REFi 0.36 ± 0.09, p = 0.0023)(Fig. B,C). Relative contribution of the radial contraction was significantly reduced in all systemic RV patients.
Conclusions. Systemic RV contraction patterns change significantly with anteroposterior contraction being dominant in patients with TGA post Mustard repair and longitudinal component being dominant in ccTGA.
3DE should be a part of routine assessment of the systemic RV, especially in TGA since no conventional echo parameters take into account anteroposterior RV contraction.
Parameters of RV systolic function Parameter Control group (N = 33) All SRV patients (N = 33) TGA (N = 21) ccTGA (N = 12) 3D EF, % 60 ± 3.8 36 ± 8.6* 34 ± 7.3* 38 ± 10* FAC, % 41.4 ± 3.7 25.9 ± 9.3* 25.1 ± 9.2* 27.1 ± 9.9* TAPSE, mm 24.6 ± 4.2 11.9 ± 3.9* 11.1 ± 2.9* 13.2 ± 5.1* RV free wall strain, % -32.5 ± 4.2 -14.5 ± 3.5* -14.5 ± 2.9* -15.5 ± 3.5* * p &lt; 0.0001 Abstract Figure.
Mitral annulus disjunction is associated with adverse outcome in patients with Marfan syndrome and Loeys-Dietz syndrome
Authors: Chivulescu M , Krohg-Sorensen K , Scheirlynk E , Lindberg B , Dejgaard LA , Lie ØH , Helle-Valle T , Skjolsvik ET , Aabel EW , Hunt TE , Estensen ME , Edvardsen T , Lingaas PS , Haugaa KH 
Published: February 2021

Abstract

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

Background
Mitral valve prolapse is a common finding in patients with Marfan (MFS) and Loeys-Dietz syndromes (LDS). Mitral annulus disjunction (MAD) is an atrial displacement of the hinge point of the mitral valve that frequently coexists with mitral valve prolapse, but its clinical relevance in connective tissue disorders is unknown.

Purpose
To explore the association between MAD and severity of mitral valve and aortic disease in patients with MFS and LDS.

Methods
We included consecutive MFS patients and LDS patients fulfilling established diagnostic criteria. MAD was identified by echocardiography and defined as the distance from the ventricular myocardium to the hinge point of the posterior mitral leaflet (Figure, panel A). Aortic surgery was defined as emergency surgery for aortic dissection or prophylactic aortic surgery for aortic aneurysm. We recorded the need of mitral valve surgery including mitral valve repair or replacement.

Results
We included 168 patients of whom 103 (61%) had MFS and 65 (39%) had LDS. We identified MAD in 69 (41%) patients. Aortic surgery was performed in 112 (67%) patients (27 dissections and 85 prophylactic interventions). Patients with MAD were younger at the time of aortic surgery than those without MAD (p log rank = 0.02) (Figure, panel B). Patients needing aortic surgery had greater MAD distance (8 [7-10] mm vs. 7 [6-8] mm, p = 0.04). Mitral valve surgery was performed in 12 (7%) patients, more frequently in patients with MAD than in those without (16% vs. 1%, p &lt; 0.001, p log rank &lt; 0.001) (Figure, panel C).

Conclusion
MAD was frequent and detected in 41% of patients with MFS and LDS. MAD was associated with a more severe disease phenotype including aortic surgery at younger age and frequent need for mitral valve surgery. Screening patients with MFS and LDS for MAD may provide prognostic information and may be relevant in planning surgical interventions.
Abstract Figure