bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of right ventricular function during exercise echocardiography in adult patients with tetralogy of Fallot
Authors: Peteiro J , Rivadulla-Varela M , Bouzas-Zubeldia B , Martinez-Bendayan I , Bouzas-Mosquera A , Vazquez-Rodriguez J 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The evaluation of right ventricular (RV) function in patients with tetralogy of Fallot (TF) is important as it could impact outcome. Further exhaustive assessments with exercise might offer added information. We aimed to evaluate different parameters of RV function and their changes during exercise echocardiography (ExE) in patients with TF, and to correlate them with functional capacity

Methods
Treadmill ExE was performed in 31 consecutive patients with corrected TF (mean age 36 ± 11, 22 male), all of them asymptomatic. Left ventricular function was studied at peak exercise, whereas RV function parameters were acquired during the immediate post-exercise period (&lt;1.5 min), along with mitral, tricuspid and pulmonary regurgitation (PR), transtricuspid and transpulmonary systolic gradients, and LV-E/e´ values. RV function was assessed by tricuspid annulus plane systolic excursion (TAPSE), S wave velocity in the RV lateral annulus, and RV area change. A blunted functional capacity (BFC) was considered in case of achieving &lt;100% of the predicted metabolic equivalents (METs) during ExE, according to age and gender.

Results
Only 1 patient had symptoms during ExE (dyspnea). Achieved METs were 13 ± 3.5 and 10 patients (32%) had BFC. LV ejection fraction (%) changed with exercise from 58 ± 10 to 63 ± 9 (p = 0.05) and E/e´ from 11 ± 4 to 10 ± 3 (p = 0.04). TAPSE did not change (19 ± 5 at rest; 21 ± 7 at exercise; p = NS), neither RV area change (41 ± 11 cm2 at rest; 39 ± 12 cm2 at exercise; p = NS), whereas TDI-S increased from 10.5 ± 2.8 to 13.8 ± 3.1 cm2/s (p &lt; 0.001), and systolic pulmonary pressure from 20 ± 8 to 27 ± 12 mmHg (p = 0.001). Patients with BFC had more frequently significant PR at rest (60% vs 14%; p = 0.015), lower peak systolic blood pressure (152 ± 30 vs 176 ± 24 mmHg, p = 0.02) and higher exercise E/e´ (12.6 ± 2.7 vs 8.9 ± 3.0; p = 0.003), without differ in other parameters. Δ-TDI-S correlated with achieved METs and with the percent achieved of predicted METs (r = 0.46; p = 0.01, y r = 0.47; p = 0.008, respectively).
In conclusion, TDI-S assessment at the tricuspid annulus is a useful parameter for assessing RV function during exercise in subjects with TF.
Abstract Figure.
Force-based left ventricular contractile reserve predicts outcome in patients with exercise stress echocardiography without regional wall motion abnormalities
Authors: Diego Maximiliano Lowenstein DML , Rosina Arbucci RA , Pablo Merlo PM , Liliana Martinez LM , Natalio Gastaldello NG , Ariel Karim Saad AKS , Gustavo Zambrana GZ , Galello Marcela GM , Miguel Amor MA , Maria Garciela Rousse MGR , Diego Alasia DA , Marcelo Eguino ME , Vicente Mora VM , Jorge Alfredo Lowenstein JAL 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Investigaciones Médicas, Cardiodiagnostic
Introduction. The behavior of the ejection fraction (EF) during exercise stress echocardiography (ESE) is used to measure the left ventricular (LV) contractile reserve (CR). Ventricular Elastance or Force defined as the ratio between systolic blood pressure (SBP) and LV end-systolic volume (ESV) could be better as it is less dependent of heart rate, preload, and afterload conditions.
Objective. To establish the relative prognostic value of EF-based and novel Force-based LVCR in patients (pts) without ischemia during ESE.
Materials and methods. In a retrospective analysis of prospectively enrolled pts, we enrolled 904 pts, (61.92 ± 12.59 years, 509 men, 56.3%) with negative ESE for RWMA. LV volumes were measured with biplane Simpson’s rule. LVCR was assessed based on EF ≥5 points increase at peak over rest and based on Force peak/rest ratio &gt; 2. The average follow-up was 17.7 ± 5.44 months. Major cardiovascular event was defined as: death, acute myocardial infarction, cerebrovascular accident and/or need for hospitalization due to cardiovascular causes.
Results. LVCR by EF was present in 536 (59.3%) and absent in 368 (40.7%) pts. LVCR by Force was present in 200 pts (22.1%) and absent in 704 pts (77.9%) pts. The overall concordance between LVCR assessed by EF and Force was 538 pts (89.6%) with presence of CR by EF and not by Force being the most frequent source of discrepant result in 336 pts. In the long-term follow up, 52 pts experienced events: 0 all-cause death, 3 acute myocardial infarctions, 5 cerebrovascular accidents and 44 for hospitalization due to cardiovascular causes. Lack of LVCR based on EF identified patients at higher risk (see Figure) but Force-based LVCR allowed to further separate patients with EF-based LVCR (n = 536) into a lower risk with (n = 200, event rate 2%) and higher risk subgroup without Force-based LVCR (n= 336, event rate 5.3 %, p&lt;.01 vs subgroup with Force-based LVCR) Cox Regression model identified Force-based LVCR was the only predictor of events (HR: 3.22, 95% CI 1.83-5.6, p &lt; 0.001).
Conclusions. In patients with negative SE for RWMA, the evaluation of LVCR based on EF allows a better stratification of outcome, which is further refined by addition of Force-based LVCR, especially useful in the subset with LVCR by EF not confirmed by Force. Force-based LVCR allowed to identify a subgroup of worse long-term prognosis outperforming EF-based LVCR.
Abstract Figure. LVCR by EF and Event Free Survival
Clinical value of stress transaortic flow rate during dobutamine echocardiography in low-gradient aortic stenosis
Authors: Vamvakidou A , Pibarot P , Plonska-Gosciniak E , Almeida AG , Kukulski T , Kasprzak JD , Flachskamf F , Senior R 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
BACKGROUND/INTRODUCTION
The clinical value of rest transaortic flow rate (FR) has been shown previously in low-gradient aortic stenosis (LGAS) for the prediction of outcome. However limited data exists on the prognostic value of stress FR in LGAS following low-dose dobutamine stress echocardiography (LDDSE).

PURPOSE
We aimed to assess the value of stress FR in patients with LGAS in the diagnosis of AS severity and the prediction of mortality.

METHODS
This is a multi-centre cohort study of patients with low left ventricular ejection fraction (LVEF) and LGAS (aortic valve area –AVA &lt;1cm²) who underwent LDDSE.

RESULTS
Of the 287 patients (mean age: 75.1 ±10 years, males: 71%) over the mean follow-up of 24 ±30 months there were 127 (44.3%) deaths and 147 (51.2%) patients underwent aortic valve intervention. Lower stress FR was independently associated with increased risk of mortality (HR= 0.99, 95%CI= 0.99-0.999, p= 0.02) after adjusting for age, chronic kidney disease, presence of symptoms (NYHA II-IV), aortic valve intervention, rest LVEF and guideline-defined severe AS (AV mean gradient- AVMG ≥40mmHg with AVA &lt;1cm² at peak stress). The minimum cut-off for prediction of mortality was stress FR 210ml/sec. Among the different criteria of AS severity during stress, i.e. guideline-defined criterion, or stress AVMG ≥40mmHg, or stress AVA &lt;1cm² at stress FR ≥210ml/s, only the latter was independently associated with mortality (HR= 1.81, 95%CI= 1.04-3.2, p= 0.04) (Table 1) and was the parameter of AS severity that predicted improved outcome following aortic valve intervention (p &lt;0.005) (Figure 1). Guideline-defined stroke volume flow reserve did not predict mortality.

CONCLUSIONS
Assessment of stress FR during LDDSE is important for the detection of both AS severity and flow reserve.
Table 1 Multivariable analysis for prediction of all-cause mortality (N = 287) for the different criteria of aortic stenosis HR 95%CI p Age 1 0.98-1.03 0.84 Chronic kidney disease 1..84 1.13-2.99 0.01 Aortic valve intervention 0.37 0.22-0.61 &lt;0.005 Presence of symptoms (NYHA II-IV) 1.87 0.66-5.31 0.24 Rest LVEF (by 1%) increase 0.97 0.95-1 0.06 Stress AVA &lt; 1cm&sup2; with stress AVMG≥40mmHg 1.02 0.31-3.34 0.97 Stress AVMG≥40mmHg 0.57 0.2-1.59 0.28 Stress AVA &lt; 1cm&sup2; at stress FR≥210mmHg 1.81 1.04-3.2 0.04 Abstract Figure 1
Left ventricular rotational mechanics in elite athletes with high dynamic component of their training - a three-dimensional speckle-tracking echocardiographic study
Authors: Nemes A , Gyenes N , Vagvolgyi A , Kormanyos A , Domsik P , Kalapos A , Ambrus N , Lengyel C 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction. In normal circumstances left ventricular (LV) apex and base rotate different directions during cardiac cycle, while LV apex rotates counterclocwise, LV base has a clockwise movement at the same time. This sort of towel-wringing-like movement is called LV twist. Three-dimensional speckle-tracking echocardiography (3DSTE) is a new, promising, easy-to-perform and reproducible modality for the evaluation of LV apical and basal rotations. Although cardiac adaptation is a known feature seen in highly trained athletes, there are conflicting results according to sport activity-related changes in LV rotational mechanics. The present study was designed to test whether differences in LV rotational mechanics could be detected in elite athletes with high dynamic, but different grade of static components of their training by 3DSTE.
Methods. The subjects group comprised 80 elite sportmen, which group of athletes was further divided according to the task force classification of the American College of Cardiology considering dynamic and static components of their training. The following groups were created regarding to their physical activity: Group C1 (high dynamic/low static)(n = 13, mean age: 24.0 ± 5.1 years, Group C2 (high dynamic/moderate static)(n = 23, mean age: 24.6 ± 7.7 years) and Group C3 (high dynamic/high static)(n = 34, mean age: 22.8 ± 6.0 years). Their results were compared to 67 age- and gender-matched non-athletic healthy controls (mean age: 24.0 ± 5.1 years, 33 men). 3DSTE was used for the evaluation of LV rotational abnormalities.
Results. Increased LV end-diastolic and end-systolic volumes could be detected in Groups C2 and C3 subjects as compared to controls. No changes in LV volumes and rotational mechanics could be detected in Group C1 cases. Reduced LV basal rotation was seen in Group C2 and C3 subjects compared to that of controls (-3.17 ± 2.81 degree and -2.88 ± 1.88 degree vs. -4.31 ± 1.82 degree, p &lt; 0.05 and p &lt; 0.05, respectively). It was accompanied with LV twist reduction in Groups C2 and C3 subjects compared to that of controls (11.3 ± 4.3 degree and 11.5 ± 4.1 degree vs. 14.0 ± 3.4 degree, p &lt; 0.05 and p &lt; 0.05, respectively). None of elite athletes showed absence of LV twist called as LV ‘rigid body rotation’ (LV-RBR).
Conclusions. Significant LV basal rotation and twist reduction could be detected in elite athletes with high dynamic and moderate/high static components of their training.
ESC 2019 guidelines on chronic coronary syndromes: can calcium scoring improve the risk underestimation associated with the updated pre-test probability risk score?
Authors: Fyyaz S , Rasoul H , Olabintan O , David S , Plein S , Alfakih K 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The European Society of Cardiology (ESC) published an updated stable chest pain guideline in 2019. It recommends the use of an updated pre-test probability (PTP) risk score (RS) to assess the likelihood of coronary artery disease (CAD), to try and reduce the risk overestimation associated with previous risk scores. We sought to assess the performance of the 2019 PTPRS in a contemporary cohort of patients undergoing CT coronary angiography (CTCA). Furthermore, we focussed on patients with PTPRS &lt;15%, and assessed the utility of CT calcium scores as a discriminator of risk.

Methods
652 patients who were investigated with CTCA for stable chest pain between January 2017 and May 2018 were included in a retrospective analysis. CTCA reported CAD degree of stenosis as normal/minimal stenosis, mild (30-50%), moderate (50-70%), or severe (&gt;70%). ESC 2019 pre-test probability risk scores were retrospectively calculated and compared.

Results
A total of 652 patients underwent CTCA between 01 January 2017 and 31 May 2018, of which 330 were male and 322 were female, with an average age of 55 years ±11 years.
Using the ESC 2019 PTPRS there were no patients with PTPRS &gt;85%. 2 patients had PTPRS 50-85%; one patient had moderate stenosis and one mild stenosis on CTCA.
There were 267 patients with PTPRS 15-50%; 23 (9%) patients had severe CTCA stenosis, 37 (14%) a moderate stenosis, and 34 (13%) a mild stenosis.
A further 379 patients had PTPRS &lt;15%; 11 (3%) had severe stenosis and 20 (5%) moderate stenosis. A further 27 (7%) patients had mild CTCA stenosis.
A total of 357 of 379 patients with PTPRS &lt;15% based on ESC 2019 had a CT calcium score. 236 patients were found to have a calcium score of zero, and 121 patients had a score greater than zero, with a range between 1 and 930. Of patients with zero calcium score, only 1 (0.4%) patient had severe stenosis, 2 (0.8%) moderate stenoses and 6 (2.5%) mild stenosis. In contrast, in patients with positive calcium scores, 10 (8%) had severe stenosis, 18 (15%) moderate stenosis, and 22 (18%) mild stenosis.

Conclusions
The ESC 2019 PTPRS classified this as an overall low risk cohort. The downward risk modification of PTPRS has led to a large number of patients being classified as low risk with PTPRS &lt;15%. No or deferred investigation is recommended by the ESC in this cohort. However, the use of CT calcium scores in patients with PTPRS &lt;15%, detected the majority of patients with any degree of CAD. CT calcium scores are a simple and low cost risk modifier, and may help identify patients who may benefit from primary prevention as per SCOT-Heart. Patients with calcium score greater than zero could be investigated with CTCA.
Resources and outcome impact of routine availability of computed tomography perfusion
Authors: Baggiano A , Del Torto A , Fusini L , Guglielmo M , Muscogiuri G , Andreini D , Mushtaq S , Conte E , Annoni AD , Formenti A , Mancini ME , Guaricci AI , Bartorelli AL , Pepi M , Pontone G 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Stress computed tomography perfusion (Stress-CTP) is a functional technique that can be added to coronary computed tomography angiography (cCTA) to improve the management of patients with suspected coronary artery disease (CAD).

Purpose
To determine the impact of routine availability of Stress-CTP added to cCTA in terms of downstream testing, radiation exposure and outcome in patients with high risk or known CAD.

Methods
Patients symptomatic for chest pain, known for CAD, with previous revascularization or with increased pre-test likelihood of CAD, referred for clinically indicated cCTA with Stress-CTP were prospectively enrolled. Data regarding evaluability, overall radiation exposure, invasive and non-invasive downstream testing, hospitalizations, revascularizations, major adverse cardiac events (MACE) as unstable angina, non-fatal myocardial infarction and cardiovascular death after index test were collected at follow-up.

Results
263 consecutive patients were prospectively enrolled (mean age: 65 ± 9 years; male: 79%), of which 162 (62%) had previous revascularization. The mean follow-up was 323 ± 175 days. cCTA and Stress-CTP were fully evaluable in 95% and 99%, respectively. Obstructive CAD and inducible ischaemia were found in 170 (65%) and 129 (49%) subjects, respectively. No significant difference was found between patients with presence or absence of perfusion defects in terms of downstream non-invasive testing (p: 0.229), while patients with inducible ischaemia had more downstream invasive testing, increased overall radiation exposure, more hospitalizations for cardiovascular reasons and revascularization (all endpoints with p: &lt; 0.001). No differences were detected between patients with inducible ischaemia treated with revascularization after index test and patients without inducible ischaemia, even if with obstructive CAD, treated medically in terms of MACE.

Conclusions
Routine implementation of cCTA with Stress-CTP is associated with subsequent low rate of other non-invasive testing, low overall radiation exposure in case of negative Stress-CTP and good prognosis if clinical management is based on combined anatomical and functional information.
Real-time cardiovascular magnetic resonance tissue characterisation in patients undergoing transcatheter aortic valve replacement
Authors: Backhaus SJ , Lange T , Beuthner BE , Topci R , Wang X , Kowallick JT , Lotz J , Seidler T , Toischer K , Zeisberg EM , Puls M , Jacobshagen C , Uecker M , Hasenfus G , Schuster A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Research Foundation (DFG, CRC 1002, D1)

Background
Myocardial fibrosis is a major determinant of outcome in aortic stenosis (AS). Novel fast real-time (RT) cardiac magnetic resonance (CMR) mapping techniques allow comprehensive quantification of fibrosis but have not yet been compared against standard techniques and histology.

Methods
Patients with severe AS underwent CMR before (n = 110) and left ventricular (LV) endomyocardial biopsy (n = 46) at transcatheter aortic valve replacement (TAVR). Midventricular short axis (SAX) native, post-contrast T1 and extracellular volume fraction (ECV) maps were generated using commercially available MOLLI (native: 5(3)3, post-contrast: 4(1)3(1)2) and RT single-shot inversion recovery fast low-angle shot (FLASH) with radial undersampling. Focal late gadolinium enhancement was excluded from T1 and ECV regions of interest. ECV and LV mass were used to calculate LV matrix volumes. Variability and agreements were assessed between RT, MOLLI and histology using intraclass correlation coefficients, coefficients of variation and Bland Altman analyses.

Results
RT and MOLLI derived ECV were similar for midventricular SAX slice coverage (26.2 vs. 26.5, p = 0.073) and septal region of interest (26.2 vs. 26.5, p = 0.216). MOLLI native T1 time was in median 20 ms longer compared to RT (p &lt; 0.001). Agreement between RT and MOLLI was best for ECV (ICC &gt;0.91), excellent for post-contrast T1 times (ICC &gt;0.81) and good for native T1 times (ICC &gt;0.62). Diffuse collagen volume fraction by biopsies was in median 7.8%. ECV (RT r = 0.345, p = 0.039; MOLLI r = 0.40, p = 0.010) and LV matrix volumes (RT r = 0.45, p = 0.005; MOLLI r = 0.43, p = 0.007) were the only parameters associated with histology.

Conclusions
RT mapping offers fast and sufficient ECV and LV matrix volume calculation in AS. ECV and LV matrix volume represent robust and universally comparable parameters with associations to histologically assessed fibrosis and may emerge as potential targets for clinical decision making.
Cardiac magnetic resonance derived global longitudinal strain outperforms established functional parameters in prognostication after ST-elevation myocardial infarction
Authors: Holzknecht M , Reindl M , Tiller C , Lechner I , Hornung T , Plappert D , Klug G , Reinstadler SJ , Bauer A , Metzler B , Mayr A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Although left ventricular ejection fraction (LVEF) is recommended for left ventricular (LV) systolic function assessment and risk stratification of patients with ST-elevation myocardial infarction (STEMI), its prognostic value is limited. Other measures of LV function such as global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE) might provide additional prognostic information post-STEMI. However, comprehensive investigations comparing these parameters in terms of prediction of hard clinical events following STEMI are lacking so far.

Purpose
We aimed to investigate the comparative prognostic value of LVEF, MAPSE and GLS by cardiac magnetic resonance (CMR) imaging in acute STEMI patients.

Methods
This observational study included 407 consecutive acute STEMI patients treated with primary percutaneous coronary intervention (PCI). Comprehensive CMR investigations were performed 3 [interquartile range (IQR): 2-4] days after PCI to determine LVEF, GLS and MAPSE as well as myocardial infarct characteristics. Primary endpoint was the occurrence of MACE defined as composite of death, re-infarction and congestive heart failure.

Results
During a follow-up of 21 [IQR: 12-50] months, 40 (10%) patients experienced MACE. Patients with MACE showed significantly lower LVEF (49% vs. 53%, p = 0.005) and MAPSE (7.9 mm vs. 9.1 mm, p = 0.001), as well as higher GLS values (-10.2% vs. -12.3 %, p &lt; 0.001). GLS showed the highest prognostic value with an area under the curve (AUC) of 0.71 (95% CI 0.63-0.79; p &lt; 0.001) compared to MAPSE (AUC: 0.67, 95% CI 0.58-0.75; p = 0.001) and LVEF (AUC: 0.64, 95% CI 0.54-0.73; p = 0.005). After multivariable analysis, GLS emerged as independent predictor of MACE (HR: 1.22, 95% CI 1.11-1.35; p &lt; 0.001). Of note, GLS remained associated with MACE (p &lt; 0.001) even after adjustment for infarct size and microvascular obstruction.

Conclusion
CMR-derived GLS emerged as strong and independent predictor of MACE after acute STEMI with additive prognostic validity to LVEF and parameters of myocardial damage.
Determinants and prognostic relevance of aortic stiffness in patients with recent ST-elevation myocardial infarction
Authors: Lechner I , Reindl M , Tiller C , Holzknecht M , Mayr A , Klug G , Bauer A , Metzler B , Reinstadler SJ 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The association between aortic stiffness, cardiovascular risk factors and prognosis in patients with recent ST-elevation myocardial infarction (STEMI) is poorly understood.

Purpose
We analyzed the relationship between cardiovascular risk factors and arterial stiffening and assessed its prognostic significance in patients with recent STEMI.

Methods
We prospectively enrolled 408 consecutive patients who sustained a first STEMI and underwent primary percutaneous coronary intervention (pPCI). Aortic pulse wave velocity (PWV), a direct measure of aortic stiffness, was determined by the transit-time method using velocity-encoded, phase-contrast cardiac magnetic resonance imaging. Patient characteristics were acquired at baseline and major adverse cardiac and cerebrovascular events (MACCE) were assessed at 13 (interquartile range [IQR] 12–31) months. Cox regression- and logistic regression analysis were performed to explore predictors of PWV and MACCE.

Results
Median aortic PWV was 6.6 m/s (IQR 5.6–8.3m/s). In multivariable analysis, age (odds ratio [OR] 1.10, 95% confidence interval [CI], 1.08–1.14, p &lt; 0.001) and hypertension (OR 2.45, 95% CI, 1.53–3.91, p &lt; 0.001) were independently associated with higher PWV. Gender, diabetes, smoking status, dyslipidemia, and obesity were not significantly associated with PWV in adjusted analysis (all p &gt; 0.05). High PWV significantly and independently predicted occurrence of MACCE in adjusted analysis (hazard ratio [HR] 2.45, 95% CI 1.19–5.04, p = 0.014).

Conclusion
In patients with recent STEMI, the impact of classical cardiovascular risk factors on aortic stiffness is mainly dependent on age and increased blood pressure. Increased aortic stiffness is associated with adverse clinical outcome, suggesting it as a relevant therapeutic target in this population.