bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial deformation parameters among beta-thalassemia major patients
Authors: Patsourakos D , Aggeli C , Gatzoulis K , Delicou S , Dimitroglou Y , Androulakis A , Tsioufis K 
Published: October 2021

Abstract

Introduction
Atrial cardiomyopathy is present in a significant proportion of beta thalassemia major (β-TM) patients, complicating their clinical condition. The diagnosis of atrial cardiomyopathy is challenging using conventional echocardiographic techniques.

Purpose
In our study we aimed to identify the presence of atrial cardiomyopathy by applying novel echocardiographic techniques in these patients.

Methods
56 β-TM patients (mean age 39.3±9 years, 50% male sex) and 30, age and sex matched, healthy controls were examined by transthoracic echocardiography. Conventional echocardiographic parameters were estimated alongside with deformation indices (left atrial strain at reservoir (LASr), conduit (LAScd) and contraction (LASct) phase respectively as well as left ventricular global longitudinal strain (GLS)). T2* was calculated by cardiac magnetic resonance imaging in β-TM patients.

Results
LAVI, E/e' ratio, GLS and left atrial deformation parameters differed between patients and controls. In patient group, left atrial deformation indices were correlated with LAVI, E/e' ratio, GLS and T2* (Table 1). GLS was also correlated with LAVI, but not with T2* or E/e' ratio. T2* was correlated only with left atrial deformation indices. Patient with prior episodes of atrial fibrillation were older, had increased E/e' and LAVI and impaired left atrial deformation indices but did not differ in terms of GLS or T2* (Figure 1). Patients with iron overload differed only in terms of left atrial deformation parameters.

Conclusions
Atrial deformation indices could be of clinical use in the early detection of atrial cardiomyopathy. Impaired left atrial strain may be associated with silent atrial fibrillation and be indicative of myocardial iron overload.

Funding Acknowledgement
Type of funding sources: None. Correlation tableScatter plot of T2* and LASr
Severe aortic stenosis echocardiographic thresholds revisited
Authors: Schwartzenberg S , Vaturi M , Wiessman M , Shechter A , Morelli O , Ofek H , Kazum S , Kornowski R , Sagie A , Shapira Y 
Published: October 2021

Abstract

Background
In view of inconsistencies in threshold values of severe aortic stenosis (AS) hemodynamic indices, it is unclear what is the relative contribution of each variable in a binary classification of AS based on aortic valve replacement (AVR) indication.

Purpose
Assess relative discriminative value and optimal threshold of each constituent hemodynamic parameter for this classification and confirm additional prognostic value.

Methods
Echocardiography studies of 168 patients with ≥ moderate AS were included. AS types were dichotomized based on intervention implication into two groups: Group-A, comprising moderate and Normal-Flow Low-Gradient (NFLG), and Group-B, comprising High-Gradient (HG), Low Ejection Fraction Low-Flow Low-Gradient (Low EF-LFLG), and Paradoxical Low-Flow Low-Gradient (PLFLG) AS. Aortic valve area (AVA), Doppler velocity index (DVI), peak aortic velocity, mean gradient and stroke volume index were assessed for A/B Group discrimination value and optimal thresholds were determined. Dichotomized values were assessed for predictive value for AVR or death.

Results
C-statistic values for binary AS classification was 0.74–0.9 for the tested variables. AVA and DVI featured the highest score, and SVI the lowest one. AVA≤0.81 cm2 and DVI≤0.249 had 87.6% and 86% respective sensitivity for Group B patients, and a similar specificity of 80.9%. During a mean follow-up of 9.1±10.1 months, each of the tested dichotomized variables except for SVI predicted AVR or death on multivariate analysis.

Conclusion
An AVA value ≤0.81 cm2 or a DVI ≤0.249 threshold carry the highest discriminative value for severe AS in patients with aortic stenosis, translating into an independent prognostic value, and should be considered in clinical decisions.

Funding Acknowledgement
Type of funding sources: None. Echo variables correlation with Group BSurvival curves for individual AS types
Sex differences in left ventricular remodeling in patients with severe aortic valve stenosis
Authors: Kuneman J H , Singh G K , Milhorini Pio S , Hirasawa K , Ajmone Marsan N , Knuuti J , Delgado V , Bax J J 
Published: October 2021

Abstract

Background
Women with severe aortic valve stenosis (AS) have better long-term outcomes after transcatheter aortic valve implantation (TAVI) but worse survival after surgical aortic valve replacement compared to men. Whether this is related to sex differences in left ventricular (LV) remodeling is unknown.

Purpose
To examine sex differences in LV remodeling and outcomes in patients with severe AS undergoing TAVI.

Methods
Patients with severe AS who underwent TAVI between 2007 and 2018 with a pre-procedural multidetector row computed tomography (MDCT) scan were included. LV volumes, mass and function were analyzed with MDCT. Patients were classified into 4 LV remodeling patterns based on LV mass index and LV mass-to-volume ratio: 1) normal geometry, 2) concentric remodeling, 3) concentric hypertrophy and 4) eccentric hypertrophy. The primary endpoint was all-cause mortality after TAVI.

Results
A total of 289 patients (age 80±6 years, 54% male) were included. Women showed smaller LV volumes and mass compared to men. Concentric hypertrophy (50%) was the most frequent pattern of LV remodeling followed by eccentric hypertrophy (33%), normal geometry (13%) and concentric remodeling (4%). Concentric remodeling was more frequently observed in men compared to women (91% vs. 9% respectively, p=0.011). However, no sex differences were observed in the remaining LV remodeling patterns (Figure 1). During a median follow-up of 3.8 (IQR 2.2–5.1) years after TAVI, 87 patients died. Women demonstrated better outcome after TAVI compared to men (log-rank χ2=4.29, p=0.038). The survival benefit of women over men was mainly present among patients with concentric hypertrophy (log-rank χ2=4.91, p=0.027, Figure 2).

Conclusion
LV concentric and eccentric hypertrophy are similarly observed in men and women with severe AS. Women demonstrated better outcome after TAVI as compared to men, particularly among those with LV concentric hypertrophy. However, the outcome benefit of females after TAVI seems not to be related to sex-differences in LV remodeling.

Funding Acknowledgement
Type of funding sources: None. Distribution of sex in LV remodelingAll-cause mortality after TAVI
Prognostic value of right ventricular systolic function by speckle tracking echocardiography beyond conventional echocardiography in significant tricuspid regurgitation
Authors: Hinojar Baydes R , Gonzalez-Gomez A , Garcia-Martin A , Monteagudo J M , Rajjoub Al-Mahdi E A , Jimenez-Nacher J J , Sanchez-Recalde A , Zamorano J L , Fernandez-Golfin C 
Published: October 2021

Abstract

Background
Right ventricular (RV) systolic function is determinant in the evaluation of patients with significant tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is limited by the geometry and position of the RV. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function with the capability of detect subclinical RV dysfunction

Purpose
This study was aimed to evaluate the prognostic value of RV strain in consecutive patients with significant TR, in comparison with conventional parameters of RV systolic function.

Methods
Consecutive patients in stable clinical status with significant TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic were included. RV systolic function was measured with conventional echocardiographic parameters (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]), DTI S wave (S') and with STE derived automatic peak global and free wall longitudinal strain (GLS, FW-LS respectively) using the EPIQ system (Philips Medical Systems, Andover, Massachusetts). A combined endpoint of hospital admission due to right heart failure or cardiovascular mortality was defined.

Results
A total of 130 patients were included (mean age was 75±17 years, 69% females, 93% in NYHA I/II). According to etiology, 14% were primary TR and 86% were functional (49% due to corrected left valve disease and 37% due to tricuspid annulus dilatation). Mean values of RV function parameters are shown in the table. During a mean follow up of 18±8 months, n=39 patients (30%) reached the combined endpoint. Patients with events showed impaired RV GLS and FW-LS. Both parameters were predictive of the combined endpoint (table 1). Conventional parameters of RV systolic function were not associated with outcomes (p&gt;0.05 for all).

Conclusion
In patients with severe TR, RV strain values are superior to conventional parameters to detect RV dysfunction. Among different measurements of RV function, RV GLS and FW-LS were the only predictors of poor prognosis. These parameters should be included in the serial evaluation of these patients.

Funding Acknowledgement
Type of funding sources: None. RV parameters
Use of passive leg rise as an add-on to dobutamine in patients with paradoxical low-flow, low-gradient aortic stenosis
Authors: Buffle E , Papadis A , Seiler C , De Marchi S F 
Published: October 2021

Abstract

Background
Dobutamine has been proposed for the assessment of low-flow, low-gradient aortic stenosis (LFLGAS). However, in 1/3 of patients, no increase in stroke volume index can be achieved by Dobutamine, thus hampering its diagnostic value. This study evaluated the manoeuvre of cardiac preload augmentation by passive leg rise (PLR) alone or on top of Dobutamine to increase stroke volume index (SVI) in patients with LFLGAS, particularly in paradoxical LFLGAS.

Methods
We examined 50 patients with LFLGAS. Patients were assigned to the paradoxical LFLGAS (Paradox) group if left ventricular ejection fraction (LVEF) was ≥50% (n=29) and to the LFLGAS with low ejection fraction (LEF) group if LVEF was &lt;50% (n=21). A modified Dobutamine stress echocardiography was performed in all patients with the following 4 steps: Rest, PLR alone, maximal Dobutamine infusion rate alone (Dmax) and Dobutamine plus PLR (Dmax + PLR). Three SVI measurement methods were used: first the left ventricular outflow tract velocity time integral (LVOT VTI) method, second the 2D Simpson's method, and third the 3D method. The corresponding aortic valve area (AVA) was obtained by the continuity equation. The increase of those values compared to measurements at rest was calculated and compared between the 3 stress steps.

Results
In the paradoxical LFLGAS group, delta SVI with Dmax assessed by both Simpson's (depicted in the figures) and 3D method was lowest compared to PLR and Dmax + PLR. PLR alone yielded an equally high delta SVI as Dmax + PLR in Simpson's and 3D, and was at least as high as Dmax across all methods. Dobutamine alone yielded the lowest delta transaortic aortic valve VTI. The highest delta aortic valve area resulted for Dmax + PLR. In the LEF group, the three stress steps yielded an equally high delta SVI with Simpson's method. Dmax never yielded a higher delta SVI than PLR alone. The yielded delta SVI was the highest for Dmax + PLR for both LVOT VTI and 3d method, although the difference was overall not as strong as in the Paradox group.

Conclusions
In patients with paradoxical LFLGAS, Dobutamine alone is inadequate for testing the potential of aortic valve opening augmentation. Instead, PLR alone or the addition of PLR plus Dobutamine should be used for that purpose. In low LVEF, adding PLR to Dobutamine also seems useful although its diagnostic added value is less evident than in the Paradox group.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Gottfried und Julia Bangerter-Rhyner-Foundation Paradox groupLow ejection fraction group
An in-vitro model of stiffened aortic valves to develop an iso-stiffness-lines graph for severity evaluation aortic stenosis
Authors: Buffle E , Stucki M , Obrist D , De Marchi S F 
Published: October 2021

Abstract

Introduction
The echocardiographic diagnosis of aortic stenosis (AS) is established by assessing its maximal opening area (OA). The behavior of OA is dependent on transvalvular flow which can be low in case of low-flow, low-gradient AS. However, current guidelines for the assessment of AS do not consider flow but rather a stroke volume. This experiment was designed to create a graphical representation of the OA versus flow for various valve stiffness values to eventually build a model with iso-stiffness lines.

Methods
We filmed harvested porcine aortic valve mounted in a pulsatile flow loop during the ejection time with a high speed camera (2000Hz), measured for each time point OA and the instantaneous flow through the aortic valve at 10 different mean flow rates (ranging from 0.5 to 5.0 liters/min) and divided both, OA and flow, by the area of left ventricular outflow tract (LVOT) in order to account for different valve sizes. We plotted each OA against its corresponding flow after correcting for the intersignal delay. Due to a time lag between flow onset and the valve opening caused by a ballooning of the valve, we only included the points corresponding to the 5% highest instantaneous flow rates (for each of the 10 mean flow rates). We stiffened the valve by treating it with a protein cross-linking agent (formaldehyde) to yield a total of three stiffness grades (a, b, c) and repeated the procedure for each of those grades.

Results
We generally observed an asymptotic appearance of the flow-OA relationship as well as a flattening of this relationship with increasing valve stiffening. This visually matches well simulated data generated with a sigmoid model.

Conclusions
We could obtain all flow/OA pairs at different stiffness grades. This will allow us to fit a sigmoid function capturing the flow-OA relationship for each stiffness grade and create iso-stiffness line that will allow classifying valve stenosis grade irrespective of the flow and the size of the valve in one single graph, potentially simplifying the grading system of aortic stenosis, especially for patient with low-flow, low-gradient AS.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Bern Center for Precision Medicine (BCPM) Stiffness stage 1All stiffness stages combined
In vitro estimation of the energy loss through turbulence in a porcine aortic valve stenosis model and silicone ascending aorta phantom using backlight particle tracking velocimetry
Authors: Chiarelli M , De Marchi S F , Obrist D , Buffle E 
Published: October 2021

Abstract

Introduction
Patients suffering from low-flow, low-gradient aortic stenosis present a decreased stroke volume due to decreased contraction or relaxation function of the left ventricle. As a low stroke volume tends to cause a low transvalvular flow, transvalvular pressure gradient (TVPG) and effective orifice area, the clinician cannot rely on those parameters with confidence for the evaluation of aortic stenosis severity. Hence new diagnostic parameters have to be developed. Energy loss through turbulence associated with aortic stenosis represented the wasted left ventricle work. Currently, echocardiographic measurement of the turbulence intensity is not validated for clinical evaluations of aortic stenosis.

Methods
Two porcine aortic valves were harvested and inserted in a flow loop that replicates the pulsatile flow of the heart. A stiffening of the valves was achieved by treating them with formaldehyde. The stiffening was externally confirmed by a custom-made force-displacement device quantifying the rigidity of the leaflet yielding two stiffness grades per valve. Each valve was tested under three different mean flow rates (1, 2.5, and 4 l/min) at each of the two stiffness grades. Moreover the pressure in the left ventricle chamber and in the aortic chamber was recorded to calculate the TVPG. Particle tracking velocimetry measurements into the transparent silicone ascending aorta phantom allowed the computation of the turbulent kinetic energy (TKE), to evaluate the energy loss due to turbulence.

Results
We could confirm the enhanced rigidity of the valve leaflets with our custom device (data not shown) and measure a consistent increase in TVPG across all mean flow rates between the two stiffness grades. Moreover, an explicit increase of the TKE in the aortic phantom could be measured after the stiffening process (73.1% under 1 l/min, and 43% under both 2.5 and 4 l/min). In addition, a good correlation (R = 0.86) between the mean TVPG and the TKE was found.

Conclusions
This project demonstrated the possibility of quantifying the energy loss attributed to turbulence for porcine valves in vitro for native and added stiffness grade. This project lays the foundation for the development of a new diagnostic tool for the assessment of stenosis severity in patients with low-flow, low-gradient aortic stenosis in cardiac imaging tool such as echocardiography.

Funding Acknowledgement
Type of funding sources: None. TVPG and its correlation with TKEIntensity graphs of the TKE
Ejection dynamics in native aortic valve stenosis using echocardiography: can it be helpful?
Authors: Bawor M , Gu K , Um K , Dennis B , Leong D 
Published: October 2021

Abstract

Background
The assessment of aortic stenosis (AS) severity has a major impact on the management of affected patients. Ejection dynamics, including acceleration time (AT), ejection time (ET), and acceleration time/ejection time ratio (AT/ET) measured using doppler echocardiography are established in the evaluation of prosthetic aortic valve stenosis with high sensitivity and specificity. However, their clinical utility in native AS has not been well described.

Purpose
The aim of this systematic review was to evaluate the diagnostic accuracy of ejection dynamics to identify severe AS and to assess whether ejection dynamics can differentiate low flow, low gradient severe AS from pseudo-severe AS.

Methods
We conducted a systematic review of Medline, Embase, and Web of Science from database inception until January 2021. We included observational studies and randomized controlled trials (RCTs) in which the diagnostic accuracy of ejection dynamics by doppler echocardiography for severe AS was compared with standard echocardiographic diagnostic criteria including peak velocity, mean pressure gradient, aortic valve area, and dimensionless index. Studies were eligible if they included AS of at least mild severity. Two authors independently screened and extracted data.

Results
We included 12 studies in the review (RCT=1, observational=11) with a total of 5182 participants. There was significant inconsistency in outcome measurement and reporting of results therefore a meta-analysis was not suitable. We used narrative synthesis to report our results. All included studies used standard echocardiographic criteria to ascertain the presence of severe AS. Mean age was 72 years and 53% of the participants were male. 1983 participants (38.3%) were classified as having severe AS. AT &gt;94–109ms had sensitivity of 74–92% and specificity of 72–89% at identifying severe AS. AT/ET &gt;0.34–0.35 showed sensitivity of 67–77% and specificity of 68–100%. Only one study compared low-flow, low-gradient AS with pseudo-severe AS, showing that an AT &gt;100ms had sensitivity 62%, specificity 76%; and AT/ET &gt;0.33, sensitivity 65%, specificity 84%. Data for ET showed insufficient consistency and diagnostic accuracy.

Conclusions
AT and AT/ET may be useful to corroborate the presence of severe AS. However, more research is needed to understand whether these parameters add incremental prognostic value to standard echocardiographic measures of AS severity.

Funding Acknowledgement
Type of funding sources: None. Summary of evidence search and selection
Ventricular-arterial coupling in hypertensive patients after TAVR. It is not all about the valve
Authors: Islas F , Bottino R , Jimenez P , Nombela L , Marcos Alberca P , D'Amato M , Lepori A , Olmos C , Perez De Isla L , De Agustin A 
Published: October 2021

Abstract

Background
In severe aortic stenosis, the left ventricle faces the challenge of the valvular load and the arterial load caused by abnormalities in systemic arterial compliance and systemic vascular resistance. The aim of this study is to assess the effect of hypertension control on left ventricular performance in patients that underwent TAVR.

Methods
68 consecutive patients who underwent TAVR were analyzed; all patients were evaluated to confirm severe aortic stenosis with transthoracic echo (TTE). Conventional echo parameters were assessed as well as left ventricular mechanics parameters and vascular parameters such as arterial elastance (Ea), ventricular elastance (Ees) and V/Ac; besides all patients underwent TTE prior to TAVR, at discharge and 90 days follow-up visit.

Results
Mean age was 82±5; mean aortic valve area was 0.69±0.19, mean left ventricular ejection fraction was 58.3±12.1 and mean ventricular-arterial coupling was 1.6±0.9. At 90 days follow up we observed a significant worsening in V/Ac in those patients with poor control of blood pressure (&gt;140/90mmHg), (1.8±0.5 vs 2.1±0.3, p=0.03). Aortic impedance was significantly higher (4.4±1.4 vs 3.5±1.2, p=0.05); Ea and Ees were also significantly higher in hypertensive patients (2.3±0.8 vs 1.7±0.6, p=0.05) and (1.4±0.7 vs 0.9±0.6, p=0.01) respectively. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) showed a slightly reduction in hypertensive patients, although not statistically significant.

Conclusions
Control of blood pressure seems to be an important factor that contributes to a better or rather worse LV performance and could have a potential role in systolic function and clinical outcome of patients after TAVR.

Funding Acknowledgement
Type of funding sources: None.