bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mitral valve prolapse: American versus European guidelines - which one is better
Authors: Brito J , Rigueira J , Rodrigues T , Aguiar-Ricardo I , Santos R , Nunes-Ferreira A , Cunha N , Pereira S , Antonio PS , Morais P , Alves Silva P , Valente Silva B , Pinto FJ , Almeida AG 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
According to the most recent recommendations of AHA, mitral valve prolapse (MVP) is defined as systolic displacement of the mitral leaflet into the left atrium (LA) of at least 2 mm from the mitral annular plane. The ESC recommendations define MVP, flail and billowing, according to the location of the leaflet tips in relation to the coaptation plan. Differences in outcomes considering these classifications are not established.

Purpose
To evaluate the differences in clinical presentation and outcomes of MVP considering AHA and ESC classifications.

Methods
Single-center retrospective study of consecutive patients with MVP (defined according to the AHA classification) documented in transthoracic echocardiogram between January 2014 and October 2019. Demographic, clinical, echocardiographic and electrocardiographic data were collected. The results were obtained using Chi-square and ANOVA tests.

Results
We included 247 patients (mean age 62.9 ± 18 years, 61% males) according to AHA classification; considering the ESC classification: 147 (59%) had prolapse, 30 (12%) flail and 67 (39%) billowing.
In comparison to patients with flail and billowing, patients with MVP had less cordae rupture (p = 0.02). Prolapse was associated with better survival (p = 0.037) and was an independent predictor of survival (OR = 0.372, CI95% [0.148-0.935], p = 0.035) Patients with flail were older in comparison to the ones with prolapse and billowing (71 ± 14 vs 63 ± 17 vs 60 ± 21 years, respectively, p = 0.022). Patients with flail were mostly men (80%, p = 0.028), with more significant mitral regurgitation (p = 0.003) and higher NYHA class (p = 0.018). They also had higher systolic pulmonary artery pressure (SPAP) (48 ± 23 vs 38 ± 18 vs 36 ± 12mmHg, p = 0.015) and higher values of LV mass and posterior wall thickness (144 ±32 vs 125 ± 44 vs 114 ± 37g/m2, p = 0.005 and 11 ± 1,5 vs 10 ± 1,7 vs 9 ± 1.9 mm, p = 0.009, respectively). Women had more billowing (p = 0.04) than prolapse and flail.

Conclusion
The ESC classification adds information to the AHA classification in what concerns to clinical presentation and prognosis of mitral valve prolapse, so both classifications should be used in daily practice.
Echocardiographic features and behavior of cardiac structural abnormalities in mucopolysaccharidosis
Authors: Saba S , Al Sergani A , Vriz O , Kholaif N , Ramzan K , Jawad Shah S , Ahmad O , Albayyat R , Di Michele S , Pergola V , Di Giannuario G , Elmahi I , Ibrahim S , Galzerano D , Di Salvo G 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Mucopolysaccharidosis (MPS) is a rare genetic lysosomal storage disorder with a wide variability of phenotype. A systematic descriptive study dealing with the echocardiographic (E) features of valvular involvement and their evolution over the time in adolescent and adult patients, whose number is growing up in adult echocardiographic laboratory, is lacking in the medical literature.

Purpose
To detect the E features of valvular involvement and their evolution in adolescent and adult patients.

Method
Study design: observational descriptive retrospective. Study group: 142 E studies in 17 adolescent and adult patients with diagnosis of MPS from 2001 until 2020. Mitral (M), aortic (A), tricuspid (T) valves (V) E features (thickness, mobility, calcification, and function), their evolution over the time and the behaviour with Enzyme replacement therapy (ERT) or bone marrow transplant (BMT) were assessed.

Result
52% male, mean age 21 yrs ranges 16 to 48 yrs. 5% of the patient had MPS type I, 11% MPS type II, 29% MPS type IV, and 52% MPS type VI. 70% received ERT and 11% BMT.
In the severe case all the valves were involved (panel A, B, C; white arrows point to valve leaflets; yellow arrows MV apparatus) the whole MV apparatus was involved since the earlier stage and in the latest stage the calcification was massive (panel C). The predominant valvular dysfunction was the regurgitation followed by mixed disorder while the most frequent severe lesion was the stenosis; the echocardiographic pattern differs from the classical hockey stick appearance of the early phase of rheumatic MV and the thickening is different from the myxomatous MV for the reduced mobility and the presence of calcification. The reduced mobility of the TV (panel C) also differs from the Loeffler syndrome because of the restriction of the leaflets and the association with thickening and calcification. Under treatment, the MV thickening was found to have a slow progression of less than 1 mm yearly in 61% cases.

Conclusion
Our results showed that all the valves are affected mainly the MV; the echocardiographic pattern of MPS, different from other valvular diseases of adolescent and adult age, can help in avoiding misdiagnose. Our observations also suggest that the cardiac involvement show slow rate of progression after the initiation of the therapy. Further studies are required to confirm our results.
Type of valve % of valve thickness % of reduced mobility % calcification diffuse % valve lesion Mitral valve 88% 65% 47% 75% Aortic valve 76% 23% 41% 57% Tricuspid valve 82% 47% 17% 52% Abstract Figure. Echocardiographic features
Presence and significance of mid-systolic notch on right ventricular outflow tract velocity envelopes in pulmonary hypertension due to heart failure
Authors: Chiba Y , Iwano H , Murayama M , Kaga S , Motoi K , Ishizaka S , Tsujinaga S , Kamiya K , Nagai T , Anzai T 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A mid-systolic notch (MSN) of the right ventricular outflow tract (RVOT) pulsed-wave Doppler envelope, which is recognized as a characteristic finding in pre-capillary pulmonary hypertension (PH), is often observed in heart failure (HF) patients. However, clinical significance of MSN formation in HF has not been elucidated.

Methods
Consecutive 233 HF patients who underwent right heart catheterization and echocardiography within 24 hours were enrolled. Isolated post-capillary PH (IpcPH) was defined as mean pulmonary arterial pressure (mPAP) &gt;20 mmHg, mean pulmonary artery wedge pressure (mPAWP) &gt;15 mmHg, and pulmonary vascular resistance (PVR) &lt;3 Wood units and combined pre- and post-capillary PH (CpcPH) was as mPAP &gt;20 mmHg, mPAWP &gt;15 mmHg, and PVR ≥3 Wood units. Pulmonary arterial capacitance (PAC) was calculated as stroke volume / pulmonary arterial pulse pressure [mL/mmHg]. MSN was defined as formation of notch within first half of the RVOT pulsed-wave Doppler envelope.

Results
Prevalence of IpcPH, CpcPH, and without PH were 87 (37%), 45 (19%), and 101 (43%), respectively and MSN was observed in 8 (9%) of IpcPH, 17 (38%) of CpcPH, and 1 (1%) of patients without PH. Among the hemodynamic and echocardiographic parameters, mPAP and PAC independently determined occurrence of MSN in all the multivariable models (Table). Interestingly, when the PH patients were dimidiated according to median PAC (3.2 mL/mmHg), 25 out of 102 PH patients (25%) with low PAC showed MSN whereas any of PH patients with high PAC did not (Figure).

Conclusion
MSN was frequently observed in HF patients showing CpcPH. Combination of elevated pressure and reduced compliance of the pulmonary circulation could determine occurrence of MSN in HF.
Determinants of MSN occurrence Univariable analysis Multivariable analysis Model 1 Model 2 Model 3 Model 4 variables OR (95% CI) p OR (95% CI) p OR (95% CI) p OR (95% CI) p OR (95% CI) p LV ejection fraction 0.97 (0.94-0.99) 0.007 1.00 (0.96-1.03) 0.795 LV mass index 1.00 (1.00-1.02) 0.143 PAW pressure 1.13 (1.08-1.18) &lt;0.001 0.92 (0.82-1.03) 0.135 Mean PA pressure 1.14 (1.09-1.19) &lt;0.001 1.08 (1.02-1.14) 0.006 1.15 (1.04-1.27) 0.004 1.08 (1.00-1.17) 0.030 1.07 (1.01-1.14) 0.025 Mean RA pressure 1.14 (1.06-1.22) &lt;0.001 1.00 (0.90-1.11) 0.978 Pulmonary vascular resistance 1.97 (1.45-2.67) &lt;0.001 1.20 (0.88-1.63) 0.225 Pulmonary arterial capacitance 0.27 (0.15-0.48) &lt;0.001 0.49 (0.26-0.92) 0.010 0.44 (0.23-0.85) 0.004 0.47 (0.24-0.93) 0.011 0.49 (0.26-0.93) 0.011 Abstract Figure.
Circulating biomarkers of cardiac fibrosis: do they correlate with the echocardiographic parameters of the myocardial mechanics in systemic sclerosis?
Authors: Vertes V , Tokes-Fuzesi M , Porpaczy A , Nogradi A , Czirjak L , Komocsi A , Faludi R 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In systemic sclerosis (SSc) myocardial fibrosis contributes to the impairment of the myocardial function resulting in manifest diastolic and subclinical systolic dysfunction of the left ventricle (LV) and impaired left atrial (LA) function. The pathophysiology of this connective tissue disease is still not fully elucidated. Recently, however, elevated serum levels of galectin-3 and soluble suppression of tumorigenicity 2 (sST2) have been reported in SSc patients suggesting that these fibrotic markers may participate in the fibrotic process in this disease. Thus we aimed to investigate the potential associations between galectin-3 and sST2 levels and the echocardiographic markers of the LV and LA function in SSc patients.

Methods
Forty patients (57.3 ± 13.7 years, 36 female) were enrolled into the study. In addition to the conventional echocardiography, tissue Doppler and speckle-tracking-derived strain techniques were used to estimate the LV systolic and diastolic function as well as the LA size and function. To assess the correlations between galectin-3 and sST2 levels and the echocardiographic variables, partial correlation method was used with age as correcting factor.

Results
In age adjusted analysis galectin-3 level showed significant correlation with LV global longitudinal strain (r = 0.460, p = 0.005); grade of LV diastolic dysfunction (r = 0.394, p = 0.013); septal e’ (r=-0.369, p = 0.021); septal E/e’ (r = 0.380, p = 0.017) and with the grade of mitral regurgitation (r = 0.323, p = 0.048) (Figure 1). No significant correlation was found between sST2 levels and the echocardiographic variables.

Conclusions
Galectin-3 levels, but not sST2 levels show significant correlation with the parameters of the LV diastolic function and with LV global longitudinal strain, a parameter reflecting the subclinical impairment of the LV systolic function. Galectin-3 may be a useful biomarker for identifying SSc patients with high risk for cardiac involvement.
Abstract Figure 1
The prediction of atrial fibrillation development in patients treated with transcatheter aortic valve implantation
Authors: Karakulak UN , Sahiner ML , Sener YZ , Kaya EB , Aytemir K 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Backround
Atrial fibrillation (AF) is associated with poor outcomes after transcatheter aortic valve implantation (TAVI).

Purpose
This study aimed to investigate whether prolonged total atrial conduction time (PA-TDI) predicts the development of AF in TAVI-treated patients.

Methods
A total of 307 TAVI-treated patients were enrolled. PA-TDI was defined as the duration from P wave onset on electrocardiography to peak A′ wave on tissue Doppler imaging echocardiography.

Results
The study was conducted with 263 patients because 44 patients had pre-existing AF. Of 263, 47 (17.8%) had new-onset AF after TAVI procedure. Age, mortality and the frequency of PM implantation were higher in the AF group. LVEDD, LVEF, aortic gradients, and AVA were similar between AF and sinus rhythm groups; however, LVESD, LA diameter, and PA-TDI duration were increased in the AF group. In Kaplan–Meier analysis (Panel A), there was an increase in risk of AF with each incremental percentile of the PA-TDI duration. In multivariate analysis, age (p = 0.005) and PA-TDI duration (p = 0.002) were found to be independent risk factors for the development of AF after TAVI. AUC was 0.630 (p = 0.005), and the sensitivity and specificity were 70% and 51% respectively at a cut-off point of 123.5 ms for PA-TDI duration (Panel B).

Conclusion
In patients treated with TAVI, post-procedural new-onset AF may lead to significant risk for morbidity and mortality. PA-TDI duration can be used for the detection of the patients with high risk of AF development.
Total (n = 263) Sinus (n = 216) AF (n = 47) p value Age (years) 78.0 ± 10.8 77.5 ± 11.2 80.6 ± 8.4 0.032 Gender (F/M) 144/119 118/98 26/21 0.932 Follow-up time (months) 2 [1-77] 2 [1-77] 1 [1-51] 0.095 Death 82 (31.2%) 59 (27.3%) 23 (48.9%) 0.004 Pacemaker implantation 44 (16.7%) 32 (14.8%) 12 (25.5%) 0.075 LV end-diastolic diameter (mm) 48.2 ± 3.5 47.9 ± 5.3 49.3 ± 5.4 0.202 LV end-systolic diameter (mm) 32.2 ± 5.5 31.7 ± 5.0 35.0 ± 6.8 0.030 LV ejection fraction (%) 55.2 ± 10.9 55.4 ± 10.9 54.2 ± 11.1 0.515 LA diameter (mm) 42.9 ± 6.5 41.9 ± 6.6 44.7 ± 6.1 0.049 Peak aortic gradient (mmHg) 78.6 ± 20.5 79.2 ± 20.5 77.2 ± 20.7 0.660 Mean aortic gradient (mmHg) 46.8 ± 13.5 46.6 ± 13.2 47.2 ± 14.3 0.838 Aortic valve area (cm2) 0.73 ± 0.15 0.73 ± 0.15 0.74 ± 0.14 0.734 PA-TDI duration (ms) 127.0 ± 26.7 125.4 ± 26.2 137.0 ± 27.2 0.009 Abstract Figure.
Heterogeneous pattern of improvement in right ventricular mechanics following hematopoietic stem cell transplant in patients with systemic sclerosis
Authors: Chen C , Nishtala A , Groenendyk JW , Schultz WM , Li E , Shah SJ , Burt RK , Freed BH 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Systemic sclerosis (SSc) is an autoimmune disorder that causes fibrosis in the skin and internal organs, including the heart. Patients with SSc can have right ventricular (RV) systolic dysfunction in the absence of pulmonary hypertension. Studies have shown a predilection for impairment of the mid and apical segments of the RV free wall compared to controls. The effect of hematopoietic stem cell transplant (HSCT) – a disease modifying treatment for SSc – on RV mechanics is not known.

Aim
To study the effect of HSCT on RV mechanics using speckle-tracking echocardiography.

Methods
Patients with SSc who underwent comprehensive 2D echocardiographic evaluation pre- and post-HSCT were identified. The modified Rodnan skin score (mRSS) was evaluated for each patient pre- and post-HSCT. Speckle tracking software was utilized to measure myocardial strain (TomTec, Unterschleissheim, Germany). RV strain was measured from the RV focused apical 4-chamber view. Paired student’s t-test and linear regression analysis were used in data analysis.

Results
Among 89 patients with SSc (average age 46 ± 11 years, 75% female) who underwent HSCT, the mRSS significantly improved after HSCT. The mean pulmonary arterial pressure measured by right heart catheterization prior to HSCT was 18.5 ± 4.5 mmHg. There was a significant improvement in RV global longitudinal strain (GLS) and free wall strain (FWS) following HSCT. The improvement in strain was significant in the mid and apical segments of the RV free wall, but not so in the basal segment. The change in RV strain was linearly related to pre-HSCT strain. The lower the RV GLS and FWS, the greater the improvement in strain after HSCT.

Conclusions
There was a significant improvement in RV strain in patients undergoing HSCT, specifically within the mid and apical segments of the RV free wall. The improvement in strain after HSCT was directly related to the baseline strain. This suggests that HSCT may directly improve RV mechanics with the preferential enhancement of the less robust mid and apical RV free wall segments.
Key clinical and echo characteristics Pre-HSCT Post-HSCT P value Median mRSS (25th - 75th percentile) 20 (13-34) 9 (4-20) &lt;0.01 RV GLS (%) -18.13 ± 3.88 -20.06 ± 4.51 &lt;0.01 RV FWS (%) -20.79 ± 5.30 -23.21 ± 5.61 &lt;0.01 RV basal free wall (%) -27.97 ± 9.33 -27.84 ± 7.94 0.93 RV mid free wall (%) -20.68 ± 9.61 -23.75 ± 7.91 0.05 RV apical free wall (%) -15.26 ± 8.57 -20.84 ± 8.92 &lt;0.01 All values are presented as mean ± SD unless indicated otherwise. Abstract Figure. Pre-HSCT RV strain vs change in strain
The loss of left atrial contractile function predicts worse outcome in HFrEF: a speckle tracking study
Authors: Mandoli GE , Pastore MC , Benfari G , Setti M , Maritan L , D"ascenzi F , Focardi M , Carrucola C , Vigna M , Valente S , Mondillo S , Cameli M 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
in chronic heart failure (HF), high cardiac pressure induces a progressive remodeling of small pulmonary arteries up to pulmonary hypertension development. At the end of left atrial (LA) conduit function, pulmonary and left heart end-systolic pressures equalize. This might affect LA systole.

Purpose
we investigated whether peak atrial contraction strain (PACS), measured by speckle tracking echocardiography (STE), was independently associated with outcome in HF with reduced ejection fraction(HFrEF).

Methods
168 outpatients with HFrEF and sinus-rhythm referred to our echo-labs were prospectively enrolled. After clinical and echocardiographic evaluation, off-line STE analysis was performed. The endpoints were cardiovascular (CV) death and HF hospitalization respectively. Spline knotted survival model identified the optimal cut-off value for PACS.

Results
The 152 included patients were stratified based on PACS &lt; 8%(n = 76) or PACS≥8%(n = 76). Mean age was 61 ± 12, mean EF was 30 ± 9%. Characteristics of the two groups are presented in Table 1. Over a mean follow-up of 3.41 ± 1.9 years, 117 events (51 CV death, 66 HF hospitalizations) were collected. By univariate and multivariate Cox analysis, global PACS emerged as a strong and independent predictor of CV death and HF hospitalization, even after adjusting for age, sex, LV strain, E/e’, LA volume index (HR 0.6 per 5 unit decrease in PACS). Kaplan Meier curves showed a sustained divergence in event-free survival rates for the two groups (Fig.1).

Conclusions
The reduction of PACS significantly and independently affects CV outcome in HFrEF. Although limited to patients with sinus rhythm, it could offer additive prognostic information for HFrEF patients.
Table 1 Variable PACS &lt; 8 PACS ≥ 8 P value Age 61.5± 11.4 61.8 ± 12.7 0.4 NYHA class &gt;2 26% (n = 39) 11% (n = 17) &lt;0.0001 NT pro BNP 2293.7 ± 1636 1335 ± 242 0.04 E/E’ ratio 16.1 ± 9.09 12.1 ± 7.09 0.0015 LV GLS -7.28 ± 3.4 -10.17 ± 3.2 &lt;0.001 sPAP 40.5 ± 13.7 30.3 ± 9.3 &lt;0.0001 LAVI 64.4 ± 20.4 45.5 ± 15.8 &lt;0.0001 PALS 9.8 ± 4.9 20.2 ± 7 &lt;0.0001 E, peak early diastolic “E” wave; E’, medium velocity of early mitral annulus descent; GLS, global longitudinal strain; LAVI, left atrial volume index; LV, left ventricular; PACS, peak atrial contraction strain; PALS, peak atrial longitudinal strain; sPAP, systolic pulmonary artery pressure. Abstract Figure. Fig.1
Computed tomography derived left ventricular global longitudinal strain associate with clinical outcomes in patients undergoing transcatheter aortic valve replacement
Authors: Fukui M , Hashimoto G , Lopes B , Du Y , Stanberry L , Garcia S , Goessl M , Enriquez-Sarano M , Bapat V , Sorajja P , Lesser J , Cavalcante J 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Computed tomography angiography (CTA) is key imaging modality for procedure planning for transcatheter aortic valve replacement (TAVR). Functional assessment by CTA with LV global longitudinal strain (LVGLS) has recently shown to be feasible. However, there is limited data on its prognostic value in patients with severe aortic stenosis (AS) who treated with TAVR.

Purpose
To evaluate the association of baseline CTA-LVGLS with post-TAVR outcome.

Methods
Patients who underwent contrast multiphasic gated CTA for TAVR planning were studied. LVGLS was measured using dedicated feature-tracking software (Medis®). Cox regression analysis evaluated the association of baseline LVGLS with a composite outcome of all-cause death and heart failure hospitalization after TAVR.

Results
A total of 431 patients were included (median [IQR] age, 83 [77,87]years; 44% female); the society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score, 3.3 [2.3,5.1]%; CTA-LVGLS, -18.0 [-21.6,-14.2]%; LV ejection fraction was preserved at 60 [55,65]%. After a median follow-up of 19 [13,27] months, 99 composite outcomes occurred after TAVR. On multivariable Cox regression analysis, LVGLS was associated with the risk of composite outcome even after adjustment for baseline characteristics (Figure A). Patients with reduced LVGLS (above the median &gt;-18.0%) had higher risk of the composite outcome than those with preserved GLS (p = 0.003; Figure B).

Conclusion
Baseline CTA-LVGLS was associated with the risk of death or heart failure hospitalization over the clinical and echocardiographic characteristics in severe AS patients undergoing TAVR.
Abstract Figure.
How clinical question influences radiation dose in paediatric cardiac CT scan?
Authors: Adla T , Koci M , Suchanek V , Salagovicova Z , Polovincak M , Miksik L , Rocek M 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Number of Cardiac CT examinations in paediatric population is rising. Clinical questions might vary from cardiac anatomy, coronary arteries, cardiac function assessment to chest examination including evaluation of large vessels, eventually combinations of these tasks. Dose reduction in children is especially important. CT scanning mode selection, reduction of kVp and limited extent of scanning in z-axis are the most important parameters for dose reduction. However, dose reduction optimization should not limit the readability of the CCT, and consequently the ability to reply the clinical question.

Purpose
This study analyses the influence of different clinical questions to radiation dose of paediatric cardiac CT.

Methods
In total 123 patients (42 females, 81 males) were examined using third generation dual-source CT scanner (SOMATOM Force, Siemens Healthineers, Forchheim, Germany), age mean 10.5 ± SD 5.9 years (min 50 days – max 18.9 years), height 138 ± 39 cm (54 – 200), weight 49 ± 25 kg (3.7 – 103). Three main categories of clinical questions (Q) were set: Q1) Extent of scanning in z-axis: heart only (from carina to diaphragm) or whole chest, Q2) Coronary arteries evaluation: yes/no, Q3) Cardiac function assessment (yes/no). Radiation dose is represented as a dose length product (DLP) in mGy*cm. Effective dose (ED) in mSv and calculated from DLP using converting factor 0.026 mSv/mGy*cm. Multiple regression was used to evaluate influence of clinical question to radiation dose.

Results
Total DLP was 202 ± 282 mGy*cm (6 – 1751), ED was 5.25 ± 7.33 mSv (0.16 – 45.53). Multiple regression of Total DLP versus Q1-Q3, height, weight and average heart rate showed statistically significant influence of cardiac function assessment (413 ± 263 vs 132 ± 253 mGy*cm, p 0.0001) and weight (p 0.0443). Multiple regression after adjusting to weight showed statistically significant influence of cardiac function assessment only (p &lt;0.0001).

Conclusions
Only clinical question about cardiac function assessment caused statistically significant higher radiation dose acquired from cardiac CT in paediatric patients. There was no statistically significant influence of coronary artery evaluation and extent of scanning.
Abstract Figure.