bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of cardiopulmonary exercise testing in valvular heart disease
Authors: Cortina Camarero C , Sarrion Catala M , Suberviola Sanchez-Caballero V , Beltran Herrera C , Gomez Mariscal E , Cortes Bengiola A , Martinez Losas P , Sanchez Hernandez A , Nogales T , Munoz Aguilera R 
Published: October 2021

Abstract

Introduction
Cardiopulmonary exercise testing (CEPT) is not routinely used for the assessment of valvular heart disease (VHD) patients. The cutoff values of percentage of predicted peak VO2 and ventilatory efficiency parameters that carry out a bad prognosis have been predominantly validated in heart failure. The aim of this study was to analyze the prognostic value of CPET parameters in a broad population of VHD patients.

Methods
163 patients (51% female) with moderate or severe VHD who underwent a CEPT (n=197) at their physician's discretion from 2017 until 2019 were included. We calculated the net reclassification index of CPET, compared to the classical clinical or echocardiographic parameters, regarding the need for surgical indication. Also, the predictive value of CPET for death and symptom development during follow-up was estimated using regression analysis.

Results
At inclusion, all patients were asymptomatic or with minimal equivocal symptoms. Aortic valvular lesions were the most common (47%), followed by mitral valvular disease (44%). There was a predominance of severe valvular heart disease (71%) and most of the CEPTs were performed on a treadmill (74%). The percentage of predicted peak VO2 was 76±18% and at anaerobic threshold was 61±18%. The mean follow-up time was 15±10 months. There were 5 deaths (3%) and 24 patients became symptomatic. The net reclassification index of CPET over either clinical or echocardiographic parameters was 46%. The CEPT parameters that predicted increased risk of death were VE/VCO2 slope (p=0.009), % of predicted peak VO2 (p=0.049) and Eq CO2 at anaerobic threshold (p=0.047). None of the CEPT parameters was predictive of symptom development during follow-up, however, in the subgroup of patients who became clearly symptomatic, the ventilatory efficiency parameters were similar to the cut off values that confer bad prognosis (see Table in Figure).

Conclusion
In our series, CPET added prognostic mortality value to patients with VHD. The cut off values used for patients with HF can also be applied in a VHD population. In addition, CEPT clearly improved the clinical decision for surgical referral. Nevertheless, these results need to be validated in a broader population.

Funding Acknowledgement
Type of funding sources: None.
Assessment of mitral valve area by 3D planimetry after percutaneous mitral valve repair
Authors: Gordillo X , Pozo Osinalde E , Salinas Gallegos A , Jimenez Quevedo P , Marcos-Alberca P , Mahia P , Tirado G , Perez De Isla L , Macaya C , Perez-Villacastin J , Fernandez-Ortiz A , Nombela-Franco L , De Agustin J A 
Published: October 2021

Abstract

Background
Percutaneous mitral valve (MV) repair has become an effective therapeutic alternative to MV surgery in high-risk surgical patients with severe MR. Persistent pulmonary hypertension after mitral valve replacement has shown an increased risk of morbidity and mortality. Improvement of pulmonary systolic arterial pressure (PSAP) post-MitraClip has been reported, however relative mitral stenosis may hamper this benefit. Few data is available regarding the best echocardiographic parameter to determine mitral stenosis after the procedure.

Purpose
To evaluate the correlation between the residual mitral valve area (MVA) by 3D planimetry, the pressure half time (PHT) and the transmitral gradient after percutaneous edge-to-edge mitral repair.

Methods
This is a single-center, retrospective study. We enrolled 88 consecutive patients who underwent a percutaneous MV repair with the MitraClip system between 2010 and 2020 at our tertiary university hospital, with eligibility evaluation by transesophageal echocardiogram (TEE). All patients had moderate to severe (3+) or severe (4+) primary or secondary MR.

Results
The mean age was 76.2±10.4 years and 64.8% of the patients were male. Above 88% of patients were in New York Heart Association class III/IV. Baseline 3D planimetry MVA was 5.3±1.4cm2 and mean gradient pre-implantation was 1.8±0.8mmHg. After the procedure, MVA reduced to 2.9±0.8cm2 and mean gradient was 2.8±1.4mmHg. Both 3D planimetry and mean gradient were very significantly correlated (r −0.5; p&lt;0.001) (Figure 1), whereas no correlation was note between mean gradient and PHT (r 0.17; p=0.117)

Conclusion
After MitraClip implantation, the assessment of mitral valve area by 3D planimetry is significantly correlated with the transmitral mean gradient, unlike PHT.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Correlation of post-procedural 3D MVA and transmitral mean gradient
Changes in Left atrial strain in patients with aortic stenosis after TAVI
Authors: Leo I , Sabatino J , Strangio A , Polimeni A , Sorrentino S , Mongiardo A , Spaccarotella C A M , Purri I , De Rosa S , Indolfi C 
Published: October 2021

Abstract

Background
Evaluation of left atrial (LA) function is an emerging biomarker of cardiovascular disease (CVD). LA strain by 2D speckle tracking echocardiography (LA strain, LAS) is feasible and reliable, and has been recently associated with adverse long-term outcomes in CVD, including aortic stenosis (AS).

Purpose
To evaluate the changes in left atrial strain (LAS) after correction of severe AS with transcatheter aortic valve replacement (TAVR) and assess its prognostic impact.

Methods
One hundred consecutive patients with severe symptomatic AS who underwent TAVR at the Magna Graecia University of Catanzaro have been enrolled. Echocardiographic examination before and after TAVR was performed using Vivid E95 system and analysed using the EchoPAC 112.99 workstation (GE Healthcare). Patients underwent clinical follow up visits regularly. The primary study outcome was the difference in ΔLAS (postTAVR-preTAVR) between patients that met the main clinical endpoint (a composite of cardiovascular mortality and heart failure hospitalization) and those not meeting the endpoint. Statistical analyses were performed using JASP (version 0.14.1) and KMWin (version 1.52). Continuous variables were presented as mean and standard deviation and were compared through the unpaired Student's t test or the Mann-Whitney U test in case of a non-normal distribution. Differences between categorical variables were tested with the chi-square test. Multiple logistic regression analysis was performed to identify independent correlates of ΔLAS and to calculate Hazard Ratios (HR) with 95% CI. Kaplan-Meier was used to assess adverse event.

Results
During a median follow-up of 31 months, 35 patients (35%) met the composite clinical endpoint. The difference between LAS post-TAVR and LAS pre-TAVR (ΔLAS) was significantly larger in patients who met the combined endpoint (HR=0.76 [0.67–0.86]; p&lt;0.001). Multivariate logistic regression analysis including ΔLAS, EuroSCORE II and left ventricular ejection fraction (LVEF) showed that ΔLAS (HR=0.80, p&lt;0.001) was the only independent predictor of the combined clinical endpoint. Kaplan-Maier analysis showed that patients with a ΔLAS above its median value had a significantly better event-free survival compared to those below the median (p&lt;0.001).

Conclusions
A lower reduction in ΔLAS after TAVR was an independent predictor of the primary composite outcome of cardiovascular death and hospitalization for HF.

Funding Acknowledgement
Type of funding sources: None.
Comparative analysis of phasic left atrial strain and left ventricular posterolateral strain to discriminate Fabry cardiomyopathy from other forms of left ventricular hypertrophy
Authors: Frumkin D , Knebel F , Stangl K , Mattig I , Laule N , Canaan-Kuehl S , Brand A 
Published: October 2021

Abstract

Background
“Classic” echocardiographic signs of Fabry cardiomyopathy (FC), such as left ventricular hypertrophy (LVH) and posterolateral strain deficiency (PLSD) have a low diagnostic accuracy in clinical practice.

Purpose
Our aim was to evaluate the diagnostic accuracy of phasic left atrial strain impairment compared to PLSD to discriminate FC from other forms of LVH.

Methods
40 patients with LVH due to bioptically and genetically confirmed FC or with LVH due to other causes, defined by exclusion of storage diseases, such as Amyloidosis or FC, by myocardial biopsy, were retrospectively analysed. Standard echocardiographic views (Vivid E9, GE, Vingmed, Horton) were used to analyse left atrial (LA) reservoir, conduit, and contraction strain using 2D speckle tracking echocardiography (2DSTE; EchoPAC software, GE) as well as the PLSD, obtained by the mean of deformation values in basal posterior and lateral segments in a 17-segment model. Receiver operating characteristic (ROC) curve analysis and a logistic regression model were performed to assess the diagnostic accuracy of LA and LV strain impairment.

Results
FC was confirmed in 20 patients by genetic testing and myocardial biopsy. In the LVH group, 12 patients were classified to have hypertrophic cardiomyopathy, two had hypertensive heart disease, and six expressed the pattern of LV hypertrophy combined with borderline myocarditis. LV septum thickness (15.8mm±3.4 in FC; 17.9mm±4.3 in LVH) and left atrial volume index (LAVI) (36.7ml/m2±11.3 in FC; 45.7ml/m2±16.3 in LVH) as well as LVEF (54.2%± 9.8 in FC; 52.5%±7.7 in LVH,) were not statistically different between groups. LV filling parameters such as E/A (1.2±0.5 in FC; 1.2±0.7 in LVH) and E/e' (11.0±4.9 in FC; 13.2±5.3 in LVH) showed a slightly more advanced impairment in the LVH group.
Global and regional LV function was not different between groups (LVGLS −13.8±3.7% in FC and −12.8±3.7% in LVH; PLSD −10.7±5.2% in FC and −8.85±3.9% in LVH; p-value?). LA reservoir strain (LASr) and LA conduit strain (LAScd) were significantly impaired in FC compared to the LVH group (LASr 14,6±2.5% in FC and 26.3±8.5% in LVH, p&lt;0.01; LAScd −5.9±2.6% in FC and −15.8±4.7% in LVH, p&lt;0.01). In ROC analysis, LASr, with an area under the curve (AUC) of 0.81 (95% CI 0.64–0.97) and LAScd with an AUC of 0.85 (95% CI 0.71–0.99), respectively, showed the highest diagnostic accuracy to discriminate FC. PLSD, in contrast, held a low diagnostic accuracy with an AUC of only 0.47 (95% CI 0.27–0.68).

Conclusion
A substantially higher diagnostic accuracy could be shown for LASr and LAScd impairment in discriminating FD and other forms of LVH compared to PLSD. The echocardiographic assessment of phasic LA strain may help to identify FC in patients with unclear LVH.

Funding Acknowledgement
Type of funding sources: None. ROC analysisRepresentative examples
Assessment of the intramural segment of interarterial anomalous coronary arteries originating from the opposite sinus of Valsalva on CT angiography
Authors: Koppel C J , Verheijen D B H , Kies P , Egorova A D , Jongbloed M R M , Vliegen H W 
Published: October 2021

Abstract

Background
Of the coronary anomaly variants, an anomalous coronary artery originating from the opposite sinus (AAOCA) with an interarterial course poses the highest the risk of sudden cardiac death. Assessment of high risk anatomical characteristics can be done with Computed Tomography Angiography (CTA). High risk features are a slit-like ostium, acute angle take-off, proximal narrowing and an intramural course. For an intramural course no clear-cut CT parameters exist.

Purpose
To deduct new CTA criteria to identify an intramural course as well as the length of the intramural segment based on peroperative findings.

Material and methods
Twenty patients were included that received unroofing surgery of the right or left AAOCA between 2010 and 2019. All patients had a pre-operative CTA (0.5–1mm slice-thickness) performed. The presence of the intramural segment was measured peroperatively by the surgeon and used as indicator for CTA evaluation. Using multiplanar reconstructions, CTA images were rotated perpendicular to the horizontal plane of the aortic valve annulus and AAOCA to assess the distance between the aortic and AAOCA lumen and the shape of the AAOCA. This was done at every 2mm for the length of the intramural course as described by the surgeon (Figure 1).

Results
Analysis of 20 patients (40% male, AAORCA n=17, age at diagnosis AAOCA 45.6±10.5 years), showed a mean intramural length of 11.5±2.4mm at surgery. The median distance between the aortic and AAOCA lumen was 0.76mm (IQR 0.72–0.97mm) for the intramural segment. At the distal end of the intramural part (indicated by no. 5 in Figure 1), the mean distance was 1.20mm±0.27mm. The median ratio between the antero-posterior and transverse diameter of the AAOCA lumen at the distal end of the intramural part was 0.94 (IQR 0.88–0.99). Along the intramural part (Figure 1, no. 1–4) this ratio was 0.56mm±0.11mm, indicating a more flattened ostial shape along the course of the vessel.

Conclusions
Results indicate that an aortic to AAOCA lumen distance of ≤0.76mm on CTA is suggestive of an intramural course. A distance between the aorta and AAOCA of ≥1.2mm combined with an antero-posterior to transverse diameter ratio of 0.94 of the AAOCA indicates that the intramural trajectory has ended.

Funding Acknowledgement
Type of funding sources: None.
Diameter and shunt act as an alleviator of pulmonary hypertension: an echocardiography assessment of patients with ostium secundum atrial septal defect
Authors: Espinola-Zavaleta N E Z , Antonio-Villa N E A V , Guerra E C G , Alexanderson-Rosas E A R , Bracamontes-Castelo G B C , Avendano-Perez L A P ,   MD/PhD (PECEM) UNAM
Published: October 2021

Abstract

Background
Ostium-secundum atrial septal defect (OS-ASD) increases pulmonary arterial systolic pressure (PSAP) and eventually leads to pulmonary hypertension (PH). Nevertheless, whether the characteristics of OS-ASD could serve as an alleviator within chronic-volume overload in the right atrium (RA) is unclear.

Aims
To evaluate a potential interaction of OS-ASD diameter and the shunt (Qp/Qs ratio) on PSAP values in patients with secondary PH.

Methods
We designed a cross-sectional study of 63 adult patients with OS-ASD. A conventional transthoracic echocardiography was performed using Vivid 9X-clear equipment (GE Vingmed Ultrasound, Horten, Norway) to evaluate the OS-ASD diameter and the Qp/Qs ratio. The PSAP was calculated by tricuspid regurgitation velocity with continuous-wave Doppler in the apical four-chamber view. Polynomic adjusted correlations were performed between the RA volume and the PSAP; we evaluated a double and triple interaction-effect of the OS-ASD diameter and Qp/Qs ratio, respectively adjusted for age, sex and body surface area.

Results
In our study population, 78% (n=49) were female, with a mean age of 41.8 (±15) years. 44% (n=28) with mild-PH, 38% (n=24) with moderate-PH and 17% (n=11) with severe-PH. Mean echocardiographic parameters were: RA volume 58.8 (±26.4) mL, PSAP of 55.9 (±20.7) mmHg, OS-ASD diameter 30.1 (±7.8) mm and Qp/Qs 2.9 (±0.9). We observed a cubic relationship between RA volume and PSAP (r=0.354, p=0.006; Figure 1A). ASD-Diameter had a negative interaction effect (β=−0.0231 95% CI: −0.043 to −0.003, p=0.03) of the relationship between RA volume and PSAP (Figure 1B). Furthermore, the addition of Qp/Qs ratio displayed a positive triple interaction effect (β=0.021 95% CI: 0.001–0.043, p=0.048) on the previously mentioned variables (Figure 1C) after adjusting for covariates.

Conclusions
The increase in OS-ASD diameter and shunt decreases PSAP values. Our results could indicate that OS-ASD could potentially ameliorate chronic-volume overload in patients with secondary PH.

Funding Acknowledgement
Type of funding sources: None. Figure 1
The relative apical sparing pattern is common in elderly patients with type 2 diabetes mellitus
Authors: Uneno K 
Published: October 2021

Abstract

Background
Type 2 diabetes mellitus (T2DM) impairs cardiac function and is one of the risk factors for heart failure. However, the mechanism of cardiac impairment is not elucidated. Despa et al. reported that amylin has aggregation properties similar to amyloidogenic proteins and impairs cardiac function in T2DM patients with hyperamylinemia. In this hypothesis, T2DM-induced myocardial impairment is thought of as amylin-induced cardiac amyloidosis. The purpose of this study is to clarify whether a relative apical sparing pattern (RASP), which is well known as a typical pattern of cardiac amyloidosis, is common in T2DM.

Methods
We studied patients aged 75 years or over who underwent echocardiography from January 2018 to December 2020 in our clinic. We calculated the quantitative relative apical sparing (qRASP) as average apical-longitudinal strain (LS)/(average basal-LS + average mid-LS) in each patient. According to the validated threshold, a qRASP ≥1.0 was defined as an obvious RASP (oRASP). We compared the ratio of oRASP between patients with and without T2DM.

Results
We researched 506 patients, mean 81.8 years, 290 females, 133 with T2DM. The average age, atrial fibrillation rate, heart failure rate, and hypertension rate were similar in both groups. The ratio of ischemic heart disease was higher in the T2DM group. Echocardiography showed that the left atrial dimension (LAD), E/e', and left ventricular hypertrophy (LVH) ratio was higher in the T2DM group. Speckle tracking echocardiography revealed that global longitudinal strain (GLS) and qRASP of the T2DM group were higher than the non-DM group (GLS;-18.0% vs. −19.2%, p&lt;0.001. qRASP; 0.809 vs. 0.699, P&lt;0.001). Furthermore, the ratio of oRASP was significantly higher in the T2DM group (19.0% vs. 1.34%, p&lt;0.001). Multivariable logistic regression analysis showed T2DM was an independent predictor for oRASP.

Conclusion
This study revealed that the qRASP and the ratio of oRASP in the T2DM group were higher than non-DM group. This finding supports the hypothesis that T2DM related cardiomyopathy is a kind of cardiac amyloidosis caused by amylin.

Funding Acknowledgement
Type of funding sources: None.
Loss of apical suction assessed by noninvasive pressure differences and twist in acute heart failure: a novel method using vector flow mapping
Authors: Ido S , Masuda K , Yoshimura S , Tanaka H , Stugaard M 
Published: October 2021

Abstract

Background
Early diastolic intraventricular pressure difference (IVPD) reflects left ventricular (LV) apical suction, and IVPD is closely related to cardiac function, especially LV twist. Vector Flow Mapping (VFM) allows visualization of regional pressure distribution and noninvasive quantification of IVPD. The purpose of the present study was to investigate if and how IVPDs are related to LV twist in a model of acute heart failure (HF).

Methods
In 15 open-chest dogs, HF was induced by intracoronary injection of microspheres. The HF model was classified into two groups based on the LV end-diastolic pressure (LVEDP) (group1: LVEDP&lt;18 mmHg (n=10), group2: LVEDP≥18 mmHg (n=8)).
Color Doppler images from apical long-axis views were acquired at baseline and during HF. From these images, pressure differences (ΔP) were calculated along the LV inflow tract throughout the cardiac cycle. For the purpose of this study, the differences between apex and base during isovolumic relaxation time (ΔPIRT) and rapid early inflow period (ΔPE) were used for analyses. Furthermore, apical and basal short axis high frame rate 2D images were acquired, and peak rotation and peak twist were analyzed.

Results
LVEDP was 7±9, 14±2, 21±3 mmHg for baseline, group1 HF, and group2 HF, respectively. Pressure differences (both ΔPIRT and ΔPE) were visibly changed by the increase of LVEDP (Figure), and the magnitude of ΔPIRT, ΔPE and peak twist decreased significantly with the severity of heart failure. There were significant relationships between pressure differences (ΔPIRT and ΔPE) and dP/dtmin, tau, EF and peak twist (Table). In multivariate analyses, tau and peak twist were independent predictors for ΔPIRT and peak twist was independent predictor for ΔPE.

Conclusion
VFM analysis is feasible to noninvasively assess the IVPDs in acute heart failure. The IVPDs are closely related to the twisting motion of the LV, and reflect loss of apical suction during severe HF.

Funding Acknowledgement
Type of funding sources: None. VFM images of pressure differencesCorrelations of pressure differences
Clinical and echocardiographic risk score predicts need for hospitalization among patients with COVID-19
Authors: Kothari J , Shah K , Daly T , Saraiya P , Taha I , Le M , Goel H , Shirani J 
Published: October 2021

Abstract

Background
Age and medical co-morbidities are known predictors of disease severity in coronavirus disease-2019 (COVID-19). Whether baseline transthoracic echocardiographic (TTE) abnormalities could refine risk-stratification in this context remains unknown.

Purpose
To analyze performance of a risk score combining clinical and pre-morbid TTE features in predicting risk of hospitalization among patients with COVID-19.

Methods
Adult patients testing positive for COVID-19 between March 1st and October 31st, 2020 with pre-infection TTE (within 15–180 days) were selected. Those with severe valvular disease, acute cardiac events between TTE and COVID-19, or asymptomatic carriers of virus (on employment screening/nursing home placement) were excluded. Baseline demographic, clinical co-morbidities, and TTE findings were extracted from electronic health records and compared between groups stratified by hospital admission. Total sample was randomly split into training (≈70%) and validation (≈30%) sets. Age was transformed into ordered categories based on cubic spline regression. Regression model was developed on the training set. Variables found significant (at p&lt;0.10) on univariate analysis were selected for multivariate analysis with hospital admission as outcome. β-coefficients were obtained from 5000 bootstrapped samples after forced entry of significant variables, and scores assigned using Schneeweiss's scoring system. Final risk score performance was compared between training/validation cohorts using receiver-operating curve (ROC) and calibration curve analyses.

Results
192 patients were included, 83 (43.2%) were admitted. Clinical/TTE characteristics stratified by hospitalization are in Table 1. Moderate or worse pulmonary hypertension and left atrial enlargement were only TTE parameters with coefficients deserving a score (Table 1). The risk score had excellent discrimination in training and validation sets (figure 1 left panel; AUC 0.785 versus 0.836, p=0.452). Calibration curves showed strong linear correlation between predicted and observed probabilities of hospitalization in both training and validation sets (Figure 1, middle and right panels, respectively). ROC analysis revealed a score ≥7 as having best overall quality with sensitivity and specificity of 70–75% in both training and validation sets. A score ≥12 had 98% and 97% specificity and ≥14 had 100% specificity.

Conclusion
A combined clinical and echocardiographic risk score shows promise in predicting risk of hospitalization among patients with COVID-19, and hence help anticipate resource utilization. External validation and comparison against clinical risk score alone is worth further investigation.

Funding Acknowledgement
Type of funding sources: None.