bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prospective validation of a non-invasive method to estimate myocardial work in aortic stenosis
Authors: Hubert A , Owashi KP , Le Rolle V , Hernandez A , Galli E , Donal E 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): ANR - Maestro project

Background
Stratification of aortic stenosis patients remains challenging and robust indices are required. Myocardial work assessment is a new afterload independent alternative to evaluate left ventricular function. Although, this method was developed in patients with normal aortic valve. We previously developed an integrated cardiovascular system simulated by a computational model to estimate non-invasively myocardial work in aortic stenosis patients* (figure 1A). In the present study, we tested our model in a prospective population of AS patients.

Method and results
9 patients with severe AS (aortic valve area &lt; 1cm2) were included. A complete trans-thoracic echocardiography with a non-invasive blood pressure by brachial artery cuff were realized immediately before a left heart catheterization to have an invasive left ventricular pressure. Myocardial work is then calculated with non-invasive and invasive LV pressure combined to LV strain curves. For constructive and wasted work, root mean squared between invasive and estimated measures were respectively r2 = 0.92 and r2 = 0.94 (figure 1B)

Conclusion
The proposed model is efficient to estimate non-invasively myocardial work indices in AS-patients. These afterload independent indices could permit in future to better stratify this population.
*Owashi KP, Hubert A and al. Model-based estimation of left ventricular pressure and myocardial work in aortic stenosis. PlosOne 2020. Mar 3;15(3):e0229609
Abstract Figure 1
Principal morphomic components of secondary mitral regurgitation
Authors: Heitzinger G , Bartko PE , Spinka G , Pavo N , Prausmueller S , Arfsten H , Gebhard C , Mascherbauer J , Hengstenberg C , Strunk G , Huelsmann M , Goliasch G 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Austrian Science Fund (FWF – identification number: KLI-818B).

Background
Secondary mitral regurgitation in patients with heart failure and reduced ejection fraction (sMR) results from distortion of the physiologic cardiac architecture. Underlying morphological components might account for the clinical impact of sMR but have not yet been assessed systematically or related to outcome.

Objectives
To investigate the morphologic features of sMR and their prognostic impact on outcome.

Methods
This study used morphomic network profiling in patients with stable heart failure under guideline directed medical therapy. Principal component analysis was applied and three factors extracted, of which Factor 1 and 2 were strongly related to sMR and outcome. Based on the factors, four morphologically distinct clusters were derived.

Results
Morphomic data from 383 patients were profiled. Factor 1 consists of high loadings of left atrial morphological information, factor 2 high loadings of left ventricular morphology. Cluster analysis revealed four morphologically distinct phenotypes. sMR was most prominent in cluster 3 and 4. The morphological difference was left ventricular size (enddiastolic volume 188ml (160-224) versus 315ml (264-408), P &lt; 0.001). Clusters were associated with mortality (P &lt; 0.001), however, sMR remained independently associated with mortality after adjusting for the clusters (adj.HR 1.42, 95% CI 1.14–1.77; P &lt; 0.01) (Figure 1/ Panel B). The detrimental association of sMR with mortality was mainly driven by cluster 3 (HR 2.18, 95% CI 1.32-3.60; P = 0.002), the "small LV cavity" phenotype (Figure 1/ Panel A).

Conclusions
These results challenge the current perception of sMR resulting exclusively from global or local LV remodeling and, supported by previous concepts, emphasize the role of the atrial component as a pathophysiologic mechanism. The association of sMR with mortality cannot be purely attributed to cardiac morphology alone. Additionally, other key aspects such as balance of closing and tethering forces contribute to mitral valve closure. The association of sMR with mortality mainly driven by the small LV cavity phenotype refines the prognostic impact of sMR in relation to the underlying anatomic variability.
Abstract Figure. Survival for clusters and adj. sMR
Atrial coupling index by standard echocardiography in degenerative mitral regurgitation: incremental determinant of survival
Authors: Essayagh B , Benfari G , Antoine C , Batista R , Maalouf J , Michelena H , Enriquez-Sarano M 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Mayo Clinic Foundation

Background
Left atrial (LA) volume is linked to outcome in degenerative mitral regurgitation (DMR) but does not encompass LA function assessment. Thus, we ought to determine the prognostic role of left atrial coupling-index (LACI), as left atrial volume-index (LAVI) by Tissue-Doppler-Imaging a’ (TDI-a’), in a large cohort of DMR.

Methods
All consecutive 4792 patients (61 ± 16 years, 48% women) with isolated degenerative mitral valve disease diagnosed at Mayo Clinic 2003-2011, comprehensively characterized, in whom LAVI and TDI-a’ in sinus rhythm was prospectively measured in routine practice, was enrolled and their long-term survival analyzed.

Results
LACI (5.8 ± 3.7–T1 &lt; 3.8; T2 3.8-6.3; T3 &gt; 6.3) was significantly higher through different DMR grades (no, mild, moderate, severe DMR: 3.77 ± 2.26, 5.08 ± 2.95, 6.54 ± 3.74 and 7.84 ±4.29 respectively; p &lt; 0.0001). Independent determinants of LA dysfunction assessed by LACI were age, E/e’, left-ventricle (LV) end-systolic-diameter, mitral-regurgitation (MR) grade, and LV ejection-fraction (all P ≤ 0.0001). LACI &gt; 6 was independently associated with dyspnea, edema, more severe functional tricuspid-regurgitation and elevated pulmonary artery pressure, irrespective of age, sex, Charlson-comorbidity-index, ventricular function and MR severity. Total follow-up was 7.03 ± 3.0 years, during which 1146 (24%) underwent mitral-valve surgery (94% repair-6% replacement) and 880 (18%) died, 780 under medical treatment and 100 after surgery. Overall survival throughout follow-up (10-year 76 ± 1%) was strongly associated with LACI (88 ± 1% vs. 78 ± 1% and 62 ± 2% for LACI &lt;3.8, 3.8-6.3 and ≥6.3, P &lt; 0.0001) even adjusting comprehensively, including for DMR severity (adjusted-hazard-ratio 1.23[1.07-1.43] for LACI &gt; 5.79, P = 0.005). Mortality under medical management was profoundly affected by LACI (adjusted-hazard-ratio 1.11[1.05-1.18] per 3 unit increment; 1.35[1.15-1.58] for LACI &gt; 5.79 vs. ≤5.79, both P = 0.0002). Survival improved after mitral surgery (time-dependent adjusted-hazard-ratio 0.40[0.28-0.65], P &lt; 0.0001) but remained humbly linked to LACI (10-year 93 ± 3% vs. 90 ± 2% and 80 ± 3% for LACI tertiles, P = 0.0008). Most importantly, LACI provided incremental prognostic information over LAVI and other conventional determinants of survival (P &lt; 0.0001) with Net-reclassification-improvement vs. LAVI of 0.21 ± 0.02, P &lt; 0.0001.

Conclusion
LA function assessed by LACI in routine practice, by conventional echocardiographic measurements, displays incremental and independent link to excess-mortality, considerable under medical management and partially alleviated by mitral surgery. Thus, LACI is a simple tool of crucial interest in DMR risk-stratification.
Abstract Figure. LACI in DMR
Clinical implications of the morphological features of left ventricular intracavitary thrombi after anterior ST elevation myocardial infarction
Authors: Vilardell P , Moral S , Albert X , Bosch D , Morales M , Frigola JM , Robles R , Pla R , Ramos R , Aboal J , Brugada R 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left ventricular thrombi (LVT) after an anterior ST elevation myocardial infarction (STEMI) are usually classified as protruding or laminar according to their morphological characteristics. However, it is unknown whether this morphology has any clinical implication.

Purpose
Determine prognostic between laminar or protruding LVT in the community of anterior STEMI.

Methods
An observational cohort study on patients with LVT after anterior STEMI detected by echocardiography between 2008 and 2019 was conducted. Laminar LVT was defined as those protruding &lt;5mm inside the cavity.

Results
Of 1.215 anterior STEMI patients, 121 (10%) cases presented LVT: 86 (71%) were protruding and 35 (29%) laminar. Mean follow-up was 323 ± 116 days. No differences in baseline clinical and echocardiographic characteristics were detected between both groups. However, protruding LVT patients were more frequently treated with triple therapy (71% vs 40%; p &lt; 0.001). Laminar LVT patients presented a lower stroke rate (3% vs 16%; P = 0.042) and embolism-related rate (3% vs 19%; p = 0.024) than protruding LVT cases (see Figure). Laminar LVT was associated with lower embolism-related events during follow-up independently than left ventricular ejection fraction (LVEF) and age (OR = 0.11; 95% CI,0.12-0.94; p = 0.045). No differences were observed in laminar LVT patients in embolism-related events during follow-up between those treated with or without triple therapy (7% vs 0%; p = 0.400).

Conclusions
Laminar LVT after anterior STEMI presented a lower rate of embolism-related complications during follow-up compared with protruding LVT regardless of LVEF, age and even with a lower rate of triple therapy.
Abstract Figure.
Comparison of pulmonary vein sizing by transesophageal echocardiogram and by direct angiogram
Authors: Bachani N , Vadivelu R , Bagchi A , Jadwani JP , Panicker GK , Shah H , Dhirawani B , Rathi C , Lokhandwala Y 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary vein (PV) anatomy and sizing is important to know before performing PV isolation. This information is conventionally obtained by angiography or by CT scan.

Aim
We undertook this study to identify and measure the PVs during TEE studies and validate these against angiography.

Method
17 consecutive patients due to undergo PV isolation for paroxysmal atrial fibrillation were analysed. Using TEE, the PVs were visualised (Upper panel) as follows: i) From the mid-esophageal four chamber view, the chamber probe was turned to the right at 110-130º for the bicaval view, where the RSPV was seen entering the left atrium adjacent to the SVC. ii) At 0º the SVC was imaged in its short axis, and the probe advanced till the interatrial septum was seen. The angle was changed to 30º to visualise the right inferior PV (RIPV). iii) From the two chamber view (70-90º), the probe was turned to the left and withdrawn to display the left superior PV (LSPV) entering the left atrium parallel to the appendage.iv) Keeping the LSPV in focus, the angle was changed to 135º and the probe advanced till the AV groove, where the left inferior PV (LIPV) was visualised. After transseptal puncture, each PV was cannulated. The PV angiograms were performed in several projections to obtain the best PV profile (lower panel). Using electronic callipers, each PV was measured within 1 cm of its entry into the left atrium, after having received all tributaries. Those PVs were considered for analysis which were measured by both TEE and angiography. The paired ‘T’ test was used to compare the PV diameters by TEE and angiography and the Bland Altman analysis was done to see the level of agreement.

Results
Of a total of 68 PVs, 62 could be adequately visualised by TEE and 50 by angiography. These 50 PVs were measured using both methods. The diameters of the PVs measured by TEE and angiography were not statistically different by the paired t test; LSPV14 ± 1.8 mm v/s 14.4 ± 2.1 mm; RSPV 13 ± 1.8 mm v/s 14.6 ± 3.5 mm; LIPV 11.9 ± 2.1 vs 13.2 ± 2.8 mm and RIPV 10.5 ± 2.7 vs 12.1 ± 2.9 mm. Bland Altman analysis showed most PV sizes estimated by TEE and angiography lay within limits of agreement.

Conclusions
A majority of PVs can be visualised by TEE using a defined protocol. TEE is a good technique to visualise and assess the size of PVs, avoiding the need for contrast medium and radiation.
Abstract Figure. TEE and angiographic images of PVs
Left atrial strain and outcome in heart failure with preserved ejection fraction
Authors: Bekki N , Hayama H , Nagai R , Miyake W , Yamamoto J , Torii S , Kubota S , Nakagawa T , Okazaki T , Yamamoto M , Okazaki O , Hara H , Hiroi Y 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial (LA) function is impaired in heart failure with preserved ejection fraction (HFpEF). However, the association between LA longitudinal strain and heart failure (HF) events in patients with HFpEF is still unknown. We evaluated whether LA strain measurements would be useful to predict hospitalizations for worsening HF in this study.

Methods
This study included 121 patients (Male 73, Female 48) with HFpEF who had echocardiogram at our institute (Age = 76 ± 14y, Left ventricular ejection fraction; LVEF = 63 ± 8%). Patients with atrial fibrillation were excluded. LA longitudinal strain was measured by speckle-tracking echocardiography, using TOMTEC imaging system. The endpoints were hospitalizations for worsening HF.

Results
During follow-up period of 319 ± 269 days, 33 patients (27%) experienced hospitalizations for worsening HF. LA strain was markedly lower in patients with HF events at 11.3 ± 5.6, whereas LA strain was higher at 20.3 ± 10.1 in patients without HF events. Kaplan-Meier analysis demonstrated a significant separation of survival curves stratified by median value of LA strain (Figure).

Conclusions
LA dysfunction in HFpEF is associated with a higher risk of HF hospitalization, and LA strain measurements would be useful to predict HF events.
Abstract Figure
Predictors of atrial fibrillation in patients with cryptogenic stroke and fifteen-days electrocardiographic monitoring. Preliminary results of the DECRYPTORING study
Authors: Vera Sainz A , Cecconi A , Martinez Vives P , Ximenez Carrillo A , Aguirre C , Ramos C , Benedicto A , Diego G , Dominguez L , Lopez B , Rojas A , Gamarra A , Vivancos J , Jimenez Borreguero LJ , Alfonso F 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

onbehalf
DECRYPTORING study

Introduction
Cryptogenic stroke (CS) represents up to 30% of all stroke types. In one third of CS, atrial fibrillation (AF) is identified as the underlying cause. Predictors of AF in the setting of CS have been described, however these findings were based on retrospective studies and with maximum ECG monitoring of 72 hours. To overcome these limitations, we designed the prospective Decryptoring study whose objective is to create a comprehensive predictive model for AF in patients with CS.

Methods
From April 2019, 41 consecutive patients with a CS and age &gt; 60 years were included. On admission, a transthoracic echocardiogram with 3D volume and left atrial (LA) strain was performed. All patients were monitored with a 15-day ECG-Holter after discharge. Patients were classified according to AF detection.

Results
AF was detected in 9 patients (22%). Patients with AF were older (75.9 ± 8 vs. 81.9 ± 4.3 years, p = 0.041). There was no difference in T-troponin levels. NTproBNP was higher in the group with AF (350 ± 586 pg / ml vs. 1084 ± 1416 pg / ml, p = 0.018). Regarding LA strain, patients with AF presented reservoir LA strain (25.5 ± 8.2% vs 17.4 ± 4.3%; p = 0.006) and conduct LA strain (12 ± 5.2% vs 7.2 ± 1.5%; p = 0.01) lower than patients without AF. There were no differences in contraction LA strain or other echocardiographic variables. The risk of developing AF was higher in patients with NTproBNP&gt; 165 pg / ml (OR 11.3 [95% CI 1.2-102.9] p = 0.031), LA reservoir strain &lt;19.1% (OR 7.7 [IC 95 % 1.5-40.0] p = 0.016) and LA conduct strain &lt;9.1% (OR 7.8 [95% CI 1.3-45.0] p = 0.022) (Table).

Conclusions
This prospective study, demonstrates that high NTproBNP, low reservoir LA strain and low conduct LA strain are associated with underlying AF in patients with cryptogenic stroke.
No AF (n = 32) AF (n = 9) P value Age (years) 75.9 ± 8 81.9 ± 4.3 p = 0.041 NTPROBNP (pg/ml) 350 ± 586 1084 ± 1416 P = 0.018 LA indexed diastolic volume (ml/m2) 30 ± 11.8 33.8 ± 9.8 P = 0.35 LA EF (%) 45 ± 16.7 45 ± 12.8 P = 1 Reservoir LA strain (%) 25.5± 8.2 17.4± 4.3 P = 0.006 Conduct LA strain (%) 12 ± 5.2 7.2 ± 1.5 P = 0.01 Contraction LA strain (%) 13.5 ±5.3 10.2± 3.9 P = 0.10 NTPROBNP &gt; 165 pg/ml 12 (41%) 8 (89%) OR 11.3 [IC 95% 1.2-102.9]; p = 0.031 Reservoir LA strain &lt;19.1% 6 (20%) 6 (67%) OR 7.7 [IC 95% 1.5-40.0]; p = 0.016 Conduct LA strain &lt;9.1% 9 (31%) 7 (78%) OR 7.8 [IC 95% 1.3-45.1]; p = 0.022
Value of TAPSE normalized to right ventricular length as a substitute to speckle tracking-derived right ventricular free wall longitudinal strain assessment
Authors: Unger P , Paesmans M , Amzulescu M , David-Cojocariu A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The diagnostic and prognostic value of right ventricular strain assessed by speckle-tracking imaging (STI-RV) has recently emerged in various clinical situations and this parameter has been incorporated into echocardiographic guidelines. However, it suffers from several limitations including the fundamental but often unmet requirement of good image quality and from the need for dedicated software with inter-vendor variability.

Purpose
We hypothesized that RV free wall (fw) longitudinal shortening, i.e. the ratio of tricuspid annular plane systolic excursion (TAPSE) to end-diastolic RV longitudinal length (RVDL) could be used as a surrogate of RVfw strain, without suffering from the abovementioned limitations. We therefore compared -(TAPSE/RVDL) to STI-RVfw strain in a series of non-selected patients undergoing echocardiography.

Patients and methods
144 consecutive ≥18 y-o patients in sinus rhythm referred to our echocardiographic laboratory underwent transthoracic echocardiography using a Vivid E9 platform (GE Vingmed, Horten, Norway). STI-RVfw strain was obtained using a RV focused apical four chamber view and -(TAPSE/RVDL) was obtained from the apical four-chamber view. Images and loop were stored digitally and analyzed offline using EchoPac 2.02 software (GE Vingmed).

Results
Poor image quality precluded the assessment of STI-RVfw strain - but not of -(TAPSE/RVDL) - in 27 patients (18.8%) and of both parameters in 4 patients (2.8%); the study group consisted in the remaining 113 patients. Among all tested RV function indices, -(TAPSE/RVDL) best correlated with STI-RVfw strain (Panel A), without significant bias between the two methods (Panel B). The area under the ROC-curve for -(TAPSE/RVDL) to detect abnormal STI-RVfw strain (using a threshold of -20.2%) was 0.97 [IC 95% 0.94-1], and sensitivity, specificity, negative and positive predictive value were 83%, 96%, 96%, and 83%, respectively.

Conclusion
In this unselected series of patients, the assessment of -(TAPSE/RVDL) performed reasonably well to predict abnormal STI-RVfw strain and was more often feasible than the latter. Its prognostic value should be prospectively tested.
Abstract Figure 1
Left atrial function assessed by speckle tracking echocardiography predicts atrial fibrillation burden after catheter ablation independently of reconduction: a RACE-AF echocardiographic sub-study
Authors: Nielsen A , Soerensen S , Skaarup K , Djernaes K , Estepar R , Hansen M , Worck R , Johannesen A , Hansen J , Biering-Soerensen T 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial (LA) function assessed by 2D speckle tracking echocardiography (STE) has demonstrated to be a useful predictor of recurrence of atrial fibrillation (AF) following catheter ablation (CA). Pulmonary vein reconduction (PVR) is one of the most important causes of recurrent paroxysmal AF (PAF) after ablation. The purpose of this study was to evaluate the association between AF burden (% of time in AF) following CA and LA strain measurements independently of PVR.

Methods
This prospective study included 66 patients with PAF who underwent CA (mean age 60 ± 8 years, 65% male). STE was performed during sinus rhythm prior to CA. AF burden was recorded by continuous rhythm monitoring using implantable loop recorders during a follow-up period of 4-6 months, excluding a blanking period of 3 months. After follow-up, all patients underwent an invasive assessment of pulmonary vein isolation to test for PVR. Multivariable linear regression analysis was used to assess the association between AF burden and peak atrial longitudinal reservoir strain (PALS), peak atrial contraction strain (PACS) and peak atrial conduit strain (PCS).

Results
Prior to CA, median AF burden was 3.8% (IQR: 0.5, 17). During follow-up, 37 patients (56%) were free of AF while median AF burden was 0.7% (IQR: 0.2, 1.6) in patients with an AF burden of more than 0%. A total of 35 patients (54%) were found to have PVR after ablation. Patients with AF recurrence had significantly lower PACS compared to patients with no AF during follow-up (10% ± 6% vs. 14% ± 5%, p = 0.004). No differences in PALS and PCS were observed. Increased PACS remained independently associated with low AF burden following CA after multivariable adjustments for clinical characteristics, comorbidities, and PVR (β=-0.262, p = 0.049) (Figure 1). PALS and PCS did not remain significantly associated with AF burden.

Conclusion
Increased PACS is strongly associated with low AF burden after CA even after adjusting for PVR. This suggests that an analysis of LA function could be useful to stratify patients prior to CA and improve treatment strategies.
Abstract Figure.