bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prosthesis-patient mismatch after aortic valve in valve procedure: incidence, predictors and clinical outcomes
Authors: Fusini L , Muratori M , Ghulam Ali S , Gripari P , Cefalu" C , Junod D , Fabbiocchi F , Roberto M , Trabattoni P , Agrifoglio M , Bartorelli AL , Alamanni F , Pepi M , Tamborini G 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Transcatheter aortic valve-in-valve (TAVI ViV) implantation is an appealing treatment option for patients with degenerated bioprostheses. However, elevated residual gradients after TAVI ViV procedure are very common. These are an unwanted effects of prosthesis-patient mismatch (PPM). Currently, the actual incidenceof PPM, its predictors and its clinical outcomes have not been completely investigated.
Purpose. The aims of this study was to investigate the incidence, predictors and clinical outcome of PPM and therefore of elevated gradients after TAVI ViV.
Methods. 75 patients (age 78 ± 9 years, 36 male), who underwent TAVI-ViV due to failed aortic biological valve (60 stented, 15 stentless), were enrolled. Mechanism of bioprosthetic valve failure was stenosis (34 cases, 45%), regurgitation (24 cases, 32%) or combination (17 cases, 23%). Elevated residual gradients were defined as a mean DP&gt; 20 mmHg. PPM was identified by the indexed effective orifice area (EOAi) measured by echocardiography (moderate PPM if 0.65 &lt; EOAi &lt; 0.85 cm²/m²; severe PPM if EOAi &lt; 0.6 cm²/m²).
Results. ViV TAVI was feasible in all patients, 33 patients (44%) were implanted with a balloon-expandable valve and 42 (56%) with a self-expandable valve. Post-procedural post-ballooning was performed in 16 out of 42 patients (38%) receiving a self-expandable valve. Post-operative mean DP&gt; 20 mmHg was found in 35 patients (48%). Moderate PPM was found in 24 cases (33%) and severe PPM in 15 (20%). A logistic regression analyses identified small size of surgical prosthesis (size &lt; 23 mm) [OR: 6.061(2.127-17.267), p = 0.001] and failed stented valve [OR: 20.727(2.522-170.364), p = 0.005] as independent predictors for the occurrence PPM. Interestingly PPM did not affect early and 1 years mortality (1 years mortality 1.3 %), while mortality was higher in pts with stentless prostheses (9%)
Conclusions. PPM is a frequent finding after ViV procedures. Despite elevated residual gradients, TAVI ViV resolved prosthetic dysfunction and PPM did not affect mortality. Therefore, this procedure represents a promising new option for patients with failed biological prosthetic valves.
Mitral annulus disjunction: is it a marker of ominous prognosis?
Authors: Cunha NPD , Rigueira J , Santos R , Nunes-Ferreira A , Rodrigues T , Antonio P , Pereira S , Morais P , Silva P , Brito J , Silva B , Placido R , David C , Pinto FJ , Almeida AG 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Mitral annulus disjunction (MAD) has been proposed as a contributing factor for arrythmias and mitral regurgitation in patients with mitral valve prolapse (MVP), however its clinical relevance is still under investigation.

Objective
To evaluate the frequency of MAD in MVP patients, to characterize clinically patients with MAD and assess potential markers for events.

Methods
Single-center retrospective study of consecutive patients with MVP documented in transthoracic echocardiogram between January 2014 and October 2019. MVP was defined according to the 2017 AHA recommendations; MAD was defined as a separation between mitral valve annulus and the left ventricle free wall. Demographic, clinical, echocardiographic, electrocardiographic data were collected. The results were obtained using Chi-square and Mann-Whitney tests; logistic regression was used to find predictors of events.

Results
247 patients were included (mean age 62.9 ± 18 years, 61% males), of these 23 (9.3%) had MAD (mean age 56 ± 20 years, 56.5% males). The maximum diameter of MAD was 10 ± 3mm (range 5-18). 21 patients (92.3%) had mitral regurgitation, and it was at least of moderate severity in 65.2% of patients. Most of the patients (91.3, n = 21) were in sinus rhythm (SR).
During follow-up (FUP) of 29 ± 19 months, 39% (n = 9) of the patients developed symptoms, 22% (n = 5) had atrial fibrillation (AF), 4.3% (n = 1) had acute aortic syndrome (AAS), 4.3% (n = 1) needed ICD, 22% (n = 5) were submitted to mitral valve intervention, 8.7% (n = 2) were admitted to hospital and 8.7% (n = 2) died. None of the patients presented sustained ventricular arrhythmias (SVA) as assessed in regular Holter monitoring.
These patients had more AAS and needed more ICD in FUP compared to patients without MAD (p = 0.007 and p = 0.006, respectively)
Mitral cord rupture (p = 0.04), age (p = 0.044), maximum velocity of tricuspid regurgitation (p = 0.04) and IVS thickness (p = 0.017) were associated with AF in MAD patients. in univariate analysis, interventricular septum thickness was a predictor of AF in this subgroup (OR 4.0, 95%CI 1.1-14.3, p = 0-032) The presence of SR was associated with survival (p = 0.03). There were no predictors of hospital admission or mitral intervention.

Conclusion
Patients with MAD had a relatively benign prognosis with few events during follow-up, although with more AAS and ICD in FUP. In our sample, AF was more common than SVA. Left ventricle hypertrophy was a predictor of AF and sinus rhythm was associated with survival. Larger studies with more patients and other methods of imaging are needed to confirm our results.
Torsional dynamics and 2D speckle tracking in heart failure with reduced ejection fraction on patients taking sacubitril/valsartan and naive
Authors: El Shafey WED , Elmelegy EHAB , Mousa WALAA , Shafek MENA 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
ARNI has been shown to be superior to enalapril in long term reducing the mortality and hospitalization of heart failure (HF). However short-term effect on diastolic function remain unclear. We sought to evaluate 6 months" effects of ARNI on left ventricular (LV) diastolic parameters determined by speckle tracking and tissue Doppler imaging.

Objectives
This study aims to evaluate the torsional dynamics and 2D speckle tracking in heart failure with reduced ejection fraction on patients taking angiotensin receptor neprilysin inhibitors (ARNI) and non.

Methods
This study was carried out in Menoufia university hospitals included 60 patients of HFrEF during the period from august 2019 to January 2020. (50%) of patients was treated with traditional treatment of heart failure and the remaining was treated with ARNI. Data were collected including history and clinical examination. ECG and speckle tracking and tissue Doppler imaging was done to evaluate the diastolic function.

Results
Our results showed no significant difference between the two groups at baseline. There was significant improvement of the LV diastolic function. Untwist time and untwist onset showed the highly significant parameters of improvement.

Conclusion
This study concluded that ARNI showed short term improvement of diastolic function of the left ventricle that can be detected by STE.
Comparison between the studied groups re Echocardiographic diastolic parameters after 6 months ARNI Traditional P-value (Sig.) Count 30 30 Diastolic dysfunction grade Grade 1 9 (30%) 1 (3.3%) 0.008 (S) Grade 2 18 (60%) 22 (73.4%) Grade 3 3 (10%) 7 (23.3%) Other doppler diastolic parameters E/A 0.93 ± 0.30 1.16 ± 0.26 0.002 (S) E/e" 9.1 ± 1.9 10.8 ± 1.6 &lt;0.001 (HS) TR velocity (m/s) 2.6 ± 0.3 2.8 ± 0.3 0.003 (S) Speckle diastolic parameters Untwist rate (°/s) -65.4 ± 5.2 -60.4 ± 4.5 &lt;0.001 (HS) Untwist onset (ms) 96.8 ± 16.2 106.1 ± 15.7 0.028 (S) Shows comparison between ARNI vs Traditionally treated patients and how the parameters of conventional and STE was improved in favor of diastolic parameters. Abstract Figure. Baseline vs 6 months inbetween studied g
Longitudinal change in cardiac structure and function following acute coronary syndrome stratified by culprit coronary artery lesion site
Authors: Ravnkilde K , Skaarup K , Grove GL , Modin D , Nielsen AB , Falsing MM , Iversen AZ , Pedersen S , Fritz-Hansen T , Galatius S , Jespersen T , Shah A , Gislason G , Biering-Soerensen T 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Acute coronary syndrome (ACS) has adverse consequences for the myocardium and subsequent cardiac function and structure. No reports exist comparing the differences in impact of culprit coronary artery lesion site on longitudinal remodeling and changes left ventricular structure and function.

Method
A total of 299 ACS patients treated with PCI were included in the present study. All patients had two echocardiographic examinations performed. The first was performed median 2 (IQR: 1; 3) days following PCI, while the second was performed median 240 (IQR: 81; 881) days after the first. Patients were grouped based on culprit coronary artery lesion (left anterior descending artery (LAD), right coronary artery (RCA) and circumflex artery (Cx)). Patients with multiple lesions were excluded from the present study. Univariable linear regression analysis was utilised to assess the association between culprit coronary artery lesion site and longitudinal change in cardiac structure and function.

Results
Mean age was 63 ± 11 years and 77% were male. At follow-up, mean left ventricular ejection fraction was 42 ± 9% and global longitudinal strain (GLS) was -13 ± 4%. Culprit coronary artery lesion was allocated as follows; 168 ACS patients were treated in LAD, 95 patients were treated in RCA, and 36 patients were treated in Cx. In the linear regression analysis, LAD patients displayed a greater improvement in GLS (b =-0.116, p = 0.048) compared to the two other lesion sites. LAD patients had the poorest GLS at both baseline and follow-up echocardiography (Figure). RCA lesions were associated with the largest decrease in left atrial maximum volume (LAVmax) (b = -0.156, p = 0.011) and the largest increase in relative wall thickness (RWT) (b = 0.139, p = 0.030), consequently resulting in an LAVmax smaller and an RWT larger at follow-up than other lesion sites (Figure). Lastly, Cx lesions were significantly associated with the largest decrease in ratio between peak early diastolic transmitral flow velocity and peak early diastolic mitral annular tissue velocity (E/e’) (b = -0.262, P &lt;0.001). Cx lesion patients were observed to have elevated E/e’ at baseline, which generally normalised at follow-up (Figure).

Conclusion
The present study suggests that culprit coronary artery lesion site has a differential impact on cardiac remodeling. This information can potentially aid the clinical understanding of cardiac structure and function following ACS according to coronary artery lesion site.
Abstract Figure
Left atrial strain reservoir in monitoring heart transplant paediatric patients
Authors: Borrelli N , Panebianco M , Di Salvo G , Alfieri S , De Angelis D , Chinali M , Amodeo A , Parisi F , Guccione P 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In heart transplant (HT) patients, high LV filling pressure is considered a marker of rejection and predictive of increased mortality.

Purpose
Our study aims to correlate echocardiographic parameters to left-ventricular end diastolic pressure (LVEDP) at cardiac catheterization in transplant recipients.

Methods
This was a retrospective study of 50 HT patients (54% male) who underwent heart transplantation in paediatric age (0-18 years-old). The echocardiographic evaluation was performed within three weeks from the left heart cardiac catheterization. From apical view, we measured: left atrial strain (LAS) indices [atrial contraction (εac), LA filling (reservoir phase, εres), and LA passive emptying (conduit phase, εcon)], mitral doppler E/A, E/e’, global longitudinal strain (LVGLS) and strain rate.

Results
Median LVEDP was 10 mmHg (IQR 8.25-12 mmHg) and had the best correlation with decreased εres (r= -0.56, p &lt; 0.0001). The other LAS indices and mitral E/e’ correlated less strongly with LVEDP (εac: r= -0.42, p = 0.004; εcon: r= -0.55, p= 0.0001; E/e’: r = 0.28, p = 0.04). E/A, LVGLS and LVGLS rate did not correlate with LVEDP. By ROC analysis, εres ≤ 16.3% was predictive of elevated LVEDP with a good sensitivity (86%) and moderate specificity (57%). A multivariate analysis produced εres as the best predictor (p = 0.0001) for high LVEDP.

Conclusions
Non-invasive εres seems to be a good surrogate of invasive LVEDP. Monitoring εres may be of value in HT patients to survey for rejection and graft disfunction.
Abstract Figure. Scatter plots LVEDP-εres correlation
Variations in regional strain under different afterload conditions may help to identify ischemic myocardium
Authors: Hortegal R , Cancellier R , Maduro Y , Cavalcanti LH , Vasconcelos LA , Paladino Filho AT , Nakayama L , Franchini K 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Acute coronary syndromes are a major health problem worldwide. The Speckle Tracking Imaging has been proposed as adjunctive for diagnosis and prognosis purposes in the context of NSTE-ACS.

Purpose
We sought to determine the regional myocardial strain in ischemic versus non-ischemic segments in subjects with NSTE-ACS, before and during acute pressure overload.

Methods
Data from 2D-echocardiography were obtained from 21 patients (mean age, 50 ± 10 years) undergoing cinecoronariography for NSTE-ACS indications. A blinded observer performed an offline analysis to obtain the Systolic Positive Peak (P), Systolic Peak Strain (S), Peak Strain (G) and Time to Peak Strain (TTP) of each segment acquired before and during pressure overload-induced by left hand-grip (42± 8 Kg) combined with simultaneous pneumatic constriction of the right arm and both lower limbs. Moreover, LVEF and GLS were also calculated. A second blinded observer labelled the ischemic regions according to AHA-16 Bull’s eye using data from cinecoronariography.

Results
The handgrip manuever caused mild reductions in the median LVEF (56 %; IQR 48 -58% vs 54%; IQR 51-56%) as well as the median GLS (-17%; IQR-19%-15% vs -16%; IQR -19-15%). For the analysis of regional myocardial function, we obtained 360 segments (29% labelled as ischemic) with optimal tracking quality. Mean regional strain changes during pressure overload were significantly different in ischemic vs non-ischemic segments for Peak S ( 1,07% x -0.5%; p-value &lt;0,01) and Peak G (0.85% x -0.65%; p-value &lt; 0.01)(Table). Notably, however, we found marked increases in the systolic deformation, restricted to the apical ischemic segments during pressure overload (Figure).

Conclusions
Our data point to a distinct increase in the systolic deformation of the apical segments in contrast to the overall reductions in the GLS and EF in the ischemic left ventricle.
Non- Ischemic segments N = 256 Ischemic segments N = 104 Baseline Handgrip Variation (%) Baseline Handgrip Variation (%) p-value* Peak P 0.33(0.57) 0.36(0.7) 0.03(0.7) 0.50(0.7) 0.57(0.8) 0.07(0.8) 0.32 Peak S -17.9(4.4) -16.8(5.3) 1.07(4.1) -16.6 (5.2) -17.2(5.6) -0.5(4.8) 0.0006 Peak G -18.5 (4.2) -17.68 (4.6) 0.85 (3.7) -17.3 (4.5) -18 (4.6) -0.65(4.2) 0.0005 TTP 377(62) 384(66) 6.5(52) 387(65_ 388(62) 1.15(46) 0.17 * t- test comparing the variations baseline-handgrip between the two groups (ischemic versus non-ischemic. Peak P= positive systolic peak; Peak S= systolic peak; Peak G= peak strain; TTP= time to peak Abstract Figure
Cardiac function during COVID-19 intensive care unit hospitalisation - deformation analysis and outcomes
Authors: Loncaric F , Fernandes JF , Sitges M , Stessel B , Dubois J , Van Halem K , Herbots L , Bijnens B 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Horizon 2020 European Commission Project H2020-MSCA-ITN-2016

Background
Although the cardiac burden of COVID-19 has been demonstrated, follow-up imaging studies are scarce. The aim was to use speckle-tracking deformation imaging (STE) to prospectively assess cardiac function during intensive care unit (ICU) hospitalisation, comparing ventricular and atrial function of COVID-10 patients that died and those that were discharged.

Methods
In a single-centre, COVID-19 patients (n = 41) (71% male, aged 65 ± 11 years) were prospectively followed with echocardiography as part of ICU treatment. The left and right ventricles (LV, RV, respectively) were studied with STE in the 4-chamber cardiac view. The endpoint was defined as death or ICU discharge. Average values of the strain parameters from the first and final scans in the ICU, respectively, were calculated for the two outcome groups.

Results
Endpoint was not reached in 15% (n = 6) at the time of analysis. The remaining patients (n = 32) were 69% male, aged 66 (interquartile range (IQR) 60-72) years, and with an ICU mortality 26% (n = 9). The median spent in ICU was 24 (IQR 15-43) days. On average, echocardiography was performed three times during ICU hospitalisation, amounting to 103 examinations. The changes in cardiac strain are shown in Table 1. The change in LV longitudinal strain during ICU hospitalisation is shown in Figure 1.

Conclusion
Worsening of LV strain and lack of improvement of RV strain is linked to higher mortality in the ICU. The assessment of cardiac function might contain prognostic information in COVID-19 patients that are admitted to the ICU.
Patients discharged from thee OCU (n = 23) Patients that died in the ICU (n = 9) P value Initial echo in the ICU LV strain, % (IQR) 18.00 (15.6-19.95) 14.4 (10.56-20.42) 0.158 RV strain, % (IQR) 16.00 (14.70-20.05) 15.50 (10.38-23.70) 0.712 Final echo before discharge LV strain, % (IQR) 17.35 (15.13-18.98) 13.20 (10.75-15.40) 0.007 RV strain, % (IQR) 17.65 (16.83-19.60) 15.75 (10.68-20.43) 0.438 ICU - intensive care unit; IQR-inter-quartile range Abstract Figure 1
Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity
Authors: Santoro C , Soloperto R , Casciano O , Esposito R , Lembo M , Canonico M , Arpino G , Giuliano M , De Placido S , Esposito G 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure.

Purpose
To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography.

Methods
Fifty Her-2 positive breast cancer women (age = 53.6 ± 11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction &lt; 50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline &gt;15%.

Results
None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p &lt; 0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p &lt; 0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=-0.40, p = 0.006) and after TRZ completion (r=-0.62, p &lt; 0.0001).

Conclusions
Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients.
Abstract Figure.
The influence of afterload on left ventricular contractility: 2D-strain and dyssynchrony in stress echocardiography
Authors: Karev E , Verbilo S , Malev E , Prokudina M , Suvorov A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background Hypertensive response to exercise (HRE) has negative prognostic value but its impact on the left ventricle (LV) contractility and on stress echocardiography (SE) results remains controversial. The global longitudinal strain (GLS) and LV dyssynchrony changes in response to afterload increase were shown even in patients with narrow QRS at rest, but not on exertion.
Purpose We aimed to analyze the relation between the blood pressure (BP) during SE and LV GLS and dyssynchrony changes.
Methods We performed exercise SE on treadmill in 96 patients without coronary artery stenosis (invasive or CT coronary angiography). Patients divided into two groups: HRE (n = 41) and normal response to exercise (NRE) (n = 55). We analyzed GLS and standard deviation of time between the onset of QRS and segmental longitudinal strain peaks (STE-TIME SD) using speckle tracking and 3d-ejection fraction (EF) at rest and on exertion.
Results 2D-EF increase was higher in patients with NRE, but 3D-EF did not differ between groups. Wall motion abnormalities (WMA) on peak stress were detected more often in patients with HRE who had higher wall motion score index (WMSI). GLS on exertion and its increment were lower in HRE group (Fig. 1 - "Bull’s eye" diagrams of GLS at rest and on exertion in patient with NRE (upper panel) and HRE (lower panel)). Among dyssynchrony markers we revealed higher values of STE-TIME SD on exertion in HRE group (Table 1). Moreover the analysis showed positive correlations between BP level on exertion and peak GLS (r = 0.56, p &lt; 0.0001), GLS increase (r = 0.54, p &lt; 0.0001) and STE-TIME SD on exertion (r = 0.27, p &lt; 0.02)
Conclusions HRE is associated with less increment in GLS and 2D-EF on exertion. Besides LV dyssynchrony signs can appear in response to exaggerated afterload increase even in patients with narrow QRS complexes.
Patients with HRE more often show stress-induced WMA and have greater WMSI on exertion in absence of coronary artery lesions, thus HRE can alter the specificity of the test in transient ischemia detection.
Table 1 HRE NRE p Δ-2D ejection fraction 5.0 (4.0; 7.0) 10.0 (8.0; 12.5) &lt;0.0000001 Δ-3D ejection fraction 8.25 (4.0; 8.25) 8.24 (8.15; 11.65) 0.09 Wall motion abnormalities on exertion 46.34% 1.8% &lt;0.00001 Wall motion score index 1.0 (1.0; 1.18) 1.0 (1.0; 1.0) 0.00013 GLS on exertion -21.0 (-22.0; -19.0) -24.0 (-26.5; -23.0) &lt;0.0000001 ΔGLS 0.0 (-1.0; 2.0) 4.0 (2.0; 6.0) &lt;0.0000001 STE-TIME SD-IMPOST 42.0 (35.0; 53.0) 35.0 (27.5; 45.0) 0.012 Left ventricle systolic function and dyssynchrony in two groups. Abstract Figure 1.