bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of no-reflow phenomenon by myocardial contrast echocardiography in patients with acute myocardial infarction with ST-segment elevation
Authors: Krinochkin D , Bessonov I , Yaroslavskaya E , Kuznetsov V 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The noninvasive assessment of myocardial perfusion by echo contrast agents in patients with acute myocardial infarction with ST-segment elevation (STEMI) after successful revascularization is becoming a relevant clinical reality. Perfusion imaging techniques with myocardial contrast echocardiography (MCE) remains the least studied and most promising ultrasound technology for the diagnosis of no-reflow phenomenon.

Purpose
To study the echocardiographic and angiographic characteristics of the no-reflow phenomenon detected by MCE in patients with STEMI.

Methods
The study included 43 patients aged from 40 to 82 years in acute stage of myocardial infarction. Patients were divided into two groups: 32 patients characterized by sufficient myocardial reperfusion after revascularization according to MCE results and 11 patients were with the impaired perfusion.

Results
The patients with impaired perfusion demonstrated a greater size of the left ventricular (LV) asynergy (40.1 ± 2.2% vs 27.4 ± 8.5%, p &lt; 0.001). LV dilatation (LV end-systolic volume 67.3 ± 20.3 ml vs 51.8 ± 17.2 ml, p = 0.015), impaired LV ejection fraction (39.5 ± 3.4% vs 47.2 ± 4.9%, p &lt; 0.001), and significant mitral regurgitation (45.5% vs 3.1%, p = 0.011) with a decrease in DP/DT (979.9 ± 363.4 mmHg/s vs 1565.7 ± 502.8 mmHg/s, p &lt; 0.001) was more often detected in this group. In more than a quarter of these patients, coronary angiography showed no perfusion disorders after revascularization. In the group with impaired perfusion by MCE, the single-vascular lesions (46.9% vs 9.1%, p = 0.033), the lesions of the anterior interventricular artery (90.9% vs 40.6%, p = 0.004), and acute occlusion (100% vs 68.8%, p = 0.043) were more often determined.

Conclusion
According to the results of MCE, the echo signs of LV dysfunction were more pronounced after successful revascularization in patients with STEMI and myocardial perfusion disorders. The SYNTAX score was twice higher in these patients compared to the patients with recovered perfusion. In addition, no-reflow phenomenon by MCE was observed in the most patients with anterior interventricular artery lesion.
Cyclic variation of integrated backscatter detects radiotherapy-induced changes better than global longitudinal strain, a three-year follow-up study in early-stage breast cancer patients
Authors: Tuohinen S , Skytta T , Virtanen V , Kellokumpu-Lehtinen P-L , Raatikainen P 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Paavo and Eila Salonen Legacy The Finnish Foundation for Cardiovascular Research

onbehalf
-

Aims
To characterize the early phases of radiotherapy-induced changes in myocardial deformation echocardiography.

Methods
Ninety-nine breast cancer patients were studied prior adjuvant treatment, after chemotherapy (CT), after radiotherapy (RT) and three years after RT (3Y). Nineteen patients with left-sided breast cancer received adjuvant CTand RT (Group A). Sixty patients with left-sided (Group B) and 20 patients with right-sided breast cancer (Group C) were treated with RT only. Echocardiography with the analysis of cyclic variation of the integrated backscatter of the septum (sCV) and the posterior wall (pCV) and global longitudinal strain (GLS) were performed.

Results
Group A patients had a sCV decline from baseline to after CT, after RT and at 3Y by 1.2 ± 3.4 dB (p = 0.146), 2.6 ± 3.9 dB (p = 0.010) and 4.1 ± 5.4 dB (p = 0.011), and GLS decline by 0.9 ± 1.7 % (p = 0.027), 0.1 ± 2.4 % (p = 0.848), and 0.9 ± 2.9 % (p = 0.124), respectively. Group B displayed sCV changes after RT by 1.4 ± 3.5 dB (p = 0.007) and at 3Y by 2.4 ± 3.2 dB (p &lt; 0.001) and the respective GLS changes were 1.1 ± 2.7 % (p = 0.003) and 1.7 ± 3.5 % (p = 0.001). sCV changes in Group C were 1.3 ± 3.9 dB (p = 0.159) after RT and 2.0 ± 4.1 dB (p = 0.049) at 3Y whereas GLS remained stable. A late decline in pCV was observed in all groups. In the whole patient population, sCV decline was independently associated with the mean LAD dose (p = 0.023, β= -0.251), CT (p = 0.044, β= -0.240) and with the use of aromatase inhibitor (AI) (p = 0.027, β=0.251). GLS impairment was independently associated with AI (p = 0.017, β= -0.281).

Conclusions
Radiation-exposed septal areas displayed a significant decline early after RT in Group A and B patients in contrast to posterior wall and patients with right-sided breast cancer. In addition, the changes were independently associated with the mean LAD radiation dose. GLS had no independent association with radiation dose . CV appears to be a more sensitive marker of radiotherapy-induced changes of the myocardial contractility than GLS.
Correlation of left atrial strain with left ventricular end-diastolic pressure in patients with coronary artery disease and preserved left ventricular ejection faction
Authors: Ohara Y , Yoshimura Y , Fukuoka Y , Tanioka K , Yamamoto K 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Elevated left ventricular (LV) filling pressures are the main physiologic consequence of LV diastolic dysfunction. Left atrial (LA) strain was recently found useful to predict elevated LV filling pressures noninvasively. However, there are few reports on the role of LA strain when predicting LV filling pressure in patients with coronary artery disease (CAD). The aim of this study was to explore the correlation between LA strain and LV end-diastolic pressure (LVEDP) in patients with CAD and preserved LV ejection fraction.

Methods
Fifty-four patients with stable CAD were enrolled. Global atrial longitudinal strain was measured by averaging all atrial segments. Resorvoir (S-LAs), conduit (S-LAe), and contractile (S-LAa) phase strain were obtained. LVEDP was invasively obtained by left heart catheterization.

Results
Patients were divided into two groups: elevated LVEDP group (LVEDP &gt; 15mmHg group: n = 23) and normal LVEDP group (LVEDP ≤ 15mmHg group: n = 31). Elevated LVEDP group showed significantly decreased S-LAs and S-LAa (S-LAs: 21.3 ± 7.2% vs. 27.5 ± 7.8%, p &lt; 0.005; S-LAa: 9.7 ± 3.3% vs. 14.6 ± 3.4%, p &lt; 0.0001). However, E/Ea and S-LAe were not significantly different between the two groups. LVEDP significantly correlated with S-LAa (r=-0.596, p &lt; 0.0001) and S-LAs (r=-0.431, p &lt; 0.001). Receiver operating characteristics curve analysis showed that S-LAa could predict elevated LVEDP (AUC = 0.84) and a cut-off value of S-LAa &lt; 11.6% was able to most accurately identify patients with elevated LVEDP.

Conclusions
LA strain, especially S-LAa, provided additional diagnostic value for the noninvasive assessment of LV filling pressure in CAD patients with preserved LV ejection fraction.
2D-echocardiography vs cardiac MRI strain using deep learning: a prospective cohort study in patients with HER2-positive breast cancer undergoing trastuzumab
Authors: Bouwer NI , Liesting C , Kofflard MJM , Brugts JJ , Kock MCJ , Kitzen JJEM , Levin M-D , Boersma E 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Private hospital(s). Main funding source(s): Promotiefonds Albert Schweitzer Hospital

Background
Subclinical cardiotoxicity due to trastuzumab could be recognized by repeated measurements of global longitudinal/radial strain (GLS/GRS) which could be performed with cardiac magnetic resonance (CMR) or two-dimensional speckle tracking echocardiography (2DE-ST). Although CMR is the gold standard for cardiac function evaluation, it is not used for cardiac monitoring. 2DE-ST might be a reasonable alternative.

Purpose
To study the predictive value of early 2DE-ST for left ventricular ejection fraction (LVEF) changes during trastuzumab for HER2-positive breast cancer.

Methods
HER2-positive breast cancer patients receiving trastuzumab, with or without anthracycline, underwent 2DE-ST at baseline and after 3 and 6 months (m) trastuzumab. Cardiac magnetic resonance (CMR) imaging (with ST) was performed at baseline and 6m. We studied the correlation between 2DE-ST- and CMR-derived GLS and GRS. We then associated baseline and 3m 2DE-ST with later CMR-LVEF, and with cardiotoxicity, defined as CMR-LVEF &lt;45% and/or absolute decline &gt;10% during trastuzumab.

Results
47 patients were included. GLS measurements based on 2DE-ST and CMR showed weak correlation (Pearson’s r = 0.33; P = 0.041); GRS measurements were uncorrelated (r = 0.09; P = 0.979). 2DE-LVEF at baseline and 3m, and 2DE-STE-GLS at 3m were predictive of CMR-LVEF at 6m (Table 1). In contrast, the change in 2DE-ST-GLS at 3m was predictive of the change in CMR-LVEF at 6m, whereas the change in 2DE-LVEF was not. Importantly, the 11 patients (28%) who developed cardiotoxicity had larger 2DE-ST-GLS change at 3m than those who did not (median 5.2% versus 1.7%; odds ratio 1.81, 95% confidence interval 1.11–2.93; P = 0.016).

Conclusion
Although correlations between 2DE-ST and CMR are weak, ST-measurements appeared useful to improve the performance of 2DE in predicting LVEF changes after 6m of trastuzumab.
Table 1 2DE CMR-LVEF after 6m TZT Mean difference (95% CI) Change in CMR-LVEF after 6m TZT Mean difference (95% CI) Cardiotoxicity OR (95% CI) Before TZT LVEF, % 0.85 (0.42, 1.27)* 0.32 (-0.16, 0.80) 0.88 (0.75, 1.02) ST-GLS, % -0.42 (-1.31, 0.46) -0.28 (-1.14, 0.58) 1.13 (0.87, 1.46) 3 Months TZT LVEF, % 0.59 (0.30, 0.88)* 0.29 (-0.04, 0.61) 0.85 (0.74, 0.98)* ST-GLS, % -1.14 (-2.07, -0.19)* -0.62 (-1.54, 0.30) 1.36 (0.94, 1.84) Change at 3 months TZT LVEF, % 0.30 (-0.11, -0.71) 0.21 (-0.19, 0.61) 0.90 (0.80, 1.01) ST-GLS, % -1.17 (-2.14, -0.20)* -1.10 (-2.02, -0.18)* 1.81 (1.11, 2.93)* * P-value &lt;0.05
Changes in mechanics of septal and lateral walls in patients with left bundle-branch block are related to extent of systolic dysfunction
Authors: Kupczynska K , Nguyen KA , Surkova E , Palermo CH , Sambugaro F , Previtero M , Muraru D , Badano L 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Karolina Kupczynska was supported by research grant awarded by the Club 30 of the Polish Cardiac Society

Background
Left bundle branch block (LBBB) affects left ventricular (LV) mechanics and promotes systolic dysfunction.

Purpose
To analyse myocardial work (MW) and myocardial work efficiency (MWE) of the septal and LV lateral wall in healthy controls and LBBB patients with various degrees of LV dysfunction using non-invasive method.

Methods
Our study involved 102 healthy controls (mean age 41.5 ± 15.7 years, 45% male) and 58 LBBB patients without coronary artery disease (mean age 65 ± 13 years, 60% male) divided into 3 groups based on their LVEF: preserved (n= 27), mid-range (n= 16) and reduced (n= 15). Myocardial work parameters were estimated in septal and lateral wall by LV pressure-strain loop obtained by echocardiography.

Results
There were no differences between septal and lateral MW and MWE in healthy controls (p = NS). We found lower septal MW in comparison to lateral MW (p &lt; 0.0001), but there were no differences in MWE (p = NS) in LBBB patients with preserved LVEF. Patients with LBBB and mid-range or reduced LVEF had lower MW (p &lt; 0.0001 in both subgroups) and lower MWE (p = 0.002 and p = 0.0001, respectively) in septum compared with lateral wall. There was a progressive decrease in septal MW and MWE with the occurring of LBBB and the worsening of LVEF (figure A). Interestingly in healthy controls there was significantly lower lateral MW but higher MWE in comparison to group with LBBB and preserved LVEF. We did not detect differences between LBBB groups with preserved and mid-range LVEF, but patients with reduced LVEF had significant reduction in terms of lateral MW and MWE (figure B).

Conclusions
Impairment in septal myocardial work escalated according to the appearance of LBBB and LVEF loss. Septal dysfunction was compensated by the effective myocardial work of the lateral wall in LBBB patients with preserved and mid-range LVEF. Mechanical dysfunction of the lateral wall was associated with severely reduced LVEF.
Abstract Figure.
Improvement in left atrial reservoir strain following hematopoietic stem cell transplant in patients with systemic sclerosis
Authors: Chen C , Nishtala A , Groenendyk JW , Schultz W , Li E , Shah SJ , Burt RK , Freed BH 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Systemic sclerosis (SSc) can cause cardiac complications as a result of multi-organ fibrosis. The study of left atrial (LA) mechanics can offer insights into the pathophysiology of cardiac involvement in SSc. LA strain measured by speckle-tracking echocardiography (STE) has been shown to be a sensitive marker of LA function. The impact of a disease modifying treatment like hematopoietic stem cell transplant (HSCT) on LA mechanics is not known.

Aim
To study the effect of HSCT on LA mechanics using both conventional echocardiography and STE.

Methods
Patients with SSc who underwent comprehensive 2D echo evaluation pre- and post-HSCT were identified. Patients with pulmonary hypertension on right heart catheterization (RHC) were excluded. 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). LA reservoir strain was measured from the apical 2-, and 4-chamber views. The ratio of E/e’ to LA reservoir strain was used to non-invasively estimate LA stiffness. Paired student’s t-test and Pearson"s correlation 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 capillary wedge pressure (PCWP) measured by RHC prior to HSCT was 9.6 ± 4.1 mmHg. LA reservoir strain was abnormal at baseline and significantly improved following HSCT. Although LA volume index and E/e’ remained unchanged, LA stiffness index decreased significantly post-HSCT. There was no correlation between LA reservoir strain and PCWP at baseline or between change in LA reservoir strain and change in LA volume index or E/e’.

Conclusions
Patients undergoing HSCT for SSc show significant improvement in LA reservoir strain and LA stiffness despite no significant change in LA volumes or estimates of LV filling pressures. This improvement in LA mechanics following HSCT thus appears to be independent of loading conditions and could represent an improvement in intrinsic LA performance.
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 LA volume index (ml/m2) 24.6 ± 8.3 24.1 ± 7.1 0.66 E/e’ 8.0 ± 2.4 8.3 ± 2.6 0.30 LA stiffness index 0.24 ± 0.12 0.18 ± 0.08 &lt;0.01 LA reservoir strain (%)* 35.8 ± 8.6 47.7 ± 11.2 &lt;0.01 All values are presented as mean ± SD unless indicated otherwise. *Normal LA reservoir strain is defined in this study as being greater than 39%.
Myocardial work index better reflects contractility than longitudinal strain in rat models of pressure- and volume overload-induced heart failure
Authors: Lakatos BK , Ruppert M , Tokodi M , Olah A , Braun S , Karime C , Ladanyi Z , Sayour AA , Barta BA , Merkely B , Kovacs A , Radovits T 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Speckle-tracking echocardiography (STE)-derived global longitudinal strain (GLS) is considered to be a sensitive marker of left ventricular (LV) function in a wide variety of cardiovascular diseases. Still, evidence suggests that GLS is significantly influenced by loading conditions. Myocardial work index (MWI) evaluates myocardial deformation in the context of afterload through the interpretation of strain in relation to instantaneous LV pressure. MWI may potentially overcome the limitations of mere strain calculation, and may better reflect cardiac contractility in hemodynamic overload states.
Accordingly, our aim was to examine the relationship of GLS and MWI with load-independent markers of LV contractility in rat models of pressure- and volume overload-induced heart failure.
Male Wistar rats underwent transverse aortic constriction (TAC; n = 12) to generate LV pressure overload, or aortocaval fistula (ACF; n = 12) was established to induce severe LV volume overload. In case of the control groups, sham procedures were performed (n = 12/12). Echocardiography loops were obtained to determine STE-derived GLS and global MWI. Pressure-volume analysis with transient occlusion of the inferior vena cava was carried out to calculate preload recruitable stroke work (PRSW), as a load-independent „gold-standard" parameter of LV contractility.
GLS was mildly reduced in the ACF group (-13.2 ± 2.4 vs. -15.4 ± 2.0%, p &lt; 0.05), while it was significantly lower in TAC group compared to controls (-7.0 ± 2.8 vs. -14.5 ± 2.5%; p &lt; 0.001). In contrast with these findings, PRSW and also MWI were significantly reduced in ACF (58 ± 14 vs. 111 ± 40 mmHg; 1328 ± 411 vs. 1934 ± 308 mmHg%, both p &lt; 0.01), however, they were comparable between TAC and the corresponding sham group (110 ± 26 vs. 116 ± 68 mmHg; 1687 ± 275 Hgmm% vs. 1537 ± 662 Hgmm%; both p = NS). In the pooled population, GLS did not show relationship with PRSW (r=-0.23; p = 0.12), while MWI showed significant correlation with it (r = 0.70; p &lt; 0.001).
GLS is significantly influenced by loading conditions, therefore, in case of severe pressure- or volume overload it may not be a reliable marker of LV contractility. In our rat model of pressure overload induced heart failure, contractility was maintained despite decreased GLS, while in the model of volume overload induced heart failure, GLS was maintained despite decreased contractility. MWI reflects contractility in hemodynamic overload states, therefore, it may be a more suitable marker of systolic function.
Abstract Figure. Pressure-strain loops of the groups
Exercise induced worsening of mechanical heterogeneity and diastolic impairment in Long QT syndrome
Authors: Charisopoulou D , Koulaouzidis G , Rydberg A , Henein MY 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left ventricular (LV) mechanical dispersion and prolonged myocardial contraction are associated with symptoms in long QT syndrome (LQTS) mutation carriers. Sub-clinical LV diastolic impairment has also been reported in this group.

Purpose
To investigate at rest and during exercise the combined effect of prolonged myocardial contraction and increased mechanical dispersion on myocardial diastolic function and symptoms in LQTS subjects.

Methods
47 LQTS patients (36 LQT1, 11 LQT2) underwent a bicycle exercise test in semi-supine position. ECG and echo parameters were recorded at rest, peak exercise (p.e) and were compared with 35 healthy individuals.

Results
No difference was seen between LQTS and control subjects for age (45 ± 15 vs 47 ± 13 years, p = 0.2), gender (53 vs 54% females, p = 0.3) or LV Ejection Fraction (65 ± 6 vs 67 ± 7%, p = 0.3). LQTS subjects, compared to controls, had not only prolonged QTc interval, but also longer contraction duration (tGLS), total isovolumic time (t-IVT), delayed early relaxation phase (tESR) and markedly decreased filling time (FT) at rest and p.e. Unlike controls, these electromechanical disturbances deteriorated further with exercise, during which additional decrease of the LV systolic (GLS) and diastolic myocardial function (ESR) and attenuated LV stroke volume response (Δ SV: +2 ± 0.5 vs +4 ± 1 vs +32 ± 4%, p&lt; 0.0001) were noted. Such abnormal response to exercise was of greater degree in symptomatic patients and in the LQT1 subgroup and appeared to be amplified by b-blocker therapy (p &lt; 0.05). Worsening myocardial contraction dispersion (SD-tGLS) at p.e was the strongest discriminator for previous clinical events (AUC 0.960, 95% CI 0.020 - 0.995, p &lt; 0.0001) and its discriminating power excelled further by adding early relaxation delay.

Conclusions
Our findings suggest that in LQTS subjects prolonged and dyssynchronous mechanical contraction during exercise may be associated with inadequate cardiac output increase and symptoms.
Table 1. REST PEAK LQT CONTROL p- LQT CONTROL p- QTc (ms) 453 ± 42 413 ± 17 &lt; 0.0001 455 ± 44 390 ± 19 &lt; 0.0001 GLS (%) 17.3 ± 4.3 18.7 ± 1.3 0.05 19.1 ± 32.6 23.5 ± 11.6 0.0001 tGLS (%) 47 ± 7.2 42 ± 6.3 0.0001 58.7 ± 10 40.1 ± 5.8 &lt; 0.0001 ESR (%) 1 ± 0.3 2 ± 0.3 &lt; 0.0001 1.1 ± 0.4 2.8 ± 0.4 &lt; 0.0001 tESR (%) 61.4 ± 6.8 58.7 ± 4.1 0.03 69.7 ± 5.9 56.1 ± 2.9 &lt; 0.0001 SD TGLS (ms) 58 ± 8 31 ± 8 &lt; 0.0001 61 ± 8 24 ± 10 &lt; 0.0001 Exercise response in long QT syndrome patients and controls
Utility of 3-dimensional transoesophageal echocardiography for mitral annular sizing in transcatheter mitral valve replacement procedures: a cardiac computed tomography comparative study
Authors: Coisne A , Pontana F , Aghezzaf S , Mouton S , Ridon H , Richardson M , Polge AS , Longere B , Silvestri V , Pagniez J , Rousse N , Modine T , Montaigne D 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. 3-dimensional transoesophageal echocardiography (3D-TEE) is frequently used as an initial screening tool in the evaluation of patients who are candidates to Transcatheter Mitral Valve Replacement (TMVR). However, little is known about the imaging correlation with the gold-standard computed tomography (CT) imaging. We aimed at testing the quantitative differences between these two modalities and finding the best 3D-TEE parameters for TMVR screening.
Methods. We included 57 patients referred to our Heart Valve Clinic for TMVR with prostheses specifically designed for the mitral valve. Mitral annulus (MA) analyses were performed using commercially available software in 3D-TEE and CT.
Results. 3D-TEE was feasible in 52 patients (91%). Although 3D-TEE measurements were slightly lower than in CT, both measurements of projected MA area and perimeter showed excellent correlation with small differences between the two modalities (r = 0.88 and r = 0.92 respectively, p &lt; 0.0001). Correlations were significant but lower for MA diameters (r = 0.68 to 0.72, p &lt; 0.0001) and mitro-aortic angle (r = 0.53, p = 0.0001). ROC curve analyses showed that 3D-TEE had a good ability to predict TMVR screening success defined by constructors based on CT measurements with a range of 12.9 to 15cm² for MA area (AUC = 0.88-0.91, p &lt; 0.0001), 128 to 139mm for MA perimeter (AUC = 0.85-0.91, p &lt; 0.0001), 35 to 39mm for anteroposterior diameter (AUC = 0.79-0.84 p &lt; 0.0001) and 37 to 42mm for posteromedial-anterolateral diameter (AUC = 0.81-0.89, p &lt; 0.0001) (Figure 1). Conclusion. 3D-TEE measurements of MA dimensions display strong correlation with CT measurements in patients undergoing TMVR screening process. 3D-TEE should be proposed as a reasonable alternative to CT in this vulnerable population.
Abstract Figure.