bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ascending aortic aneurysm haemodynamics are associated with aortic wall biomechanical properties
Authors: McClarty Davis , Ouzounian Maral , Tang Mingyi , Eliathamby Daniella , Romero David , Nguyen Elsie , Simmons Craig A , Amon Cristina , Chung Jennifer Chia-Ying 
Published: October 2021

Abstract

OBJECTIVES
The effect of aortic haemodynamics on arterial wall properties in ascending thoracic aortic aneurysms (ATAAs) is not well understood. We aim to delineate the relationship between shear forces along the aortic wall and loco-regional biomechanical properties associated with the risk of aortic dissection.

METHODS
Five patients with ATAA underwent preoperative magnetic resonance angiogram and four-dimensional magnetic resonance imaging. From these scans, haemodynamic models were constructed to estimate maximum wall shear stress (WSS), maximum time-averaged WSS, average oscillating shear index and average relative residence time. Fourteen resected aortic samples from these patients underwent bi-axial tensile testing to determine energy loss (ΔUL) and elastic modulus (E10) in the longitudinal (ΔULlong, E10long) and circumferential (ΔULcirc, E10circ) directions and the anisotropic index (AI) for each parameter. Nine resected aortic samples underwent peel testing to determine the delamination strength (Sd). Haemodynamic indices were then correlated to the biomechanical properties.

RESULTS
A positive correlation was found between maximum WSS and ΔULlong rs=0.75, P = 0.002 and AIΔUL (rs=0.68, P=0.01). Increasing maximum time-averaged WSS was found to be associated with increasing ΔULlong (rs=0.73, P = 0.003) and AIΔUL (rs=0.62, P=0.02). Average oscillating shear index positively correlated with Sd (rs=0.73,P=0.04). No significant relationship was found between any haemodynamic index and E10, or between relative residence time and any biomechanical property.

CONCLUSIONS
Shear forces at the wall of ATAAs are associated with local degradation of arterial wall viscoelastic hysteresis (ΔUL) and delamination strength, a surrogate for aortic dissection. Haemodynamic indices may provide insights into aortic wall integrity, ultimately leading to novel metrics for assessing risks associated with ATAAs.
Assessment of intracardiac flow dynamics for the evaluation of patients with different ventricular geometry
Authors: Leo I , Sabatino J , Strangio A , Maglione M , Troilo F , Loliva G , Canino G , Critelli C , De Rosa S , Indolfi C 
Published: October 2021

Abstract

Background
Over the last decades growing evidence have demonstrated the promising role of intracardiac flow dynamic analysis in evaluating cardiac performance. Diastolic forces contribute to the formation of vortices, complex structures capable of kinetic energy storage and responsible of a smoother transition of blood from left ventricular (LV) inlet to outlet. Change in shape and location of these structures has been related with cardiovascular disease and prognosis.

Purpose
To investigate quantitative changes in vortices parameters in patients with different ventricular geometry.

Methods
We enrolled 72 consecutive patients (age 66±11 years, 49 male, 68%) with LV concentric hypertrophy (CH, n=15), eccentric hypertrophy (EH, n=13), concentric remodeling (CR, n=15) and normal LV geometry (CTRL, n=29). Each patient underwent a complete echocardiographic examination and a non-invasive intracardiac fluid dynamic analysis by Color Vector Flow Mapping. A 3-chamber apical view with a frame rate between 22 and 25 Hz has been acquired and subsequently analyzed offline by a semi-automatic software obtaining the following parameters: vortex area (VA) (the ratio between the total vortex area and the left ventricular (LV) area); vortex length (VL) (the longitudinal length of the vortex relative to the total LV length; vortex depth (VD) (the distance of the vortex center from the LV base relative to the total LV long axis). Bland Altman Plot has been used to assess intra and inter-observer variability.

Results
Mean VD was higher in CR, CH and EH compared to CTRL (p=0.013, p=0.001 and p=0.022, respectively). Moreover, CH showed higher VL (p=0.006) and larger VA (p=0.012) compared to CTRL. A similar trend was noticed in EH patients, despite did not reach statistical significance (p=0.21 and p=0.07 for VA and VL respectively). No significative differences in vortices parameters have been observed between CH and EH.

Conclusion(s)
This is the first study providing quantitative echocardiographic parameters of vortex location and morphology in different LV geometries. Higher values of VD were found in CR, CH and EG. Quantitative intra dynamic fluid assessment was feasible and reliable in the whole population and could provide additional information to the standard echocardiographic examination.

Funding Acknowledgement
Type of funding sources: None.
Right ventricular improvement is associated with left ventricular diastolic function and size enhancement in PAH patients: an echocardiographic study
Authors: Fauvel C , Raitiere O , Si-Belkacem N , Viacroze C , Artaud-Macari E , Schleifer D , Dominique S , Bauer F 
Published: October 2021

Abstract

Background
While pulmonary vasodilation therapy improves right ventricular (RV) function in pulmonary arterial hypertension (PAH), data regarding left ventricular (LV) function remain sparse.

Purpose
We aimed to investigate whether PAH therapy improve LV function in PAH patients.

Methods
Between 2002 and 2020, all incident PAH patients from one PH referral centers were included, treated and followed-up according to current ESC/ERS guidelines. All patients had comprehensive echocardiography both investigating right and left ventricular function before and after 1-year of vasodilation therapy. In addition to RV echocardiographic evaluation, we focused on LV ejection fraction from Modified Simpson method, LV diameters by M-mode, transmitral pulsed-wave E/A ratio, Flow to tissue Doppler imaging E/e' ratio, and left atrial size.

Results
126 patients were included (63% female, 57±17 yo), mainly from connectivite tissue associated and idiopathic PAH (24% and 28% respectively) causes. Compared to baseline, 1-year NYHA functional class (p&lt;0.01), NTproBNP plasma level (p&lt;0.001), invasive mean pulmonary arterial pressure (p&lt;0.01) and cardiac index (p&lt;0.01) significantly improved. While LV ejection fraction (p=0.68), LV end-diastolic diameter (p=0.11) as well as LA area and volume (p=0.09) were not significantly enhanced under vasodilation therapy, LV diastolic function, assessed by mitral E wave (p&lt;0.01), tissue doppler imaging mitral e' wave (p=0.04), and E/A ratio (p=0.045) were significantly improved at 1-year. There was a significant correlation between LV end-diastolic diameter (p&lt;0.001) and RV end-diastolic area (p&lt;0.001) owing to the normalization of right- to left ventricular interdependence, as well as between mitral E wave and TAPSE (p=0.045).

Conclusion
By improving RV function, PAH vasodilation therapy enhances LV size and diastolic function and normalizes the biventricular interdependence.

Funding Acknowledgement
Type of funding sources: None.
Prognostic value of left atrial function in patients with severe primary mitral regurgitation undergoing mitral valve repair
Authors: Stassen J , Van Wijngaarden A L , Butcher S C , Palmen M , Bax J J , Delgado V , Marsan N A 
Published: October 2021

Abstract

Background
Timing of mitral valve surgery for primary mitral regurgitation (MR) remains challenging. Since MR has a significant hemodynamic impact on the left atrium (LA), assessment of LA function may have prognostic value in these patients which is incremental to LA volume and left ventricular (LV) remodeling parameters.

Purpose
This study sought to investigate whether preoperative assessment of LA reservoir strain (LASr) by speckle tracking echocardiography is associated with long-term outcome in patients undergoing mitral valve repair for severe primary MR.

Methods
Echocardiography was performed prior to mitral valve surgery in 566 patients (age 64±12 years, 66% men) with severe primary MR. Complete clinical information was collected and the endpoint was all-cause mortality after operation. The study population was divided based on a cut-off value of LASr (22%) derived from a spline curve analysis (hazard ratio for all-cause mortality &gt;1).

Results
Patients with LASr ≤22% (n=277) were significantly older, had more impaired renal function and were more symptomatic (NYHA functional class III to IV) compared to patients with LASr &gt;22% (n=289). In terms of echocardiographic data, patients with LASr ≤22% had significantly lower LV ejection fraction and LV global longitudinal strain (LV-GLS) and significantly higher systolic pulmonary artery pressures and LA volume index compared with patients with LASr &gt;22%.
During a median follow-up of 95 (56 – 147) months, 129 patients (22.8%) died. Patients with LASr ≤22% experienced significantly higher mortality rates compared to patients with LASr &gt;22% (log rank chi-square 35.1; p&lt;0.001) (Figure). On multivariable analysis, age (hazard ratio (HR): 1.06; 95% confidence interval (CI): 1.03 to 1.09; p&lt;0.001), LV-GLS (HR: 1.08; 95% CI: 1.02 to 1.15; p=0.014) and LASr (HR: 0.96; 95% CI: 0.93 to 0.99; p=0.014) were independently associated with all-cause mortality. The addition of LASr to a clinical model (including: age, coronary artery disease, estimated glomerular filtration rate, NYHA class III-IV, atrial fibrillation, LV end-diastolic volume index, LV ejection fraction, LV-GLS, LA volume index and systolic pulmonary artery pressure) showed a significant increase in the chi-square value (chi-square differences = 6.9; p=0.011), demonstrating the incremental prognostic value of LASr in patients with primary MR.

Conclusions
Preoperative LASr is independently associated with all-cause mortality in patients undergoing mitral valve repair for primary MR, has incremental prognostic value over LA volume and LVEF and might therefore be helpful to guide surgical timing.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Jan Stassen has received an ESC training grant (Appehab724.011364741) Association of LASr and outcome
Correlation of intraprocedural and follow up parameters for mitral regurgitation grading after percutaneous edge-to-edge repair
Authors: Salinas Gallegos A , Pozo Osinalde E , Gordillo X , Jimenez Quevedo P , Marcos-Alberca P , Mahia P , Tirado G , Gomez De Diego J J , Macaya C , Perez-Villacastin J , Fernandez-Ortiz A , Nombela-Franco L , De Agustin J A 
Published: October 2021

Abstract

Background
Percutaneous edge-to-edge mitral repair has merged as an effective therapy for moderate-to-severe mitral regurgitation (MR) in high surgical risk patients. Transesophageal echocardiogram (TEE) is crucial for procedure guiding and immediate result evaluation, whereas transthoracic echocardiogram (TTE) is largely used in follow up. However, there is no consensus on the best intraprocedural parameter to evaluate residual MR.

Purpose
To evaluate the predictive value of different MR parameters from intraprocedural TEE with grading in consecutive TTE during the follow up.

Methods
All the consecutive patients who underwent percutaneous mitral repair with the MitraClip system between 2010 and 2020 in our tertiary university hospital were considered for this study. Immediate posprocedural MR parameters (number of jets, summatory and maximum vena contracta (VC), summatory and maximum 3D effective regurgitation orifice (ERO) and pulmonary vein (PV) flow parameters) were reassessed when possible blindly to the follow up MR grading in sequential TTE.

Results
We included 88 patients (64.8% males) with a mean age of 76±10 years. Baseline MR was graded as moderate-to-severe in 13 (14.8%) and severe in 75 (85.2%). The most frequent MR etiology was secondary (44.3%) followed by primary (35.2%) and mixed (20.5%). Patients presented with mild left ventricular systolic dysfunction (LVEF 44.5±15.3%) and dilatation (LVEDVi 71.8 [51.5–102.8] mL/m2). MR grading distribution remained stable at 1 and 6 months follow up TTE. Among all the aforementioned criteria only summatory and maximum VC remained significant for different MR grade prediction. Thus, these values were able to identify MR ≥3 at 1 and 6 months (Table). Moreover, on ROC analysis maximum VC demonstrated an excellent discriminatory power to identify significant MR at 6 months (Figure). Thereby, a cut-off point of 0.45 cm was able to predict MR ≥3 with 88% sensitivity and 89% specificity.

Conclusion
Among intraprocedural TEE parameters to evaluate residual MR in percutaneous edge-to-edge mitral repair, maximum and summatory VC appeared to be the more reliable to predict significant insufficiency in the follow up.

Funding Acknowledgement
Type of funding sources: None. Table 1. Differences in intraprocedural TEE VC in relation with significant MR in follow-up TTEFigure 1. ROC curve of maximum VC for prediction of significant MR at 6 months
Analysis of right ventricle echocardiographic function parameters for the prediction of outcomes in significant functional tricuspid regurgitation
Authors: Romero Delgado T , Travieso Gonzalez A , Luque Diaz T , Vivas Balcones D , Mahia Casado P , Vilacosta I 
Published: October 2021

Abstract

Introduction
Functional tricuspid regurgitation is a common disease that significantly impairs survival and quality of life. The role of echocardiographic right ventricular (RV) function parameters to detect patients with worse prognosis that may benefit from invasive treatment is still under debate.

Methods
121 consecutive patients with grade III and IV functional tricuspid regurgitation were evaluated. RV function parameters and clinical variables were assessed at baseline, and then patients were prospectively followed-up. The primary endpoint was the combination of death or heart failure (HF) admissions. Comparison of imaging parameters was done using receiver-operating characteristics (ROC) curves. Multivariate logistic regression analysis was preformed to establish independent predictors of outcomes.

Results
Median follow up was 27.3 months. 73.6% of the patients were female, and mean age was 80.4 years. 63.6% were grade IV tricuspid regurgitation.
In the univariate analysis using the area under the ROC curve (AUC), RV-free wall strain (RVS, AUC=0.633) and pulmonary artery systolic pressure (PASP, AUC=0.605) were the best predictors of death and HF admissions, although the individual diagnostic performance was weak.
In the multivariate analysis including either clinical and echocardiographic variables, independent predictors of death and HF admissions were Age (OR 1.07, p=0.029), RVS &gt;−16 (OR 5.0, p=0.001), Diabetes mellitus (OR 3.0, p=0.011), eGFR (ml/min, OR 0.96, p=0.001) and Hemoglobin (g/dL, OR=0.74, p=0.048). The model including these variables was superior than RVS and PASP alone (AUC 0.884, p&lt;0.001) (graph 1), showing high sensitivity (78.8%) and specificity (67.3%).

Conclusions
In patients with significant functional tricuspid regurgitation, RVS and PASP show the best performance for the detection of death and HF admissions. A multivariate model including age, diabetes, eGFR, hemoglobin and RVS was superior than the individual imaging parameters.

Funding Acknowledgement
Type of funding sources: None. Table 1Graph 1
Multimodality imaging and systemic biomarkers in classical low-flow low-gradient aortic stenosis: key findings for cardiac remodeling evaluation
Authors: Lopes M.A.A.A.M.L , Campos C M , Rosa V E E , Sampaio R O , Morais T C , Brito F S , Vieira M L C , Mathias W , Medeiros H N A A , Santis A S A L , Rochitte C E , Ribeiro M H , Santos L M , Abizaid A , Tarasoutchi F 
Published: October 2021

Abstract

Background
Elevated levels of troponin I (hsTnT) and B-type natriuretic peptide (BNP) have been related with poor prognosis in patients with LFLG-AS. Biomarkers are less expensive, more practical and more accessible than imaging tests, so their use can be an alternative to imaging in the evaluation of patients with LFLG-AS.

Purpose
The aim of the present study is to assess multimodality imaging findings according to systemic biomarkers (i.e. hsTnT and BNP) in Low-Flow, Low-Gradient Aortic Stenosis (LFLG-AS) and reduced left ventricular ejection fraction (LVEF) patients.

Methods
Prospective study with LFLG-AS patients (LVEF &lt;50%, aortic valve area ≤1,0 cm2 and mean gradient &lt;40 mmHg) that underwent hsTNnT, BNP, cardiac magnetic resonance (CMR) with T1 mapping and 2 dimensional echocardiogram (2DEcho). All patients also underwent dobutamine stress echocardiogram to define aortic stenosis severity. Patients were divided into 3 groups according to BNP and hsTnT levels: Group 1: BNP and hsTnT levels below median (BNP &lt;395 pg/ml and TnI-Ultra &lt;0.042 ng/ml); Group 2: BNP or hsTnT higher than median; and Group 3: both hsTnT and BNP higher than median.

Results
49 patients with LFLG-AS were included (Group 1: 17 patients, Group 2: 14 patients and Group 3: 18 patients). Clinical characteristics (including risk scores) were not able to stratify these groups. Patients with elevation of both biomarkers had lower valvuloarterial impedance (P=0.03), lower LVEF (P=0.02), less moderate/severe mitral (P=0.01) and tricuspid regurgitation (P&lt;0.01) by 2DEcho. CMR identified a progressive increase (from Group 1 to 3) of right and left chamber volumes; reduction in right and left ejection fraction and a marked increase in myocardial fibrosis assessed by extracellular volume (ECV) and indexed extracellular volume (iECV) (Figure 1).

Conclusion
Higher levels of BNP and hsTnT in LFLG-AS patients were associated with worse multi-modality imaging parameters and can be a surrogate of cardiac remodeling.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): No funding
Imaging and circulating biomarkers: a united approach for secondary tricuspid regurgitation
Authors: Spinka G , Bartko P E , Heitzinger G , Teo E , Prausmueller S , Arfsten H , Pavo N , Winter M P , Mascherbauer J , Hengstenberg C , Huelsmann M , Goliasch G 
Published: October 2021

Abstract

Background
Secondary tricuspid regurgitation (STR) is frequent among patients with heart failure with reduced ejection fraction (HFrEF), however inheres considerable diagnostic challenges. The assessment of circulating biomarkers reflecting neurohumoral activation may constitute a valuable supplement to the currently imaging-based diagnostic process. This study therefore sought to investigate (i) the expression of a set of complementary biomarkers in STR, (ii) to evaluate their association with STR severity, and (iii) to analyse whether the combination of neurohormone measurement and echocardiographic grading improves the individual patient risk assessment.

Methods
We included 576 HFrEF patients under guideline-directed therapy recording functional, echocardiographic, invasive hemodynamic and biochemical measurements, i.e. N-terminal pro-B-type natriuretic peptide, mid-regional pro-atrial natriuretic peptide (MR-proANP), mid-regional pro-adrenomedullin, C-terminal pro-endothelin-1 (CT-pro-ET1) and copeptin.

Results
Plasma levels of aforementioned neurohormones were significantly rising with increasing STR severity (for all P&lt;0.001). Among all measured biomarkers, CT-pro-ET1 and MR-proANP were closest related to severe STR, even after multivariate adjustment for established clinical confounders (adj. OR 1.46; 95% CI 1.11–1.91, P=0.006 and adj. OR 1.45, 95% CI 1.13–1.87, P=0.004, respectively). By means of individual outcome in patients with moderate to severe STR, adding the selected biomarkers (i.e. CT-pro-ET1 and MR-proANP) resulted in a substantial improvement in the discriminatory power regarding long-term mortality (C-statistic: 0.54 vs. 0.65, P&lt;0.001; continuous NRI 57%, P&lt;0.001).

Conclusions
Circulating biomarkers closely relate to STR severity and correlate with hemodynamic and morphologic mechanisms of STR. Specifically, MR-proANP and CT-pro-ET1 are closely linked to the presence of severe STR and a combined assessment with the guideline recommended echocardiographic grading leads to a significant improvement of individual risk stratification.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): FWF - Austrian Science Fund Graphical AbstractNeurohumoral profiles of STR
Myocardial deformation techniques as potential tools to detect arrhythmogenic cardiomyopathy in early stages of the disease
Authors: Segura Rodriguez D , Bermudez-Jimenez F J , Gonzalez Camacho L , Oyonarte-Ramirez J M , Moreno Escobar E , Bautista-Paves A , Macias Ruiz M R , Alvarez Lopez M , Tercedor Sanchez L , Jimenez-Jaimez J 
Published: October 2021

Abstract

Introduction
Arrhythmogenic Cardiomyopathy (ACM) is a life-threatening entity which predispose to malignant arrhythmias and sudden cardiac death even in early stages of the disease. Deformation techniques obtained by echocardiography are promising tools which can identify subtle pathologic changes in the myocardial wall. Our aim is to investigate how myocardial deformation parameters may be affected throughout ACM spectrum.

Methods
A cohort of ACM 45 subjects, was characterized using advanced transthoracic echocardiography and divided into groups according to left ventricle ejection fraction (LVEF). Twenty-three healthy volunteers were also included as control group (CG). We analyzed regional wall motion abnormalities and left ventricular myocardial deformation parameters by 2D Speckle Tracking, such as global longitudinal strain (GLS), mechanical dispersion (MD) [standard deviation (SD) and range (delta)].

Results
23 (51,1%) of the ACM cohort were men, with a mean age of 43,13±16,55 years. Next-generation sequencing identified a potential pathogenic mutation in 37 (82,2%) of the patients. Those ACM subjects with low LVEF (ACM-L) presented lower GLS values when compared to those with normal LVEF (ACM-N) (−16,17±2,68% vs. ACM-N −19,39±2,97%; p&lt;0.001) with no significant differences in MD parameters. ACM-N showed no differences in GLS regarding to CG, but significant differences were found when analyzing MD values, with pathological dispersion times in the ACM-N group (ACM-N DMSD 50,50±20,39ms vs. CG 37,35±17,15ms; p=0,016; ACM-N DMDelta 167,4583±75,07ms vs CG 125±49,13ms; p=0,033).

Conclusions
MD may be an additive tool for identifying ACM patients in early stages of the disease when LVEF is still preserved.

Funding Acknowledgement
Type of funding sources: None.