bluuebunny/crossref_metadata_2025_split huggingface dataset:
384 Morpho-functional analysis of subvalvular apparatus in mitral valve prolapse and response to dipyridamole stress echocardiography. A pilot study
Authors: Diana Giovanni , Filice Monica , Manfredonia Laura , Ravenna Emanuele , Graziani Francesca , Lombardo Antonella , Palma Federica , Lanza Gaetano Antonio , Massetti Massimo , Crea Filippo , Locorotondo Gabriella 
Published: December 2021

Abstract

Aims
Myocardial fibrosis has been found in papillary muscles (PM) and basal segment of left ventricular (LV) inferior-lateral wall in patients with mitral valve prolapse (MVP), which may be due to stretch from valve. Moreover, ST-segment depression is common in patients with MVP, despite low prevalence of epicardial coronary artery disease, and it is attributed to microvascular dysfunction or myocardial stretch. Longitudinal strain (LS) correlates with myocardial fibrosis, while dipyridamole stress echocardiography (DSE) identifies microvascular dysfunction. We aimed at assessing morphology and function of PM and left ventricular walls at rest and during DSE by LS, and at determining prevalence of microvascular dysfunction in patients with MVP.

Methods and results
Seven consecutive patients with MVP (age 55.4 ± 15.7 years, 57% female) and LV ejection fraction 64 ± 5% underwent DSE. Length and LS of PM were measured at rest and retrospectively compared with those of patients with ischaemic heart disease (n = 8, age 67.1 ± 10.1 years, 37% female) and healthy controls (n = 8, age 39.6 ± 13.3 years, 50% female). LS of PM and LV was also determined at rest and during stress in MVP. Length of PM did not differ among groups, but in MVP, posterior PM was longer than the anterior PM (24 ± 3.8 vs. 20.6 ± 3.6 mm, P = 0.028). Significant difference in resting PM LS was found among groups (overall P = 0.04), with PM LS value in MVP (16.7 ± 7.1%) intermediate between ischaemic (14.2 ± 3.2%) and controls (20.5 ± 2.7%). No difference was found between rest and stress LS of PM in MVP. Global LS tended to increase in MVP during DSE compared to rest (23.1 ± 3.8% vs. 21.1 ± 2.6%, respectively, P = 0.07), while no significant difference between rest and stress LS was found in every LV myocardial segments. Nevertheless, in MVP, LS of LV inferior-lateral wall tended to improve under DSE in patients with mild regurgitation (19.7 ± 4.6 vs. 14.2 ± 5 at rest), but to decrease (16 ± 6.1 vs. 20.3 ± 2.3 at rest) in patients with severe mitral regurgitation (P = 0.006 for interaction). ST-segment depression was elicited by DSE in 29% of MVP. No significant difference in echocardiographic parameters was found between patients with and without ST-segment depression.

Conclusions
In MVP, sub-valvular apparatus may have peculiar morpho-functional features. DSE does not alter LS of PM, neither of LV walls, except for inferior-lateral wall, which impairs in severe mitral regurgitation. Prevalence of microvascular dysfunction is comparable to that of the general population.
396 Echocardiography and magnetic resonance for differential diagnosis of left ventricular hypertrofy: diagnostic and prognostic implications
Authors: Licordari Roberto , Grigoratos Chrysanthos , Todiere Giancarlo , Barison Andrea , Di Bella Gianluca , Aquaro Giovanni Donato 
Published: December 2021

Abstract

Aims
Left ventricular hypertrophy (LVH) may be due to different causes, ranging from benign secondary forms to severe cardiomyopathies. Transthoracic Echocardiography (TTE) and ECG are the first level examination for LVH diagnosis. Cardiac magnetic resonance (CMR) defines accurately LVH type, extent and severity. To evaluate the diagnostic and prognostic role of CMR in patients with TTE and/or ECG evidence of LVH.

Methods and results
We performed CMR in 300 consecutive patients with echocardiographic and/or ECG signs of LVH. Overall, 275 patients had TTE evidence of LVH with initial suspicion of hypertrophic cardiomyopathy (HCM) in 132 (44%), cardiac amyloidosis in 41 (14%), hypertensive LVH in 48 (16%), aortic stenosis in 4 (1%), undetermined LVH in 50(16%). The initial echocardiographic diagnostic suspicion of LVH was confirmed in 172 patients (57.3%) and changed in 128 patients (42.7%, P &lt; 0.0001): the diagnosis of HCM increased from 44% to 71% of patients; hypertensive and undetermined LVH decreased significantly (respectively, to 4% and 5%). CMR allowed a diagnosis in 41 out of 50 (82%) with undetermined LVH at TTE. CMR also identified HCM in 17 out of 25 patients with apparently normal echo but with ECG criteria for LVH. Finally, the reclassification of the diagnosis by CMR was associated with a change of survival risk of patients: after CMR reclassification no events occurred in patients with undetermined or hypertensive LVH.

Conclusions
CMR changed echocardiographic suspicion in almost half of patients with LVH. In the subgroup of patient with abnormal ECG, CMR identified LVH (particularly HCM) in 80% of patients. This study highlights the indication of CMR to better characterize the type, extent, and severity of LVH detected at echocardiography and suspected with ECG.
366 The use of dedicated long-axis views focused on the left atrium improves the accuracy of left atrial volumes and function measured by cardiovascular magnetic resonance
Authors: Menè Roberto , Tondi Lara , Badano Luigi , Torlasco Camilla , Florescu Diana Ruxandra , Volpato Valentina , Parati Gianfranco , Giannattasio Cristina , Lombardi Massimo , Muraru Denisa 
Published: December 2021

Abstract

Aims
The use of apical views focused on the left atrium (LA) has improved the accuracy of LA volume evaluation by two-dimensional echocardiography. However, routine cardiac magnetic resonance (CMR) evaluation of LA volumes still uses standard 2- and 4-chamber cine images focused on the left ventricle. To investigate the potential of LA-focused CMR cine images, we compared LA maximal (LAVmax) and minimal (LAVmin) volumes, and emptying fraction (LA-EF) calculated on both standard and LA-focused long-axis cine images with LA volumes obtained by short-axis cine stacks covering the LA.

Methods and results
LA volumes and LA-EF were obtained from 108 consecutive patients by applying the biplane area-length algorithm to both standard and LA-focused 2- and 4-chamber cine images. Manual segmentation of a short-axis cine stack covering the LA was used as the reference method. Compared to the reference method, the standard approach significantly underestimated LA volumes (LAVmax: bias −13 ml; LOA = +11 ml, −37 ml; LAVmin; bias −10 ml, LOA: +9 ml, −28ml), and overestimated LA-EF (bias= 5%, LOA: +23%, −14%). Conversely, LA volumes (LAVmax bias −0.03 ml; LOA: +10 ml, −10 ml. LAVmin bias = −1.5 ml; LOA: +7 ml, −10 ml), and LA-EF (bias 2%, LOA: +11%, −7%) by LA-focused cine images were similar to those measured using the reference method. Moreover, LA volumes by LA-focused images were obtained faster than using the reference method (1.2 vs. 4.5 min, P &lt; 0.001).

Conclusions
LA volumes and LA-EF measured using dedicated LA-focused long-axis cine imaging are more accurate than using standard (LV-focused) cine images.
94 Combined use of voltage mapping and speckle tracking echocardiography for the early diagnosis of ARVC/D: a case report
Authors: Sisti Nicolò , Santoro Amato , Baiocchi Claudia , Biancofiore Antonio , Pistoresi Simone , D’Ascenzi Flavio , Mandoli Giulia Elena , Cameli Matteo 
Published: December 2021

Abstract
A 38 years-old man was admitted to our hospital after ventricular tachycardia with left-bundle-branch block and inferior axis morphology. After undergoing different examinations the criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) were met. An electrophysiological study was then performed together with endocardial bipolar and unipolar voltage map. Unipolar and bipolar voltage mapping of the right ventricle showed low voltage areas and corresponding fragmented potentials from the tricuspid annulus to the inferior apex. On the right ventricular outer tract (RVOT), the bipolar voltage mapping was normal while the unipolar mapping showed low-voltage areas in the antero-septal outer tract. An off-line map was used to perform speckle tracking analysis on intracardiac echocardiography (ICE) clips of right ventricle and standard echocardiography. A reduction of the strain analysis was stored in correspondence of the fragmented electrograms area, in particular, speckle tracking analysis on ICE views showed a reduction of the RV LS in the segments below tricuspid valve, in the three different myocardial layers. The endocardial longitudinal strain was reduced from sub-tricuspidalic segments to the RV apex in accordance with the fragmentated potentials stored during voltage mapping. On the contrary, at anterior RVOT wall, the unipolar voltage mapping showed fragmented potentials and the STE analysis revealed a reduced epicardial LS. This case report lays emphasis on the importance of the integration of ICE-derived right ventricular strain and voltage mapping in the improvement of the sensibility of an early diagnosis of the ARVC.
725 Assessment of myocardial work for the evaluation of patients undergoing transcatheter aortic valve implantation (TAVI)
Authors: Leo Isabella , Sabatino Jolanda , Strangio Antonio , Bella Sabrina La , Sorrentino Sabato , Polimeni Alberto , Spaccarotella Carmen , Mongiardo Annalisa , Procopio Concetta , Di Salvo Giovanni , De Rosa Salvatore , Indolfi Ciro 
Published: December 2021

Abstract

Aims
A growing number of patients is undergoing transcatheter treatment of severe Aortic Stenosis. Changes in cardiac mechanics after removal of afterload in these patients are under-investigated. Myocardial Work (MW) is emerging as a useful non-invasive correlate of invasively measured myocardial performance and oxygen consumption. Aim of this study was to assess the usefulness of non-invasive MW indices in the clinical assessment of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI).

Methods and results
Consecutive patients with severe aortic stenosis referred for TAVI in a single tertiary centre were included. Echocardiography recordings (GE-Healthcare) with systolic and diastolic non-invasive pressures, were obtained immediately before TAVI and after TAVI to measure myocardial work index (MWI), myocardial constructive work (MCW), myocardial wasted work (MWW), and myocardial work efficiency (MWE). Consecutive patients with severe AS (n = 73) undergoing TAVI and matched controls (n = 50) were included. Mean transaortic gradient, AV area, and peak transvalvular velocity were significantly improved (all P &lt; 0.05). No changes in left ventricular ejection fraction nor in global longitudinal strain (GLS) were observed. GWI (P &lt; 0.001) and GCW (P &lt; 0.001) were significantly reduced after TAVI. On the contrary, we observed no significant change in GWW (P = 0.241) nor GWE (P = 0.854). Women had higher GWI (P = 0.007) and GCW (P = 0.014) compared to men, with a larger delta change of GCW. Patients with a low flow low gradient (LF-LG) AS had lower LVEF (P &lt; 0.001), worse GLS (P &lt; 0.001) and lower baseline GWI (P &lt; 0.001), GCW (P &lt; 0.001), and GWE (P = 0.003). The improvement in GWI and GCW observed after TAVI in the general study population were abolished among LF-LG patients.

Conclusions
The use of non-invasive myocardial work might be useful to further classify patients with AS and could be useful to predict non responders.
751 Quantitative changes in intracardiac vortices between patients with different ventricular geometry
Authors: Strangio Antonio , Sabatino Jolanda , Leo Isabella , Maglione Marco , Troilo Fabio , Loliva Giuseppe , Romano Letizia Rosa , Critelli Claudia , Di Salvo Giovanni , De Rosa Salvatore , Indolfi Ciro 
Published: December 2021

Abstract

Aims
Over the past decades growing evidence have demonstrated the promising role of intracardiac fluid-dynamics in evaluating cardiac performance. To investigate quantitative changes in vortices parameters in patients with different ventricular geometry.

Methods and results
We enrolled 50 consecutive patients with one of the following: LV concentric hypertrophy (CH), eccentric hypertrophy (EH), concentric remodelling, and normal LV geometry (CTRL). They underwent a complete echocardiographic examination with intracardiac fluid-dynamic analysis by Color Vector Flow Mapping (Hyperdoppler). The following parameters were obtained: vortex area (VA); vortex length (VL); and vortex depth (VD). Bland Altman Plot has been used to assess intra and inter-observer variability. 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.

Conclusions
This is the first study providing quantitative echocardiographic parameters of vortex location and morphology in different LV geometries. Quantitative fluid-dynamic assessment was feasible and reliable in the whole population.
309 Upgrading from a dual-chamber pacemaker to a cardiac resynchronization therapy defibrillator in situs inversus totalis with dextrocardia following mitral valve replacement and tricuspid annuloplasty using a left-sided approach
Authors: Bacci Elodi , Santoro Amato , Sisti Nicolò , Baiocchi Claudia , Cameli Matteo 
Published: December 2021

Abstract
A 71-year-old female patient was referred to our centre to upgrade a dual-chamber pacemaker to a cardiac resynchronization therapy defibrillator (CRT-D) following the detection of worsened systolic function (ejection fraction: 25–30%) via transthoracic echocardiography. The patient had situs inversus totalis with dextrocardia. She had undergone mitral valve replacement and tricuspid annuloplasty in July 2019, with a concomitant left upper pulmonary lobectomy for neoplasm, detected at cardiac tomography incidentally. In January 2020, we performed an upgrade of the preexisting device to a CRT-D system because the patient developed heart failure, reduction in systolic function, and numerous nonsustained ventricular tachycardias. The right ventricular lead that had been previously implanted was extracted. To facilitate the intervention, we decided to flip the fluoroscopic image, obtained with a right-anterior oblique view, by 180 °C (right–left), creating the optical impression of a levocardial position.
121 Imaging of improved right ventricular function and risk status in pulmonary arterial hypertension
Authors: Miotti Cristiano , Badagliacca Roberto , Vizza Carmine Dario 
Published: December 2021

Abstract

Aims
Right ventricular function adaptation to afterload as assessed by the ratio of tricuspid annular plane excursion (TAPSE) to systolic pulmonary artery pressure (PASP) has been shown to be of prognostic relevance in pulmonary arterial hypertension (PAH). To test the hypothesis that improvement in TAPSE/PASP under targeted therapies is associated with the likelihood to achieve a better prognostic low-risk status in PAH.

Methods and results
The study retrospectively enrolled 677 PAH patients (55% idiopathic) with follow-up clinical, right heart catheterization, and echocardiographic evaluations within 12 months [interquartile range (IQR): 180–344 days] after initiation of targeted therapies from 2005 to 2017 in 11 Italian centres. European guidelines-derived and United States Registry to Evaluate Early and Long-Term PAH Disease Management registry REVEAL 2.0 risk scores were assessed at baseline and follow-up. The patients improved their functional class and 6-min walk distance, but a minority of them achieved or maintained the low risk status as assessed either with the European or the REVEAL 2.0 score (30% and 27%, respectively). The TAPSE/PASP ratio increased curvilinearly in proportion to decreased pulmonary vascular resistance (PVR) by more than 50%. Patients at low risk were, respectively, 4.93 and 3.37 times more likely to have TAPSE/PASP ≥0.35 mm/mmHg than those at intermediate or high risk, according to the ESC/ERS [odds ratio: (OR) 4.93, confidence interval (CI): 3.40–7.14; P = 0.0001] and the REVEAL 2.0 score (OR: 3.37, CI: 2.32–4.90; P = 0.0001).

Conclusions
Improvement of TAPSE/PASP under targeted therapies in PAH is associated with a low risk status, marked reduction in PVR, and improved outcome.
150 Incremental value of cardiopulmonary exercise testing in intermediate-risk pulmonary arterial hypertension
Authors: Badagliacca Roberto , Rischard Franz , Giudice Francesco Lo , Howard Luke , Papa Silvia , Valli Gabriele , Manzi Giovanna , Sciomer Susanna , Palange Paolo , Garcia Joe G. N , Vanderpool Rebecca , Rinaldo Rocco , Vigo Beatrice , Insel Michael , Fedele Francesco , Vizza Carmine Dario 
Published: December 2021

Abstract

Aims
Risk assessment in pulmonary arterial hypertension (PAH) is essential for prognostication. However, the majority of patients end-up in an intermediate risk status despite targeted-therapy, offering insufficient guidance in clinical practice. The added value of cardiopulmonary exercise testing (CPET) in this setting remains undefined.

Methods and results
Two independent cohorts with idiopathic PAH at intermediate risk were used to develop (n = 124) and externally validate (n = 143) the prognostic model. Risk assessment was based on the simplified version of the ESC/ERS guidelines score. The same definition of clinical worsening (CW) was used for both cohorts. Discrimination and calibration were assessed. Seventy-four derivation cohort patients experienced CW (51.2%) during a median of 34 months. Stroke volume index (SVI) and 6-min walk-distance (6MWD) were independent predictors of CW. With addition of CPET variables, SVI and VO2 peak independently improved the power of the prognostic model, determined by the integrated discrimination integral (IDI) index. ROC-derived cut-off values for SVI and VO2 peak were 34 and 14 ml/kg/min, respectively. Forty-eight validation cohort patients experienced CW (33.5%) during a median of 27 months follow-up. Different combinations of cut-off values of SVI and VO2 peak defined three meaningful groups showing good discrimination and calibration. The event-free survival rates at 1, 2, and 3 years were, respectively, 96%, 89%, and 89% for high SVI/high VO2 peak combination; 85%, 73%, and 61% for high SVI/low VO2 peak; and 80%, 70%, and 56% for low SVI/low VO2 peak.

Conclusions
Combinations of VO2 peak and SVI during follow-up is important in the prognostication of intermediate-risk prevalent patients with idiopathic PAH.
372 Machine learning and pulmonary hypertension
Authors: Soriente Lucia , Cerulo Luigi , Mercurio Giovanna , Iuliano Giuseppe , Mancini Francesco Paolo 
Published: December 2021

Abstract

Aims
Pulmonary hypertension (IP) characterized by an average resting pulmonary pressure ≥20 mmHg can sustain various clinical conditions that differ in physiopathological, haemodynamic, and therefore therapeutic aspects. The goal of our work was to apply a machine learning algorithm that could accurately distinguish pre- and post-heart pulmonary hypertension through non-invasive methods (medical history, clinical, and echocardiographic data).

Methods and results
In order to achieve our goal we used the ‘decision tree’ machine learning algorithm implemented in the C5.0 package of the R development environment. The first step was the preparation of the data. The dataset of patients with IP was composed of 85 patients divided into XX precapillary IP (1) and YY postcapillary (2). Each patient is described by 11 features: some comorbidities (arterial hypertension and atrial fibrillation), BMI, right axial deviation on ECG, DLCO, and some echocardiographic measurements (e/e′, right atrial area, S wave at TDI, acceleration time on the pulmonary, inferior vena cava, diameters of the right ventricle). The dataset was divided into a data.train training subset (45 patients) and an evaluation subset (40 patients), maintaining the proportion between classes. Starting from the training dataset, the C5.0 algorithm generated the decision tree shown in Figure 1. The root node was made up of the mitral pattern e/e′, followed by the right axis deviation on the ECG and the acceleration rate on the lung that the algorithm considered the best discriminated features. The model was then validated in the validation dataset and through the Caret package and the Confusion matrix function we calculated the performance metrics of the algorithm obtaining an accuracy of 0.87, a kappa statistic of 0.742, a sensitivity of 0.913, and a specificity of 0.823. The true positive rate was 0.87 while the true negative rate was 0.87. The performance of the model was also measured using the ROC curve, obtaining an area under the curve of 0.916.

Conclusions
Our results show that the ‘decision tree’ algorithm starting from echocardiographic data and the ECG has a good ability to discriminate between the precapillary and postcapillary IP. In particular, the decision chain consisting of: mitral pattern and / and ratio ≤8, right axial deviation on the ECG and acceleration time on the lung ≤80 ms seems to predict the IP class with reasonable accuracy. Our results confirm that the probability of prediction and the prediction itself depend, however, on what degree of purity the partitions learned during the decision tree construction process are made up. To improve the estimation of the algorithm’s performance and thus generalize the results obtained, we believe to evaluate this approach on larger datasets also considering different machine learning algorithms.

372 Figure