bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does global longitudinal strain predict long-term outcome in patients presenting to the emergency department with chest pain?
Authors: Fuks A , Liel-Cohen N , Blondheim DS , Shimoni S , Jabaren M , Leitman M , Adawi S , Asmer I , Ganaeem M , Lavi I , Saliba W , Shiran A 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Two-Dimensional Strain for Diagnosing Chest Pain in the Emergency Room (2DSPER) was a prospective multicenter study designed to determine whether 2D longitudinal strain (2DLS) can assist in triage of patients with chest pain in the emergency department (ED). In that study 2DLS was not useful to rule out acute coronary syndromes (ACS) in the ED, partly because many patients without ACS had abnormal 2DLS. The prognostic significance of 2DLS in these patients is unclear.
The aim of the current study was to determine whether global longitudinal strain (GLS), measured using 2D echocardiography in the ED, can predict long-term outcome.

Methods
Long-term (median 7.7 years [IQR 6.7-8.2]) major adverse cardiac events (MACE; cardiac death, ACS, revascularization, hospitalization for heart failure or atrial fibrillation) was available in 525 of 605 patients (87%) enrolled in the 2DSPER study. The study prospectively enrolled patients presenting to the ED with chest pain and suspected ACS but without a diagnostic ECG or elevated troponin. Global longitudinal strain (GLS) was computed from echocardiograms performed within 24 hours of chest pain using a dedicated 2DLS software (EchoPAC SW; GE Vingmed Ultrasound AS). MACE of patients with worse GLS (&gt;median) was compared to those with better GLS (≤median).

Results
Median GLS was -18.8%. MACE occurred in 43/249 (17.3%) of patients with worse GLS (-16.8 ± 1.5) as compared with 49/276 (17.8%) with better GLS (-20.8 ± 1.6), HR 0.98 (95%CI 0.65-1.4, p = 0.9) (Figure). Similarly, there was no significant difference in total mortality (6% vs. 4.7%, p = 0.5), cardiac death (0.4% vs. 0.7%, p = 0.6), ACS (8% vs. 8.3%, p = 1), revascularization (10% vs. 10.9%, p = 0.8), hospitalization for heart failure (0.8% vs. 2.2%, p = 0.2) or atrial fibrillation (3.6% vs. 4.3%, p = 0.7) between groups. Predictors of MACE were male gender (HR 2.5, 1.4-4.3, p = 0.02), history of coronary artery disease (HR 3.3, 2-5.4, p &lt; 0.0001) and hypertension (HR 1.8, 1.2-2.8, p = 0.005), but not GLS (HR 0.98, 0.7-1.5, p = 0.9).

Conclusions
GLS did not predict long term outcome in patients presenting to the ED with chest pain. Long-term outcome was favorable in the group of patients with worse GLS, similar to better GLS.
Abstract Figure.
The influence of hemodialysis-induced preload changes on the propagation speed of natural shear waves
Authors: Bezy S , Orlowska M , Van Craenenbroeck A , Cvijic M , Duchenne J , Puvrez A , Werner A , Meijers B , Voigt JU 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation - Flanders (FWO)

Background
Shear wave elastography (SWE) is a novel ultrasound technique based on the detection of transverse waves travelling through the myocardium using high frame rate echocardiography. The propagation speed of these shear waves is dependent on the stiffness of the myocardium. Previous studies have shown the potential of SWE for the non-invasive assessment of myocardial stiffness. It is unclear, however, if preload changes lead to measurable changes in the shear wave propagation speed in the left ventricle. In patients undergoing hemodialysis, the volume status is acutely changed. In this way, the effect of preload changes on shear wave speed can be assessed.

Purpose
The aim of this study was to explore the influence of preload changes on end-diastolic shear wave propagation speed.

Methods
Until now, 6 patients (age: 80[53-85] years; female: n = 2) receiving hemodialysis treatment were included. Echocardiographic images were taken before and every hour during a 4 hour hemodialysis session. Left ventricular parasternal long-axis views were acquired with an experimental high frame rate ultrasound scanner (average frame rate: 1016[941-1310] Hz). Standard echocardiography was performed with a conventional ultrasound machine. Shear waves were visualized on tissue acceleration maps by drawing an M-mode line along the interventricular septum. Shear wave propagation speed after mitral valve closure (MVC) was calculated by measuring the slope of the wave pattern on the acceleration maps (Figure A).

Results
Over the course of hemodialysis, the systolic (141[135-156] mmHg vs. 165[105-176] mmHg; p = 0.35 among groups) and diastolic blood pressure (70[66-75] mmHg vs. 82[63-84] mmHg; p = 0.21 among groups), heart rate (56[54-73] bmp vs. 57[50-67] bpm; p = 0.76 among groups), E/A ratio (1.6[0.7-1.8] vs. 1.2[0.6-1.4]; p = 0.43 among groups) and E/e’ (14[9-15] vs. 9[8-13]; p = 0.24 among groups ) remained the same. The ultra-filtrated volumes are shown in Figure B. The shear wave propagation speed after MVC gradually decreased during hemodialysis (6.7[5.4-9.7] m/s vs. 4.4[3.6-9.0] m/s; p = 0.04 among groups) (Figure C). There was a moderate negative correlation between shear wave speed and the ultra-filtrated volume (r=-0.63; p &lt; 0.01) (Figure D).

Conclusion
The shear wave propagation speed at MVC significantly decreased over the course of hemodialysis and correlated to the ultra-filtrated volume. These results indicate that alterations in left ventricular preload affect the speed of shear waves at end-diastole. End-diastolic shear wave speed might therefore be a potential novel parameter for the evaluation of the left ventricular filling state. More patients will be included in the future to further explore these findings.
Abstract Figure.
Vendor-independent software shows limited variability in speckle tracking strain measurements on images of different vendors
Authors: Unlu S , Mirea O , Bezy S , Duchenne J , Pagourelias ED , Bogaert J , Thomas JD , Badano LP , Voigt JU 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background
Vendors use proprietary speckle tracking software algorithms for echocardiographic strain measurements, which results in high inter-vendor variability. Little is known about potential advantages or disadvantages of using vendor-independent software in clinical practice.

Purpose
We therefore investigated the reproducibility, accuracy, and ability to identify scar of strain measurements on images from different vendors by using a vendor-independent software.

Methods
A vendor-independent software (TomTec Image Arena) was used to analyze datasets of 63 patients which were obtained on four ultrasound machines from different vendors (GE, Philips, Siemens, Toshiba). We measured the tracking feasibility, inter-vendor bias, the relative and absolute test-re-test variability of strain measurements and their ability to detect scar. Cardiac magnetic resonance delayed enhancement images were used as the reference standard of scar definition.

Results
Tracking feasibility differed depending on the image source (p &lt; 0.05). Variability of global longitudinal strain (GLS) (Figure 1A) was similar (ANOVA p = 0.124) among the images of different vendors whereas variability of segmental longitudinal strain (SLS) (Figure 1B) showed modest difference (ANOVA- peak systolic strain (PS); p = 0.077, end-systolic strain (ES); p = 0.171, post-systolic strain (PSS); p = 0.020). Relative test-re-test variability of GLS showed no differences (ANOVA p = 0.360). Absolute test-re-test errors of SLS measurements showed modest differences among images of different vendors (ANOVA- PS; p = 0.018, ES; p = 0.001, PSS; p = 0.090). No relevant difference in scar detection capability was observed (Figure 1C).

Conclusions
Vendor independent software leads to low bias among strain measurements on images from different vendors. Likewise, measurement variability and the ability to identify scar becomes similar. Our findings suggest that a vendor independent speckle tracking software could help to overcome inter-vendor bias. To which extend such measurements would be more accurate compared to vendor specific software remains to be determined.
Abstract Figure 1
Improvement of left ventricular systolic performance during sacubitril/valsartan in a cohort of patients with heart failure and reduced ejection fraction
Authors: Monosilio S , Filomena D , Cimino S , Neccia M , Luongo F , Mariani M , Birtolo LI , Benedetti G , Fedele F , Maestrini V , Agati L 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sacubitril/valsartan is a well-established therapeutic option for patients with heart failure with reduced ejection fraction (HFrEF). While it was clearly demonstrated to improve patients’ clinical conditions, its potential role in inducing left ventricle (LV) reverse remodeling is still under investigation.

Purpose
to evaluate clinical and echocardiographic effect of sacubitril/valsartan on a cohort of patients with HFrEF after six months of therapy.

Methods
36 patients with HFrEF eligible to start a therapy with sacubitril/valsartan were enrolled. A standard and advanced echocardiographic evaluation was performed before starting the therapy and after six months of follow up (FU). Off-line analysis of left ventricle global longitudinal strain (GLS), longitudinal strain of the free wall of the right ventricle (RVFWSL) and left atrial strain (LAS) was conducted. Clinical and biochemical parameters were evaluated as well.

Results
At six months of FU NYHA class improved in the vast majority of patients (NYHA class III at baseline vs FU: 56% vs 5%, p 0.001). We observed a significant reduction in LV end-diastolic (99.62 ± 33.24 vs 91.54 ± 33.36, p 0.043) and end-systolic (69.99 ± 26.01 vs 58.68 ± 25.7, p 0.001) volumes and an improvement of LV ejection fraction (30.4 ± 5.02 vs 37.3 ± 6.4, p &lt; 0.001). After six months of therapy, GLS significantly improved (-9.71 ± 2.87 vs -13.04 ± 3.14, p &lt; 0.001). No differences in left and right atrial volumes (respectively 56.6 ± 29 vs 54 ± 30, p 0.349; 54.7 ± 23.7 vs 48.3 ± 19, p 0.157), RVFWSL (-16,5 ± 5,4 vs -16,8 ± 1,5) and LAS (14 ± 6 vs 19 ± 8, p 0.197) were found at FU.

Conclusion
Left ventricular function evaluated with standard and advanced echocardiographic parameters improved after six months of therapy with sacubitril/valsartan in HFrEF patients. Reduction in LV volumes was found as well.
Echo Analysis Baseline Echo Analysis (n= 36) 6 Months FU Echo Analysis (n= 36) p LVEDVi, mL/m2 99, 62 ± 33,24 91,54 ± 33,36 0,043 LVESVi, mL/m2 69,99 ± 26,01 58,68 ± 25,7 0,001 LVEF, % 30,4 ± 5, 02 37,3 ± 6,4 &lt; 0,001 E/E’ average 12,16 ± 3,74 9,71 ± 1,33 0,023 LS Endo Average ,% -9,71 ± 2,87 -13,04 ± 3,14 &lt; 0,001 LVEF left ventricular ejection fraction, LVEDVi: left ventricular end diastolic volume indexed, LVESVi: left ventricular end systolic volume indexed; LS: longitudinal strain
The combined use of electrocardiography, echocardiography and cardiac magnetic resonance imaging in left atrium evaluation among beta-thalassemia patients
Authors: Patsourakos D , Aggeli C , Gatzoulis K , Delicou S , Dimitroglou Y , Androulakis A , Tsioufis C , Tousoulis D 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Beta-thalassemia major (β-TM) patients are subjected to iron overload as a consequence of chronic blood transfusions. The redundant iron affects, among other organs, the heart resulting in myocardial dysfunction. Iron deposition does not only affect ventricular myocardium but atrial myocardium as well. According to current practice, the overall myocardial iron status is estimated by calculating T2* at the middle section of the ventricular septum using cardiac magnetic resonance imaging (CMR). Current CMR technology limits the direct estimation of atrial iron status.

Purpose
The current study evaluates left atrial function by novel echocardiographic techniques and correlates these findings with CMR data.

Methods
37 β-TM patients (mean age 41.17 years (SD = 8.33), 51.4% male), were subjected to electrocardiography, echocardiography and CMR imaging and P wave axis, PR segment duration, left atrial volume index (LAVI), left atrial strain at reservoir phase (LASr) and T2* were measured.

Results
No correlation between T2* and LASr (r = 0.253, p = 0.131) or T2* and LAVI (r = 0.044, p = 0.796) were found. However, a correlation was found between the echocardiographic parameters LAVI and LASr (r = -0.676, p &lt;0.001). P wave axis did not correlate with any other parameter, while PR segment duration was correlated with LASr (r = -0.399, p = 0.015). Regression analysis revealed correlation between LAVI and LASr (r2 = 0.457, p &lt;0.001).

Conclusions
The current study suggests that despite the undisputed contribution of CMR in left ventricular iron load estimation, it may be less accurate in atrial iron status estimation. Considering the limitations of current CMR technology regarding the iron status of the thin atrial and right ventricular walls, our study highlights the role of speckle tracking in combination with CMR imaging for a more comprehensive evaluation of β-TM patients.
Correlation table P axis PR segment T2* LAVI LASr P axis 0,151 (p = 0,373) 0,112 (p = 0.,508) -0,140 (p = 0,410) -0,117 (p = 0,489) PR segment 0,151 (p = 0,373) 0,051 (p = 0,766) 0,278 (p = 0,096) -0,399 (p = 0,015) T2* 0,112 (p = 0.,508) 0,051 (p = 0,766) 0,044 (p = 0,796) 0,253 (p = 0,131) LAVI -0,140 (p = 0,410) 0,278 (p = 0,096) 0,044 (p = 0,796) -0,676 (p &lt;0,001) LASr -0,117 (p = 0,489) -0,399 (p = 0,015) 0,253 (p = 0,131) -0,676 (p &lt;0,001) T2*: obtained by cardiac magnetic resonance imaging LAVI left atrial volume index (ml/m2) LASr left atrial strain at reservoir phase Abstract Figure. Correlation between LASr and T2*
Left ventricle longitudinal strain alterations in asymptomatic or mildly symptomatic pediatric patients with recent SARS-CoV-2 infection
Authors: Sirico D , Costenaro P , Di Chiara C , Dona" D , Cozzani S , Fumanelli J , Di Candia A , Biffanti R , Cerutti A , Reffo E , Castaldi B , Da Dalt L , Giaquinto C , Di Salvo G 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: This work has been partially supported by the ORCHESTRA project, H2020 Grant Agreement Number 101016167.

Background
Evidence suggests that clinical manifestations of children’s COVID-19 may be less severe. However, it has been described the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) which resembles other inflammatory conditions (i.e. Kawasaki disease). Patients affected by PIMS-TS showed cardiac involvement with myocardial injury, reduced left ventricle systolic function and coronary artery abnormalities. Little is known regarding cardiac involvement in pediatric patients with asymptomatic or mildly symptomatic SARS-CoV-2 infection.

Methods
We analyzed 23 pediatric patients (13males, 56%) with diagnosis of SARS-CoV-2 infection based on PCR analysis of nasopharingeal swab (NPS), and asymptomatic or only mildly symptomatic for COVID-19. Patients underwent standard transthoracic echocardiogram (TTE) within 2-3 month from diagnosis and after negative NPS for SARS-CoV-2. We performed offline analysis with GE EchoPAC software to measure global longitudinal strain (GLS) of the LV using 2D speckle tracking imaging. Therefore, we compared the results with a matched group of 23 controls (13males, 56%).

Results
Cases and controls were similar regarding age (5.9 ± 4.1years vs. 6.4 ± 4.4 years, p = 0.63), body surface area (0.98 ± 0.3m2 vs. 0.8 ± 0.4m2, p = 0.17), LV FS (37.9 ± 5.9% vs. 36.4 ± 8.3%, p = 0.74) and LV biplane EF (63.9 ± 5.2% vs. 66.4 ± 5.3%, p = 0.11). GLS analysis showed significant strain reduction of the LV mid-wall segments and of the basal anterior, posterior and septal inferior segments among cases compared to controls. Furthermore, in the case group there were 7 subjects (30%) with a strain below 16.5% in at least 3 segments.

Conclusion
SARS-CoV-2 infection may affect LV deformation in asymptomatic or only mildly symptomatic children, showing a peculiar pattern with lower longitudinal strain in all mid-wall segments of LV compared to control subjects. The clinical significance of this findings is unclear and follow-up is needed to verify the reversibility of this alterations.
Multimodality imaging approach by speckle tracking echocardiography and cardiac magnetic resonance of heart failure with preserved ejection fraction, a step forward
Authors: Rimbas RC , Mihalcea DJ , Chitroceanu AM , Visoiu SI , Mihaila-Baldea S , Magda LS , Luchian ML , Marinescu AV , Necula AI , Vinereanu D 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Project No. PN-III-P1-1-TE-2016-0669, within PNCDI III, and grant 5/2018 and 83/2018
Background. Heart failure with preserved ejection fraction (HFpEF), defined by 2016 guidelines and new 2019 scoring system, is one of the most challenging diagnosis in cardiology. A better understanding of this entity might provide us a better way to treat. Myocardial work (MW) by speckle-tracking echocardiography (STE) might be a promising tool for analysis of myocardial function. However, there is no data on MW changes in HFpEF patients.
Methods. We assessed 94 patients (67 ± 9 yrs, 33 men) with HFpEF (NTproBNP of 349 ± 418 pg/ml), by 2D and STE, and compared them with 25 normal, age-matched, subjects; 80 patients had also a CMR evaluation. We measured LV ejection fraction (LVEF), mean E’ (E’m), E/E’, sPAP, left atrial volume indexed (LAVi), and global longitudinal stain (GLS). We assessed MW by 2DSTE: global constructive work (GCW), as the "positive" work of the heart; global wasted work (GWW), as the "negative work"; global work efficiency (GWE), as GCW/(GCW + GWW) in %. We evaluated by CMR LVEFcmr, LV mass, T1 mapping with mean extracellular volume (ECVm), and pre-gadolinium times quantification (preGDT1m) as markers of myocardial fibrosis.
Results. Feasibility of the MW analysis was 97%. As expected, E/E’ and sPAP were higher, while GLS was lower in HFpEF patients. GCW did not change, whereas GWW increased and GWE decreased significantly in HFpEF patients (Table). NTproBNP correlated with sPAP, LAVi, preGDT1m, and ECVm. ECVm was the only independent predictor of NTproBNP level (r = 0.40, p = 0.04). GWE corelated significantly with E’m, LVEFcmr, LV mass, and preGDT1m (all r &gt; 0.40, p = 0.001). GWW corelated significantly with sPAP, E/E’ ratio and E’m, LVEFcmr and LVmass, preGDT1m, and ECVm (all r &gt; 0.4, p &lt; 0.05). GWW was best predicted by a model composed by E"m, LVmass, preGDT1m (r = 0.5, r2 = 0.25, p = 0.003).
Conclusion. MWE decreases, whereas WW increases in HFpEF. Both parameters corelates significantly with diastolic dysfunction parameters, LV mass, LVEF, and most important with myocardial fibrosis markers evaluated by CMR. ECVm by CMR was the only independent predictor of NTproBNP. Therefore, new parameters of myocardial work, derived from 2DSTE, might provide a better understanding of HFpEF.
Table.Comparison between groups Group LVEF (%) E/E’ sPAP (mmHg) GLS (%) GWE (%) GCW (mmHg%) GWW (mmHg%) Controls (25) 58 ± 6 7.3 ± 2.4 23.2 ± 8.1 -21.5 ± 2 95.5 ± 1.8 2282 ± 552 87.9 ± 39.6 HFpEF (91) 60 ± 5.7 11.3 ± 3.5 34.3 ± 8.3 -18.2 ± 3 93.7 ± 3.9 2295 ± 279 119.6 ± 79.8 P value 0.09 &lt;0.001 &lt;0.001 0.01 0.03 0.90 0.03 Abstract Figure. Myocardial work assessment
Left atrial filling index in prediction of exercise induced pulmonary hypertension in patients with asymptomatic primary mitral regurgitation
Authors: Zvirblyte R , Montvilaite A , Tamulenaite E , Saniukaite A , Vaskelyte JJ 
Published: February 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction. In patients with chronic mitral regurgitation (MR), left atrium (LA) is one of the first cardiac structures, that are affected by progressive volume overload. Previous studies have shown that higher LA filling index (FI) could be a potential negative prognostic marker and it may provide additional information in cases where surgical valve correction is considered.
Purpose. The aim of this study was to evaluate the connection between the LA FI and exercise–induced pulmonary hypertension (EIPH) in patients with asymptomatic primary moderate to severe MR.
Methods. The study sample consisted of 50 patients (age 61.88 ± 12.88 years) with asymptomatic primary moderate to severe MR and preserved left ventricular (LV) ejection fraction (EF) (&gt;60%). All of the patients underwent resting and stress (bicycle–ergometry as per protocol 25 + 25W every 3 minutes) echocardiography. The ratio of the early–diastolic mitral inflow peak velocity (E) and LA reservoir strain was calculated as the LA FI. EIPH was considered as systolic pulmonary artery pressure (SPAP) ≥60 mmHg during peak stress.
Results. EIPH was identified in 13 (26%) patients with primary asymptomatic MR. LA FI at rest, during initial and peak stress was higher in patients with EIPH (p = 0.041, p = 0.023 and p = 0.036, respectively). LA FI at rest (r = 0.334; p = 0.044), during initial (25W) stress (r = 0.371; p = 0.037) and during recovery phase (r = 0.408; p = 0.023), weakly correlated with SPAP during maximal achieved workload. In univariate logistic regression analysis, LA FI during initial and peak stress was significantly related to EIPH (Table 1). According to ROC analysis, LA FI &gt;6.46 during initial stress could predict EIPH with 70.0% sensitivity and 75.0% specificity (p = 0.023). LA FI &gt;9.59 during peak stress could distinguish the possibility of underlying EIPH with 60.0% sensitivity and 94.3% specificity (p = 0.036).
Conclusions. Resting and exercise LA FI was higher in subjects with EIPH. LA FI during stress could be the potential predictor of EIPH in patients with asymptomatic primary MR and preserved LV EF.
Table 1 Parameter β Chi-Square Odds ratio Standard error 95% CI p value LA FI at rest 1.21 3.549 3.271 0.106 0.984 - 1.489 0.071 LA FI during initial (25 W) stress 1.535 6.056 4.812 0.195 1.047 - 2.250 0.028 LA FI during peak stress 1.662 7.364 4.646 0.236 1.047 - 2.638 0.031 LA FI during recovery phase 1.257 3.998 3.139 0.129 0.976 - 1.619 0.076 LA - left atrium FI - filling index Abstract Figure. Picture 1