bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tricuspid regurgitation in rheumatic heart valve disease. New insights from 3D transthoracic echocardiography
Authors: Mahia P , Marcos Alberca P , Olmos C , Pozo E , Luaces M , Gomez De Diego J J , Rivadeneira M , De Agustin J A , Perez Villacastin J 
Published: October 2024

Abstract

Background
The assessment of tricuspid valve (TV) and functional tricuspid regurgitation (FTR) in left side valvular disease is crucial in assessing the need for surgical intervention. Despite the declining incidence of rheumatic disease, it remains a a common cause of valvulopathy. According to current guidelines, TV surgery is recommended in presence of severe TR or non-severe with annulus dilatation assessed by two-dimensional echo (2DE).

Objectives
To assess tricuspid annulus (TA) 3D dimensions in relation to the severity of tricuspid regurgitation (TR) and to identify new parameters associated with the presence of severe TR in this scenario.

Methods
Fifty patients (Age: 69±9, 82% women) with rheumatic heart disease without previous valve replacement and functional tricuspid regurgitation (FTR) were prospectively included. Two-dimensional echocardiography (2DE) and three-dimensional transthoracic full-volume datasets of the tricuspid valve (TV) were acquired. Two orthogonal planes corresponding to the anatomical antero-posterior (APD), septum-lateral (SLD), long intercommisural (LID), and area (A3D) of the TA were analyzed by 3D transesophageal echocardiography (3DTE) (Figure 1), in addition to 2D diameter. TR was graded into two groups: severe (n=14) or non-severe (n=26). The area under the curve (AUC), sensitivity (Se), and specificity (Sp) to identify the presence of severe FTR were calculated.

Results
All parameters differed significantly (p&lt;0.05) between the two groups (2D: 18.6±1.9 vs. 23.3±2.0 mm/m2; APD 17.0±3.3 vs. 21.5±3.0 mm/m2; SLD: 18.9±2.0 vs. 22.5±2.0 mm/m2; LID: 20.9±2.6 vs. 26.1±3.5 mm/m2; A: 5.6±1.3 vs. 7.6±1.4 cm2/m2). 2D diameter (Cut-off point: 20.6 mm/m2, AUC: 0.850, Se: 86%, Sp: 72%), A3D (Cut-off point: 6.5 cm2/m2, AUC: 0.835, Se: 86%, Sp: 78%), and LID (Cut-off point: 23.3 mm/m2, AUC: 0.833, Se: 78.6%, Sp: 77.8%) were the parameters with the best performance for severe FTR detection.

Conclusions
New 3D-derived parameters provide relevant information in the assessment of TA and offer good diagnostic performance for identifying severe FTR in this subgroup of patients.2D/3D Echo TA measurements
Feasibility, accuracy, and reproducibility of device sizing in virtual reality for percutaneous left atrial appendage closure - a single center study
Authors: Heidari H H , Kanschik D K , Wolff G W , Maier O M , Kelm M K , Werner N W , Zeus T Z , Jung C J , Afzal S 
Published: October 2024

Abstract

Background
Left atrial appendage closure (LAAC) is a safe and effective procedure for stroke prevention in patient with non-valvular atrial fibrillation. Procedural planning and device sizing remains challenging due to the highly complex and variable three-dimensional (3D) anatomy of the left atrial appendage (LAA). Virtual reality (VR) is a innovative, recent technology allowing a superior spatial orientation visualization of 3D imaging datasets.

Purpose
Therefore, we aimed to evaluate feasibility and accuracy of LAA measurements in VR for device sizing in patients planned for LAAC.

Methods
Twenty-one patients (79±7 years, 62% male) with non-valvular atrial fibrillation scheduled for LAAC were randomly included in our study. Preprocedural a multi-slice computed tomography (MSCT) was performed for device sizing in all patients. MSCT-based 3D models were established and visualized in VR using a dedicated software (VMersive, Warsaw, Poland). LAA dimensions (Ostium, landing zone (LZ), and depth) were assessed directly in the virtual environment. Conventional measurements of LAA ostium, landing zone (LZ) and depth using commercially available software were compared to measurements in VR.

Results
3D reconstruction of MSCT datasets and visualization in VR were successfully performed automatically in all patients within a few seconds. MSCT and VR demonstrated good correlations for ostium minimum (r = 0.93), maximum (r = 0.8) and mean (r = 0.88, all p&lt;0.001) diameters. Additionally, LZ minimum (r=0.84), maximum (r=0.86) and mean (r=0.9) diameters showed good correlation (all p&lt;0.001). Moderate correlation was observed for depth measurements (r=0.76, p&lt;0.001). Furthermore, intraclass correlation coefficients ranging from 0.88 to 0.98 denoted high inter- and intraobserver agreement.

Conclusion
Immersive VR allows highly feasible, accurate and reproducible measurements of the LAA dimensions directly in the virtual environment, hence enabling accurate device sizing for LAAC.
Reverse RV remodeling after isolated tricuspid valve surgery
Authors: Mane F , Luque M , Azzam I K , Melo C , Anguita Gamez M , Mahia P , Gomez De Diego J J , Olmos C , Luaces Mendez M , Vilacosta I , Perez-Villacastin J , De Agustin A , Maroto L , Carnero M , Pozo Osinalde E 
Published: October 2024

Abstract

Background
Impact of tricuspid regurgitation (TR) on right ventricular (RV) and atrial (RA) size and function is one of the main determinants of prognosis. However, there is scarce data about the recovery of right chambers after isolated tricuspid valve surgery (ITVS).

Purpose
Our aim is to evaluate postsurgical changes in right chamber morphofunctional parameters by echocardiography after ITVS.

Methods
We selected all the patients that underwent ITVS in our tertiary centre between 2009 and 2022 excluding those with congenital anomalies. Echocardiographic right ventricular classical parameters (RV diameters, RA area, TAPSE and fractional area change (CAF)) as well as myocardial deformation (free wall (FW)- and 4 chambers (4C)- global longitudinal strain (GLS)) were compared in baseline studies, early and late postsurgical periods.

Results
Among the 45 patients included (65 ± 2 years-old, 51% female, TRI-SCORE 2 [1-4]) surgical indication was functional TR in 51%, 29% underwent tricuspid valve repair and 71% replacement. The treatment was considered ineffective (postoperative TR ≥ moderate) in 9%. In the early postsurgical phase (1.9 [1.2 – 3] months) a significant reduction in basal (-17%, p&lt;0.01), mid (-15%, p&lt;0.01) and longitudinal (- 7%, p&lt;0,01) RV diameters as well as RA area (-26%, p&lt;0.01) was noted. These changes persist in the late postoperative period for basal (-16%, p&lt;0.01) and mid (-20%, p&lt;0.01) RV diameters and RA area (-19%, p=0.03). RV function parameters suffer significant reduction in the early phases: TAPSE (-39%, p&lt;0.01), FAC (-24%, p&lt;0.01), FW-GLS (-17.1%, p&lt;0.01) and 4C-GLS (-16.3%, p&lt;0.01). In later stages the major worsening in classical parameters persist: TAPSE (-28%, p=0.01) y FAC (-20%. P=0.01). However, strain variables recover to the baseline values. Postoperative RV reverse remodeling is reflected in Table and Figure.

Conclusions
Postoperative changes in echocardiographic right chambers features after ITVS suggest that myocardial deformation parameters should be the method of choice for follow-up of this surgical procedure.
Table. Comparison of baseline and postsurgical echocardiographic parameters.
Figure. Echocardiographic parameters evolution.TableFigure
Deep learning for fully automated echocardiographic measurements of left ventricular wall thickness and chamber dimensions in the parasternal long-axis view
Authors: Holmstrom V , Smistad E , Ostvik A , Holte E , Nyberg J , Lovstakken L , Dalen H , Grenne B 
Published: October 2024

Abstract

Background
Accurate quantification of left ventricular (LV) wall thickness and chamber dimensions in the echocardiographic parasternal long-axis view (PLAX) is crucial for clinical decisions in patients with heart disease. However, there is a need for more reproducible and time-efficient methods. Fully automated deep learning (DL)-based methods could address this need.

Purpose
To develop a DL-based method for fully automated measurements of LV wall thickness and chamber dimensions in PLAX, validate its performance in a large population cohort, and evaluate its capacity to differentiate between hypertensive and normotensive groups.

Methods
DL networks were trained on PLAX recordings from 207 subjects. The DL method performed cardiac segmentation, timing of end-systole and end-diastole, and measured LV wall thickness and chamber dimensions in PLAX. The model was validated in a large populational echocardiography dataset including a subset with test-retest evaluation. Agreement with expert reference measurements, test-retest reproducibility, and comparison of normotensive and hypertensive (defined as those on hypertensive medication or with systolic blood pressure &gt;160 mmHg) groups were evaluated.

Results
In the populational study of 2047 subjects, the novel DL method demonstrated a feasibility of 97.6%. Strong agreement was observed between the automated DL method and expert readers in measuring end-diastolic septal thickness, posterior wall thickness, and LV diameter (bias 0.1 mm, 0.2 mm, and 2.2 mm, respectively, Figure 1). In a test-retest dataset (n=40, with 2 recordings per patient and 4 readers), the novel DL method displayed improved reproducibility compared to inter-reader measurements, with minimal detectable change for interventricular septal diameter 2.2 mm versus 2.6 mm, posterior wall diameter 1.2 mm versus 2.5 mm, and LV diameter 5.0 mm versus 6.3 mm (Figure 2). The DL method measured significantly wider septal diameter in the hypertensive group compared to normotensive group (p&lt;0.001). Mean analysis time for wall thickness and chamber dimensions using the DL method was 1.2 seconds.

Conclusion
The novel DL method accurately measured LV wall thickness and chamber dimensions in the PLAX view, and demonstrated improved test-retest reproducibility compared to experienced echocardiographers. Additionally, it was able to detect significantly wider septal diameters in the hypertensive population. By providing fast and reliable measurements in retrospective data, and with potential for real-time measurements during image acquisition, this DL method has the potential to improve the yield, efficiency, and workflow in echocardiography.Bland-Altman posterior wall diameterTest-retest posterior wall diameter
Accuracy of right atrial pressure estimation by transthoracic echocardiography
Authors: Ruge M , Pancio G , Mehrotra P , Marhefka G 
Published: October 2024

Abstract

Background/Introduction
Transthoracic echocardiography provides an estimate of right atrial pressure (RAP) using the guideline-recommend method of measuring inferior vena cava (IVC) diameter and collapsibility. Despite being ubiquitously reported and necessary for the estimation pulmonary artery systolic pressure, the accuracy of this method for RAP estimation has not been rigorously validated.

Purpose
To evaluate the accuracy of the guideline-recommended method for the estimation of RAP by TTE.

Methods
A single center, retrospective chart review of patients who had a TTE and right heart catheterization (RHC) within 48 hours of each other from January 2018 to December 2020. Maximum and minimum IVC diameter were measured by trained study personnel. Accuracy was then stratified by the presence/absence of a history of two variables that could modify IVC diameter independent of RAP—syncope, which is associated with more dilated IVC in some studies and liver disease, which could result in compression (from parenchymal fibrosis surrounding the IVC) or dilation (from diversion of portal blood flow through the IVC among other mechanisms) of the IVC.

Results
The 117 patients who met inclusion criteria had a median age of 67 years old (interquartile range [IQR] 58 – 75) and median RAP of 13 mmHg (IQR 8 – 18) on RHC. The median time between TTE and RHC was 9.6 hours (IQR 3.8 – 24.5 hours) during which 24 (20.5%) patients received intravenous fluids (median 220 mL administered; IQR 145 – 320). Forty-three (35.9%) received diuretics between the studies with most patients receiving either 1 (26 patients, 61.9% of those who received diuretics) or 2 (13 patients, 31.0%) diuretic doses.
In evaluating accuracy, only 26 patient’s (20.5%) RAP by RHC fell within estimated RAP range by TTE (Figure 1). After excluding the 60 patients who received fluids and/or diuretics between the TTE and RHC, the TTE estimate was still only accurate in 13 (22.8%) patients. When analyzing how each subcomponent of the TTE guidelines for RAP estimation correlated with RAP via RHC, maximum IVC diameter and percent collapsibility had Pearson’s correlation coefficients of 0.47 and 0.24 respectfully (Figure 2A and 2B).
Past medical history was significant for syncope in 16 patients (13.7%) and liver disease in 8 patients (6.8%). Compared to those without each factor, the absolute accuracy of the TTE estimate was lower when stratified by a history of syncope (12.5% accurate vs 21.8%, p = 0.60) and liver disease (12.5% vs 21.2%, p = 0.90) though neither were statistically significant.

Conclusion
In this retrospective chart review, RAP estimation by TTE using the guideline-recommended method had limited accuracy. Prospective evaluation with minimal time between RHC and TTE is needed to validate the accuracy of the TTE guidelines.Accuracy of TTE for RAP estimationCorrelation between RAP & TTE Variables
Small heart size and premature death in 366,484 individuals with normal ejection fraction
Authors: Rowe S , Paratz E , Fahy L , Janssens K , Spencer L , D'ambrosio P , Strange G , Prior D , Playford D , La Gerche A 
Published: October 2024

Abstract

Background
In patients with preserved left ventricular ejection fraction (LVEF), small ventricular size has been associated with reduced functional capacity, but its impact on clinical outcomes is unclear.

Purpose
The goal of this study was to determine the relationship between small heart size and premature mortality within a large multi-centre adult patient cohort with transthoracic echocardiographic examinations.

Methods
We divided 366,484 individuals with LVEF ≥ 50% (including a sub-set of 279,442 individuals with high-normal LVEF ≥ 60%) by sex and increasing quartiles for LV end-diastolic volume (LVEDV), LVEDV indexed to body surface area (LVEDVi) and LV end-diastolic diameter to assess associations with 5-year mortality through linkage with the National Death Index.

Results
During 2-million person-years of follow-up, 65,241 deaths occurred. Increasing LV chamber size was associated with reduced odds of 5-year all-cause mortality, particularly for higher LVEF. As compared with the larger quartiles, the smallest cardiac size quartiles were associated with higher 5-year all-cause mortality, even after adjusting for age (Figure 1). The smallest LVEDVi quartile was associated with a 14% and 18% higher odds of 5-year all-cause mortality for males and females, respectively, with a greater effect with high-normal LVEF. For cardiovascular-related mortality, females in the smallest quartile for LVEDVi had a 17% increased odds of mortality, which increased to 30% in those with LVEF was ≥ 60%. In men, there was no significant association between smallest cardiac size and cardiovascular-related mortality.

Conclusions
In individuals with normal LVEF, small ventricular size is associated with increased mortality, particularly among females and those with higher LVEF.
Automated selection of echocardiographic views using a novel artificial intelligence software
Authors: Gessert N G , Szasz D , Wehle S , Chaudhari A , Waechter-Stehle I , Slivnick J A , Cotella J , Mor-Avi V , Lang R M 
Published: October 2024

Abstract

Background/Introduction
Evaluation of a single echocardiographic study involves sorting, selecting, measuring and interpreting a large number of images. As these steps are currently performed manually, this can turn into a repetitive, time-consuming and tedious task. Although the use of artificial intelligence (AI) software could potentially improve this entire workflow, most of the efforts have been focused on measurement automatization. Incorporation of automated selection of echocardiographic views could further optimize this process.

Purpose
We investigated whether an AI-derived measurements software can be supplemented by automated view selection using an AI model. We hypothesized that automated selection of echocardiographic views yields similar results compared to manually selected views when using the same tool for automated measurements in both groups (Figure 1, top).

Methods
We trained an AI model (convolutional neural network) to recognize the main standard 2D echocardiographic views. This model was trained on individual frames from 20,000 DICOM clips to predict a specific cardiac view, based on the view annotation provided by an echocardiography expert (ground-truth). We then selected a test set of 5,000 DICOMs where we applied the AI model to all images in the study. We selected the highest-ranking apical 2 chamber (A2C) and apical 4 chamber (A4C) images, based on the model’s output probability (Figure 1, bottom). For the same 21 studies, an expert selected the best A2C and A4C image for left ventricular volumes and ejection fraction measurements. Then, we ran Philips AutoMeasure both on manually and automatically selected images. We then compared the measurement values for statistical significance using a pair-wise t-test, see Figure 2.

Results
The AI model achieved an accuracy of 96% and AUC of 0.99 on the test set. The results obtained when comparing the automatic and manually selected images in the 21 studies are shown in Figure 2. For all the measured parameters, there was no statistically significant difference in mean values between both selection methods.

Conclusions
Manual and AI-derived selection of standard echocardiographic images do not lead to a statistically significant difference in automated measurements, suggesting that incorporation of automated view selection may contribute to improve daily echocardiographic workflow. Future research could aim in extending these findings to more cardiac views, parameters, and populations.Comparison of the approachesResults
Sex differences in diastolic function following myocardial infarction on doppler echocardiography
Authors: Chan N I , Atherton J J , Hammett C , Stewart P , Mallouhi M , Vollbon W , Parsonage W , Prasad S B 
Published: October 2024

Abstract

Background
Whilst females have relatively greater preservation of left ventricular ejection fraction (LVEF) following myocardial infarction (MI), they have higher rates of heart failure, presumably due to diastolic dysfunction (DD).

Objectives
This study sought to assess sex differences in LV diastolic function on Doppler echocardiography following MI.

Methods
Data on 2505 consecutive patients with a first-ever MI were included. Echocardiography was performed within 24 hours of admission. Significant DD was defined as grade 2+3 DD according to current ASE/EACVI guidelines. Diastolic function score (DFS) was calculated by summing the number of abnormal parameters out of the 4 key diastolic parameters (e’ velocity, E/e’ ratio, left atrial volume index [LAVI], tricuspid regurgitation velocity [TRV]).

Results
Compared to males, females were older, had greater co-morbidity, less 3-vessel disease, and a higher LVEF (55.0+9.8% versus 52.7±9.8%, p&lt;0.001). LAVI, e’ velocity, E/e’ ratio, significant DD and DFS were significantly associated with female sex on univariate group comparisons. In multivariable models incorporating clinical, angiographic and echocardiographic data to determine independent predictors of diastolic parameters, female sex was independently associated with abnormal LAVI (OR 1.42, p=0.013), E/e’ ratio (OR 2.86, p&lt;0.001), TRV (OR 1.83, p=0.005), significant DD (OR 2.12, p&lt;0.001) and DFS (OR 2.60, p&lt;0.001).

Conclusions
Female sex is a strong independent correlate of diastolic dysfunction on Doppler echocardiography in patients with a first-ever MI. This may explain the higher incidence of heart failure despite relatively preserved LVEF in females following MI.
Endogen microvascular dysfunction is associated with worse outcomes in heart transplantation
Authors: Abadie B , Besir B , Bhat P , Jacob M , Starling R , Ziada K , Tang W H , Jaber W 
Published: October 2024

Abstract

Background
Cardiac allograft vasculopathy (CAV) affects the health of both epicardial and microvascular blood vessels in heart transplants. Coronary microvascular dysfunction (CMD) has been associated with poor outcomes in the non-transplant population. Two patterns of microvascular dysfunction have been characterized, classical (low stress flow) and endogen (high rest flow). Whether these patterns of microvascular dysfunction are associated with outcomes in the transplant population has not been thoroughly evaluated.

Purpose
The purpose of the study was to assess the relationship between microvascular dysfunction and adverse outcomes in patients with heart transplants.

Methods
Patients with no history of angiographic CAV who underwent positron emission tomography myocardial perfusion imaging and were found to have normal perfusion (summed stress score = 0) were included in the study. Patients were then classified by microvascular dysfunction: normal (flow reserve ≥ 2.0) versus abnormal (flow reserve &lt;2.0). Patients were further subclassified based on pattern of microvascular dysfunction, classical (stress myocardial flow &lt;1.7 mL/min/g) and endogen (stress myocardial flow ≥1.7 mL/min/g). The two primary outcomes were all-cause mortality and a composite of death, heart failure hospitalization, acute coronary syndrome, and revascularization. Kaplan-Meier survival and Cox proportional regression were used to assess the relationship between microvascular function and outcomes.

Results
In total, 359 patients were enrolled in the study, of which 29 (8%) had classical CMD and 78 (22%) had endogen CMD. Patients with endogen CMD were more likely to be women (46%) compared to 31% for normal microvascular function and 24% for classical CMD. During a median follow up period of 2.0 years (Q1 1.7, Q3 2.3), 36 patients had an adverse event and 19 patients died. Endogen CMD was associated with a significantly higher risk of both the composite outcome, HR 2.30 (1.15 – 4.61), and all-cause mortality, 4.19 (1.64 – 10.73). Classical CMD was not associated with either the composite outcome, HR 0.88 (0.20 – 3.84) or death, HR 1.02 (0.12 – 8.33), however assessment of classical CMD was limited by small sample size.

Conclusions
Endogen-type CMD is associated with worse intermediate-term outcomes in transplant patients compared to normal microvascular function and classical-type CMD, although comparison to classical-type CMD was limited by small sample size.Table 1:DemographicsFigure 1:KM Survival Curves