bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right atrio-ventricular strain as a predictor of death in left-sided heart failure
Authors: Vijiiac A E , Scarlatescu A , Petre I , Onciul S , Vatasescu R 
Published: October 2024

Abstract

Background
Right ventricular (RV) strain is an established outcome predictor in heart failure (HF). However, the role of right atrial (RA) strain in the setting of left-sided HF is incompletely understood.

Purpose
We sought to evaluate the RV, RA and combined right atrio-ventricular (RAV) strain using speckle-tracking echocardiography in a cohort of patients with left-sided HF and to assess their prognostic role.

Methods
121 consecutive patients (mean age 59±14 years, 74% men) with HF with reduced ejection fraction (HFrEF) referred to our echocardiography department were prospectively enrolled. The main endpoint was all-cause death. RV strain was measured as the average longitudinal strain of the basal, mid, and apical segments of the RV free wall and was reported as a positive value, thus a lower RV strain reflecting a greater longitudinal dysfunction. RA strain was defined as the maximal longitudinal displacement of the atrial wall at end-systole, corresponding to atrial reservoir function. RAV strain was defined as the sum of RV strain and RA strain.

Results
During a median follow-up of 19±11 months, 26 patients (21%) died. Patients who reached the endpoint had lower left ventricular ejection fraction (LVEF) (21±7% vs. 26±7%, p=0.001), lower tricuspid annular plane systolic excursion (16±3 vs. 18±5, p=0.02) and lower RA strain (13± 10% vs. 18±11%, p=0.03). In univariable Cox regression, RV, RA and RAV strain were all predictors of death: HR=1.05 [95% CI, 1.00-1.11], p=0.045 for RV strain, HR=0.95 [95% CI, 0.91-0.99], p=0.02 for RA strain, HR=0.97 [95% CI, 0.94-0.99], p=0.01 for RAV strain. We constructed a multivariable model with well-established event predictors in HFrEF and one strain index at a time. After adjustment for LVEF, maximal left atrial volume, tricuspid regurgitation severity and pulmonary artery systolic pressure, only RAV strain remained an independent predictor of death (HR=0.97 [95% CI, 0.94-1.00], p=0.04), while RV strain and RA strain did not (p=0.07 for both). LVEF did not emerge as a predictor of death in multivariable regression (p=0.57).

Conclusion
In left-sided HF, RV and RA strain were predictors of death. Combining the longitudinal strain of both right heart chambers might improve risk stratification, since RAV strain remained the only independent predictor of adverse outcome after adjustment for confounders.
Inter-Vendor differences in speckle tracking strain - A ten year follow-up on the Strain Standardization Task Force Inter-Vendor Comparison Study
Authors: Balinisteanu A E , Duchenne J , Puvrez A , Wouters L , Bezy S , Youssef A , De Groef K , Van Langenhoven L , Papangelopoulou K , Cieplucha A , Cattapan I , Tostes P , Vinereanu D , Voigt J U 
Published: October 2024

Abstract

Background
Global longitudinal strain (GLS) derived from two-dimensional speckle-tracking echocardiography is feasible and accurate. Nonetheless, in 2013, the Inter-Vendor Comparison Study showed significant differences of measurement results among vendors. In order to make tracking-based strain imaging a clinically accepted and useful parameter, it is of outmost importance to have interchangeable and accurate measurement results from all vendors.

Purpose
To investigate if the efforts of the EACVI/ASE/Industry Task Force to Standardize Deformation Imaging have led to a reduction of inter-vendor differences during the past ten years.

Methods
In an unique setting, in one single room, 372 echocardiographic examinations were performed in sixty-two subjects (50 male, age 56.1 ± 16.98) with a wide range of left ventricular (LV) function (ejection fraction from 30% to 64%) using ultrasound systems from six manufacturers. Each subject was scanned consecutively on all machines by the same assigned experienced sonographer. For each subject two image sets of LV apical views were acquired in order to assess reproducibility in a true test-retest setting. We assessed mean GLS (GLSAV) as average peak systolic global strain from the three apical views on five vendor-specific and five vendor-independent software solutions. We measured endocardial and mid-/full-wall GLS. Since there is no gold standard method to measure GLS, we compared GLSAV of each vendor to the average of the GLS values only from vendors that provide tracking software solutions (SWS) for clinical use.

Results
For both endocardial (Figure 1) and mid-/full-wall (Figure 2) GLS measurements from clinical SWS were comparable and within a very narrow range (mean GLS of vendors 17.25 ± 0.3% and 15.36 ± 0.3% respectively). The maximum absolute difference between all SWS was 4.1% and 4.9% strain units for endocardial and mid-/full-wall GLS respectively. GLSAV of each software versus the mean of clinical SWS showed significant correlation for most of the companies (r² &gt;0.8, p&lt;0.001). Test-retest variability of GLS measurements expressed as relative mean error was good and lower than for LV ejection fraction (6.3% on average for mean GLS and 7% for LV ejection fraction, p&gt;0.05).

Conclusions
Our data show a substantial inter-vendor bias in GLS measurements. Nevertheless, in contrast to the situation ten years ago, companies that provide tracking software solutions for clinical use provide now very similar GLS values. In addition, most companies do now allow mid-/full-wall tracking. Our data indicate that the efforts of the strain standardization task force have been fruitful. A continuing effort is needed until all software providers adhere to the task force consensus recommendations.Figure 1Figure 2
Long-term prognostic value of heart rate recovery in patients with left bundle branch block without inducible ischemia and without known coronary artery disease
Authors: Boskovic N , Tomovic S , Dedic S , Viduljevic M , Tesic M , Jovanovic I , Aleksandric S , Antonijevic N , Petrovic O , Banovic M , Nedeljkovic I , Beleslin B , Giga V , Djordjevic-Dikic A 
Published: October 2024

Abstract

Background
Heart rate recovery (HRR) has been shown to predict cardiovascular and all-­cause morbidity and mortality. Left bundle branch block (LBBB) is often associated with significant heart disease and is often the result of underlying coronary artery disease (CAD), myocardial injury, strain or hypertrophy. However, there are insufficient data on the prognostic value of HRR in patients with LBBB without inducible ischemia and without known CAD.

Aim
The aim of this study was to determine the long-term prognostic value of HRR in patients with LBBB without inducible ischemia and without known CAD.

Methods
This retrospective study included 182 patients (64, 35.2% male gender, average age 63 ± 10 years) with LBBB and without known CAD who were referred to the SECHO test for chest pain. All the patients had negative SECHO test according the Bruce protocol. Risk factors for CAD (diabetes, smoking, hypertension, high cholesterol and positive family history of CAD), functional capacity (Metabolic Equivalents - METs) and heart rate recovery (HRR) were recorded in all patients. HRR was calculated as the difference between heart rate at the peak stress and heart rate in the first minute of rest. Slow HRR was defined as ≤18 beats/min. Median follow up of the patients was 102.5 months (IQR 68-146 months) for the occurrence of MACE (all-cause mortality, non-fatal myocardial infarction (MI), coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI)).

Results
Overall, 16pts (8.8%) had slow HRR. During the follow-up period 34 out of 182 patients (18.7%) had an adverse event (16 deaths, 10 non-fatal MI, 1 CABG and 7 PCI). Using the Cox regression analysis, univariate predictors of MACE were age (B=0.050, HR 1.051 [95% CI 1.011-1.093], p=0.012), hypertension (B=-1.219, HR 3.385 [95% CI 1.071-10.699], p=0.038), MET (B=-0.183, HR 0.833 [95% CI 0.706-0.982], p=0.030), diabetes (B=0.981, HR 2.667 [95% CI 1.267-5.612], p=0.010) and slow HRR (B=1.171, HR 3.225 [95% CI 1.307-7.959], p=0.011). However, in the multivariate analysis only slow HRR remained the independent predictor of MACE (B=0.974, HR 2.648 [95% CI 0.980-7.151], p=0.048). Using the Kaplan-Meier survival curve we see that the patients with slow HRR had much shorter event-free time compared to the patients with normal HRR (106.9 ± 14.9 months vs 157.9 ± 24 months, Log Rank 7.227, p=0.007) (Figure 1.).

Conclusion
Slow HRR is an independent long-term predictor of adverse events in patients with left bundle branch block without inducible ischemia and without known coronary artery disease.Kaplan-Meier survival curve for the MACE
Comparative analysis of the 2016 diastolic guidelines and left atrial stiffness in predicting exercise tolerance and cardiac events
Authors: Noh S A , Park J S , Choi H M , Hwang I C , Yoon Y E , Cho G Y 
Published: October 2024

Abstract

Background
While the 2016 ASE/EACVI guideline for diastolic dysfunction is a robust tool for prognostication, their complexity and 20% rate of indeterminate limit their routine clinical practice.

Purpose
Left atrial (LA) stiffness, calculated as the E/e' ratio divided by LA strain, provides a simpler measure that indirectly reflects LA pressure. This study aims to evaluate whether LA stiffness can be better than the 2016 guidelines in predicting poor exercise tolerance and cardiac events (cardiac death or heart failure hospitalization) in patients with dyspnea.

Methods
In this retrospective single-center cohort study, 404 patients who underwent echocardiography and cardiopulmonary exercise test simultaneously were reviewed. Poor exercise tolerance was defined by a peak oxygen uptake (VO2) of &lt;14 ml/kg/min or a minute ventilation-carbon dioxide production (VE/VCO2) slope of ≥ 40. The predictive abilities of LA stiffness for peak VO2, VE/VCO2 slope, and cardiac outcomes (cardiac death or heart failure hospitalization) were compared to those of the 2016 guidelines using ROC curve analysis.

Results
The mean left ventricular ejection fraction was 50% (IQR 58.58-66.70). Of the 404 patients (mean age 58.51, male 50.74%), peak VO2 &lt; 14 and VE/VCO2 ≥ 40 were observed in 38 and 24 patients, and cardiac events occurred in 37 patients during median follow up of 85.45 months. ROC analysis showed that LA stiffness had AUC values of 0.697 (95% CI: 0.604-0.789) for peak VO2 &lt; 14, 0.645 (95% CI: 0.529-0.760) for VE/VCO2 slope ≥ 40, and 0.628 (95% CI: 0.541-0.715) for cardiac events. The 2016 guidelines achieved AUCs of 0.685 (95% CI: 0.604-0.766), 0.586 (95% CI: 0.481-0.690), and 0.589 (95% CI: 0.505-0.674). Statistical comparison revealed no significant difference between the predictive capabilities of LA stiffness and the 2016 guidelines (p-values: 0.735, 0.165, and 0.439, respectively). (Figure)

Conclusion
LA stiffness offers comparable diagnostic accuracy to the 2016 ASE/EACVI guidelines in assessing poor exercise tolerance and cardiac events in patients with dyspnea. Given its simplicity and ease of measurement, LA stiffness represents a viable alternative for evaluating diastolic dysfunction.ROC curve
Effects of short-term exposure to high altitude on cardiac function
Authors: Xu Y U N , Wang Y I , Wang S , Yin L 
Published: October 2024

Abstract

Background
What effect does short-term high altitude exposure have on heart function? Can people exercise in the highlands? what changes occur in heart function during exercise in highland areas? This study will explore these topics.

Objectives
To investigate the difference of heart function between people at sea level and at high altitude, and to study the changes of short time exercise on heart function at high altitude.

Methods
36 healthy subjects were recruited to go to high altitude area after underwent exercise echocardiography on a supine bicycle at sea level. They ascended to 3600m within 24 hours by bus.Another exercise echocardiography was performed on the day of arrival.Heart rate (HR), blood pressure (BP) and blood oxygen saturation (SaO2) were monitored in real time during both examinations. Parameters such as left ventricular ejection fraction, E/ E 'and mean pulmonary artery pressure (mPAP) after rest and exercise were calculated.ΔmPAP /CO was calculated by (mean mPAP at peak -mean mPAP at rest )/(mean CO at peak-mean CO at rest).

Results
At peak exercise,SaO2,TRV,RVD2,SPAP,mPAP,PVR, ePLAR,RVAS,ΔMpap/CO were much higher at high altitude levels. (P &lt; 0.001); E,A,FAC,ΔS were significantly lower than that of the sea leval; at rest, HR,TRV,sPAP,mPAP ,PVR were much higher at high altitude levels than at sea leval(P &lt; 0.001)，SaO2,RVOT ACT, were significantly lower than that of the sea leval(P &lt; 0.001).

Conclusions
When healthy people are in high altitude environment, the heart function changes obviously. Supine bicycle exercise stress echocardiography can well monitor the heart function changes and provide quantitative data, providing new technical methods for future related research.
Noninvasive identification of ANOCA endotypes by stepwise, multi-stress, multi-marker stress echocardiography
Authors: Dedic S , Boskovic N , Tesic M , Ciampi Q , Jovanovic I , Giga V , Nedeljkovic I , Cortigiani L , Picano E , Djordjevic Dikic A 
Published: October 2024

Abstract

Background
Angina with non-obstructive coronary artery disease (ANOCA) is increasingly recognized in clinical practice, but effective therapy is difficult due to the heterogenity of pathophysiological substrates: organic coronary microvascular dysfunction (CMD), functional (vasospastic) CMD, epicardial artery vasospasm, non-cardiac chest pain. Current guidelines recommend invasive coronary function testing with the inherent cost of catheterization time, radiation exposure, iodinated contrast effects and risks of invasive procedures.

Objective
To evaluate the feasibility of a step-wise, multi-marker, multi-stress assessment of ANOCA patients by stress echocardiography (SE).

Methods
In a prospective study design, we enrolled 54 ANOCA patients (age =54±14 years, 14 men, 25 %), without significant coronary artery disease (CAD) on invasive or noninvasive angiography. In all patients hyperventilation (HYPER) test (30 deep breaths/min for 5 min) was performed, followed by semi-supine exercise (EX) if negative. All patients underwent adenosine (ADO) test with coronary flow velocity reserve (CFVR) measurement in the mid-distal left anterior descending artery (LAD). Positivity criteria were a coronary flow velocity (CFV) decrease during HYPER despite the increase in the double product (DP) indicating functional CMD i.e. vasoconstriction); the presence of inducible regional wall motion abnormality (RWMA) with HYPER-EX (microvascular/epicardial spasm), and CFVR ≤2.0 with ADO hyperemia (organic CMD).

Results
Fifty one pts (94%) had normal increase in CFV at ADO: CFV rest 0.264±0.078 vs ADO 0.608±0.133, p&lt;0.001, while 3pts (5%) showed decrease in CFV at ADO suggesting organic CMD. Double product (DP) increased during HYPER (rest 10061 ±2406 vs. HYPER 13580 ±3356, p&lt;0.001). Twenty-nine pts (53%) showed a paradoxical vasoconstrictor response during HYPER despite the increase in DP (CFV decreased during HYPER: CFV rest 0.261±0.059 vs HYP 0.216±0.057, p&lt;0.001). With HYPER-EX, RWMA was induced in 15 patients (27%), while 7 patients had also RWMA during HYPER.

Conclusion
In patients with ANOCA, a stepwise multi-marker (CFVR and RWMA) and multi-stress (ADO, HYPER and EX) SE identifies CMD phenotypes and actionable therapeutic targets. According to our results functional vasospastic CMD (paradoxical decrease of CFV with HYPER), is more frequent than organic CMD (reduced CFVR with ADO) in patients with ANOCA. Inducible RWMA with HYPER-EX indicate severe vasoconstrictor response.
Assessment of circulating biomarkers and hemodynamic response during stress to detect early cardiopulmonary complications in systemic sclerosis
Authors: Agoston G , Morvai-Illes B , Jdid Mahmoud S , Hullo D , Szabados T , Varga A , Kovacs L , Bencsik P 
Published: October 2024

Abstract

Background
Systemic sclerosis (SSc) is characterised by persistent immune-inflammatory system activation and excessive extracellular matrix (ECM) accumulation leading to fibrosis. Exercise Doppler Echocardiography (EDE) is a promising method to detect the early changes of fibrosis-related pulmonary and myocardial complications, like elevated left ventricular filling pressure or stress-induced pulmonary hypertension (PH).

Aims
The study aims to assess the linkage between the activity of fibrosis markers and abnormal exercise haemodynamics during stress in patients with SSc.

Methods
A total of 18 patients with SSc were enrolled in the single-centre prospective study (age 54±15,5years, 94,4 % women). SSc patients with resting PH and moderate to severe pulmonary fibrosis were excluded. According to a standardised protocol, all subjects underwent resting and exercise echocardiography on a semi-recumbent cycle ergometer with an incremental (25 watts) workload up to the maximally tolerated workload. Measurements focused on the left ventricular diastolic function (E/e’) and right ventricular haemodynamics (estimated systolic pulmonary pressure: PASP, right ventricular coupling: TAPSE/PASP, pulmonary vascular resistance: PVR). Blood samples were taken immediately before the stress test, and the Matrix Metalloproteinase-9 and 2 (MMP-9, MMP-2) levels were assessed with gelatin zymography method.

Results
During the EDE, PASP from baseline increased significantly (24,6mmHg±11 vs 38±16mmHg, p &lt;0,0001), also PVR (1,2±0,49 vs 1,5±0,15 Wood unit, p&lt;0,001) RV coupling was decreased significantly (1,2±0,68 vs 0,93±0,5, p&lt;0,001). Left ventricular E/e’ was also increased during the stress (8,2±2 vs 10,5±5,1, p&lt;0,05). Enzymatically active MMP-9 level was significantly correlated with RV coupling at rest and stress (p&lt;0,05, r 0,63 at rest and r 0,52 at stress) and negatively correlated with PASP (p&lt;0,05, r:-0,62 at rest and r -0,5 at stress). MMP-2 level only negatively correlated with resting PASP (p&lt;0,05, r:-0,527). The left ventricular parameters did not show any relationship with MMP levels.

Conclusions
The level of circulating MMP-9 predicts haemodynamic behaviour during stress in SSc. MMPs could be a promising marker for detecting early changes in the right ventricle-pulmonary circulation unit.
Prognostic preoperative factors for recurrence of tricuspid regurgitation following annuloplasty: examining the influence of 3d echocardiography
Authors: Verikas D , Krivickiene A , Jakuska P , Siudikas A , Vaskelyte J J , Ereminiene E 
Published: October 2024

Abstract

Introduction
The increasing worry revolves around the reappearance of tricuspid regurgitation (TR) following tricuspid annuloplasty (TA) among individuals dealing with functional tricuspid regurgitation (FTR). Despite TA's efficacy as a treatment, a complete understanding of the echocardiographic elements influencing the recurrence of TR is pivotal. This knowledge holds the potential to guide the development of more robust preventive strategies, aiming to ease the incidence of recurrent TR after TA.

Aim
The aim of this study was to examine the prognostic value of tricuspid valve (TV) and echocardiographic parameters related to both right ventricular (RV) geometry and function. Specifically, our focus is on understanding these relationships in the context of recurrent TR following TA.

Methods
This prospective observational cohort study aimed to investigate determinants of recurrent TR post-surgical TV repair. The focus was on patients with moderate or severe functional TR related to left heart valvular disease, primarily severe mitral regurgitation, excluding those with ischemic heart disease. The study involved 66 participants, assessed preoperatively with 2D and 3D echocardiography, examining RV and right atrial (RA) geometry, functional, and TV parameters. TR severity followed ESC guidelines. Two groups were formed: effective TA group (50 patients) and recurrent TR group (16 patients), defined by mild to moderate TR and significant moderate-severe TR one year post-surgery, respectively. Statistical analysis employed SPSS software, with adjusted univariate logistic regression considering age and gender.

Results
Of the patients, 54% were male, with a mean age of 68±9 years. Echocardiography parameters in Table 1 showed no significant differences in gender, left ventricular, atrial geometrical, functional parameters, or preoperative effective regurgitant TV orifice area between groups (recurrent TR vs. effective TA: 38 [33] mm2 vs. 29 [15] mm2, p=0.117). Univariate logistic regression analysis highlighted RV and RA geometry, along with TV diameter, as predictors for recurrent TR. Notably, 3D TV geometrical parameters had prognostic significance, as confirmed by univariate adjusted logistic regression analysis. Functional RV parameters did not exhibit statistical significance in this analysis.

Conclusion
In conclusion, the recurrence of moderate-severe functional tricuspid regurgitation following tricuspid annuloplasty is linked to the tricuspid annulus size, as well as the geometry of the right atrium and right ventricle before surgery. Notably, no correlation was identified between the recurrence of TR and alterations in RV function.
Speeding up echocardiographic examination by automated generation of 2D imaging views from 3D volumetric data using machine learning
Authors: Fan Y , Tam J , Wong K Y , Lee A 
Published: October 2024

Abstract

Background
3D echocardiographic data contain infinite 2D echocardiographic planes generated by multiplanar reconstruction, but the process is labor-intensive and time-consuming. Artificial intelligence (AI) utilizing cutting-edge machine learning techniques may improve the accuracy and efficiency of the process. In the study, we developed and validated an AI software that automatically reconstructs 7 2D views recommended by the American Society of Echocardiography from 3D echocardiographic data.

Method
Convolutional neural network (CNN) architecture utilizing Spatial Configuration Net was used as the machine learning model. We identify a minimum of 3 key feature landmarks on each 2D cross-sectional plane, with the 3D coordinates representing 2D cross-sectional planes accordingly. Subsequently, these landmarks are accurately labeled within a 3D space. 31 landmarks were identified across 7 2D cross-sectional planes and a total of 472 3D volume data were labelled. The performance of the model is evaluated by Root Mean Square Error (RMSE) of the predicted landmark coordinates.

Results
The mean RMSE over 31 predicted landmarks evaluated in testing is 2.70% for the input 3D volume dimensions. The average time used to generate the 7 2D imaging views was 19.91±3.19 seconds (figure).

Conclusion
The AI algorithm can efficiently convert 3D echocardiographic data into guideline-recommended 2D images, which shortens the length of echo examination but still preserves the accuracy.AI generation of 2D views from 3D echo