bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right ventricular-pulmonary artery coupling assessed by two-dimensional strain predicts in- hospital complications in takotsubo syndrome
Authors: La Vecchia G , Iannaccone G , Russo M , Scarica V , Lillo R , Camilli M , Sanna T , Lombardo A , Lanza G A , Graziani F , Leone A M , Trani C , Burzotta F , Crea F , Montone R A 
Published: October 2024

Abstract

Background and purpose
Takotsubo syndrome (TTS) may lead to serious in-hospital complications. Our study aims to investigate the prognostic impact of right ventricular-to-pulmonary artery (RV-PA) coupling in patients with TTS.

Methods
Consecutive TTS patients were prospectively enrolled. RV function was evaluated by RV global longitudinal strain (RVGLS) and RV free wall strain (RVFWS) and RV-PA coupling was measured as the ratio of either tricuspid annular plane systolic excursion (TAPSE), RVGLS or RVFWS to pulmonary artery systolic pressure (PASP). Data about in-hospital complications (defined as acute heart failure, life-threatening arrhythmias and death from any cause) were collected.

Results
A total of 80 patients were analysed (71±11 years, female 77.5%) and in-hospital complications occurred in 33 (41%). Patients who experienced in-hospital complications had lower LV ejection fraction (LVEF), lower TAPSE/PASP, RVFWS/PASP and RVGLS/PASP and higher left atrial volume indexed (LAVi) values. LVEF (OR 0.913, 95% CI [0.858–0.971], p=0.004) and RVGLS/PASP (OR 0.098, 95% CI [0.012–0.788], p= 0.029) were independent predictors of in-hospital complications. Receiver operating characteristics (ROC) curve analysis showed an area under the curve (AUC) of 0.696 (95% CI [0.57–0.82], p= 0.002) of RVGLS/PASP for the prediction of in-hospital complications. A cut-off value of RVGLS/PASP of ≤ 0.48 %/mmHg showed a sensitivity and specificity of 75% and 60%, and allowed to identify 24% of patients who experienced in-hospital complications despite a preserved LVEF (≥50%).

Conclusion
RV-PA coupling assessed by RVGLS/PASP may help identifying TTS patients at higher risk of cardiovascular complications with an additional prognostic value to LVEF alone.
Left fascicular pacing is not inferior to left bundle branch pacing in preserving ventricular mechanical synchrony and cardiac function
Authors: Mao Y , Yang Y , Sheng X I A , Zhang J F , Ye Y , Wang M I N , Yang Y , Sun Y , Ma M M , Fu G S 
Published: October 2024

Abstract

Background
Left bundle branch pacing (LBBP) has emerged as a more physiological alternative to right ventricular pacing.However, capturing the pre-divisional LBB is not easy to accomplish. This study investigates if left fascicular pacing(LFP), defined as the capture of one of the LBB fascicles, could achieve comparable left ventricular (LV) mechanical synchronicity and cardiac function compared to LBBP.

Methods
Thirty-one patients with pacing indication for bradycardia were retrospectively collected: LBBP was successfully performed in 13 patients and 18 achieved LFP. All patients underwent echocardiography before and after implantation and at one-year follow-up. Left ventricular (LV) volumes, ejection fraction (EF) and global longitudinal strain (GLS) were measured. The lateral-septal (LW-SW) work difference was used as a measure of mechanical dyssynchrony. Septal flash, apical rocking and septal strain patterns were also assessed.

Results
Although LW-SW work difference were significantly higher in the LBBP groups than that in the LFP group at baseline(272±269 mmHg*% vs 25±279mmHg*%,p=0.02), a similar increase in LW-SW work difference was observed during follow-up(199±342 mmHg*% vs 371±384mmHg*%,p=0.21). In addition, both LFP and LBBP induced septal flash or apical rocking in some patients, and resulted in subtle changes in strain patterns, which were not significantly different between groups. At one year follow-up, LV ejection fraction (EF) remained almost unchanged in both LBBP and LFP patients(ΔLVEF: 1.1+3.1% vs -0.3±4.8%,p=0.35) , and global longitudinal strain (GLS) was slightly and equally decreased in LFP compared to LBBP (ΔLVGLS: -1.6±2.3% vs -1.2±2.7%,p=0.69).

Conclusion
LFP and LBBP did not differ in mechanical dyssynchrony or LV remodelling.
The implementation of speckle tracking echocardiography for cardiac resynchronization therapy optimization. A rotational myocardial mechanics interpretation
Authors: Stefanidis A , Korlou P , Margos P , Ikonomidis I , Paraskevaidis I , Gatzoulis K , Aivalioti E , Routsakou E , Delakis J , Kostopoulos K 
Published: October 2024

Abstract

Background
Cardiac resynchronization therapy (CRT) has an additive therapeutic influence on left ventricular (LV) function in heart failure (HF) patients, but the underlying mechanisms through which it works are not completely explained. Our aim was to further elucidate the role of this intervention via rotational mechanics using 2D speckle tracking echocardiography (2D-STE).

Methods
We investigated 46 patients (65 ± 9 years) who received CRT. All enrolled patients were assessed on admission by 2D-STE and 6 min walk test (6m WT) and followed in the outpatient device clinic by 2D-STE (at one week and 6 months post-implantation) and 6m WT (at 6 months post-implantation). On their first appointment all biventricular systems were optimized by atrioventricular delay optimization and by changing the temporal activation of ventricular electrodes aiming to reach the highest effective LV stroke volume (eff SV) across all activation options. A new 2D-STE based index (twist integral – TI) targeting to assess the rotational mechanics of the whole cardiac cycle was also measured to further explain the CRT response. For the calculation of LV TI of the full cardiac cycle, serial isochronal apical and basal rotation measurements (in degrees) were exported to a worksheet Excel file and the final algebraic summation was calculated by the formula: Twist Integral = (systolic twist integral – diastolic twist integral) Σ twisti= twist1+twist2+...+twistn (table 1).

Results
Twenty-two (48%) patients with dilated cardiomyopathy as the predominant aetiology of HF were responders at 6-month follow-up. The commonest selected mode that was related with the greatest LV performance response was the simultaneous activation of the 2 ventricular leads (39%). The strongest predictor of CRT response was the improvement of eff SV between admission and first appointment at clinic, followed by the improvement of TI, the non-existence of CAD, and the improvement of peak systolic twist (table 2).

Conclusions
Additional CRT optimization via changing the temporal activation of ventricular electrodes is beneficial for LV performance in HF patients. Rotational mechanics essentially explain the beneficial CRT contribution to these patients.
Association between CHA2DS2-VASc score and left atrial function by speckle tracking echocardiography in patients with sinus rhythm
Authors: Mostafa K , El Deeb H , Mahmoud K , Bakhoum S 
Published: October 2024

Abstract

Background
The CHA2DS2-VASc score is a scoring system that was first used for the risk assessment of cerebrovascular or thromboembolic events in patients with atrial fibrillation (AF). The factors that constitute the CHA2DS2-VASc scoring system can all individually have an impact on LA function. The application of this scoring system can also be applied to patients without AF. The LA structural remodeling and/or functional impairment play a part in the pathogenesis and development of AF and independent of rhythm, may result in atrial hemostasis and confer a prothrombotic diathesis, resulting in thromboembolic stroke. Speckle- tracking echocardiography (STE) makes it possible to measure LA function with relatively high accuracy and at the very early stage even in the absence of LA enlargement.

Purpose
The aim of our study was to assess the left atrial function in patients with sinus rhythm with different CHA2DS2-VASc scores (low, moderate and high) by speckle tracking echocardiography and to identify the association between them.

Methods
This study was conducted using prospectively collected data (1st May, 2022 to 30th October 2022) from patients with sinus rhythm and different CHA2DS2-VASc scores (50 Low risk score patients (1 for females and 0 for males), 50 moderate risk score patients (2 for females and 1 for males) and 50 high risk score patients (≥3 for females and ≥2 for males) After obtaining an informed consent, all volunteers underwent thorough history taking, 12 lead ECG and conventional transthoracic echocardiography and speckle-tracking echocardiography.

Results
LA strain during the reservoir (LASr) and conduit phases (LAScd) were statistically significantly lower in the high-risk score group (33.2 ± 7.1 and 20.3 ± 5.7) than the moderate-risk score group (36.9 ± 6.1 and 23.5 ± 4.8, p = 0.005 and 0.003 respectively) and low -risk score group (40.6 ± 5.6 and 26.9 ± 3.9, p &lt; 0.001). In addition, LASr and LAScd were statistically significantly lower in moderate- risk score group (36.9 ± 6.1 and 23.5 ± 4.8) than the low -risk score group (40.6 ± 5.6 and 26.9 ± 3.9 ,p=0.007 and 0.001 respectively).

Conclusion
Higher CHA2DS2-VASc scores were associated with decreased LA strain during the reservoir and conduit phases as markers of LA function with relatively high accuracy and at the very early stage even in the absence of LA enlargement.
Right atrial strain: the hidden proof of bi-atrial cardiomyopathy in AF patients?
Authors: Ruscio E , Gabrielli F A , Pinnacchio G , Spera F R , Giordano F , Narducci M L , Bencardino G , Perna F , Crea F , Pelargonio G 
Published: October 2024

Abstract

Background
Although assessment of left atrium (LA) abnormalities has been extensively studied in atrial fibrillation (AF), structural and functional changes in the right atrium (RA) have remained almost unexplored in this context.

Purpose
We investigated the role of bi-atrial strain in patients with AF undergoing catheter ablation (CA).

Methods
Fifty-six consecutive patients undergoing catheter ablation of AF were prospectively studied with speckle-tracking echocardiography and electrophysiological study, before and after CA (median follow-up: 7±3 months). A group of 32 subjects undergoing CA of paroxysmal atrioventricular node-reentrant tachycardia, without structural heart disease, served as control group.

Results
Patients with AF had worse LA, but also RA strain indexes compared to controls [RA strain parameters: peak RAS reservoir (pRASr): 22.1±12.6 vs 29.8±12.7%, p=0.009; RA dispersion: SD-regional-RA-time-to-peak (SD-regional-RA-TTP): 0.048±0.015 vs 0.038±0.009, p=0.020)]. Patients with persistent AF showed similar LA strain values, but worse RA strain indexes, compared to patients with paroxysmal AF (pRASr: 24.8±12.1 vs 15.9±11.7%,p=0.017; SD-regional-RA-TTP:0.043±0.023 vs 0.062±0.030, p=0.016). RA function showed a significant relation with both LA strain and volume indexes and with abnormal LA electroanatomical substrate (pRASr and pLASr, Pearson correlation: r 0.594, p&lt; 0.001; pRASr and low-voltage LA area: -0.316, p=0.018). RA, but not LA, parameters were found significantly reduced in patients with AF recurrence post-CA compared to those who maintain sinus rhythm (pRASr: 14.1±11.7 vs 24.6±13.5, p=0.039; SD-regional-RA-TTP: 0.054±0.031 vs 0.032±0.010, p=0.002), while the only independent clinical predictor of AF recurrence remained cardiovascular risk profile (CHA2DS2 VASc Score: HR 1.47,CI 1.003-2.158, p= 0.048).

Conclusion
RA function, as assessed by strain imaging, resulted progressively impaired in worse subtypes of AF, showing a strong correlation with bi-atrial mechanical and electroanatomical parameters, and associated with AF recurrences post-ablation.Graphical Abstract
Echocardiographic left and right ventricular strain reference values and their associated characteristics in a healthy adult population from the ELSA-Brasil Study
Authors: Pianca E , Foppa M , Canon-Montanez W , Duncan B B , Santos A B S 
Published: October 2024

Abstract

Background/Introduction
Impaired left ventricular (LV) systolic function is a well-known predictor of cardiovascular morbidity and mortality. Global longitudinal strain (GLS) analysis has been shown a robust measure to detect early systolic dysfunction and a prognostic parameter beyond traditional echocardiographic systolic parameters. Standard reference values for echocardiography measures have been established by echocardiography societies. However, these data may not accurately represent diverse world populations.

Purpose
We aimed to describe, from a Brazilian multiethnic population, age and sex-specific reference values for left (LV) and right ventricles (RV) GLS in a sample free of cardiovascular disease and risk factors, and to describe the impact of these risk factors according to GLS distribution.

Methods
ELSA-Brasil is a prospective cohort to investigate cardiovascular disease and diabetes including 15,105 participants aged 35 to 74 years. A predefined representative randomly selected sample with echocardiographic exam was included. We categorized the sample in tertiles according to severity of LV and RV systolic function measured by GLS, and applied trend tests across ordered groups to illustrate the association between GLS and demographic characteristics and echocardiographic measures of cardiac structure and function.

Results
In the study population (n=527), the mean age was 50.2 years and 59% were women. The overall mean value of LVGLS was -19.0 ± 2.4%, while the mean value of RVFWLS was -28.35 ± 3.06%. Women had higher absolute values of LV and RV GLS compared to men.

Conclusion
Our study provided the reference ranges for LV and RV GLS in a large middle-aged healthy Brazilian sample, with sex-differences reflected on these values.Central FigureTable 1:Tertiles of LVGLS and RVFWLS
Improvement of myocardial contractility after iron replacement in stable heart failure patients
Authors: Benavent Garcia C , Romero Valero A , Garcia Suarez A , Del Rio Lopez M , Lledo Ortiz C , Izquierdo Hernandez A , Moreno Martinez M , Vicente Ibarra N , Garcia Honrubia A , Tormo Juarez P , Castillo Castillo J , Martin Torres J M , Garcia Cano L , Santos Martinez S , Morillas Blasco P 
Published: October 2024

Abstract

Background
Iron deficiency replacement with intravenous ferric carboxymaltose (FCM) has demonstrated to improve clinical and prognostic parameters in patients with heart failure with reduced left ventricular ejection fraction (HFrEF). Improvement of myocardial contractility is proposed as possible hypothesis and strain could behave as an early and high sensitive parameter to assess this improvement in myocardial deformation due to increased iron availability after replacement of iron deficiency.

Purpose
Evaluate the effect of iron deficiency replacement with FCM in the strain of both ventricles in patients with stable HFrEF.

Methods
Observational, analytical, longitudinal and prospective study that included 73 patients with stable HFrEF who presented iron deficiency without anemia defined as serum ferritin &lt;100 ug/L or between 100 and 300 ug/L if the transferrin saturation was &lt;20%. They were randomized 2:1 to iron replacement with FCM or control group. A central core lab, blinded to the treatment/control groups, performed 3D echocardiograms and strain analysis basal and four weeks after the randomization.

Results
Mean age of the study population was 70 years old, 77% were male, 75% had high blood pressure, 70% dyslipidemia and 41% diabetes. Of the total, 51 patients were assigned to the replacement group and 22 patients to the control group. Mean left ventricular ejection fraction (LVEF) was 33%, without basal differences between both groups. Four weeks after the randomization, a significant improvement of LVEF of 2.47±2.32% (p=0.018) was observed in the replacement group, as well as in the left ventricle global longitudinal strain (LV-GLS) of -0.96±2.08% (p=0.006). Nevertheless, these changes were not observed in the control group.

Conclusions
In patients with stable HFrEF replacement of iron deficiency with FCM is associated with an improvement of myocardial contractility, of LVEF measured by 3D and LV-GLS.Variation of parametersLV-GLS before and after FCM
Left atrial strain differences between hypertensive and sarcomeric left ventricular hypertrophy: a sign of sarcomeric auricular myopathy?
Authors: Ramos Jovani M , Forado I , Loncaric F , Doltra A , Sanchis L , Arenas A , Rodriguez-Arias J J , Sole E , Pereda D , Quintana E , Garcia-Alvarez A , Sitges M 
Published: October 2024

Abstract

Introduction
In clinical practice, left ventricular (LV) hypertrophy is a common finding that can be caused by physiologic or pathologic conditions. An etiologic diagnosis is extremely important because it may change the prognosis and management of the patient and his family. Left atrial (LA) dysfunction is common due to diastolic dysfunction but, in patients with sarcomeric LV hypertrophy, primary cardiomyopathy disease could also be present.

Purpose
To evaluate if there are differences in LA function between arterial hypertension (HT) and hypertrophic cardiomyopathy (HCM) patients.

Methods
73 patients with HCM (according to ESC guidelines criteria) and 82 patients with HT (under treatment with ≥1 hypertensive drug for ≥3 months) and ≥13mm of LV hypertrophy underwent an echocardiography to assess LA function with strain analysis and LV diastolic function. Continuous normally distributed variables were compared with T-student test and categoric variables with square-chi or exact Fisher test if required, accepting as significant a p-value &lt;0.05.

Results
Globally, HCM patients showed thicker LV walls and larger LA indexed volumes (18.7±4.7 vs. 13.3±0,8 mm and 44.9±20.7 vs. 30.7±8.8 ml/m2, p&lt;0.000 for both). Also, HCM patients presented diastolic dysfunction and atrial fibrillation history in a higher frequency (31 vs. 7.6% and 16.4% vs. 0%, p&lt;0.000 for both). LA strain was significantly lower in HCM patients as compared to the HT group (LA contractile 11.5±5.8 vs. 17.2±4.4, p&lt;0.000; LA conduit 12.2±5.4 vs. 13.3±3.8, p=0.041; and LA reservoir 23.9±8.7 vs. 31.1±5.9, p&lt;0.000).
In the subgroup of patients with moderate-severe LV hypertrophy (&lt;17mm) and no significant mitral regurgitation (n=103; HCM=21, HT=82), LA contractile strain remained lower in HCM as compared to HT patients (13.2±4.8% vs. 17.2±4.4%, p&lt;0.000) (figure 1); without differences in diastolic dysfunction, LA volumes, significant mitral regurgitation or atrial fibrillation history.

Conclusions
Our results show that LA strain is more impaired in HCM patients as compared to HT patients. Specifically, contractile LA strain remained lower even in those patients with moderate-severe LV hypertrophy, despite having similar LV diastolic function, LA indexed volumes, significant mitral regurgitation, or atrial fibrillation history. These findings could be caused by HCM involvement of the LA myocytes. In the context of moderate-severe hypertrophy of unknown origin with non-significant mitral regurgitation, the detection of abnormally reduced LA strain could indicate the presence of an HCM.Figure 1
Left atrial function and long-term survival after cardiac resynchronization therapy
Authors: Hammersboen L E R , Stugaard M , Puvrez A , Larsen C K , Remme E W , Kongsgaard E , Duchenne J , Galli E , Khan F H , Sletten O J , Penicka M , Donal E , Voigt J U , Smiseth O A , Aalen J M 
Published: October 2024

Abstract

Background
Left atrial (LA) reservoir strain after CRT has been linked to long-term outcome, but the role of LA function in response to cardiac resynchronization therapy (CRT) is incompletely understood. LA dyssynchrony during left bundle branch block has negative effects on LA function beyond LA reservoir strain. We hypothesized that correction of LA dyssynchrony after CRT has added value to LA reservoir strain as a marker of long-term outcome.

Purpose
To explore the role of LA function in long-term survival after CRT.

Methods
In a recent prospective multicenter study of 168 patients, LA segmental and global strains were measured by speckle-tracking echocardiography before and 7 ± 1 months after CRT. LA reservoir strain was measured as the difference between peak and minimum global strain during the atrial cycle and LA dyssynchrony as the time delay between onset systolic stretch of the interatrial septum and LA lateral wall. Since LA reservoir strain &lt; 18% is associated with elevated LV filling pressure, we used 18% as cutoff and for LA dyssynchrony 43 ms (mean after CRT in the present study). All-cause mortality was used as clinical endpoint during follow-up.

Results
After 6 years ± 21 months (mean ± SD) follow-up, 35 (21%) patients died. LA reservoir strain was significantly lower (15 ± 9% vs 20 ± 10%, p = 0.003) and LA dyssynchrony numerically higher (61 ± 68 ms vs 39 ± 69 ms, p = 0.099) in patients who died compared to survivors. LA reservoir strain ≥ 18% after CRT was associated with favorable long-term survival (HR: 0.51, 95% CI: 0.26 - 0.98) (upper panel in the Figure). LA dyssynchrony was not independently associated with mortality. However, when used in concert with LA reservoir strain ≥ 18% after CRT, it identified patients with perticularly excellent long-term survival (HR: 0.17, 95% CI: 0.05 - 0.58 vs patients with reservoir strain ≥ 18% and persistent LA dyssynchrony) (lower panel in the Figure). Patients with preserved LA reservoir strain but persistent LA dyssynchrony had similar outcome as patients with reduced LA reservoir strain (HR: 0.98, 95% CI: 0.45 - 2.12).

Conclusion
LA reservoir strain ≥ 18% and absence of LA dyssynchrony is associated with excellent long-term survival after CRT.LA strain after CRT and survival
Which echocardiographic measure of longitudinal function is most informative?
Authors: Cunha De Almeida A , Stowell C C , Howard J P , Ng T , Cole G D , Bhattacharyya S , Sehmi J , Alzetani M , Demetrescu C D , Singh A , Mangion K , Rajani R , Rana B S , Francis D P , Shun-Shin M J 
Published: October 2024

Abstract

Background
The longitudinal function of the left ventricle can be quantified by measuring the myocardial excursion with or without normalising by the diastolic length to derive strain. Furthermore, these lengths can be determined from the curved myocardial length or in a straight-line from the mid-annulus to the apex parallel to the long axis. All four combinations have been advocated and used, but the optimal is unknown.

Purpose
Compare the prognostic information contained by these four measures of longitudinal function in a large retrospective cohort, with measurements performed by AI.

Methods
The cohort consisted of echocardiograms performed during 2015 at our institution for which mortality data were available. Our previously published AI based view classifier selected the apical 4-, 2-, and 3-chamber views from each study, before the endocardial contour and annular and apical points were segmented by another neural network. From this the curved and long-axis excursion was calculated, and then strain was derived using the diastolic length. Nested non-linear Cox-models including age and sex and each of the longitudinal measures were constructed, and the information contained by each variable was quantified via Chi-Square and compared using bootstrap methods.

Results
1733 patient studies were included, the median age was 64 (IQR 49 to 75) years and 51% were male. A total of 213 (14%) deaths occurred. The median excursion and strains were 3.25 cm (IQR 2.68 to 3.81) and -17% (IQR -20% to -14%) along the endocardial curve and 2.36 cm (IQR 1.88 to 2.87) and -14% (IQR -17% to -11%) along the long axis. All four longitudinal measures significantly added to a base model containing age and sex (p=0.003, p=0.005, p=0.005, p=0.002). Whilst the simple long axis excursion was numerically the most prognostic, none of the measures were significantly different from each other.

Conclusions
In this head-to-head AI-assisted retrospective cohort study using mortality as the endpoint, there was no good evidence that more complex measures of longitudinal function had better prognostic performance.Information provided by model componentsLong axis excursion calibration curve