bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of preoperative four-chamber strain on failure of the maze IV procedure for atrial fibrillation: insights from conventional and speckle-tracking echocardiography
Authors: Kislitsina O N , Jankowski M , Rigolin V H , Thomas J D , Mehta C K , Hodges K E , Baldridge A , Kruse J , An S , Malaisrie S C , Cox J L , Johnston D R , Mccarthy P M 
Published: October 2024

Abstract

Background
Prior studies have linked decreased left atrial (LA) and left ventricular (LV) function to the failure of both catheter ablation and surgery for atrial fibrillation (AF). Yet, the effects of right atrial (RA) and right ventricular (RV) function on the failure of interventional therapy remain unexplored. This study evaluates four-chamber strain parameters using conventional echocardiography and speckle-tracking analysis to evaluate the contributions of preoperative left heart and right heart function to the failure of surgery for atrial fibrillation.

Methods
We retrospectively analyzed 821 patients who had surgical AF ablation, using pre- and postoperative data from electronic records to assess AF recurrence and thromboembolic events. Of these, 531 had LA ablation only and 290 had bi-atrial Maze-IV procedures. Four-chamber strain was evaluated via speckle-tracking on preoperative echos with TomTec Arena, excluding low-quality images. Univariate and multivariate logistic regression analyses were conducted to assess the influence of AF duration, LV ejection fraction, age, and gender on post-PAF surgery AF recurrence, thromboembolic events with results shown as odds ratios (ORs) in the table. An OR over 1.00 indicates a higher recurrence risk per variable increment. SAS software was used for all statistical analysis.

Results
In our cohort with a median age of 67.4±11.0 (46.2% female), unadjusted analyses revealed that increased LA and RA volumes and decreased RV free wall strain were significantly associated with AF recurrence post-surgical ablation. Conversely, each unit decrease in LA and RA peak reservoir strain corresponded to a 6% increase in the risk of AF recurrence, indicating an inverse relationship. Adjusted analyses for LA and RA end diastolic volumes and strain values showed a similar direction of association with AF recurrence, though these were not statistically significant. Similarly, lower LA and RA peak strains and larger atrial volumes were suggestive of an increased risk for postoperative thromboembolic stroke, but did not reach statistical significance, potentially due to the low event rate (1.8% of the cohort).

Conclusion
Conventional echocardiography offers a practical tool for identifying patients at high risk for AF recurrence and potential thromboembolic events after AF ablation surgery. Our study confirms that reduced preoperative LA, RA and RV strain values and enlarged volumes of LA and RA are strongly associated with AF recurrence following surgical ablation. Additionally, RA strain and volume are as predictive as LA metrics, underscoring their importance in risk stratification. These echocardiographic parameters may also hold value in forecasting the likelihood of postoperative stroke.
The left ventricular strain-volume loop in a healthy Dutch population: age- and sex related differences
Authors: Zwaan R R , Keuning Z A , Kerstens T P , Bowen D J , Hirsch A , Vos H J , Van Dijk A P J , Thijssen D H J , Roos-Hesselink J W , Van Den Bosch A E 
Published: October 2024

Abstract

Introduction
By combining left ventricular (LV) global longitudinal strain (GLS) with LV volume during the cardiac cycle, LV strain-volume loops can be generated. LV SV-loop derived parameters provide new insights into the interaction between cardiac contraction and volume in a variety of cardiac diseases (1,2) and may even have prognostic value. (3,4) Reference values for healthy individuals with attention to sex- and age-related differences have not been established yet. Therefore, the aim of this study is to provide reference ranges in a healthy adult population and investigate potential sex- and age-related differences of LV SV-loop characteristics.

Methods
In 125 healthy volunteers aged 18-72 years, apical 2-, 3- and 4-chamber views were acquired to measure GLS. Custom software was used to combine strain and volume data to construct SV-loops. Different parameters were derived: (i)linear slope of systolic strain-volume relation (S-Slope); (ii) early linear slope of systolic strain-volume relation (ES-Slope); (iii) early linear slope of diastolic strain-volume relation (ED-Slope); and (iv) uncoupling between systolic and diastolic strain-volume relation (UNCOUP).

Results
For the systolic strain-volume relation higher values were observed in females as compared with males with S-Slope values of 0.19 [0.17-0.22] %/mL m-² and 0.13 [0.11-0.15] %/mL m-² respectively. ED-Slope was higher in females as compared with males with values of 0.18 [0.09-0.28] %/mL m-² and 0.12 [0.06-0.18] %/mL m-² respectively. Relative coupling of the systolic and diastolic strain-volume relation was observed with a mean value of 0.34 ± 1.1. UNCOUP was correlated with age with a value for r of 0.4.

Conclusion
Higher values for the systolic and early-diastolic strain-volume relation in females can be reflective of different cardiomechanics as LV contraction is not only comprised of longitudinal but also circumferential and radial deformation. In line with current literature our custom software found relative coupling of the systolic and diastolic strain-volume relation in our cohort of healthy subjects. Towards older age relative uncoupling of the systolic and diastolic strain-volume relation was found.Figure 1.Strain-volume loop
The application of supine bicycle exercise stress echocardiograph for identification of susceptibility to acute mountain sickness
Authors: Xu Y U N , Wang Y I , Yin L 
Published: October 2024

Abstract

Background
Exposure to high altitude is likely to lead to acute mountain sickness (AMS). At present, there are no definite parameters that can accurately predict the occurrence of AMS.

Objectives
The purposes of this study are (1) to assess the relationship between stress echocardiographic parameters and AMS, (2) to identify the predictors of AMS at sea level by exercise stress echocardiography.

Methods
A total of 36 healthy adults were enrolled and underwent resting and exercise stress echocardiography on a supine bicycle at sea level. Heart rate (HR) and blood pressure (BP) were monitored during stress echocardiography. Left ventricular (LV) ejection fraction and E/e’ were calculated at rest and peak stage. Other right ventricular systolic function parameters and pulmonary artery pressure (PAP) were calculated at the same time, which included tricuspid regurgitation velocity (TRV), tricuspid annular peak systolic excursion (TAPSE), systolic PAP (sPAP), right ventricular (RV) dimension by 2D, right ventricular area at the end of diastole (RVAD), right ventricular area at the end of systolic (RVAS),RV fraction of area change (FAC), right ventricular outflow tract velocity time integral (RVOT VTI).Pulmonary vascular resistance (PVR) was calculated. All subjects ascended to 3600m within 24 hours by bus. AMS was identified by 2018 Lake Louise Questionnaire Score. Univariable and multivariable logistic regression analysis assessed independent factors associated with AMS.

Results
At the altitude of 3600m, 13 of 36 subjects had AMS, which defined as AMS (+) group. And the rest was AMS (-) group. There were no significant differences in HR, BP, and LV systolic and diastolic function between the two groups (P &gt; 0.05). TRV, sPAP, and PVR were much higher at peak stage in AMS (+) group (P &lt; 0.05). No significant differences were found in RV systolic function at rest and peak stage between the two groups. By multivariable logistic regression model, PVR and RVAD at peak stage were significantly associated with AMS occurrence (PVR-OR =1.962,95% CI: 0.689-0.973,p =0.002; RVAD-OR =1.962,95% CI: 0.638-0.967,p =0.005;). The cutoff value to predict AMS were 1.55 for PVR (AUC: 0.831) and 11.45 cm2 for RVAD (AUC: 0.802).

Conclusions
Supine bicycle exercise stress echocardiography is a useful and noninvasive technique to identify subjects susceptible to AMS. Subjects with higher PVR and RVAD at peak stage were associated with susceptibility to AMS.
Functional correlates of ischemic electrocardiographic changes during stress echocardiography. data form stress echo 2030 survey
Authors: Kobal S , Arbucci R , Zagatina A , Padang R , Peteiro Vazquez J , Boshchenko A , Celutkiene J , Saad A , Bursi F , Djordjevic-Dikic A , Lisi M , Manganelli F , Ciampi Q , Pellikka P A , Picano E 
Published: October 2024

Abstract

Background/Introduction
Cardiac stress tests are carried out in populations with a low probability of ischemic heart disease (IHD) much more frequently than in the past. Stress ECG remains a frequently used modality for the diagnosis of IHD in vast areas of the world with limited facilities.

Purpose
To assess the diagnostic value of stress ECG for diagnosing IHD using inducible regional wall motion abnormalities (RWMA) on stress echocardiography (SE) as the gold standard method of diagnosis.

Methods
The 12-lead ECG response was retrospectively analyzed in 4317 patients (age 64±13 years, 59.6% males) undergoing SE for chronic coronary syndromes who were prospectively recruited from 39 cardiac centers between March 2021 and February 2024. Exclusion criteria were left bundle branch block or pacemaker rhythm. ECG response was considered ischemic according to standard criteria (if ST-segment deviated &gt;1.0 mm from baseline in ≥2 contiguous leads at 80 ms from J point) during an exercise (n=2980, 69.8%), dobutamine (n = 766, 18.0%), or vasodilator (n=519, 12.2%) SE. All patients underwent a comprehensive SE protocol with an assessment of wall motion score index (WMSI), B-lines (4-site simplified score), left ventricular contractile reserve (LVCR) based on force, coronary flow velocity reserve (CFVR) in the mid-distal left anterior descending artery (LAD), and heart rate reserve (HRR).

Results
ECG changes occurred in 641 patients (14.8%, Group 1) for the overall studied population. Compared to patients without ECG changes (Group 2, n=3676, 85.2%), patients with ECG changes showed higher values of peak WMSI and lower values of CFVR and LVCR (see table).Amongst patients without inducible RWMA (n=3553), there were 392 (11%) patients with an ischemic ECG at stress (89% specificity). Of 764 patients with inducible RWMA during SE, 249 had an ischemic ECG trace (sensitivity 33%). In patients without inducible RWMA, those with ischemic ECG changes showed similar abnormal stress B-lines (23% vs. 21%, p=0.719), LVCR (61% vs. 63%, p=0.602), CFVR (31% vs 33%, p=0.607) and HRR (37% vs 41%, p=0.097) compared to those without ECG changes. Amongst patients with inducible RWMA and ECG changes, CFVR was significantly lower in patients with ECG changes (39.2% and 60.8%, respectively, p&lt;0.001).

Conclusions
Simple standard stress ECG diagnostic value in the current era in populations with a low probability of IHD seems to be low. However, during SE, stress-induced ischemic ECG changes are associated with more extensive RWMA and blunted global LVCR, with reduced CFVR in the LAD. Therefore, analysis of ST segment changes during stress imaging studies can offer additional, significant information.
Time to target heart rate in dobutamine stress echocardiography is shortened by using dynamic, but not isometric handgrip
Authors: Medilek K , Hrecko J , Parizek P 
Published: October 2024

Abstract

Background
Dobutamine stress echocardiography (DSE) is widely used for the detection of obstructive ischaemic heart disease. In our previous study we demonstrated that the magnitude of myocardial injury measured by hsTnT is associated with DSE duration. Shortening of DSE time is therefore desirable. Use of hangrip (HG) during DSE is generally recommended. However, there are no published studies comparing the efect of dynamic and isometric HG on the length of DSE.

Purpose
To compare the effect of dynamic and static HG on DSE duration.

Methods
211 patients undergoing DSE for ischaemia assessment were randomised into no HG (noHG, n=74), isometric HG (isoHG, n=68) and gynamic HG (dynHG, n=69) groups. All patients taking rate limiting medication were instructed to stop it 48 hours prior the test. DSE was performed according to the standard protocol (dobutamine infusion 5, 10, 20, 30, 40 ug/kg/min., increased in 3 min. intervals). HG was applied at the level of 40% maximum isometric muscular effort from the dobutamine dose of 20ug/kg/min. and atropine was administered in 1 min. intervals in 100 ug increments from the dose of 30 ug/kg/min. Patients who did not achieve their target heart rate (HR) or suffered from dobutamine side effects were excluded from the study.

Results
There were no differences in the groups characteristics (gender p=0.187, known ischaemic heart disease p=0.361, age p=0.128, basal HR p=0.367, target HR p=0.107, achieved HR p=0.257, positive test for ischaemia p=0.583). There was a significant difference in the time to target HR between dynHG and noHG groups (9.97±2.34 vs 11.96±3.02 min., p&lt; 0.001) but not between isoHG and noHG groups (10.76±3.12 vs 11.96±3.02 min., p=0.058). Also, the was a similar difference in the length of dobutamine infusion between dynHG and noHG, but not between isoHG and noHG groups (11.76±2.37 vs 13.78±3.09 min., p&lt; 0.001 and 13.34±4.90 vs 13.78±3.09 min., p=0.308, respectively). No significant correlation was found between the time to target HR and basal (r=0.43) or target HR (r=0.38).

Conclusion
Dynamic, but not isometric handgrip shortens the length of dobutamine stress echocardiography.
Predictive factors for recurrent tricuspid regurgitation after tricuspid annuloplasty: 3D echocardiography study
Authors: Verikas D , Krivickiene A , Jakuska P , Siudikas A , Vaskelyte J J , Ereminiene E 
Published: October 2024

Abstract

Introduction
There is growing concern about the recurrence of tricuspid regurgitation (TR) after tricuspid annuloplasty (TA) in individuals with functional tricuspid regurgitation (FTR). While TA is effective in treating FTR, a comprehensive understanding of the echocardiographic factors influencing TR recurrence is crucial.

Aim
This study aims to employ multivariate regression analysis to investigate the prognostic significance of tricuspid valve (TV) geometry and echocardiographic parameters associated with both RV geometry and function. The focus is on comprehending these relationships in the context of recurrent TR subsequent to TA.

Methods
This prospective observational cohort study aimed to explore factors contributing to recurrent tricuspid regurgitation (TR) after tricuspid annuloplasty (TA). The focus was on patients with moderate or severe functional TR due to left heart valvular disease, particularly severe mitral regurgitation, excluding those with ischemic heart disease. The cohort included 66 individuals undergoing preoperative assessments with 2D and 3D echocardiography, quantifying RV and right atrial (RA) geometry, functional, and tricuspid valve (TV) parameters. TR severity followed ESC guidelines. Patients were categorized into effective TA (50 patients) and recurrent TR (16 patients) groups, defined by mild-moderate TR and significant moderate-severe TR one year post-surgery, respectively. SPSS software facilitated statistical analysis, with adjusted logistic regression considering parameters such as age and gender.

Results
Among the patients (54% male, mean age 68±9 years), no significant differences were found in gender, left ventricular and atrial parameters, or preoperative TV orifice area between groups (recurrent TR vs. effective TA: 38 [33] mm2 vs. 29 [15] mm2, p=0.117). Univariate logistic regression analysis identified Septal-Lateral Systolic TA Diameter (OR 1.62), Septal-Lateral Diastolic TA Diameter (OR 1.99), and Major Axis Diastolic TA Diameter (OR 1.59) as key predictors. For diagnostic efficacy, ROC analysis revealed Major Axis Diastolic TA Diameter (AUC 0.848; cut-off 52.5 mm), TV Leaflet Tenting Volume (AUC 0.778; cut-off 5.1 ml), and RV Basal Diameter (AUC 0.763; cut-off 47.5 mm) as the most predictive parameters. The combined use of predefined RV basal diameter and Major Axis Diastolic TA Diameter showed the highest odds ratio for recurrent TR.

Conclusion
Key predictors, including Septal-Lateral Systolic and Diastolic TA Diameters, and Major Axis Diastolic TA Diameter, were identified, emphasizing their significance in understanding TR recurrence after tricuspid annuloplasty. The combination of predefined RV basal diameter and Major Axis Diastolic TA Diameter showed the highest odds ratio for recurrent TR, offering valuable insights for clinical assessment and preventive strategies.
Comparing the utility of 3D vs 2D left atrial volumes by echocardiography to predict stroke in the general population
Authors: Yafasov M , Javier Olsen F , Dyrby Johansen N , Grundtvig Skaarup K , Christian Hoejbjerg Lassen M , Soegaard P , Boje Jensen G , Schnohr P , Moegelvang R , Biering-Soerensen T 
Published: October 2024

Abstract

Background
Left atrial (LA) volume dilatation is associated with stroke in the general population. Two-dimensional echocardiography (2DE) is commonly used to measure LA size but is known to underestimate LA volumes compared to three-dimensional echocardiography (3DE). It is unknown whether this difference has clinical significance.

Purpose
We hypothesized that LA volumes by 3DE are more closely associated with stroke risk than 2DE in the general population.

Methods
We included 2,085 participants from a longitudinal cohort study from the general population who underwent 3DE and 2DE assessment of maximal and minimal LA volume index (LAVimax and LAVimin, respectively). After excluding participants with poor image quality, low volume rate, atrial fibrillation at baseline and non-sinus-rhythm during examination, a total of 1,956 participants were included for this analysis. The endpoint was stroke. Multivariable Cox regression models were adjusted for the CHA2DS2-VASc stroke risk score (age, sex, heart failure, hypertension, stroke, vascular disease, and diabetes).

Results
Mean age was 54±17 years, 43% were male, mean CHA2DS2-VASc score was 1.6±1.3. During a median follow-up of 4.8 years (interquartile range 4.3-5.5 years), 36 participants (1.8%) developed stroke. After multivariable adjustment, 2D LA volumes were not associated with stroke, whereas both 3D-LAVimax (HR 1.03 (95% CI 1.00-1.06), p=0.046, per 1 mL/m2 increase) and 3D-LAVimin (HR 1.05 (95% CI 1.02-1.08), p=0.002, per 1 mL/m2 increase) remained significantly associated with stroke (Figure 1). In addition, 3D-LAVimin showed the highest discrimination for predicting stroke with a C-statistic of 0.70 (95% CI: 0.59-0.80), which was significantly higher than 2D-LAVimax (C-statistic: 0.58 (95% CI 0.48-0.69); p=0.02), 2D-LAVimin (C-statistic: 0.54 (95% CI 0.42-0.65); p&lt;0.001) and 3D-LAVimax (C-statistic: 0.62 (95% CI 0.52-0.73); p=0.004). 3D-LAVimin also showed incremental prognostic information when added to the CHA2DS2-VASc risk score (continuous net reclassification index 0.28±0.17; p=0.047).

Conclusion
Increasing 3D-LA volumes are significantly associated with higher risk of stroke in the general population which was not the case for 2D-derived LA volumes.
3D modelling-based left atrium geometry analysis to predict atrial fibrillation in patients with cryptogenic stroke
Authors: Martinez Vives P , Cecconi A , Vera A , Viliani D , Montejano S , Diego Nieto G , Benedicto Buendia A , Vilches Miguel L , Santos Martin B , Lopez Melgar B , Dominguez Arganda L , Alfonso F , Torrado Carvajal A , Jimenez-Borreguero L J 
Published: October 2024

Abstract

Introduction
Atrial fibrillation (AF) is a high prevalence condition associated with high morbidity and mortality. Its early diagnosis allows to initiate several prophylactic treatments that have proved to improve its prognosis. 3D modeling techniques allow to design accurate representations of cardiac cavities from diverse source images.

Purpose
We evaluated the association between new geometrical measurements obtained by 3D echocardiographic models of the left atrium (LA) and the presence of underlying paroxysmal AF in patients with cryptogenic stroke (CS).

Methods
3D LA volumes from a sample of consecutive patients aged ≥60 years old and admitted to our Stroke Unit with the diagnosis of CS from April 2019 to November 2020 were analyzed. 15 days ECG monitoring was performed after discharge to detect underlying paroxysmal AF. All 3D echo volumes were analyzed by a 3D modeling open-source application. From this analysis several LA geometry parameters were obtained: sphericity, elongation, flatness, major axis length, minor axis length, maximum 2D diameter (max2Ddiam) and surface-volume ratio (S/V). Functional atrial parameters (3D left atrial ejection fraction, LAEF) were also determined.

Results
36 patients were analyzed. Mean age was 78 ± 7 years old. 19% were diabetic, 58% had high blood pressure and 14% of patients had history of ischemic cardiomyopathy. Mean body-mass index was 26. These baseline characteristics were equally distributed between groups.
Baseline proBNP was significantly higher in patients developing atrial fibrillation (949 vs 275 pg/mL; p= 0,014.).
Maximum 2D diameter (max2Ddiam) and Surface-volume ratio (S/V) were the best predictors of AF (AUC of ROC curves: 0.69; 0.49 – 0.88 and 0.63; 0.42 – 0.84, respectively). An optimal cut-off point of 39 mm was selected for max2Ddiam and of 0.20 for S/V. These values were included in a multivariate model adjusted by baseline proBNP. A Max2Ddiam &lt;39 mm and a S/V ≥0.20 were both significantly associated with the presence of paroxysmal AF (OR 6.96; p= 0.048 and OR 12.22; p = 0.043, respectively).

Conclusions
New geometrical atrial parameters can be obtained from echo 3D models and might be able to predict AF in patients with CS. Further analysis and larger samples are required to better understand these findings.TableFigure