bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial function and the risk of new-onset atrial fibrillation in cardiac amyloidosis
Authors: Adam R D , Neculae G , Badelita S , Stassen J , Jercan A , Rosca M , Calin A , Beladan C , Enache R , Coriu D , Bax J , Baicus C , Ajmone Marsan N , Popescu B A , Jurcut R 
Published: November 2023

Abstract

Background
Cardiac amyloidosis (CA) is an infiltrative disease characterized by the accumulation of misfolded proteins into the extracellular matrix of the myocardium. Ventricular but also atrial myopathy are described in CA, with higher risk of atrial fibrillation (AF) and cardioembolic events even during sinus rhythm.

Purpose
We aimed to investigate which parameters of left atrial (LA) structure and function could predict new-onset AF (NOAF) in patients with CA, aiding in improved follow-up.

Methods
We prospectively included patients diagnosed with CA, both light chain (AL) and variant transthyretin (ATTRv) with no history of AF, from 2 tertiary European centers. Cardiac involvement was assessed according to current European recommendations. Comprehensive echocardiographic studies were performed at baseline with measurement of both classical structure and function parameters parameters derived from speckle tracking echocardiography measured with a vendor-dependent analysis software and the primary outcome was NOAF.

Results
Of the 179 patients diagnosed with CA, 86 were excluded due to history of AF, unacceptable image quality and non-AL or non-ATTRv diagnoses. Finally, 93 patients with CA were included (mean age 54.3±9.8, 58% males), and 44 patients developed NOAF during a median follow up of 11 (32.5) months. Patients with NOAF had heavier hearts (LVMi 155.5±39.6 vs. 136.6±44.3 g/m2, p= 0.03), worse global LV function (LVEF 46.7±10.9 vs. 53.8±11.2 %, p= 0.003), more LV longitudinal impairment (GLS -10.0±4.7 vs. -13.4±3.7 %, p= 0.0002), larger atria (LAVi 44.6±14.3 vs. 35.4±13.6 mL/m2, p= 0.002) and worse LA function (LA emptying fraction 28.5±15.5 vs. 44.9±14.6 %, p&lt; 0.001; LA peak longitudinal strain (PALS) 13.6±11.3 vs. 20.5±10.4 %, p= 0.003). In the multivariate analysis adjusting for confounding factors, including LA diameter, LAVi and other LA function parameters, lower PALS was independently associated with higher risk for NOAF (HR: 0.874, 95% CI: 0.784-0.974, p= 0.014). Using the receiver operating characteristics curve analysis, we identified the optimal cut-off of PALS for predicting NOAF as 14.3% (Sn 71%, Sp 73%, AUC 0.75). Furthermore, PALS ≤14.3% was an independent predictor for NOAF (HR: 5.259, 95% CI: 2.653–10.423, P&lt; 0.001). The Kaplan–Meier curves showed that patients with PALS ≤14.3% had a higher risk for NOAF than those with PALS &gt;14.3% (P&lt;0.001 by log-rank test, Figure 1).

Conclusions
PALS is an independent predictor for NOAF in patients with CA.Figure 1.Kaplan-Meier curves for NOAF
Echocardiographic nomograms for left ventricular parameters in 13,454 infants
Authors: Voegg R O B , Sillesen A S , Wohlfahrt J , Pihl C A , Norsk J B , Axelsson Raja A A , Vejlstrup N , Elia E , Sleeper L , Colan S , Iversen K K , Boyd H A , Bundgaard H 
Published: November 2023

Abstract

Background
Cardiac dimensions and function are key parameters in the management of children with cardiopulmonary abnormalities and are important predictors of clinical outcome. In particular, left ventricular (LV) dimensions and function are important predictors of clinical outcome and prognosis. In pediatric echocardiography, nomograms are essential in the separation of normal variation from pathological conditions and ascertaining normal growth. However, data from cohorts of newborns are limited, and current nomograms remain an insufficient approximation of the range of values that should be considered normal.

Purpose
We developed nomograms and Z scores for two-dimensional echocardiographic measurements of LV structure and function in a large group of healthy newborns.

Methods
Our study population included newborns from a large population study of newborns (n &gt;25,000) who were born at term to healthy mothers, had a systematic transthoracic echocardiogram (TTE) performed within 30 days of birth, and with no signs of any major congenital heart diseases. We developed nomograms for 10 LV parameters by modelling these parameters as a function of body surface area (BSA) through joint modelling of the mean, standard deviation, skewness, and kurtosis. We then evaluated the impact of infant sex and age at time of echocardiography on the model fit.

Results
The 13,454 infants in the study population (48.5% females), had a median age of 12 days at TTE for both boys and girls (interquartile range IQR 8–15 and 8–12 days, respectively), and a median BSA of 0.23 m2 (IQR 0.22 m2 - 0.24 m2). All nomograms had acceptable goodness-of-fit within strata of sex. In contrast, model fit was worse for infants examined &lt;7 days of age, compared with those examined from 7 to 30 days of age, necessitating the creation of separate nomograms for the two age groups. Examples of the plotted Z scores of one of the 10 LV parameters is shown in the figure.

Conclusions
We provide a large normative dataset and Z scores for echocardiographic measures of LV structure and function in neonates. Normative data is crucial in the management of patients with heart disease and these results provide a needed tool for evaluation of LV size and function in the newborn population.Plotted Z scores of the IVSd
Identification of abnormal ventricular asymmetry in 2nd trimester fetal ultrasound using artificial intelligence
Authors: Levy M , Stos B , Thorey V , Askinazi E , Gardella C 
Published: November 2023

Abstract

Introduction
Prenatal ultrasound screening for congenital heart disease (CHD) suffers from poor detection yield (10%-56%)[1, 2], with a strong impact on neonatal morbidity and mortality. The need for expertise in fetal cardiology and the high volume of screening cases limit the current detection rates. Computer-assisted prenatal screening could support clinicians in improving diagnostic yield, including for abnormal ventricular asymmetry, which is often hard to discriminate from physiological asymmetry. Here we aim at evaluating a deep neural network (DNN) for detection of abnormal ventricular asymmetry, which can be linked to multiple types of CHD, including coarctation of the aorta, pulmonary or aortic valve stenosis, ventricular hypoplasia or univentricular heart.

Purpose
To determine if a novel DNN can identify cases of abnormal ventricular asymmetry in 2nd trimester fetal ultrasound videos.

Methods
We used as an endpoint the presence of any abnormality causing a significantly abnormal asymmetry of the ventricles as seen in the fetal ultrasound.
Consecutive patients who had an echocardiography performed at one center were included retrospectively starting from 2022, January 1st. Inclusion criteria were single pregnancy between 18 and 25 weeks of gestation. To have a high number of positive patients, patients were included separately if they were expected to be positive (n=35) or negative (n=75) to the endpoint, based on their medical record. Each case was reviewed by one of two physicians expert in fetal echocardiography interpretation to confirm the presence or absence of the endpoint. For each patient, a single video showing an interpretable four chamber view was selected. Patients with no such video were excluded.
The DNN takes as input fetal ultrasound videos, and predicts the absence or presence of the endpoint for each video. If its confidence is low, the DNN predicts an "inconclusive" output instead. The DNN has a ResNet-50 architecture[3] adapted to videos and was trained on data from patients not included in the evaluation. The detection performance of the DNN and the proportion of conclusive outputs were assessed.

Results
Overall, 37 positive and 66 negative ultrasound videos were included. The DNN achieved an AUC of 75.5%, a sensitivity of 71.4% (54.9-83.7, 95%CI) and a specificity of 64.4% (51.7-75.4, 95%CI) in identifying cases of abnormal ventricular asymmetry, after excluding inconclusive diagnosis. The DNN predicted a conclusive diagnosis in 91.3% of cases.

Conclusion
A DNN could accurately identify cases of abnormal ventricular asymmetry in fetal heart ultrasound videos. Importantly, this evaluation was performed in a population of patients who had an echocardiogram, and which therefore contains more abnormal cases compared to patients undergoing standard screening. This work lays the ground for diagnostic support to enable a more efficient, accurate, and scalable analysis of fetal heart ultrasounds.
Clinical characteristics and outcomes of left ventricular thrombus patients with mildly reduced and preserved left ventricular ejection fraction
Authors: Goh F , Teo Y N , Teo Y H , Leow A S T , Chan M Y Y , Yeo L L L , Kong W K F , Poh K K , Ho J S Y , Yeo T C , Tan B Y Q , Sia C H 
Published: November 2023

Abstract

Background
Abnormal left ventricular ejection fraction (LVEF) is associated with the development of left ventricular thrombus (LVT) following acute myocardial infarction and also in non-ischaemic cardiomyopathies. LVT formation in normal LVEF is less common.

Purpose
We aimed to describe the clinical characteristics and outcomes of patients with LVT and LVEF&gt;40%, and compare them against patients with LVT associated with LVEF≤40%.

Methods
We retrospectively studied 551 consecutive patients with LVT from our tertiary centre’s echocardiography database between March 2011 and January 2021. We compared baseline co-morbidities and echocardiographic parameters between patients with LVT and LVEF&gt;40% versus LVEF≤40%. The Kaplan Meier method with log-rank test was used to compare rates of thrombus resolution, stroke and all-cause mortality between the 2 groups. Multivariable Cox regression models were constructed to correct for potential confounders.

Results
Mean age of the study population was 59.8 ± 12.9 years old and 86/551 (15.6%) were female. LVT in patients with LVEF&gt;40% made up 100/551 cases (18.1%), of which 91.0% were associated with ischaemic heart disease. Patients with LVEF&gt;40% were younger and had fewer cardiovascular co-morbidities than their counterparts with LVEF≤40%, including a lower prevalence of hypertension, hyperlipidaemia, diabetes mellitus, ischaemic heart disease and heart failure (Figure 1). Patients with LVEF&gt;40% more often had a smaller thrombus (mean diameter 14.1 ± 5.9 mm) compared to those with LVEF≤40% (mean diameter 17.2 ± 8.2 mm). LVT with LVEF&gt;40% was independently associated with thrombus resolution (HR 1.42, 95% CI 1.08–1.87, p=0.013) corrected for anticoagulant use, as well as lower mortality (HR 0.49, 95% CI 0.26–0.94, p=0.031) corrected for baseline co-morbidities (Figure 2). LVEF did not influence stroke rates.

Conclusions
In patients with LVEF&gt;40%, LVT was less common. These patients had fewer cardiovascular co-morbidities, developed smaller thrombi, were more likely to have thrombus resolution and had a lower mortality rate. However, overall stroke risk was similar to patients with a reduced LVEF.Figure 1:Baseline characteristicsFigure 2:Outcomes
Left atrial strain as an independent predictor of sinus rhythm maintenance after catheter ablation for paroxysmal atrial fibrillation in HFpEF patients
Authors: Katbeh A , De Potter T , Geelen P , Vanderheyden M , Bartunek J , Van Camp G , Penicka M 
Published: November 2023

Abstract

Background
The early AF treatment by radio-frequency catheter ablation (CA) is very important for improving clinical outcome in patients with history of atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF). Left atrial (LA) strain showed to be a useful index to monitor atrial function in AF and HFpEF states. However, the accuracy of LA strain to predict the long-term maintenance of sinus rhythm (SR) in HFpEF patients with paroxysmal AF undergoing CA is still under debate.

Aims
To define the best echocardiography derived parameters to predict the long-term maintenance of SR in paroxysmal AF patients with high probability of HFpEF undergoing CA.

Methods
We prospectively enrolled 200 consecutive patients (62 ± 10 years, 58% males) with dyspnea (NYHA≥II), paroxysmal AF and preserved LV ejection fraction (≥50%). All patients had a H2FPEF score suggesting high probability of HFpEF. During sinus rhythm, all patients underwent comprehensive transthoracic echocardiography at baseline, including assessment of left ventricular (LV) global longitudinal strain (GLS), left atrial (LA) reservoir strain (LASr), LA conduit strain (LAScd) and LA contractile strain (LASct) using two-dimensional speckle tracking in apical views.

Results
After 42+/-8 months follow-up, a total of 34 (17%) patients had a documented recurrence of AF. Patients with AF recurrence had lower LASr (22.2% vs. 28.3%, p &lt; 0.001) and LASct (10.9% vs. 13.2%, p &lt; 0.01) compared to patients who keep on SR. Among speckle tracking derived LA phasic strain indices, LASr showed the largest area under the curve (AUC = 0.8, p &lt; 0.001) and the strongest independent predictive value (LASr &gt; 22%) of long-term maintenance of SR with sensitivity of 80% and specificity of 66% (Figure 1). Other parameters of LA function, LA diameter, maximum or minimum LA volume index, LV GLS or ejection fraction, and indices of LV diastolic function had lower area under the curve. Using multivariable logistic regression, only LASr (OR 0.89, 95% CI 0.81-0.97, p=0.013) was independently associated with long-term SR maintenance while other LA size and function indices were not.

Conclusion
In HFpEF patients with paroxysmal AF undergoing CA, LASr is more accurate predictor of SR maintenance than other standard echocardiographic parameters in long-term follow-up.
Left atrial functional assessment a prime clue in solving the puzzle of stable angina symptoms in suspected coronary artery disease patients
Authors: Tewari S , Khare H , Sahu A , Khanna R , Kumar S , Garg N , Kapoor A 
Published: November 2023

Abstract

Background
Assessing clinically for significant coronary artery disease (CAD) in stable angina patients presents a formidable task. Routinely performed echocardiography is limited in diagnosing CAD with provision for the regional wall motion abnormality (RWMA) for left ventricle (LV) systolic dysfunction and altered mitral inflow velocities for LV diastolic dysfunction. However, the advent of two-dimensional (2D) speckle-tracking technique has established the era of strain imaging, opening new possibilities in echocardiography. It is now possible to have a detailed functional assessment of left atrium (LA). We utilised speckle tracking imaging to obtain strain parameters for LA function. Combining these strain parameters with the doppler myocardial velocities and mitral inflow velocities, may prove useful mode of imaging to diagnose significant CAD in stable angina patients.

Purpose
To study the parameters of left atrial functions utilising echocardiographic strain imaging and evaluate their correlation with the syntax score-II in patients with symptoms of stable angina.

Methods
103 patients with symptoms of stable angina undergoing coronary angiography for suspected coronary artery disease(CAD), were considered for LA function assessment and compared with their syntax-II score.

Results
The LA reservoir function parameters, peak atrial longitudinal strain (PALS) and peak global systolic strain rate (LAsSR), decreased with increasing syntax-II score (p values 0.011 and 0.001 respectively) and the parameter of LA conduit function, peak global early diastolic strain rate (LAeSR) increased (p value &lt;0.001). The LA filling pressures reflected by E/e`, also increased with more severe syntax-II score (p value &lt;0.001). We, further, configured cut off values of &lt; 23.56 for PALS, &lt; 1.15 for LAsSR, &gt; -1.09 for LAeSR, and E/e` ratio &gt; 10.39 as predictors of significant CAD, with good sensitivity and specificity. Therefore, stable angina patients who had significant CAD on coronary angiogram represented by severe syntax score-II, had higher LA filling pressures and deranged LA function with transition from more of reservoir chamber to merely a conduit.

Conclusion
Our study shows a significant association between LA strain parameters (PALS, LAsSR, and LAeSR) and LA filling pressures (E/e`), with the presence of significant CAD in these patients. The stable angina patients with more severe CAD as quantified by their severe syntax score-II, have an impaired LA reservoir and LA functions more as a conduit, with elevated filling pressures. This study establishes a significant association between LA deformation strain variables and severity of CAD and hence LA strain imaging can be a useful tool to diagnose significant CAD in stable angina patients.
The prognostic value of echocardiographic right ventricular global longitudinal strain in heart failure: A systematic review and meta-analysis
Authors: Anastasiou V , Papazoglou A S P , Moysidis D V M , Daios S D , Peteinidou E P , Zegkos T Z , Giannakoulas G G , Karamitsos T K , Ziakas A Z , Kamperidis V K 
Published: November 2023

Abstract

Background
Right ventricular (RV) dysfunction is a well-recognized adverse prognostic feature in patients with heart failure (HF). However, accurate RV functional assessment remains challenging in clinical practice. Recently, many studies have demonstrated that RV global longitudinal strain (RV GLS) assessed using speckle tracking echocardiography might be a powerful prognosticator in HF.

Aim
To systematically appraise and quantitatively synthesize the prognostic evidence of RV GLS derived by echocardiography, across the entire spectrum of left ventricular ejection function (LVEF) in HF.

Methods
A systemic literature review was conducted in MEDLINE, Scopus and Cochrane databases to identify every study reporting the predictive role of RV GLS in HF subjects irrespective of LVEF. A random-effects meta-analysis was conducted to quantify the adjusted and unadjusted hazard ratios [(a)HRs] for all-cause-mortality and the composite outcome of all-cause mortality or any HF-related hospitalization per each unit of increase in RV GLS. Subgroup analysis was feasible for patients with LVEF&lt;45%.

Results
Thirteen studies were deemed eligible for inclusion in the systematic review. Of them, 8 provided appropriate quantitative data for the meta-analysis, encompassing a total of 3,736 patients. When adjusted for pre-specified clinically-relevant parameters, it was shown that each unit of increase in RV GLS conferred increased risk of all-cause mortality (pooled aHR=1.08 [1.03-1.13]; p&lt;0.01; I²=76%) and the composite outcome (pooled aHR= 1.10 [1.06-1.15]; p&lt;0.01; I²=0%) for patients with HF (Abstract Picture 1 and 2). Subgroup analysis for HF patients with LVEF&lt;45% yielded similar results, with each increase of 1% in RV GLS being independently associated with increased risk of all-cause mortality (pooled aHR=1.10 [1.06-1.13]; p&lt;0.01; I²=0) and the composite end-point (pooled aHR= 1.13 [1.07-1.20]; p&lt;0.01; I²=0%) (Abstract Picture 1 and 2).

Conclusion
RV GLS assessed by speckle-tracking echocardiography is a novel echocardiographic biomarker that can further add in patient prognostication across a wide range of HF populations regardless of LVEF.RV GLS and all-cause mortalityRV GLS and the composite outcome
Association between implanted cardioverter-defibrillator and mortality for patients with left ventricular ejection fraction near 35%
Authors: Wasfy J , Achanta A , Hidrue M K , Urbut S , Axtell A L , Berman A B , Chen C , Gustus S , Picard M H 
Published: November 2023

Abstract

Background
Consensus guidelines support the use of implanted cardioverter-defibrillators (ICD) for primary prevention of sudden cardiac death in patients with either non-ischemic or ischemic cardiomyopathy with left ventricular ejection fraction ≤ 35%. Despite that class 1 recommendation, evidence from trials for efficacy specifically for patients with left ventricular ejection fraction (LVEF) near 35% is weak. Past trials are underpowered for this population and future trials are unlikely to be performed. As such, we aimed to use a large longitudinal echocardiography database linked to mortality to assess the comparative effectiveness of ICD therapy near the conventional primary prevention LVEF threshold.

Methods
Patients with lowest LVEF between 33-38% without an ICD prior to the lowest-LVEF echo (defined as "time zero") were identified by querying echocardiography data from November 28, 2001 until July 9, 2020 at large general hospital-based echocardiography registry linked to ICD treatment status. These data were then linked to mortality and comorbidity data. After inclusion and exclusion criteria were applied, 6,144 patients remained for the analytic cohort.
Given evidence of covariate imbalance around the LVEF = 35% threshold, fuzzy regression discontinuity methods were considered but not used. Instead, to assess the association between ICD and mortality, multiple propensity score methods including matching and inverse probability of treatment weighting (IPTW) were used to create synthetic reference groups. Survival was then assessed with Cox proportional hazards models considering treatment status as a time-dependent covariate.

Results
In bivariate unadjusted comparisons, patients who received ICDs were substantially more often male (85.6% vs. 64.9%, p &lt; 0.0001), more often white (87.3% vs. 82.9%, p &lt; 0.048), and more often had a history of ventricular tachycardia (41.1% vs. 12.1%, p &lt; 0.0001) and myocardial infarction (42.1% vs. 34.7%, p = 0.008). In the propensity matched sample, after accounting for time-dependence, there was no association between ICD and mortality (HR 1.09, 95% CI 0.86-1.39, p = 0.474). In the IPTW analysis, there also was no association between ICD and mortality (HR 1.09, 95% CI 0.91-1.30, p = 0.3672).

Conclusions
ICD therapy was not associated with reduced mortality near the conventional LVEF threshold of 35%. Although this treatment design cannot definitively demonstrate lack of efficacy, our results are concordant with available prior trial data. A definitive, well-powered trial is needed to answer the common and important clinical question of primary prevention ICD efficacy near the threshold of LVEF = 35%.