bluuebunny/crossref_metadata_2025_split huggingface dataset:
A new perspective on mixed moderate aortic valve disease
Authors: Son J H , Kim O Y , Park S J , Kim J H , Kim D R , Kim E K , Chang S A , Lee S C , Park S W 
Published: January 2025

Abstract

Background
Mixed aortic valve disease (MAVD) is common in patients with aortic valve disease. Some studies suggest that outcomes of mixed moderate aortic stenosis and regurgitation (ASR) are similar to severe aortic stenosis (AS). However, there is limited data on moderate ASR in the Asian population. This study aims to analyze the characteristics and outcomes of MAVD at our center and compare them with isolated moderate AS and severe AS to determine the prognosis of MAVD.

Methods
This retrospective study collected MAVD patients from a single tertiary center from January 2000 to January 2023 (n=1452). Patients with severe aortic valve stenosis and/or regurgitation, left ventricular ejection fraction (LVEF) ≤40%, other significant valve disease, previous valve surgery, and age &lt;18 years were excluded. Eventually, we identified 55 patients with moderate ASR (mean aortic peak velocity 3.7 ± 0.6 m/s, mean pressure gradient 31.0 ± 11.0 mmHg, aortic valve area 1.3 ± 0.2 cm², AR vena contracta width 0.4 ± 0.1 cm). We compared them with the isolated moderate AS group (n=648) and severe AS group (n=749). We analyzed the outcomes of AVR and mortality across the three groups. In a sub-analysis, AVR rates were compared between the moderate ASR and moderate AS groups.

Results
Mean age was the lowest in the moderate ASR group (63.7±13.2 years) compared to the moderate AS group (72.2±10.8 years) and severe AS group (72.6±10.5 years, p&lt;0.001). The proportion of males was similar among the three groups. In moderate ASR group, the etiology of valve was identified as 21.8% of bicuspid valve (12/55), 25.5% of rheumatic valve (14/55) and 50.9% of degenerative trileaflet valve (28/55). (Table1) Mean follow-up duration was 4.15 ± 4.02 years.
In outcome, the mortality showed similar between the moderate ASR group and moderate AS group, but significant higher in severe AS group in time-varying adjusted cox regression analysis. The cumulative incidence of AVR was higher in the moderate ASR group by the Kaplan-Meier curve (p=0.025, Figure). Freedom from AVR in the moderate ASR group was 71% at 3 years, 61% at 5 years and 54% at 7 years, indicating more slow progression than previous study.

Conclusions
In this study, mortality rates between the moderate ASR and the moderate AS groups were similar, but the AVR rates were higher in the moderate ASR group. Compared to previous studies, differences in etiology of the valve and ethnicity may affect the slow progression rate of moderate ASR. Further studies with larger cohorts are needed in the future.
Echocardiographic evaluation of mechanical abnormalities to predict significant ventricular arrhythmias in mitral valve prolapse: a systematic review and meta-analysis
Authors: Viva T , Sperlongano S , Bruno V D , Glauber M , Lancellotti P 
Published: January 2025

Abstract

Background
A subset of patients with MVP (mitral valve prolapse) is at high risk of malignant ventricular arrhythmias (VAs). Recently, a role of strain echocardiographic parameters has emerged in the risk prediction of these events.

Purpose
This systematic review and meta-analysis aimed to analyze the association between strain parameters and VAs and sudden cardiac death in MVP.

Methods
A systematic review and meta-analysis were performed for studies including patients with MVP, in which strain parameters were analyzed and an history of significant VAs was reported. The aim was to evaluate the association between strain parameters and the occurrence of significant VAs and to compare these parameters between patients with significant VAs ("Arrhythmogenic mitral valve prolapse", AMVP) vs No VAs ("Non-arrhythmogenic mitral valve prolapse", NAMVP).

Results
Seven observational studies1–7 (six retrospective and one prospective) were included and a total of 1065 patients with MVP were part of the analysis. GLS (global longitudinal strain), mechanical dispersion (MD), and post-systolic index (PSI) demonstrated to be associated with significant VAs in our analysis (GLS: OR = 1.16, 95% CI 1.02 - 1.33, p = 0.03, MD: OR = 1.05, 95% CI 1.01 - 1.09, p &lt; 0.01, PSI: OR = 1.13, 95% CI 1.03 - 1.23, p &lt; 0.01, Fig.1), although some conflicting data exist in literature. A "double-peak pattern" in the LV infero-lateral basal wall was also associated with the occurrence of VAs (HR 4.81, 95% CI 2.22 – 10.4, p &lt; 0.001). GLS was significantly lower in patients with AMVP compared with NAMVP (mean difference = 1.24%, 95% CI 0.33 - 2.15, p &lt; 0.01, I2 = 52%, Fig.2); MD and PSI were found significantly higher (MD: mean difference = 7.78 ms, 95% CI 2.81 – 12.75, p &lt;0.01, I2 = 61% difference = 1.12%, 95% CI 0.53 – 1.72, p &lt;0.01, I2 = 0%, Fig.2) in AMVP patients.

Conclusions
Three echocardiographic strain parameters (GLS, MD, PSI) were significantly different between patients with AMVP vs NAMVP and predict the risk of VAs. Further studies are required to confirm the utility of these parameters in patients with MVP.
Performance of effective regurgitant orifice and 3D vena contracta area for the diagnosis of severe mitral regurgitation in patients with localized and diffuse mitral valve prolapse.
Authors: Auberson D , Soylemez N , Tzimas G , Arangalage D , Antiochos P , Rutz T , Hugelshofer S , Monney P 
Published: January 2025

Abstract

Background
Mitral valve prolapse (MVP) is heterogenous, ranging from localized disease to diffuse bi-leaflet involvement in Barlow myxoid degeneration. Mitral regurgitation (MR) may be localized or diffuse, holosystolic or end-systolic, depending on the valve morphology. We aimed to compare the diagnostic accuracy of effective regurgitant orifice by conventional 2D PISA (ERO) on transthoracic echocardiography (TTE) with 3D vena contracta area (3D-VCA) on transoesophageal echocardiography (TOE) in patients with localized and diffuse MVP.

Methods
Patients with MVP assessed with TTE, 3D-TOE and cardiac magnetic resonance (CMR) for moderate to severe MR were included. MR was considered severe when the regurgitant fraction (RF) by CMR was ≥40%.1 3D-VCA was acquired in multi-beat mode during breath-hold and 3D-VCA was measured at end-systole. The diagnostic accuracy of 3D-VCA and ERO were compared using ROC analysis in patients with diffuse (6 prolapsing scallops) versus localized prolapse

Results
77 patients had undergone all three exams. Diffuse bi-leaflet prolapse was present in 24 patients (31%, Barlow). In the group with localized prolapse (69%, non-Barlow), 90% had a single scallop prolapse, and 85% had a flail leaflet. 53 of the patients (70%) had severe MR by CMR, and severe MR was less frequent in Barlow (46%, versus 79% in non-Barlow).
ERO could not be calculated accurately by TTE in 10 patients (8 with non-Barlow, 2 with Barlow). Hence, 67 patients were included in the comparative analysis. On average, 3D-VCA overestimated ERO by 20mm2 in non-Barlow and by 24mm2 in Barlow (Figure 1). Diagnostic accuracy of 3D-VCA and ERO was comparable in non-Barlow (AUC 0.79 vs 0.84, p=0.45), but 3D-VCA tended to perform poorly in Barlow (AUC 0.66 vs 0.84, p=0.2) (Figure 2).

Conclusion
3D-VCA measured in end-systole consistently overestimated ERO as determined by the conventional 2D PISA method on TTE. While its diagnostic performance was comparable to ERO in the case of localized prolapse, it seems to demonstrate low performance in the context of Barlow disease.
Figure 1
Figure 2
Dapagliflozin improves ejection fraction, radial/longitudinal strain and reduces systemic H-FABP and pro-inflammatory cytokines in models of dororubicin/trastuzumab induced cardiotoxicity
Authors: Maurea N , Palma G , Luciano A , Maurea F , Bruzzese F , Paccone A , Izzo F , Barbato M , Arianna R , Giacobbe I , Giordano V , Di Mauro A , Ferrara G , Berretta M , Quagliariello V 
Published: January 2025

Abstract

Background
The use of anthracyclines as a standard cancer therapy is limited by the potential for the development of cardiac dysfunction, arrhythmias, and clinical heart failure. The incidence of cardiac dysfunction or heart failure post-trastuzumab plus anthracycline therapy is higher compared to monotherapy regimen, exposing cancer patients to cardiotoxic risk. Dapagliflozin exerts several cardiometabolic benefits in patients with and wthout T2DM through SGLT2-NLRP3 mediated pathways. In this study, we highlighted on new beneficial properties of Dapagliflozin in preclinical models of doxorubicin-HER-2 blocking agent induced cardiotoxicity.

Methods
Female C57Bl/6 mice were untreated (Sham, n=6) or treated for 10 days with doxorubicin i.p at 2.17 mg/kg associated to HER-2 blocking agent i.p at 2,25 mg/kg (DOXO/TRA, n=6), DAPA at 12 mg/kg (DAPA, n=6) or doxorubicin-HER-2 blocking agent combined to DAPA (DOXO/TRA–DAPA, n=6). Cardiac function studies, including EF, FS and radial/longitudinal strain were analysed through transthoracic echocardiography (Vevo 2100) . Systemic levels of ferroptosis-related biomarkers, galectin-3, high-sensitivity C-reactive protein (hs-CRP), and pro-inflammatory chemokines (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12, IL17-α, IL-18, IFN-γ, TNF-α, G-CSF, and GM-CSF) were quantified.

Results
Dapagliflozin increased EF and FS compared to DOXO groups (p &lt; 0.01), prevented the reduction of radial and longitudinal strain after 10 days of treatment with DOXO-TRA (RS) 40.2% in EMPA-DOXO vs 14.9% in DOXO-TRA mice; LS – 26,8 % in DOXO/TRA-DAPA vs – 9,7.3% in DOXO/TRA mice (p &lt; 0.001 for both). Dapagliflozin associated to Doxorubicin reduces of 53,8 % plasma levels of H-FABP compared to DOXO group (p&lt;0.001). Myocardial expression of H-FABP were also reduced, indicating cardioprotective properties of SGLT2i. Significant reductions in ferroptosis, xanthine oxidase expression, cardiac fibrosis and apoptosis in DAPA associated to DOXO/TRA were also seen. A reduced expression of systemic pro-inflammatory cytokines and NLRP3 was also seen in in DOXO/TRA-DAPA group compared to DOXO/TRA (p &lt; 0.001).

Conclusion
For the first time, Dapagliflozin demonstrated significant improvements in cardiac functions and reductions of systemic H-FABP and troponin levels during doxorubicin associated to HER- blocking agent therapy, indicating new potential pathways of cardioprotection in cancer patients.
Distinct phenotypic groups and related clinical outcomes in patients with hypertrophic cardiomyopathy
Authors: Kwak S , Kim J , Kim H K , Lee S C 
Published: January 2025

Abstract

Background
Hypertrophic cardiomyopathy (HCM) is a heterogeneous disorder with varying risks of clinical outcomes, including sudden cardiac death (SCD).

Purpose
We aimed to identify distinct phenotypes among patients with HCM in relation to SCD risk factors, interpret their clinical characteristics, and examine their outcomes.

Methods
This retrospective study analyzed 1,231 consecutive patients with HCM from two tertiary hospitals. We performed latent class analysis (LCA) to categorize patients into phenotypic groups, which is a probabilistic modeling technique that reveals hidden patterns and subgroups within a dataset.

Results
Three distinct phenotypic groups were identified using LCA. Group 1 (n=554) consisted of young patients with HCM with minimal SCD risk factors and favorable cardiac remodeling. Group 2 (n=114) comprised young patients with HCM and a high prevalence of SCD risk factors, whereas Group 3 (n=563) included older patients (median age, 68 years). Over a median 6.5-year follow-up, 34 SCD-related events, 131 cardiovascular (CV) events, 133 all-cause mortality, and 70 non-CV mortality were observed. Group 2 exhibited the highest rate of SCD-related events (5-year SCD rate: Group 1 vs. 2 vs. 3: 0.8% vs. 8.2% vs. 4.0%, respectively, p&lt;0.001), and CV events were more frequent in Group 2 and 3 compared to Group 1 (Figure 1). All-cause and non-CV mortality were the most frequent in Group 3. A simplified decision tree was developed for the straightforward assignment of phenotypic group membership, demonstrating fair concordance. The phenotypic categorization and the decision tree is shown in Figure 2.

Conclusions
This study identified three distinct clinical phenotypes in patients with HCM, each associated with different SCD risks and outcomes. Data-driven phenotyping of patients with HCM offers effective risk stratification and may optimize patient management.
Abnormal right ventricular strain predicts poor prognosis in transthyretin amyloidosis
Authors: Istratoaie S , Bourg C , Lee K C , Al Wazzan A , Marut B , Antonelli J , L'official G , Donal E 
Published: January 2025

Abstract

Background
The diagnosis of transthyretin amyloidosis (ATTR) significantly impacts the management and prognosis of patients initially presenting with heart failure (HF). Despite recent advances in treatment, defining the prognosis of ATTR remains challenging. Biological staging systems have been used to stratify disease severity. Valuable insights have emerged from echocardiography parameters.

Purpose
We aimed to assess echocardiographic parameters associated with mid-term prognosis in patients with wild-type ATTR using a biomarker staging system as a reference point.

Methods
Consecutive wild-type ATTR patients referred to a referral center were identified between 2016 and 2022.
The staging system was based on NT-proBNP and eGFR, with cut-offs set at 3000 pg/mL and 45 mL/min/1.73 m², respectively. Echocardiographic indices including all-chamber strains were compared across the staging system. Patients were all treated by Tafamidis 61mg on top of the management of signs and symptoms of HF. Primary endpoint was a composite of death or hospitalization for HF.

Results
182 patients were enrolled (91% male, median age 82 years). Using NT-proBNP and eGFR cutoffs, we divided patients into stage I (101 patients, 55.5%), stage II (53, 29.0%), and stage III disease (28, 15.5%). Patients in a higher ATTR stage were older, with lower body-mass-index and higher NYHA-functional class and more likely to develop AF. Patients classified in stage I presented with subtle signs of left ventricle(LV) and right ventricle(RV) systolic dysfunction, as well as diastolic dysfunction, evident by a reduced global longitudinal strain, right ventricular free-wall-strain (RVFWS) and left atrial strain, respectively. Higher ATTR stage was associated with worse LV and RV systolic functions, worse diastolic function and increase in pulmonary pressures. Over a fixed follow-up of 18 months, 48 patients (26.4%) experienced the composite outcome of death or HF hospitalization. When compared with stage I ATTR, the hazard ratio for death or hospitalization was 1.55 (95% CI 0.62–3.86) for stage II ATTR and 4.53 (95% CI 1.66–12.4, p = 0.0116) for stage III ATTR. Among echocardiographic parameters, reduced RV FWS was independently associated with all-cause mortality or HF hospitalization after adjustment for the staging system (HR 2.03, 95% CI 1.07-3.85, p &lt; 0.05).

Conclusion
RV FWS should be routinely assessed for all patients with ATTR. It is an independent predictor of poor prognosis and provides additional value beyond biomarker staging system.
Epicardial adipose tissue thickness - a new predictive factor for coronary artery disease
Authors: Loghin-Turturica M , Iancu D , Gurzun M 
Published: January 2025

Abstract

Introduction
The role of pericardial adipose tissue has been investigated in numerous studies in relation to the development of coronary artery disease (CAD) and other cardiac pathologies. Total pericardial fat (TPF) consists of epicardial adipose tissue (EAT), which is located between the myocardium and the visceral pericardium, and pericardial fat (PCF), which adheres to the parietal pericardium. The suspected mechanisms are complex and include the acceleration of inflammation and oxidative stress as well as proximity to the coronary arteries.

Purpose
The aim of the study was to investigate the existence of a correlation between the thickness of epicardial and pericardial adipose tissue and the presence of CAD, with the hope of using this marker in the future for risk stratification of cardiovascular disease.

Methods
This study enrolled 264 patients with a mean age of 59,9 +/- 10.6 years, 60,6% (160 pts) male, with cardiovascular risk factors who were investigated for suspected CAD. In all patients, the thickness of the TPF, EAT, and the PCF were measured echocardiographically during end-diastole, at the anterior atrioventricular groove. Intra- and interobserver variability was excellent (ICC 0.995-0.998 and ICC 0.992-0.995 for all three layers).

Results
Out of the total patients included, 54,2% (142 pts) had lesions on conventional angiography, of which 46% had hemodynamically significant lesions requiring revascularization. There were no statistically significant differences in the thickness of the three layers according to the presence of cardiovascular risk factors (diabetes mellitus, smoking, hypertension) and there was no correlation with body mass index. There were statistically significant differences in the dimensions of the pericardial adipose tissue layers between the group of patients with CAD and the group of patients without CAD (EAT 7,1 +/-2,34 vs 5,07+/-2,36 mm, PCF 9.3+/-3,01 vs 7,2+/-2,9 mm and TPF 16,7+/-3,8 vs 12.59+/-4,3 mm, p=0.001 for all cases). There were no statistically significant differences between patients who had one, two, or all three coronary arteries affected (p=0.5). There is a significant correlation between EAT and TPF (r 0.81), PCF and TPF (r 0.83), but no significant correlation between the two substrates (r 0.44). Women without CAD had a lower epicardial layer thickness than men without CAD (4,8+/-0,26 vs 5,4+/-0,29,p &lt;0,001), but this difference did not exist in those with CAD (6.9+/-0.47 vs 7.2+/-0.24).

Conclusions
The study shows that echocardiographic measurement of the thickness of pericardial adipose tissue layers is a feasible method, easy to perform with good intra- and interobserver reproducibility. The data presented suggest that the thickness of the pericardial adipose tissue layers (EAT and TPF) may represent an independent risk factor for CAD and could be included in the pre-test risk assessment of patients with suspected CAD.
A prospective study on the correlation of right atrial pressure determined non-invasively via inferior vena cava versus tricuspid E/e among patients undergoing dobutamine stress echocardiography
Authors: Manalili M K C , Go L 
Published: January 2025

Abstract

Background
Right atrial pressure (RAP) gives insight to a patient's cardiovascular hemodynamics and pulmonary status. It is used to estimate the pulmonary arterial pressure (PAP), but since its definite measurement requires right heart catherization, physicians tend to rely on non-invasive modalities such as echocardiography. Aside from the IVC method, secondary indices, such as tricuspid E/e' and hepatic vein flow pattern, may also be employed to estimate RAP. Methodology: This was a prospective observational single-center study done from November 2023 until April 2024 which included a total of 55 adult patients who underwent dobutamine stress echocardiography (DSE). Baseline characteristics and echocardiographic parameters were obtained, and RAP values using IVC (RAP IVC) and tricuspid E/e’ (RAP E/e’) methods were compared. The correlations of the derived systolic and mean PAP values using the two methods were also determined.

Results
The RAP IVC and RAP E/e’ values had statistically significant difference. The cut-off values used for tricuspid E/e’ overestimate RAP when compared with the IVC method. Analysis on sPAP values had mixed results as to the detection of pulmonary hypertension (PH). Grading of PH severity using derived mPAP values from the two methods also showed statistically significant difference. Lastly, our post-hoc analysis manifested that increasing dobutamine dose has a statistically significant effect to RAP determined via echocardiography.

Conclusion
At the time of this writing, estimating RAP using the tricuspid E/e’ method is not a good alternative to the IVC method. In addition, derived sPAP and mPAP values using tricuspid E/e’ also did not correlate with those determined using the IVC method. Higher tricuspid E/e’ cut-off values, larger sample size, and possible need for correction factors in the derivation of sPAP and mPAP may lead to better correlation between the two methods. Finally, our post-hoc analysis showed that dobutamine &gt;10 mcg/kg/min can cause IVC dilatation and/or plethora, hence caution is needed when interpreting presence of IVC dilatation and/or plethora, and RAP and PAP estimates which were obtained using echocardiography among patients on dobutamine support.
Demographic and clinical profile
Algorithm of procedures
Assessment of cardiac structure and function 1.5 years after COVID-19: results from the EPILOC study
Authors: Schellenberg J , Matits L , Bizjak D , Peter R , Rothenbacher D , Deibert P , Friedmann-Bette B , Niess A , Goepel S , Erz G , Merle U , Kern W , Steinacker J 
Published: January 2025

Abstract

Background
Impaired left and right ventricular function have been observed mainly in hospitalized patients with acute SARS-CoV-2 infection. The long-term cardiac sequelae have not yet been conclusively clarified in large, well-defined cohorts. In addition, it is not yet certain whether cardiac function is related to persistent cardiopulmonary symptoms or reduced exercise capacity after COVID-19.

Purpose
Differences in cardiac structure and function in patients with suspected post-COVID syndrome (PCS) and in recovered control patients (CON) were analysed with regard to the association with cardiopulmonary symptoms and physical performance.

Methods
In this multicentre study, transthoracic echocardiography was performed in 1154 individuals (49±12 years, 760 women) 1.5 years after SARS-CoV-2 infection (October 2020 till April 2021) in southwest Germany. Left and right ventricular global longitudinal strain (LV/RV GLS) and RV free wall strain (FWS) were determined with post-processing software in 679 PCS and 475 CON. Cardiopulmonary exercise testing (CPET) was performed with a ramp protocol on a bicycle ergometer.

Results
PCS showed lower LV GLS (-20.25% vs. -20.73%, p=0.003), diastolic function (E/A 1.16 vs. 1.21, p=0.022) and TAPSE (24.45 vs. 25.05, p=0.022) compared to CON, while RV strain values did not differ. Echocardiographic parameters were within the normal clinical reference range. LV GLS was negatively associated with VO2max (p=0.004) and positively associated with rapid physical exhaustion (p=0.050), but not with cardiopulmonary symptoms.

Conclusions
Significantly reduced cardiac function in PCS compared to CON 1.5 years after SARS-CoV-2 infection could indicate long-term left myocardium involvement, while signs of RV involvement were inconsistent. The differences between the groups appear to be small and could be explained by deconditioning due to PCS or the more frequent presence of cardiovascular disease in PCS. Nevertheless, it cannot be ruled out that a slight reduction in cardiac function and physical performance could be a long-term consequence of COVID-19 in patients with persistent symptoms. Further (long-term) studies are therefore necessary to investigate the connection between persistent exercise intolerance and cardiac involvement. This could lead to further diagnostic steps and therapy recommendations.