bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atrial strain and strain rate in a general population: do these measures improve the assessment of elevated NT-proBNP levels?
Authors: Roesner A , Kornev M , Caglayan H A , Queiros S , Malyutina S , Ryabikov A , Kudryavtsev A V , Schirmer H 
Published: January 2025

Abstract

Background and Purpose
Noninvasive assessment of elevated filling pressure in the left ventricle (LV) remains an unresolved problem. Of the many echocardiographic parameters used to evaluate diastolic pressure, the left atrial strain and strain rate (LA S/SR) have shown promise in clinical settings. However, only a few previous studies have evaluated LA S/SR in larger populations.

Methods
A total of 2033 participants from Norwegian and Russian (Know Your Heart) population studies, equally distributed by age and sex, underwent echocardiography, including atrial and ventricular S/SR and NT-proBNP measurements. Of these, 1069 were identified as healthy (without hypertension (HT), atrial fibrillation (AF), or structural cardiac disease) and were used to define the age- and sex-adjusted normal ranges of LA S/SR. Furthermore, the total study population was divided into groups according to ejection fraction (EF) ≥50%, EF &lt;50%, and AF. In each group, uni- and multiple regression and receiver operating characteristic curve analyses were performed to test LA and LV functional parameters as potential indicators of NT-proBNP levels above 250 ng/ml.

Results
The mean LA S/SR values in this study were higher than those in previous large studies, whereas the lower references were comparable. In normal hearts, atrial total strain (ATS) and mitral valve E deceleration time (MV DT) were independent factors indicating elevated NT-proBNP levels, whereas in hearts with reduced EFs, the independent indicators were peak atrial contraction strain (PACS) and LV stroke volume. The areas under the curve for these significant indicators to discriminate elevated NT-proBNP levels were 0.639 (95% confidence interval (CI): 0.577-0.701) for normal EF and 0.805 (CI: 0.675-0.935) for reduced EF.

Conclusion
The results confirm good intra-study reproducibility, with mean values in the upper range of previous meta-analyses. In the future automated border-detection algorithms may be able to generate highly reproducible normal values. Furthermore, the study showed atrial S/SR as an additional indicator of elevated NT-proBNP levels in the general population, demonstrating the incremental value of both ATS and PACS in addition to conventional and ventricular strain echocardiography. Thus, the LA S/SR may be regarded as an important addition to the multiparametric approach used for evaluating LV filling.
Normal Ranges
ROC curve analysis
Optimal cut plane for the measurement of tricuspid annular plane systolic excursion: how should we measure TASPE?
Authors: Murayama M , Kaga S , Yamaguchi M , Yokoyama S , Nishino H , Goto M , Yanagi Y , Kambayashi M , Shimono Y , Nakamura K , Tamaki Y , Ishizaka S , Iwano H , Nagai T , Anzai T 
Published: January 2025

Abstract

Introduction
Assessment of right ventricular systolic function plays an important role in management of cardiovascular disease. Tricuspid annular plane systolic excursion (TAPSE) is the most widely used quantitative parameter; however, there is a lack of evidence regarding the appropriate cut plane for its measurement.

Purpose
This study aimed to elucidate the optimal cut plane for TAPSE measurement, focusing on the incidence angle of the M-mode cursor and relationship to an angle-independent right ventricular systolic parameter.

Methods
This retrospective study included 113 adult patients referred for echocardiography for a variety of clinical indications. TAPSE was measured using the M-mode in the standard, focused, and modified apical four-chamber views (Figure 1). Incident angles between the M-mode cursor and the direction of the lateral tricuspid annulus movement were also measured. Right ventricular free wall longitudinal strain was measured as an angle-independent parameter.

Results
TAPSE measured from the modified apical four-chamber view was the largest among the three approaches (standard apical four-chamber view: 20.7 ± 5.2 mm; focused apical four-chamber view: 19.9 ± 4.7 mm; modified apical four-chamber view: 22.9 ± 5.5 mm; one-way repeated measures ANOVA P &lt; 0.001) (Figure 2A). The incident angle was the smallest in the modified apical four-chamber view (standard apical four-chamber view: 24.1 ± 9.8 degrees; focused apical four-chamber view: 28.6 ± 11.0 degrees; modified apical four-chamber view: 14.7 ± 7.9 degrees; one-way repeated measures ANOVA P &lt; 0.001) (Figure 2B). TAPSE from the modified apical four-chamber view showed a better correlation with right ventricular free wall longitudinal strain compared to other approaches (standard apical four-chamber view: r = 0.632 [95% confidence interval: 0.506 to 0.731], p &lt; 0.001; focused apical four-chamber view: r = 0.626 [95% confidence interval: 0.499 to 0.727], p &lt; 0.001; modified apical four-chamber view: r = 0.700 [95% CI: 0.592 confidence interval 0.783], p &lt; 0.001, respectively).

Conclusions
The modified apical four-chamber view was the most optimal for TAPSE measurements owing to the largest value and the smallest incident angle. Standardization of measurements to the modified apical four-chamber view would provide accurate assessment of the right ventricular systolic function in daily practice.
Figure 1
Figure 2
Right ventricular function of patients with multiple myeloma treated with carfilzomib
Authors: Fraix A , Basin S , Cezar M , Pace N , Filippetti L , Schulmann S , Selton-Suty C , Huttin O , Chabot F , Chaouat A , Valentin S 
Published: January 2025

Abstract
Carfilzomib is an irreversible proteasome inhibitor used for treatment of multiple myeloma which improves progression-free survival and reduces the risk of death. Several adverse effects are described and especially cardiovascular events. Pathophysiological mechanisms are not fully understood but oxidative stress may damage cardiomyocytes (1).
Most common cardiovascular side effects are arterial hypertension, left heart failure, arrhythmia and thromboembolic events. Therefore, transthoracic echocardiogram (TTE) is recommended prior to the initiation of treatment and throughout the follow-up. Carfilzomib has also been shown to be associated with the development of pulmonary hypertension, however the effect on right ventricular function remains unknown (2). We aimed to evaluate the evolution of right ventricular (RV) function and RV-pulmonary artery coupling under carfilzomib.
This retrospective study included thirty-six patients diagnosed with multiple myeloma with a median age of 65.5 [58.8 – 71.5] years. The main comorbidity was systemic hypertension (n=18, 50%) and twenty-eight (77.8%) patients received at least one line of chemotherapy before carfilzomib. Every patient underwent TTE before and during treatment with carfilzomib.
Our results showed that the baseline TTE revealed preserved left ventricular (LV) function with a median LV ejection fraction of 60 [58.8 – 63.5] % without LV dilatation. Concerning RV function, tricuspid annular plane systolic excursion (TAPSE) was 24.5 [21.1 – 27.3] mm, and lateral tricuspid annulus peak systolic velocity (S’ wave) was 13.0 [11.7 – 15.0] cm/s. Systolic peak tricuspid regurgitation velocity (peak TRV) was measured at 2.4 [2.2 – 2.6] m/s. RV-pulmonary artery coupling, estimated by TAPSE/sPAP ratio was 0.94 [0.79 – 1.11] mm/mmHg. During the follow up, TAPSE significantly decreased under carfilzomib treatment at 21.5 [19.9 – 25.3] (p=0.03). TAPSE decreased in more than 57.1% of patients with a mean of 5.4 ± 4.1 mm. However, peak TRV was not different during follow-up (2.4 [2.3 – 2.5]] m/s, p=0.97) nor TAPSE/sPAP ratio (0.88 [0.80 – 1.10] mm/mmHg, p=0.17).
These data are the first to suggest that carfilzomib may impair right ventricular (RV) function even in the absence of evident pulmonary hypertension. Therefore, close monitoring of RV function in patients treated with carfilzomib is crucial due to the risk of RV side effects. Transthoracic echocardiography (TTE), particularly the follow-up of tricuspid annular plane systolic excursion (TAPSE), seems to be a valuable screening tool for monitoring these patients before they undergo more specific evaluations.
Right ventricular function and pulmonary coupling in relation to loop diuretic resistance in patients with congestive heart failure
Authors: Zaborska B , Imiela T , Pilichowska-Paszkiet E , Imiela A M , Bednarczyk T , Piszcz K , Budaj A 
Published: January 2025

Abstract

Background
Right ventricular (RV) dysfunction has been proven to be a prognostic factor among heart failure (HF) patients. Loop diuretic resistance (LDR) is associated with worse clinical outcomes, greater symptom burden and mortality. Limited data exist to characterise the relation between RV and kidney function, especially LDR.

Purpose
To assess relationship of different echocardiographic RV function parameters with loop diuretic resistance in patients with congestive HF exacerbation.

Methods
Consecutive patients with congestive HF exacerbation were prospectively included in the study. LDR was defined as persistent congestion on the 4th day of hospital stay despite high i.v. loop diuretic dose. Transthoracic echo with detailed assessment of right heart geometry and function, clinical and biochemical parameters were evaluated on the 1st and 4th day of hospital stay. A TAPSE/PASP ratio was used to assess RV to pulmonary circulation coupling. Results are presented as mean±standard deviation or median (interquartile range).

Results
40 patients were included in the study with median age 84 (72,8; 86) years, mean left ventricle ejection fraction (EF) 37.3±13.0 %, mean E/e’ 18.6±5.0, median NT-proBNP 8967.5 (3024; 15241) pg/ml. LDR was found in 14 (35%) patients. Univariate analysis identified the following risk factors for LDR: pulmonary artery systolic pressure (PASP), right ventricle to pulmonary circulation coupling index (TAPSE/PASP ratio), serum creatinine concentration, serum urea concentration, serum low-density cholesterol (LDL) concentration (results are shown in the table). TAPSE/PASP on admission correlated negatively with NT-pro BNP (r -0.44 , p=0.007) and positively with diuresis/40mg of furosemide (r 0.38, p=0.02). In the multivariable model, the significant negative relationship between LDR and TAPSE/PASP (beta coefficient -0.653, p= 0.047) as well as LDL (beta coefficient -0.055, p=0.043) was observed.

Conclusions
TAPSE/PASP, one of the most significant non-invasive indexes of RV failure, assessed at admission might be a clinically relevant marker of LDR in patients with congestive HF exacerbation.
Study group characteristics
Arrhythmogenic mitral annular disjunction: papillary muscle abnormalities as a novel component
Authors: Sienkiewicz K , Wabich E , Dorniak K , Fijalkowska J , Szurowska E , Fijalkowski M , Danilowicz-Szymanowicz L 
Published: January 2025

Abstract

Purpose
Mitral annular disjunction (MAD) is a relatively common condition that can be associated with ventricular arrhythmias. This study aims to assess the significance of abnormalities in the left ventricular papillary muscles, as detected by cardiac magnetic resonance imaging (MRI), and their correlation with the echocardiographic Pickelhoube sign and arrhythmogenic burden in patients with MAD.

Methods and Materials
A retrospective study was conducted involving 63 consecutive patients with MAD identified via a 1.5T MRI scanner. All patients underwent echocardiography, and 51 patients (81%) also completed a 24-hour Holter electrocardiography. The study evaluated the visual presence of the dark papillary muscle sign (dark PAP), late gadolinium enhancement in the papillary muscles (PAP LGE), and the echocardiographic Pickelhoube sign, known to be associated with a higher risk of ventricular arrhythmias. Additionally, the 24-hour Holter ECG assessed the number of premature ventricular contractions (PVCs), using a threshold of more than 1000 beats per 24 hours, and the presence of nonsustained ventricular tachycardia (nsVT).

Results
The average MAD length in the study population was 5.29 ± 0.43 mm (95% CI). The dark PAP sign was observed in 42 patients (67%), PAP LGE in 11 patients (17%), and the echocardiographic Pickelhoube sign in 34 patients (54%). Ventricular arrythmias (nsVT and more than 1000 PVCs per 24 hours) were found in 24 patients (38%). The dark PAP sign was significantly associated with the echocardiographic Pickelhoube sign (p &lt; 0.001). Ventricular arrhythmias (PVCs) were more frequent in patients with PAP LGE (p &lt; 0.03). The small number of nsVT cases (6 patients) precluded statistical analysis.

Conclusion
The study found that the dark PAP sign correlates with the echocardiographic Pickelhoube sign, and PAP LGE is associated with a higher burden of ventricular arrhythmias. Further prospective studies in larger populations are needed to evaluate the potential of papillary muscle characteristics in risk stratification for ventricular arrhythmias in patients with MAD.
dark PAP positive
dark PAP negative
Maladaptive remodeling reduces survival in patients with moderate aortic stenosis and preserved ejection fraction
Authors: Petrovic O , Paunovic I , Jovanovic I , Rakocevic I , Vidanovic S , Tesic M , Boricic-Kostic M , Vratonjic J , Milasinovic D , Mehmedbegovic Z , Trifunovic-Zamaklar D , Ivanovic B , Stankovic G 
Published: January 2025

Abstract

Background
Aortic valve stenosis (AS) is a common cause of left ventricular (LV) pressure overload and subsequent hypertrophy and diastolic dysfunction. The extent of LV hypertrophy does not necessarily correlate with the severity of valve stenosis and excessive LV remodeling can be seen in moderate AS. Therefore aortic stenosis is the disease of valve and myocardium. Left ventricular hypertrophy (LVH) with different geometric patterns is associated with adverse prognosis, The concept of staging AS disease rather than merely classifying AS based on hemodynamic severity seems more appropriate. Current guidelines do not address whether aortic valve replacement should be recommended in patients with moderate aortic valve stenosis regardless of the presence of LV dysfunction.

Purpose
This study aimed to investigate differences in left ventricular remodeling and its impact on survival in patients with unequivocally moderate aortic stenosis and preserved LV ejection fraction.

Methods
We retrospectively analyzed 182 unequivocally moderate AS patients (57% were male, age was 70±9), who underwent transthoracic echocardiography from March 2018 to November 2021. AS severity was defined by specific threshold values peak velocity 3-4 m/sec, an MPG 20-40 mmHg and an AVA 1-1.5 cm. All values were concordant and suggested moderate AS. All patients were in sinus rhythm and with LV ejection fraction &gt;50%. We calculated the LV mass index (LVMI) and ventricular geometry was assessed with a relative wall thickness (RWT). Left ventricular hypertrophy (LVH) was defined as LV mass index &gt;95g/m2 in women and &gt;115g/m2 in men and was defined as concentric when associated with a RWT&gt;0.42 and eccentric when RWT was ≤0.42. Concentric remodeling was defined as normal LVM index and increased RWT. The follow-up assessment in December 2023 ascertained vital status and data on aortic valve replacement (AVR).

Results
LVH was present in 91 patients (50%). Eccentric LVH was present in 49 (27%), concentric LVH in 42 (23%), and concentric remodeling in 27 (15%). During a median 41 months follow-up, 49 (27%) deaths occurred. 32 (18%) patients undervent AVR. As expected, LV hypetrophy was associated with all-cause mortality (HR 2.556; CI: 1.007-6.448; p = 0.048), and if concentric hypertrophy was present mortality was even higher (HR 3.736; CI: 1.553-8.992; p = 0.003) AVR had a non-statistically significant protective effect (HR 0.654; CI: 0.193 -2.220; p = 0.496).

Conclusion
Maladaptive remodeling is associated with worse outcomes in patients with moderate AS. RWT is important for identification of abnormal geometry. Further studies investigating the adequate timing of AVR in patients with moderate AS with maladaptive LV response are needed.
Left ventricular, left atrial dysfunction and BNP progression in asymptomatic moderate and severe aortic stenosis
Authors: Dulgheru R , Lambert A , Damas F , Demarneffe N , Postolache A , Lancellotti P 
Published: January 2025

Abstract

Introduction and aim
Aortic stenosis (AS) is the most common valve disease in industrialized countries. Its prevalence is set to increase considerably in the coming years as the population ages (1). Data regarding the natural evolution in patients with moderate and severe AS are derived from cohorts of patients from 30 years ago (2, 3). We have thought to analyze the evolution of clinical, echocardiographic parameters and blood brain natriuretic peptide (BNP) in a recent cohort of truly asymptomatic patients with moderate to severe AS followed in the Valve Clinic. We also wanted to determine which is the echocardiographic parameter who’s annualized change will influence all-cause mortality in these patients.

Methods
We have enrolled 63 patients with moderate or severe truly asymptomatic AS (negative exercise test in each patient) followed up in our Valve Clinic from 2010 to 2023 who had at least 2 or 3 transthoracic echocardiographic examination (TTE) of excellent quality while still asymptomatic. All patients had a complete TTE with images suitable for left ventricular (LV) and left atrial (LA) deformation analysis by 2D speckle tracking. All conventional TTE parameters were analyzed as well as BNP measurements at the time of the TTE. Patients were followed up (mean follow up of 401 days) and all-cause mortality was assessed.

Results
Our results show progression of AS severity, a decrease in LV systolic function (GLS decreased significantly but LVEF and SV index remained changed), progression of LV diastolic dysfunction (progressive increase in E /e' ratio, in LA index volume with a significant decrease in LA reservoir function (PALs)). A progressive increase in estimated systolic pulmonary arterial pressure (PAPs) and a higher probability of pulmonary hypertension during follow-up was observed, while RV function parameters, TAPSE and S’ remained unchanged. BNP levels increased significantly over time. No patient was lost to follow-up and 23 (36.5%) patients died, 3 of cardiovascular cause. After adjustment for sex, age, presence of type 2 diabetes and coronary artery disease, all-cause mortality seemed to be significantly higher in patients with a decrease in LA reservoir function during follow-up (OR 0.77, CI 0.59-0.99, p=0.046).

Conclusion
To our knowledge, this is the first longitudinal contemporary study to describe the progression of AS and of all parameters of LV, LA, RV function and PHT in moderate to severe truly asymptomatic AS patients followed in a Valve Clinic. A higher risk of all-cause mortality was seen in patients with a poorer LA reservoir function. Annualized changed in LV and LA functional parameters may become a tool to improve risk stratification and therapeutic decision-making in asymptomatic severe AS if larger studies were to confirm our findings.
Impact of strictly defined phenotypes of tricuspid regurgitation on clinical outcome
Authors: Hu C , Li W , Tsai W 
Published: January 2025

Abstract

Background
Moderate to severe tricuspid regurgitation (TR) is widely recognized as a significant contributor to right ventricular (RV) failure and mortality. Our previous study using a step-by-step approach to classified phenotypes of TR has shown different phenotypes of TR had different effects on RV remodeling. Current study was tried to find the impacts of these phenotypes on clinical outcomes.

Methods
There were 670 patients (7.7%) exhibited moderate to severe TR in our echocardiography laboratory from January to June 2018. These participants were classified into 8 phenotypes by a step-by-step approach including primary TR, secondary TR related to RV instrumentation, related to left heart disease, related to congenital heart disease, related to pulmonary hypertension, related to RV myopathy, atrial TR, and true idiopathic TR. Combined outcome endpoints included death, heart failure, acute coronary syndrome, stroke, and new arrhythmia.

Results
There were 28 participants lost follow-up and only 6 participants had been classified as RV myopathy were excluded. The remaining 636 participants (mean age 70.9 ± 15.4 years, 254 (40%) men) were included in the study. After mean follow-up 43.2 ± 27.9 months, a total of 321 (50.5%) participants reached combined endpoints. Different phenotypes demonstrated different rates of outcomes included 43.7% in primary TR, 66.7% in secondary TR related to RV instrumentation, 58.1% in left heart disease, 45.8% in congenital heart disease, 51.5% in pulmonary hypertension, 42.6% in atrial TR, and 29.9% in true idiopathic TR. After multivariate COX regression analysis, independent factors for prognosis included TR phenotypes (HR 1.079, 95% CI 1.000-1.165), age (HR 1.023, 95% CI 1.013-1.033), eGFR (HR 0.991, 95% CI 0.985-0.996), systolic pulmonary pressure (HR 1.008, 95% CI 1.002-1.013), RV fractional area change (HR 0.986, 95% CI 0.977-0.995), and left ventricular ejection fraction (HR 0.989, 95% CI 0.980-0.998). The Kaplan-Meier curves significantly separated according to different TR phenotypes (Log Rank p &lt; 0.001).

Conclusion
The identification and classification of different TR phenotypes according to our step-by-step approach had significant impact on patient outcomes. Simply using this step-by-step approach from echocardiography can identify high risk TR patients who urge for further intervention.
Acute postprocedural myocardial strain changes after transcatheter edge-to-edge mitral valve repair
Authors: Peszek-Przybyla E , Gallina T , Jedrzejek M , Michalewska-Wludarczyk A , Pysz P , Wojakowski W , Smolka G 
Published: January 2025

Abstract

Introduction
Despite the increasing utilization of transcathether edge-to-edge mitral valve repair (TEER) its effect on global myocardial function and segmental performance remains poorly understood. The immediate changes in volume and wall tension induced by the TEER procedure present an interesting area of study, regarding their influence on myocardial function, which may be crucial for future understanding of cardiac mechanics.

Purpose
The purpose of this study is to investigate the direct impact of TEER implantation on changes in left ventricle function and geometry

Methods
A prospective observational study was conducted involving consecutive patients undergoing TEER for severe MR. Echocardiographic assessments were performed before and in the cath-lab, immediately after the procedure, with strain analysis performed using speckle-tracking echocardiography.

Results
The study includes 27 patients with severe MR, with a mean age of 77 ± 5.9 years. The analysis revealed no significant changes in LVEF before and after the procedure (41,7% vs 40,7%, p= 0,234, respectively). However, it shows a significant decrease in global longitudinal strain (GLS) post-procedure compared to pre-procedure (-10.7% vs -12.4%, p=0.019, respectively). Subgroup analysis of individual myocardial segments demonstrated significant reduction in strain values between pre- and post-procedure assessments, particularly in segments 3, 9, 12, 17, and 18.

Conclusion
The findings suggest that TEER for severe MR leads to acute changes in myocardial strain, particularly in myocardial segments at the region of papillary muscles. This phenomenon may be caused by the tension of the subvalvular apparatus due to TEER procedure. Changes in strain analysis were observed despite no changes in EF. Further research is necessary to elucidate the clinical implications of these findings and their impact on patient outcomes.