bluuebunny/crossref_metadata_2025_split huggingface dataset:
Misinterpretation of indeterminate diastolic dysfunction: awareness and insights from a nationwide survey among Brazilian cardiologists
Authors: Rassi D C , Rassi S , Assef J E , Beck A L S , Felix A S , Cruz C B B V , Barberato S H 
Published: January 2025

Abstract

Introduction
Cardiac diastolic dysfunction is highly prevalent and is associated with significant morbidity and mortality. The latest American Society of Echocardiography and European Association of Cardiovascular Imaging (ASE/EACVI) guidelines have simplified the definition of diastolic dysfunction and introduced the classification of indeterminate diastolic dysfunction (IDF). Despite these advancements, IDF remains poorly understood in clinical practice, with variable prevalence rates.

Purpose
This study aims to assess the understanding of IDF among non-echocardiographer cardiologists across Brazil, eight years after the guideline update.

Methods
A nationwide online survey was conducted among non-echocardiography readers cardiologists, distributed via mobile messaging platforms. A brief questionnaire, using anonymous responses, assessed awareness and interpretation of IDF.

Results
A total of 570 cardiologists participated from all regions of Brazil, with good representation across Southeast (29.65%), Central-West (23.80%), Northeast (18.77%), South (16.14%), and North (11.58%). Most participants (64.21%) had over ten years of clinical experience. While 71% correctly identified degrees 2 or 3 as indicative of elevated filling pressures, only 34.21% accurately understood the criteria for reporting IDF. Misconceptions attributing IFD included presence of pathologies that interfere with accurate assessment (49.12%) or technical limitations of echocardiography machines (3.33%) or lack of knowledge among echocardiographers (4.91%). Additionally, 46.7% encountered IDF rarely in reports, 33.51% believed it influenced patient management, and 43.51% felt that the examination could have been better executed.

Conclusion
Despite widespread knowledge of diastolic dysfunction grading, misinterpretation of DIF persists among Brazilian non-echocardiographer cardiologists. Enhanced education and perhaps clearer guidelines are necessary to improve clinical echocardiographic collaboration and accurate diagnosis.
Heart failure with preserved ejection fraction: incidence and impact on mortality in patients with secondary tricuspid regurgitation
Authors: Pugliesi G , Anand V , Singh S , Scott C G , Pislaru S V , Nkomo V T , Borlaug B A 
Published: January 2025

Abstract

Introduction
Secondary tricuspid regurgitation (STR) is a highly prevalent valve disease. STR and Heart Failure with preserved Ejection Fraction (HFpEF) share common features including exertional intolerance and high burden of atrial fibrillation (AF) and pulmonary hypertension (PH), making it challenging to disentangle HFpEF from TR. The incidence of clinically-recognized HFpEF in STR and its impact on mortality are not well established.

Purposes
To define the incidence of newly diagnosed HFpEF and its impact on mortality in a cohort of patients with significant STR and to evaluate the likelihood of a larger hidden burden of HFpEF.

Methods
Patients with a first diagnosis of ≥moderate-severe STR between 2004-2019 at our institution were retrospectively included. Patients with left ventricle ejection fraction &lt;50%, left-sided valve diseases, and intracardiac device leads were excluded. HFpEF was identified by manual chart review as well as by use of ICD codes. The estimated prevalence of HFpEF was evaluated using an H2FPEF score ≥6, which corresponds to a ≥90% probability of having HFpEF.

Results
Of 2118 patients (mean age 70 ± 14, 36% females), 1057 (50%) had systemic hypertension (HTN) and 1091 (51%) had AF, with median 2.3 years of follow-up. From this cohort, 536 (25%) patients were diagnosed with HFpEF based upon chart review during the follow up period, while ICD diagnosis was only present in fewer than 50% of these patients (254). High H2FPEF score was present in 880 patients (41.5%), of whom 383 received a chart diagnosis of HFpEF, while 153 patients with H2FPEF score &lt;6 received a chart HFpEF diagnosis. The cumulative incidence of chart-based diagnosis of HFpEF was 20.8% (N=158) at 1-year and 38.6% (N=273) at 5-years in patients with an H2FPEF score ≥6 and 5.5%(N=60) at 1-year and 11.1%(N=111) at 5-years in those with a score &lt;6 (Figure). In Cox regression analyses, the diagnosis of HFpEF during follow-up was associated with increased mortality (HR 2.14, CI 1.86-2.46, p &lt; 0.001) after adjusting for age, sex, body mass index, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, diuretics, HTN, pulmonary hypertension, chronic kidney disease and AF.

Conclusions
The incidence of clinically documented HFpEF in a cohort of patients with significant STR at index evaluation is high (25%). Use of ICD code underestimates clinical recognition, with the actual burden of HFpEF probably being even greater, as indicated by an H2FPEF score ≥ 6. Among those with significant STR, HFpEF diagnosis is an independent risk factor for mortality.
Feasibility of non-invasive echocardiographic estimates of intraventricular pressure differences by blood speckle tracking in adults
Authors: Witso M , Luo H , Holm T , Kristiansen H M , Frostelid V C , Aalen J , Sorensen K , Fadnes S , Nyrnes S A , Lovstakken L , Flattum M , Stugaard M , Kongsgaard E , Skulstad H , Remme E W 
Published: January 2025

Abstract

Introduction
Non-invasive estimation of the intraventricular pressure difference (IVPD) in early diastole using high-frame-rate ultrasound-based blood speckle tracking (BST) has been reported in pediatric cardiology of various pathologies. This novel echocardiographic technology has recently become available in probes suitable for the adult population.

Purpose
We tested the feasibility by analyzing intra- and interobserver variability and investigating if IVPD in the left ventricular inflow exhibited the expected differences in controls vs a group of heart failure patients to indicate the ability of this new index to assess diastolic function.

Methods
Apical BST images of LV inflow were acquired using a GE Vivid E95 ultrasound scanner and the M5Sc probe in healthy volunteers (n=9) and patients with heart failure and left bundle branch block (LBBB) (n=15) implanted with cardiac resynchronization therapy (CRT) 6±2 months (mean±SD) earlier. Echocardiography was performed both with CRT turned on and off. IVPD was analyzed from the BST acquisitions using custom software (Figure 1). Blinded intra- and interobserver variability analysis were performed on the measurements from the healthy controls with the same observer and two other observers, respectively.

Results
All the controls and 11 of the 15 patients had BST acquisitions eligible for IVPD-analysis, giving a total feasibility of 83%. Intraobserver reliability was excellent (intraclass correlation coefficient 0.96 [0.85, 0.99], mean and 95% CI) and interobserver reliability was good (intraclass correlation coefficient 0.88 [0.59, 0.97] and 0.84 [0.48, 0.96]) respectively. IVPD was highest in controls (-1.7±0.5 mmHg), and higher with CRT on (-1.3±0.7 mmHg, p=NS vs controls) than off (-0.9±0.5 mmHg, p&lt;0.05 compared to both on and controls) in the patients.

Conclusions
Estimating the intracavitary pressure difference that accelerates blood into the LV during early filling seems feasible and reproducible in adult hearts by BST. IVPD is reduced in patients with heart failure and LBBB, and increases in patients with LBBB when treated with CRT. IVPD based on BST is a potential new echocardiographic method to evaluate diastolic function. Future improvements of the technology are warranted for widespread use.
Changes in myocardial function related to plasma potassium: a POTCAST substudy
Authors: Sakthivel T , Winsloew U , Zheng C , Danielsen E M , Bosselmann H , Haugan K J , Bruun N E , Joens C , Bundgaard H , Risum N 
Published: January 2025

Abstract

Background
Derangement of plasma potassium (p-K) is associated with an increased risk of developing cardiac arrhythmias. Small studies indicate that variations in p-K levels may also affect the mechanical function of cardiomyocytes. A recent clinical study demonstrated improvements in myocardial function by echocardiography after a short follow-up in patients randomized to p-K increasing treatment. However, the long-term effect of increasing p-K on cardiac function is unknown.

Purpose
To investigate if p-K increasing treatment improves diastolic and systolic myocardial function measured by echocardiography after an extended follow-up time.

Methods
The "Targeted potassium levels to decrease arrhythmia burden in high-risk patients with cardiovascular diseases trial" (POTCAST), randomizes patients at high risk of malignant cardiac arrhythmias (1:1) to either the intervention group or the control group. Patients in the intervention group were treated with oral potassium supplements and mineralocorticoid receptor antagonists (MRA) to reach high-normal levels of p-K (4.5-5.0 mmol/l). In total, 289 consecutive patients from the POTCAST trial were included in this substudy. Echocardiographies were performed at baseline and after at least six months of follow-up and compared by left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global constructive work (GCW), and diastolic parameters (E, e’, and E/e’).

Results
Patients (mean age: 58 years (SD±13.4), 77.5% male) had a median follow-up time of 729 days (IQR 475 days). The mean difference in change of p-K was 0.22 mmol/l (95%CI -0.31; -0.13), P&lt;0,001 when comparing the intervention group to the control group between follow-up and baseline. No significant differences in changes in systolic function were found with LVEF -0.6% (-2.22; 1.08), p=0.5, GLS -0.26% (-0.96; 0.45), p=0.5 or GCW -3.99 mmHg (-89.5; 61.6), p=0.9. An improvement was found in the parameters e’lat with a mean difference in change of 0.77 cm/s (0.13; 1.4), p= 0.019, and E/e’ lat with a mean difference in change of -1.16 (-2.07; -0.26), p= 0.012. However, no difference in change was found in e’, E/e’ or other diastolic parameters.

Conclusion
When evaluating long-term effects of p-K increasing treatment on myocardial function by echocardiography, no overall differences were found in diastolic or systolic myocardial function when comparing the intervention group to the control group.
Identifying biomarkers and establishing their threshold values concordantly with LV remodeling for predicting long-term MACE following STEMI
Authors: Krasniqi X , Bakalli A , Kocinaj D , Krasniqi F , Vincelj J 
Published: January 2025

Abstract

Background
Following STEMI, diastolic function is altered by myocardial necrosis and microvascular disfunction. Consistent with these changes, the cardiac troponins are degraded and the release of cardiac natriuretic hormones inhibit the pathophysiological mechanisms responsible for ventricular remodeling (adverse diastolic remodeling, worsening of diastolic function ≥ 1 grade or persisting of restrictive pattern), thus NT-proBNP in non-acute phase of STEMI (early phase of ventricular remodeling) is a strong predictor of heart failure and mortality.

Methods
Prospective study population consisted of 96 consecutive patients with STEMI of onset &lt;12h who underwent primary percutaneous coronary intervention (pPCI). The levels of creatine kinase (CK), the MB fraction of creatine kinase (CK-MB), troponin I, NT-proBNP, CRP, and other routine laboratory parameters were measured. In particular, we evaluated the levels troponin I on the first and seventh days (enzyme-linked immunosorbent assay (ELISA) ) and NT-proBNP in seventh day ( electro-chemiluminiscence method) after reperfusion therapy in all patients.

Results
The follow-up period was 12 months. Baseline clinical characteristics of patients are presented in table 1. A receiver operating characteristics (ROC) curve plots the true positive rate against the false positive rate at different cut-off points for NT-proBNP AUC=0.69 (95% CI, 0.53-0.85), p=0.012 and other biomarkers (Figure 1 and Table 2). Kaplan-Meier curves were used to show the number of MACE and the proportion of patients that survived at each even time point based on the cut-off value of NT-proBNP on the seventh day (1131pg/mL). The log-rank test for the difference in survival resulted in a p value of 0.007 (Figure 2.) In total 17 (17.7%) patients suffered from heart failure, 5 (5.2%) among patients with NT-proBNP value ≤ 1131pg/mL and 12 (12.49%) with value &gt; 1131pg/mL (p &lt; 0.001).

Conclusions
Adverse diastolic remodeling in the non-acute phase of STEMI (early phase of ventricular remodeling) were associated with high rates of MACE after STEMI, with significant variability in the NT-proBNP values.
Presence of paradoxical mid-systolic longitudinal strain (stretching) with speckle tracking in the basal inferior-to-lateral segments in mitral valve prolapse
Authors: Auriti A , Monaco L , Rauseo E , Antonini L , Colivicchi F 
Published: January 2025

Abstract

Background and Purpose
Abnormality in the motion of the inferior papillary muscle was found, in the past, in Mitral Valve Prolapse (MVP). We visually observed an odd movement not only in the inferior wall but also in the anterolateral and inferolateral basal walls in several MVP patients as well. Therefore, the purpose of this work was to analyze this findings with the help of Strain (Speckle Tracking).

Methods
60 MVP patients, having a superior displacement of the posterior leaflet of at least 2 mm, and 20 normal controls were included. Longitudinal Strain was calculated in the 3 apical views (Philips iE 33 Matrix - implemented Strain software). The Strain in the 3 above mentioned basal segments was measured at 160 msec from the beginning of systole (mid-systole) and then averaged to form a "triad" that could be compared among the groups for statistical calculations. The Global Longitudinal Strain (GLS) was calculated for all as well. The Mann-Whitney U-test for comparisons was used. A "p" value ≤ 0.05 was considered significant.

Results
According with the Strain patterns, we could identify two Groups of MVP patients: Group 1: having a "paradoxical" Strain at 160 msec (positive, that means stretching) in at least one of the three told basal segments (n = 35), and Group 2 : not having a "paradoxical" Strain (n = 25) in any of the told three basal segments at the same mid-systolic point. Statistical significance was found between Groups 1 and 2 at 160 msec (fig 1) and at the peak (p&lt; 0.0001 for both) and for GLS (p&lt; 0.01) as well. Group 1 vs controls also displayed significant difference in the Strain at 160 msec (p&lt;0,0001) while Group 2 vs controls did not do and even not at the peak (bull-eye summary view in fig 2 ).

Conclusions
According with our results, there is a MVP population (more than the half in our series) having a "paradoxical" Strain (stretching) in one of the basal inferior-to-lateral segments in mid-systole. The passive continuous stretching of myocardial cells is known to lead, with time, to the replacement with fibrosis (and fibrosis is a condition that is well known to be a source of arrhythmias, and even malignant). Cardiac Magnetic Resonance (CMR) already demonstrated the presence of fibrosis just in the same basal wall segments in some MVP patients. Thus, considering our results in the Strain, in MVP patients with ventricular arrhythmias it is mandatory to analyze the Strain (not expensive tool), and then, if the Strain were to be found to be "paradoxical" even in only one segment of this previously called "triad", a further evaluation with CMR (even if expensive) is highly recommended to look for the presence of fibrosis. The Strain is highly recommended because the topic is implicated in prognosis, in the further study of arrhythmias, and in the choice of a proper therapy as well.
Fig 1
Fig 2
Severe secondary tricuspid regurgitation is associated with nonfatal heart failure hospitalization but not with mortality in patients with chronic heart failure aged 80 years or older
Authors: Kawata T , Ikeda A 
Published: January 2025

Abstract

Background
Previous studies have shown that tricuspid regurgitation secondary to heart failure (HF) is common with considerable effect on their outcomes. However, impact of secondary tricuspid regurgitation (sTR) on survival and hospitalization in patients with ultra-elderly HF are uncertain.

Purpose
To investigate impact of severe sTR in ultra-elderly HF.

Methods
We retrospectively enrolled 163 patients (median age, 87 years, 72 male) with HF aged ≥ 80 years-old admitted to our hospital for the treatment of decompensated HF. Clinical characteristics including echocardiographic data were obtained before discharge. In the present study, severe sTR was defined as vena contracta width ≥ 7mm based on the current guidelines. The date of discharge was considered the entry time-point of observation. Primary outcomes were defined as all-cause death, cardiac death or nonfatal HF hospitalization.

Results
Severe sTR was present in 35 patients (21.5%). During a median follow-up period of 500 (interquartile range, 255-1268) days, 60 all-cause deaths, 41 cardiac deaths and 51 nonfatal HF hospitalizations were occurred. In univariate Cox proportional hazards analysis, age, body mass index, albumin, hemoglobin, B-type natriuretic peptide (BNP), estimated glomerular filtration rate and the ratio of peak early diastolic trans-mitral flow velocity to annular velocity (E/e’) were associated with all-cause death. In multivariate Cox proportional hazards analysis, hemoglobin [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.59-0.90, p = 0.0037] and BNP levels (HR 1.003, 95%CI 1.001-1.004, p = 0.0008) were independently associated with all-cause death. Similarly, age, body mass index, presence of ischemic heart disease, albumin, hemoglobin, BNP and E/e' were associated with cardiac death in univariate analysis, and multivariate analysis showed that hemoglobin (HR 0.74, 95%CI 0.58-0.93, p = 0.013) and BNP (HR 1.003, 95%CI 1.001-1.004, p = 0.0034) were independently associated with cardiac death. Severe sTR was not associated with mortality even in univariate analysis. On the other hand, univariate analysis showed that age, albumin, hemoglobin and severe sTR were associated with nonfatal HF hospitalization, and multivariate analysis revealed that severe sTR (HR 1.91, 95%CI 1.02-3.42, p = 0.044) was the only factor independently associated with nonfatal HF hospitalization.

Conclusion
In ultra-elderly patients with chronic HF aged ≥ 80 years, severe sTR was associated with nonfatal HF hospitalizations but not with both cardiac and all-cause deaths. This result may indicate that percutaneous therapies should focus on the optimal timing of intervention in patients with severe sTR with respect to overall survival and quality of life.
Initial single-center experience with transapical beating heart mitral valve chordal repair of primary mitral regurgitation
Authors: Zadori A , Szolnoky J , Andreka P 
Published: January 2025

Abstract

Introduction
Ten patients underwent off-pump transapical mitral valve repair with chordal implantation for the treatment of primary mitral valve regurgitation (MR) between 01.2023 and 03.2024 in our tertiary referral center.

Purpose
Our aim was to examine the safety, feasibility and effectivity of the surgical method.

Methods
We fulfilled the retrospective analysis of the patients’ preoperative, operative and postoperative data.

Results
Median age was 75.5 years [IQR: 74; 80], Euroscore II 2.8 [IQR: 2; 3], and STS Score 3.8 [IQR: 2; 4]. Three patients were in NYHA II, four patients in NYHA III and three patients in NYHA IV functional stage. The patients had severe co-morbidities as congestive heart failure (n=9), pulmonary hypertension (n=10), chronic renal failure (n=4), more than mild coronary artery disease (n=4), peripheral arterial disease (n=4), previous pulmonary embolism (n=4), atrial fibrillation (n=3), chronic obstructive pulmonary disease (n=2), previous stroke (n=1).
All the patients had posterior mitral leaflet prolapse ± chordal rupture, causing severe mitral regurgitation. Six patients had isolated P2 disease and four had more complex pathology. Median MR PISA radius was 14 mm [12-15.8], 3-dimension vena contracta area 0.56 cm2 [IQR: 0.56-0.57], effective regurgitant orifice 0.61 cm2 [IQR: 0.5-0.84], regurgitant volume 83 ml [IQR: 65-111], leaflet-to-annulus index 1.23 [IQR: 1.2-1.3] and coaptation index 5 mm [IQR: 4.5-5].
All the surgeries were successful, with median 90 minutes [IQR: 75; 100] surgery time, 2-5 chordal implantations. The intra-operative echocardiography showed trace or mild MR in seven cases, and mild-to-moderate MR in three cases. There was no operative/early postoperative mortality, or early valvular/chordal failure. One case of postoperative bleeding occurred with successful surgical revision. There was one case of 30-days-mortality in a critically ill patient with severe heart failure. Mild left-sided pleural effusions and postoperative atrial arrhythmias were detected in five and three patients, respectively. Median ICU stay was 27 hours [IQR: 23.5; 27.8], and postoperative in-hospital stay was 8 days [IQR: 7; 9].
Predischarge transthoracic echocardiography showed trace-to-mild MR in eight patients, and mild-to-moderate MR in two patients, while three months postoperatively we detected four cases of mild, four cases of mild-moderate or moderate and one case of moderate-to-severe MR. In comparison to the baseline values, five patients were in NYHA I, two in NYHA II and two in NYHA III functional stage three months after surgery.

Conclusion
In summary, transapical beating heart mitral valve chordal repair seems a relatively safe and effective option for high-risk patients, however, we emphasize the significance of judicious preoperative risk and echocardiographic eligibility assessment and the need for further studies to examine the durability and long-time efficacy of the method.