bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing myocardial function assessment in hypertension patients through the integration of exercise stress echocardiography and pressure-strain loop technique.
Authors: Zhang Q , Wang Y I , Yin L I X U E 
Published: January 2025

Abstract

Objective
This study aims to investigate the characteristics of myocardial work(MW) and reserve function in left ventricular remodeling hypertension (LVRH) patients through exercise stress echocardiography (ESE) and pressure-strain loop (PSL) technique,and further to investigate the associations of MW parameters with the exercise capacity in this observational study.

Methods
One hundred and five hypertensive patients with left ventricular remodeling{Left ventricular mass index (LVMI) ≥115 g/m2 (male) and LVMI ≥95 g/m2 (female)} underwent ESE examination according to established guidelines, the test was terminated at 85% of the target heart rate. Additionally, 59 healthy subjects were included as a control group. Speckle tracking software was utilized for analysis, the myocardial work parameters were calculated by combining the longitudinal strain with the noninvasive left ventricular pressure curve.Exercise capacity and reserve function,global and segment work index were evaluated and analysed.

Results
Global work index (GWI) , global constructive work (GCW) and global wasted work (GWW) were significantly increased both at rest and peak in LVRH group, while global work efficincy(GWE) were decreased. The GWI from basal to apiex both at rest and peak showed increasing trend in the order of the control group. GWI-rest showed prominent relation with exercise metabolic equivalent(METs)(r=-0.502,p＜0.001),E/e-peak ( (r=0.612,p＜0.001), ΔGobal longitudinal strain (GLS) (r=0.421,p＜0.001).Further GWI-rest and ΔGWI as well as E/e-peak add increased predictive utility of exercise capacity, superior to the change in GLS .The myocardial work reserve function can be available for predicting patients with LVRH{ΔGWI，AUC: 0.869 (95%CI,0.815−0.924), providing incremental value for LVRH diagnostic performance.

Conclusion
MW parameters can reflect the contractile force under hemodynamic overload,provide a more comprehensive and compelling perspective for evaluating cardiac function. GWI is an important predictor of systolic and diastolic function and a variable closely related to exercise endurance in patients with LVRH.
comparison rest and peak parameters
ROC for identify LVH patients
Assessment of blood pressure response to physical activity: influence on the results of five-step stress echocardiography
Authors: Safarova N , Safarova A , Timofeeva T , Kobalava Z H 
Published: January 2025

Abstract

Introduction
Due to the high prevalence of hypertensive blood pressure response to exercise (HER) during stress echocardiography (SE), the unclear prognostic significance, and the possible impact on SE results, it seems appropriate to analyze the prevalence of HER in outpatients and inpatients. Additionally, it is essential to identify the influence of HER on the results of the modern SE protocol.

Aim
To evaluate the incidence of HER during SE with physical activity on a treadmill or horizontal bicycle ergometer in patients and the impact of HER on the results of five-step SE.

Materials and methods
This single-center study included 193 patients who underwent five-step SE according to clinical indications. The steps in the protocol are as follows: Step A: Evaluates local contractility abnormalities; Step B: Assesses B-lines/diastolic function; Step C: Measures the contractile reserve of the left ventricle; Step D: Assesses the reserve coronary blood flow velocity in the anterior interventricular branch; Step E: Evaluates heart rate reserve. The blood pressure (BP) response to exercise was assessed as hypertensive with a systolic blood pressure (SBP) ≥190 mm Hg on the treadmill and 200 mm Hg on a bicycle ergometer in women, and ≥210 mm Hg and 220 mm Hg, respectively, in men. Alternatively, HER was defined as an increase in SBP ≥180 mm Hg from the second stage of the test or when SBP rises relative to the baseline by ≥60 mm Hg in men and ≥50 mm Hg in women. The incidence of HER during the SE study and the relationship of HER with positive outcomes of the study protocol steps were examined.

Results
The prevalence of HER in patients undergoing SE was 36.3% (70 patients). Patients with HER were significantly more likely to have low exercise tolerance (p=0.013). Blood flow velocity in the coronary artery, both at rest and under load, and the amount of contractile reserve were significantly higher in patients with HER (p=0.009, p=0.008, and p=0.002, respectively). There was a trend towards a greater value of relative LV wall thickness in patients with HER (p=0.070). Among patients with HER, a decrease in contractile reserve was less common than among patients with an adequate blood pressure response: 45 (64.3%) versus 99 (80.5%) (p=0.013).

Conclusion
An excessive increase in blood pressure may be a limiting factor, leading to premature termination of testing. Patients with HER are significantly more likely to have poorer exercise tolerance and require more careful monitoring and control of risk factors. There is a relationship between the response of blood pressure to exercise and the results of SE, particularly the effect of peak blood pressure on contractile reserve. The relationship between BP response to exercise and SE steps, as well as its prognostic significance, requires further study.
Additive value of simultaneous exercise echocardiography to cardiopulmonary exercise testing in unexplained dyspnea
Authors: Verelst F , De Schutter S , Nasser R , Hens W , De Bliek E , Van De Heyning C , Van Craenenbroeck E , Meems L G M , Gevaert A B 
Published: January 2025

Abstract

Background/Introduction
Exertional dyspnea is a nonspecific symptom and frequently serves as the initial sign of numerous cardiac and non-cardiac illnesses. Cardiopulmonary exercise testing (CPET) is often used in the workup of dyspnea, but specific markers for cardiac and peripheral causes of dyspnea are lacking. Combining CPET with exercise echocardiography (CPETecho) can non-invasively identify all pathophysiological mechanisms limiting exercise capacity, including cardiac, pulmonary, and peripheral disorders.

Purpose
To evaluate the use of CPETecho in patients with unexplained exertional dyspnea compared to CPET alone.

Methods
In this retrospective observational study, we evaluated patients with unexplained dyspnea (normal resting echocardiography and normal lung function) who underwent CPETecho at two university hospitals between July 2021 and November 2023. CPETecho was conducted on a semi-supine bicycle ergometer. At rest, submaximal exercise (heart rate ±100 bpm) and peak exercise echocardiography was performed. Respiratory gases, heart rate, and electrocardiogram were recorded continuously. We evaluated limitations to exercise according to cutoffs in published literature and compared them to diagnoses obtained via CPET alone, with exercise echo values being blinded. CPET reports were interpreted by 3 independent reviewers with expertise in cardiac rehabilitation and consensus was obtained.

Results
We enrolled 123 patients (63% women, mean age 67 ± 12 years). CPETecho identified a cause for dyspnea in 101 patients (81%), compared to 87 patients (71%) with CPET alone. However, only 36 patients (29%) had a ‘certain and complete’ diagnosis using CPET alone. CPET alone missed a diagnosis in 48% of patients, most commonly missing heart failure with preserved ejection fraction (HFpEF 27%), exercise pulmonary hypertension (20%) and LV or RV systolic dysfunction (20 and 20% respectively). Twenty eight patients were deemed to have a normal test by CPET, however CPETecho identified a cause for dyspnea in 89% of these patients, mainly cardiac disorders.

Conclusion
In summary, our study emphasizes the value of CPETecho in assessing patients with exertional dyspnea. CPETecho offers superior diagnostic accuracy compared to CPET alone, specifically aiding in the identification of cardiac disorders.
Additive value of simultaneous cardiopulmonary exercise testing to exercise echocardiography in unexplained dyspnea
Authors: De Schutter S , Verelst F , Nasser R , Hens W , De Bliek E , Van De Heyning C M , Meems L M G , Gevaert A B 
Published: January 2025

Abstract

Background
In patients with unexplained dyspnea, exercise echocardiography with diastolic stress testing is recommended to diagnose heart failure with preserved ejection fraction (HFpEF). Combined cardiopulmonary exercise testing (CPET) with echocardiography (CPETecho) adds respiratory gas analysis and is thus able to characterize all physiologic abnormalities limiting exercise capacity including cardiac, pulmonary and peripheral causes.

Purpose
To evaluate the use of CPETecho in patients with unexplained dyspnea compared to exercise echocardiography alone.

Methods
In this retrospective observational study, we evaluated patients with unexplained dyspnea (normal resting echocardiography and normal lung function) who underwent CPETecho at two university hospitals between July 2021 and November 2023. CPETecho was conducted on a semi-supine bicycle ergometer. At rest, submaximal exercise (heart rate ±100 bpm) and peak exercise echocardiography was performed. Respiratory gases, heart rate, and electrocardiogram were recorded continuously. We evaluated limitations to exercise according to cutoffs in published literature, and compared them to diagnoses obtained via exercise echocardiography values alone with CPET values being blinded.

Results
We enrolled 124 patients (63% women, mean age 67 ± 12 years). Peak VO2 was 88 ± 19% of the predicted value. CPETecho identified causes for dyspnea in 101 patients (81%), compared to 121 patients (98%) with exercise echocardiography. However, only in 60 out of the 121 patients (50%) exercise echo could provide a ‘certain and complete’ diagnosis. In 37 patients (31%), the correct diagnosis was missed by exercise echo: peripheral or pulmonary limitations, hyperventilation or V/Q mismatch. Additionally, in 19 patients (15%) exercise echo incorrectly diagnosed chronotropic incompetence, left ventricular (LV) systolic dysfunction, or impaired right ventricular (RV) reserve while actually patients had a submaximal performance. Finally, 4 patients (3%) had both missing and uncertain diagnoses.
In contrast, CPETecho allowed immediate detection of a submaximal test, ensuring that the identified diagnoses can be considered ‘certain’ (101 patients, 81%). Nineteen patients (15%) had an ‘uncertain’ diagnosis due to a submaximal test, 1 patient (1%) had an uncertain diagnosis despite a maximal test performance, and 3 patients had missing data due to poor image quality (2%).

Conclusions
In patients with unexplained dyspnea, CPETecho led to more accurate diagnoses compared to exercise echocardiography alone. Exercise echocardiography alone misclassified several patients, primarily due to its incapacity to identify pulmonary or peripheral limitations, and the inability to detect a submaximal test.
Hemodynamics and prognostic values of exercise stress echocardiography in the perioperative period for patients undergoing transcatheter edge-to-edge repair
Authors: Toki M , Hayashida A , Nakatsukasa T , Kimura A , Morikawa T , Hiraoka A , Aritaka S , Yoshida K 
Published: January 2025

Abstract

Background
Exercise stress echocardiography (ESE) is widely used and recommended by guidelines for assessing the severity and prognostic values of mitral regurgitation (MR). However, the changes observed in ESE after MR improvement through transcatheter edge-to-edge repair (TEER) and the relationship between pre- and post-operative ESE evaluations and prognosis remain unclear.

Purpose
The aim is to investigate the hemodynamic changes observed in ESE before and after TEER using echocardiographic parameters, and to identify factors related to prognosis based on the hemodynamics before and after the procedure.

Methods
The study included 75 out of 250 cases that underwent TEER from January 2019 to August 2023, which were evaluated with ESE before and after the procedure. Cases with significant valvular disease other than mitral valve disease, those who could not achieve adequate exercise load, and cases with MR due to multiple factors were excluded.

Results
A significant correlation was observed between postoperative mean pressure gradient (mPG) and pulmonary arterial systolic pressure (PASP) at peak stress (r=0.40, p&lt;0.001), while no significant correlation was found between changes in stroke volume (SV) and changes in PASP (r=0.25, p=0.03). An increase in SV observed on ESE after TEER was associated with a better prognosis compared to cases without such increase, suggesting it as a potential predictor for cardiovascular death (p&lt;0.0001). However, stratification of prognosis based on the presence of peak mPG elevation (mPG ≥ 5 mmHg) or the occurrence of exercise-induced pulmonary hypertension (EIPH) was not achievable. Furthermore, patients who showed an increase in SV in either preoperative or postoperative ESE showed the most favorable prognosis for cardiovascular death (p&lt;0.001).

Conclusions
Exercise-induced systolic pulmonary artery pressure elevation was found to correlate with the mean pressure gradient postoperatively. Performing exercise stress echocardiography not only for preoperative diagnosis but also postoperatively is useful for prognostic evaluation. Patients with increased stroke volume exhibit a favorable prognosis.
Speckle tracking analysis during dobutamine stress echocardiography in patients undergoing percutaneous coronary intervention for chronic total occlusion
Authors: Onishi T , Iwakura K , Tanaka K , Watanabe H , Okamura A 
Published: January 2025

Abstract

Background
Dobutamine stress echocardiography (DSE) is often used as a non-invasive diagnostic modality for detection of myocardial ischemia and viability. A "biphasic response" in DSE can occur, in which contractility improves in dysfunctional segments with low dose stage and then becomes dysfunctional again at higher doses due to ischemia. We investigated if speckle tracking analysis during DSE can evaluate patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO).

Methods
DSE was performed one day before CTO-PCI in consecutive 43 patients (25 female, age=67±12 years). Since 40 patients had 1 vessel, and 3 patients had 2 vessel CTO lesions, total of 46 regions were analyzed. Global (GLS) and regional longitudinal strain (RLS) were calculated as an averaged value of peak longitudinal strain in the apical 4-, 2-chamber, and long axis views at baseline echo, at low-dose, at high-dose DSE, and 6 months after CTO-PCI using available software (QLAB, Philips Medical Systems). Improvement in wall motion was defined as the change ratio in strain during DSE less than -10% and worsening was more than 10%. Improvement 6 months after CTO-PCI was defined as the change ratio in strain less than -10% and in left ventricular ejection fraction (LVEF) more than 5%.

Results
CTO-PCI was successfully done in all patients. GLS and RLS were feasible in all regions. Overall, GLS (-16.9±3.3% at baseline v.s. -18.6±3.4%, p&lt;0.0001) and LVEF (56±8% v.s. 59±7%, p=0.0003) significantly improved 6 months after CTO-PCI. There was also significant improvement of RLS for the obstructed CTO regions (-14.0±4.2% v.s. -16.6±4.4%, p&lt;0.005). During DSE, ventricular segments exhibited one of four response types. A. Biphasic response (n=23, 50%): improvement in wall motion at low dose with worsening at high dose DSE, B: Sustained improvement (n=15, 33%): keep improving in wall motion during DSE, C: Worsening (n=4, 9%): further deterioration of resting wall motion during DSE without any improvement, D: No change (n=4, 9%): no change in wall motion during DSE. Interestingly, the rate of improved RLS for obstructed CTO regions 6 months after CTO-PCI was significantly different in 19 (83%) for type A, 12 (80%) for type B, 3 (75%) for type C, 1 region (25%) for type D (p&lt;0.05), although GLS in 14 (61%), 7 (47%), 3 (75%), 2 (50%) (p=0.8) and LVEF in 11 (46%), 5 (33%), 1 (25%), 0 (0%) (p=0.2) were similar.

Conclusion
Speckle tracking analysis is feasible during DSE. CTO-PCI may improve both global and regional cardiac functions in patients with myocardial viability.
A case of "biphasic response type"
Left anterior velocity reserve by adenosine is not related to angiographic severity of isolated left main stenosis: Potential relevance for revascularization decision making.
Authors: Armenis I , Leontiadis E , Tsiapras D , Kyrzopoulos S , Iakovou I , Athanassopoulos G D 
Published: January 2025

Abstract

Background
Revascularization of asymptomatic left main stenosis (LM) estimated by coronary angiography in the range of ambiguity (40-60%) necessitates further documentation by either intravascular imaging or fractional flow reserve. Distal left anterior descending artery velocity reserve (LADVR) by transthoracic Doppler echo has provided efficient prognostic yield for intermediate LAD lesions.

Purpose
Aim of the study was to assess the relationship between LADVR and LM stenosis and to evaluate the long-term cardiovascular outcome in patients with intermediate LM stenosis, following decision making for revascularization based on an efficient LADVR, on top of the dobutamine stress echo (DSE) result.

Methods
Eighty nine asymptomatic patients (age: 67±9 years, men/women: 70/19, ejection fraction EF: 52±6%, follow up: 50±25 months) were selected prospectively. They had an isolated intermediate stable LM stenosis (stenosis range 30-70%, with absence of hemodynamically significant LAD stenosis (&lt;50%) and they were referred for DSE with a concomitant evaluation of LADVR after administration of adenosine. All patients had a negative DSE for ischemia with an estimated LADVR &gt;2. Based on these data revasularization was deferred.
Distribution of patients according to % LM stenosis was: LM 30-40%: 55 patients /LM 40-50%: 25 patients /LM50-60%: 6 patients /LM60-70%: 3 patients

Results
LADVR was not related to age or EF and was similar among LM increments: LM30-40%: 2.9±0.6 vs LM40-50%: 2.6±0.4 vs LM50-60%: 2.8±0.8 (distribution of values: figure1)
A negative follow up for cardiac events was available in all patients. Moreover, 45 patients had an additional stress test negative for ischemia (either ECG or DSE/ SPECT) (LM30-40%: 30 patients, LM40-50%: 11patients, LM50-60: 2patients, LM60-70%: 2patients). LADVR was estimated during follow-up in 26±45 patients and it was &lt;2 in 2 patients (both with a new significant LAD stenosis). Changes of LADVR during follow up compared to the initial LADVR were not related to LM stenosis ((% differences: figure2)

Conclusion
LADVR in the presence of an isolated LM disease is not related to the angiographically estimated stenosis. Moreover, evolution of LADVR is independent of the initial severity of LM stenosis. A negative DSE combined with adenosine LADVR&gt;2 provides an efficient prognostic yield for a safe long-term outcome in isolated LM disease.
Left ventricular mass by three-dimensional echocardiography is associated with myocardial replacement fibrosis and ventricular arrhythmias in hypertrophic cardiomyopathy
Authors: Rella V , Delcea C , Clement A , Perelli F , Tomaselli M , Penso M , Buta A , Oliverio G , Castelletti S , Parati G , Crotti L , Badano L , Muraru D 
Published: January 2025

Abstract

Background
In hypertrophic cardiomyopathy (HCM) patients, quantification of left ventricular (LV) mass carries important prognostic implications. Two-dimensional echocardiography (2DE) has limited accuracy for LV mass calculation, due to plane position errors, geometric assumptions and asymmetric distribution of LV hypertrophy in HCM.

Purpose
We aimed to explore: (1) the accuracy of three-dimensional echocardiography (3DE) vs 2DE to quantify LV mass in HCM compared to cardiac magnetic resonance (CMR); (2) the relationship of 3DE LV mass with non-sustained ventricular tachycardia (NSVT) and late gadolinium enhancement (LGE)≥15% by CMR.

Methods
In consecutive HCM patients referred to our Cardiomyopathy Clinic between 2020 and 2023, 2DE and 3DE were used to assess LV mass. LV systolic function was assessed by 3DE ejection fraction (LVEF) and peak global 2D longitudinal strain (2DGLS). Clinical, 24h ECG Holter and CMR data were collected.

Results
A total of 180 HCM patients (pts, age 58±18 years, 55% men) were enrolled. Apical HCM was present in 56 pts (31%) and obstructive HCM in 69 pts (38%). Maximal LV wall thickness (MWT) by 2DE was 19.5±4.6 mm. LV mass was 150±51 g/m2 by 2DE, 80±25 g/m2 by 3DE, and 79±26 g/m2 by CMR. Fifty-seven pts (32%) had evidence of NSVT at ECG Holter monitoring. LGE≥15% was present in 32% pts.
Aim #1: In a subset of 63 pts who underwent CMR, 3DE LV mass was strongly correlated with CMR LV mass (r=0.85, p&lt;0.001), while 2DE LV mass was not (p=0.38). LV mass by 3DE showed a better agreement with LV mass (bias 3.8 g/m2, LOA -25 to 32 g/m2) by CMR than 2DE (bias 68 g/m2, LOA -35 to 172 g/m2).
Aim #2: In the entire cohort, 3DE LV mass had a stronger association compared to 2DE LV mass with the presence of LGE≥15% (AUC 0.68 for 3DE versus 0.56 for 2DE, p=0.08) and NSVT (AUC 0.65 for 3DE versus 0.54 for 2DE, p=0.06). By multivariable analysis, LV mass by 3DE was an independent predictor of LGE≥15% (HR 1.03) and of NSVT (HR 1.03), outperforming 2DGLS and MWT in the latter regression. Using the Youden Index from ROC curve, the optimal cutoff for predicting LGE≥15% using 3DE mass was 87 g/m² (sensitivity 47%, specificity 91%). The addition of 3DE LV mass to a model including 2DE MWT, 2DE LV mass and 2DGLS had a significant incremental value for the prediction of LGE≥15% (Figure 1).

Conclusions
In HCM patients, LV mass by 3DE was strongly correlated to LV mass by CMR and was an independent predictor of significant LV myocardial fibrosis and ventricular arrhythmias. In centers with low access to CMR, implementation of 3DE to measure LV mass in HCM patients may improve arrhythmic risk stratification compared to 2DE.