bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rate of progression of tricuspid regurgitation and clinical implications
Authors: Arteagoitia Bolumburu A , Monteagudo Ruiz J M , Mahia P , Perez David E , Gonzalez T , Sitges M , Li C H , Capellades Olivella H , Alonso D , Carrasco F , Luna Morales M , Adeba A , De La Hera J M , Zamorano Gomez J L 
Published: November 2023

Abstract

Background
Tricuspid regurgitation (TR) is a prevalent valvular disease. Recent studies demonstrated that significant TR is associated with an increased mortality. However, information regarding the progression rate of TR is lacking, crucial for the correct clinical evaluation of such patients. Due to this fact, current guidelines fail to propose a scheduled follow-up programme in patients with significant TR; contrary to patients with left-sided valvular disease. The aim of this study is to examine the rates of TR progression and its clinical implications.

Objectives
To analyse the rate of progression of TR during follow-up and evaluate the impact of TR progression in hospitalizations due to heart failure (HF) or cardiovascular (CV) death.

Methods
1843 patients with at least moderate TR were prospectively followed up with consecutive echocardiographic studies and/or clinical evaluation. Clinical and echocardiographic features were recorded to assess their impact in TR progression. TR progression was defined as at least worsening of one grade according to Hahn and Zamorano classification based on Vena contracta width and effective regurgitant orifice area. The cumulative event rates were estimated with the Kaplan-Meyer method and compared by means of the log-rank test.

Results
Median follow-up time was 3.7 (IQR: 1.2 to 3.8) years. During the follow-up period, death occurred in 525 patients (28.5%); due to cardiovascular causes in 174 (9.4%) of them. Figure 1 shows the incidence of TR progression from moderate to at least severe TR during follow-up period. Moderate TR had 4.9%, 10.1% and 24.8% 1-year, 2-year and 3-year risk of progression to at least severe TR, respectively. The combined endpoint of cardiovascular mortality and hospitalization for heart failure was higher among progressors (23.5% vs. 37.7%; log rank P &lt; 0.001, Figure 2).

Conclusions
Progression of TR is associated with an increased risk of hospitalizations and cardiovascular mortality. According to the rate of progression in our study, we support serial echocardiographic testing for these patients similar to that proposed by current guidelines for left-sided heart disease. However, we still need evidence of the impact of serial testing in TR.Incidence of TR progression from moderatKaplan Meier survival curves free from h
The effect of aortic valve replacement on 4D flow-measured flow displacement in patients with bicuspid and tri-leaflet aortic valves with severe aortic stenosis
Authors: Richards C , Alfuhied A , Parker A , Aslam S , Debiec R , Mccann G P , Singh A 
Published: November 2023

Abstract

Introduction
Eccentric outflow jet direction in the ascending aorta is correlated with the altered haemodynamic flow patterns thought to contribute to bicuspid aortic valve (BAV)-associated aortopathy.

Purpose
We aimed to analyse the impact of surgical aortic valve replacement (AVR) on outflow jet displacement in the ascending aorta, and determine if differences exist between individuals with BAV and tri-leaflet aortic valves (TAV).

Method
Four-dimensional flow-cardiac magnetic resonance imaging (4D Flow) of the aorta was performed in prospectively recruited patients with BAV and TAV and severe symptomatic aortic stenosis (AS), before and 12 months after AVR. Healthy individuals with BAV and TAV morphology, but no significant valve disease, were also recruited as controls. Outflow direction was calculated from the in-plane, normalised flow displacement (NFD), defined as the distance between the centre of the aortic lumen (Clum) and the centre of velocity (Cvel) of the forward flow and normalised to the lumen diameter (Figure 1). Mean NFDs were evaluated at peak systole on planes perpendicular to 25 equidistant nodes along the centreline between the aortic root to the level of the pulmonary artery bifurcation in all subjects using custom Matlab code.

Results
32 subjects with severe symptomatic AS (BAV n=11, TAV n=21; mean age 68±10 years) and 17 controls (BAV n=8, TAV n=9; mean age 57±7 years) were assessed (Table 1). In those with TAV, there were no differences in NFD between patients with severe AS pre-AVR compared to post-AVR, or compared to TAV controls. However, in BAV subjects, pre-AVR BAV patients with severe AS had a significantly higher mean NFD compared to BAV controls, and compared to pre-AVR TAV patients with severe AS. Post-AVR, there was no longer a significant difference in mean displacement between BAV vs TAV.

Conclusion
Our observations suggest that the BAV morphology plays a predominant role in the abnormal eccentric flow displacement in the ascending aorta, which may be normalised following bioprosthetic valve replacement. This may have implications for monitoring aortas post-AVR in BAV subjects.
Application of a novel echocardiographic scoring system to estimate left ventricular filling pressure in aortic stenosis
Authors: Aoyagi H , Iwano H , Murayama M , Yokoyama S , Nishino H , Nakabachi M , Nakamura K , Tamaki Y , Motoi K , Kobayashi Y , Ishizaka S , Kaga S , Kamiya K , Nagai T , Anzai T 
Published: November 2023

Abstract

Background
Despite the increased number of aortic stenosis (AS) patients, non-invasive estimation of the left ventricular (LV) filling pressure (FP) is often challenging partly because of unavailability of E/e' due to the presence of mitral annular calcification (MAC). Recently, an echocardiographic scoring system to estimate LVFP, visually assessed time difference between the mitral valve and tricuspid valve opening (VMT) score was proposed. Because VMT score can be applied for patients with significant MAC, we hypothesized that VMT score could be an alternative parameter of E/e' in AS.

Purpose
To test whether VMT score could be used as an alternative marker of LVFP to E/e' in AS patients.

Methods
We enrolled consecutive 116 patients with at least moderate AS in sinus rhythm who underwent right heart catheterization and echocardiography within 7 days. Mean pulmonary artery wedge pressure (PAWP) was measured as invasive parameter of LVFP. LV diastolic dysfunction (DD) was graded according to the ASE / EACVI guidelines. Using two-dimensional echocardiographic images, time sequence of opening of mitral and tricuspid valves was assessed and scored to 0 to 2 (0: tricuspid valve first, 1: simultaneous, 2: mitral valve first). This was based on the phenomenon in which early-diastolic opening of the mitral valve becomes earlier than tricuspid valve with an increase in LV FP and pulmonary artery pressure. When the inferior vena cava was dilated, 1 point was added and VMT score was finally calculated as 0 to 3.

Results
Overall, PAWP was 12±7 mmHg and elevated (≥15 mmHg) in 29 patients. MAC was observed in 82 patients. Although E/e' was higher in patients with elevated PAWP than in those without (23±11 vs 18±8, P=0.007), its predictive ability to elevated PAWP was non-significant (c-index: 0.59, P=0.13), resulting in low specificity of DD grading to predict elevated LVFP (sensitivity: 79%, specificity: 36%). In contrast, VMT score predicted elevated LVFP with c-index of 0.74 (P&lt;0.001). When VMT score was used instead of E/e', diagnostic accuracy of DD grading was improved (c-index: 0.57 vs 0.82, P&lt;0.001).

Conclusion
VMT score could be an alternative marker of LVFP to E/e' in AS patients.
The prognostic value of left atrial strain in patients with low-flow, low-gradient aortic stenosis
Authors: Ozturk C , Happe M , Shamekhi J , Zimmer S , Nickenig G , Tiyerili V , Sedaghat A 
Published: November 2023

Abstract

Background
Left atrial (LA) function is known to be an independent prognostic parameter in patients undergoing transcatheter aortic valve replacement (TAVR). However, the impact of LA function on postinterventional outcomes in patients with severe low-flow, low-gradient aortic stenosis (LFLG AS) is unknown.

Objectives
We aimed to evaluate postinterventional changes and prognostic value of LA strain in patients with LFLG AS who underwent TAVR.

Methods
We retrospectively included 88 patients (79.66 ± 6.33, 37.5% female) with symptomatic LFLG AS who underwent TAVR at the Heart Center Bonn. LA global function and strain were comprehensively assessed by the postprocessing left atrial phasic strain analysis – LA reservoir strain, LA conduit strain, and LA contractile strain ­– using a commercially available postprocessing software at baseline and three years after the procedure. The apical four-, two-, and three-chamber views with sufficient image quality were used for strain analysis.

Results
Baseline LA strain was found to be impaired in all patients (reservoir: 13.17 ± 7.62 %; conduit: 6.7 ± 6.4 %; contractile: -1.7 ±1.5 %). All-cause mortality was 41 % three years after the procedure. In the overall collective, LA reservoir strain was increased at follow-up (13.17 ± 7.62 % to 15.21 ± 10.13 %, p= 0.049), whereas conduit and contractile strain remained unchanged (p &gt; 0.05). According to the survival at follow-up, we divided the cohort into survivors and non-survivors. Baseline reservoir (14.55 ± 8.14 % vs 9.59 ± 5.23 %, p= 0.002) and conduit (7.66 ± 7.14 % vs 4.44 ± 4.1 %, p= 0.017) strain were significantly higher in survivors.
All LA strain parameters were significantly improved in survivors at follow-up. In contrast, non-survivors showed no relevant changes in LA strain parameters. In comparison of ROC curves, reservoir strain was found to be the best predictor for postinterventional survival after TAVR (reservoir AUC: 0.677, cutoff: 10 %, p = 0.007; conduit AUC: 0.642, cutoff: 3.7 %, p = 0.037; contractile AUC: 0.672, cutoff: -1,3 %, p = 0.008). Concordantly, we found that all LA strain parameters are independent predictors for three-year all-cause mortality after TAVR in cox regression analysis (reservoir OR: 0.89, p=0.005; conduit OR: 0.90, p=0.03, contractile OR: 0.71, p=0.029) in cox regression analysis. According to multivariate analysis, reservoir strain (OR: 0.91, p=0.05) and conduit strain (OR: 0.94, p=0.04) were found to be independent predictors for postinterventional survival. According to log-rank analysis, patients with a baseline reservoir strain &lt; 10 % and a baseline conduit strain &lt; 4 %) showed significantly higher mortality (p = 0.048).

Conclusion
Using LA strain parameters might optimize risk stratification and better decision-making with sufficient patient selection in this vulnerable cohort.
Diagnostic accuracy of apical sparing pattern in transthyretin-derived cardiac amyloidosis assessed by two-dimensional strain echocardiography
Authors: Suzuki W , Kikuchi S , Kawada Y , Ito T , Kitada S , Goto T , Amano T , Seo Y 
Published: November 2023

Abstract

Background
Cardiac amyloidosis (CA) is a rapidly progressive disease that portends poor prognosis. Recently, transthyretin-derived CA (ATTR-CA) has attracted attention due to the emergence of specific drugs, and its simple and accurate diagnosis is required. Apical sparing pattern of regional longitudinal strain (LS) distribution has been known as specific echocardiographic finding for CA. However, its diagnostic significance is unclear when limited to ATTR-CA.

Aims
This study aimed to investigate the diagnostic accuracy of apical sparing pattern to distinguish ATTR-CA from other left ventricular hypertrophic diseases.

Methods
This was a retrospective study evaluating 32 patients underwent endomyocardial biopsy for differentiation of left ventricular hypertrophy from November 2018 to August 2022. Based on clinical data, patients were classified into 9 patients in ATTR-CA, 14 patients in hypertrophic cardiomyopathy (HCM), and 9 patients in hypertensive heart disease (HHD). In addition to routine echocardiographic findings, left ventricular LS analysis was performed. Relative regional strain ratio (RRSR) as an index of apical sparing pattern was measured as the average of apical LS divided by the sum of the average of mid and basal LS values.

Results
RRSR in ATTR-CA group was significantly higher than in HCM and HHD groups (0.96 vs. 0.68 vs. 0.72, P=0.004) (Table). In the receiver-operating characteristic analysis of RRSR for differentiating ATTR-CA from HCM and HHD, the optimal cut-off value of RRSR for the diagnosis of ATTR-CA was 0.93 (sensitivity 67%, specificity 96%, area under the curve 0.84) (Figure).

Conclusions
Apical sparing pattern may have acceptable accuracy in diagnosing ATTR-CA versus other left ventricular hypertrophic diseases, but the relatively low sensitivity may be a clinical limitation.Table:Echocardiographic dataFigure
Left ventricular speckle-tracking-derived mechanical dispersion in patients with transthyretin amyloidosis and their first-degree relatives
Authors: Holcman K , Rubis P , Stepien A , Graczyk K , Dziewiecka E , Karabinowska A , Mroz K , Sachajko Z , Kurek M , Keska M , Podolec P , Kostkiewicz M 
Published: November 2023

Abstract

Background
Mechanical dispersion has shown to predict ventricular (LV) arrhythmias and sudden cardiac death in populations with established cardiac diseases, such as cardiomyopathies and heart failure. Transthyretin amyloid (ATTR) cardiomyopathy arises from deposition of misfolded, insoluble transthyretin (TTR) in extracellular matrix. The disease impacts profoundly cardiac tissue architecture and its mechanical properties.

Purpose
The aim of this prospective study was assessment of LV speckle-tracking-derived mechanical dispersion in patients with ATTR cardiomyopathy and their first-degree relatives.

Methods
We present data based on evaluation of 85 patients, including 34 (group 1) index patients with ATTR and 51 (group 2) first-degree relatives who were studied between June 2020 and January 2023. Study protocol included clinical data, free light chain blood immunoglobulins and urine immunofixation, transthoracic echocardiography (TTE) with global longitudinal strain (GLS) analysis, hybrid technique single-photon emission computed tomography and computed tomography (SPECT/CT) with [99mTc] Tc 3,3-disphono-1,2-propanodicarboxylic acid (DPD), genetic testing by an amplicon-based next-generation TTR sequencing approach, and in selected cases cardiac or soft tissue biopsy. Mechanical dispersion was calculated manually from GLS measurements and defined as the standard deviation (SD) of contraction duration from R on the electrocardiogram (ECG) to peak negative longitudinal strain of all LV segments.

Results
In group 1 patients were older (66.6±11 vs. 50.7±14) and presented with higher New York Heart Association (NYHA) class (2.4± 1 vs. 1.1± 0.6) (p&lt;0.05). Overall, there were detected following types of TTR variants - Phe53Leu, Ala101Val, Glu112Lys, Glu109Lys, Glu122Lys, Glu82Lys. Compared to group 2, group 1 presented with higher N-terminal (NT)-pro hormone BNP (NT-proBNP) value (5859±7320 vs. 281±990 pg/ml), greater intraventricular septum thickness (19±4 vs. 12±3 mm) and LV mass index values (199±69 vs.111±42 g/m2), impaired LV ejection fraction (44±13 vs. 59±10 %) and GLS (-12.7±6 vs. -18.7±4 %) (p&lt;0.05). Moreover, patients with ATTR cardiomyopathy had significantly higher value of LV speckle-tracking-derived mechanical dispersion compared to their first-degree relatives (96.2±22.3 vs. 77.9±23.3 ms, p=0.0007).

Conclusions
Patients with ATTR cardiomyopathy present with significantly higher LV mass index value, impaired GLS and higher value of LV speckle-tracking-derived mechanical dispersion compared to their first-degree relatives (p&lt;0.05). Assessment of LV speckle-tracking-derived mechanical dispersion may in future translate into further enhancement of disease evaluation and improving prognosis in the group of patients.
Progression of definite and non-definite Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) and risk of major adverse cardiac events
Authors: Aljehani A , Baig S , Sommerfeld L C , Fabritz L , Steeds R P 
Published: November 2023

Abstract

Background
In patients with Arrhythmogenic right ventricular cardiomyopathy (ARVC, also called"Arrhythmogenic Cardiomyopathy"), it is a challenge to predict those at greatest risk of major adverse cardiac events (MACE). Our hypothesis is that risk of arrhythmia may be preceded by change in ventricular structure and function.

Purpose
To assess the association between change in ventricular structure and function over time and risk of (MACE) in ARVC.

Methods
101 definite and non-definite ARVC patients (defined as per Revised Task Force criteria (TFC)) were included with at least two sequential echocardiography and ECGs between 2010 and 2022. Structural progression was defined as development of new 2010 TFC on echocardiography during follow-up. MACE were defined as ventricular fibrillation (VF), sustained ventricular tachycardia (Sus VT), appropriate implantable cardio-defibrillator (ICD) therapy (shock/anti-tachycardia pacing (ATP)), heart failure, cardiac transplantation and death.

Results
Of the 101 patients, 51 had a definite diagnosis of ARVC, and 50 had a non-definite ‘early’ diagnosis, of whom a total of 66 (68%) carried a pathogenic variant associated with ARVC. Most were male 58 (57%), and the median age at presentation was 39 years (IQR: 27 - 53). Palpitations 41 (41%) and syncope 25 (25%) were the most common symptoms at baseline. 21 (23%) of the entire population were engaged in competitive exercise. At baseline, 22/101 (22%) patients presented with MACE, in which 20 (91%) definite patients met either minor or major imaging criteria at inclusion. During 4 years follow up (IQR: 2 – 6), 22 patients experienced MACE, in which 11 with history of MACE and 11 without, of those (15 (68%)) had structural progression. Additionally, 9 patients had structural progression of which 5 patients had history of MACE and no second event during follow up and 4 patients had no MACE at baseline or during follow up. Results showed that the odds of structural progression were significantly higher in patients with MACE than without (Table 1).

Conclusion
Structural progression was strongly associated with MACE events. This finding raises the possibility that tracking change over time identifies those patients at greatest risk of arrhythmia, with significant changes in right ventricular measurements.
Quantification of extracellular volume with cardiac computed tomography in patients with left ventricle dysfunction
Authors: Baggiano A , Fusini L , Mushtaq S , Annoni A , Formenti A , Mancini E , Fazzari F , Volpe A , Tassetti L , Maragna R , Junod D , Gaudenzi M , Conte E , Guaricci A I , Pontone G 
Published: November 2023

Abstract

Background
Myocardial fibrosis (MF) is a common endpoint in the majority of pathological mechanisms affecting cardiac muscle, ultimately resulting in cardiac failure. Cardiovascular magnetic resonance (CMR) with gadolinium-based contrast agent and T1 mapping technique is able to deliver a non-invasive quantification of the extracellular volume (ECV) expansion. Recently, ECV estimation with cardiac computed tomography (ECV-CCT) has been validated in the setting of cardiac amyloidosis, showing good agreement with ECV-CMR. However, no evidence is available with last generation single source single energy CT scanner in the clinical context of newly diagnosed left ventricular dysfunction. Therefore, the aim of this study is to test the diagnostic accuracy of ECV-CCT for the detection of MF in patients with recent diagnosis of reduced left ventricle ejection fraction (LVEF), having ECV-CMR as reference technique.

Methods
A consecutive cohort of 41 patients with newly diagnosed left ventricle dysfunction (LVEF &lt; 50%) was enrolled. Time interval of maximum 30 days was present between CCT and CMR. Myocardial segment evaluability with each technique, agreement between ECV-CMR and ECV-CCT, regression analysis and Bland-Altman analysis were performed.

Results
Age of enrolled patients was 62 ± 11 years, and mean LVEF at CMR was 35.2 ± 10.7%. Mean total amount of administrated iodinated contrast was 112.6 ± 22.2 ml, while overall radiation exposure for ECV estimation was2.1 ± 1.1 mSv. Out of 656 myocardial segments available, 656 (100%) segments were evaluable at CCT while 640 (97.6%) were evaluable at CMR. ECV-CCT demonstrated slightly lower values compared to ECV-CMR both at global and region-based comparison (all segments, 33.1 ± 8.5% vs 35.5 ± 10.7%, p &lt; 0.001). At regression analysis, strong correlations were described both at global and region-based analysis (all segments, r = 0.877, 95% CI: 0.840 to 0.914). On Bland-Altman analysis, bias between ECV-CMR and ECV-CCT for global analysis was 2.4 (95% CI: -7.8 to 12.7).

Conclusions
ECV estimation with last-generation single source single energy CT scanner is feasible and accurate. Integration of ECV measurement in comprehensive CCT evaluation of patients with newly diagnosed left ventricular dysfunction can be performed with a small increase in overall radiation exposure.
Qp/Qs in ostium secundum atrial septal defect mitigates right ventricular dysfunction in patients with secondary pulmonary hypertension
Authors: Guerra E C , Espinola-Zavaleta N , Cabello-Ganem A , Luna-Alcala S , Aparicio-Ortiz A D , Proano-Bernal L , Antonio-Villa N E 
Published: November 2023

Abstract

Background
Ostium-secundum atrial septal defect (OS-ASD) can potentially lead to pulmonary hypertension (PH) and associated right ventricle (RV) - pulmonary artery (PA) uncoupling. This, in turn, may eventually result in RV systolic dysfunction. Notwithstanding, whether the characteristics of the OS-ASD could mitigate this relationship is unclear.

Purpose
To evaluate a potential interaction of the OS-ASD shunt (Qp/Qs ratio) on the relationship with RV–PA coupling and RV systolic function in patients with secondary PH.

Methods
We designed a cross-sectional study of 63 adult patients with OS-ASD in which we performed a conventional transthoracic echocardiogram using Vivid 9X-clear equipment (GE Vingmed Ultrasound, Horten, Norway). We evaluated the OS-ASD shunt and other echocardiographic parameters, including the tricuspid annular plane systolic excursion (TAPSE), the systolic pulmonary artery pressure (sPAP) ratio and the right ventricular free wall longitudinal strain (RVFWLS). Polynomic adjusted correlations were performed to model the relationship between the TAPSE/sPAP ratio and the RVFWLS, then we evaluated an interaction effect of the OS-ASD shunt (Qp/Qs ratio), respectively adjusted for age, sex, body mass index, body surface area and right atrial area.

Results
In our study, 49 (78%) subjects were male, with a mean age of 41.8 (±15) years; 7.94% (n=5) had mild PH, 42.9% (n=27) had moderate PH and 49.2% (n=31) had severe PH. Mean echocardiographic parameters were: TAPSE 24.5 (±5.1) mm , sPAP of 55.9 (±20.7) mmHg, TAPSE/sPAP 0.49 (±0.2) mm/mmHg, RVFWLS -25.6 (±6.6) % and Qp/Qs 2.9 (±0.9). We observed a quadratic relationship between the TAPSE/sPAP ratio and the RVFWLS (r=0.691, p &lt; 0.001; Figure 1). OS-ASD shunt had a positive interaction effect (β=10.9, 95% CI: 2.09-19.6, p=0.018) on the relationship between TAPSE/sPAP and RVFWLS after adjusting for covariates (Figure 2).

Conclusions
In conclusion, in patients with OS-ASD, the RV systolic function decreases as the RV-PA uncoupling increases, as reflected in the quadratic regression between the TAPSE/sPAP and the RVFWLS. Moreover, the increase in OS-ASD shunt decreases RVFWLS values in relationship to the TAPSE/sPAP ratio as observed in the interaction model. These results could suggest that the OS-ASD characteristics could potentially mitigate RV dysfunction in patients with secondary PH.Figure 1.Quadratic regressionFigure 2.Interaction model