bluuebunny/crossref_metadata_2025_split huggingface dataset:
Validation of a fully automated AI system for accurate left ventricular mass measurement in echocardiography
Authors: Sveric K , Platzek I , Haussig S , Linke A 
Published: January 2025

Abstract

Background
Accurate measurement of left ventricular mass (LVM) with 2D transthoracic echocardiography (Echo) provides prognostic information, and aids in tailoring treatment plans.

Purpose
We sought to validate a fully automated artificial intelligence (AI) system for LVM measurement in Echo against human measurements and computed tomography (CT), considered the gold standard.

Methods
101 patients with symptomatic aortic valve stenosis (AS), 48 with mitral valve regurgitation (MR), and 41 with tricuspid valve regurgitation (TR) underwent both Echo and cardiac spiral CT on the same day, the latter for planning interventional valve repair. End-diastolic septal and posterior wall thickness (IVSD, PW), along with end-diastolic diameter (EDD) from LV parasternal long axis views in Echo, were independently measured for 1-dimensional LVM calculation by both an AI and an experienced cardiologist (&gt;10 years) (Figure 1A). Notably, the AI performed fully automated view selection from the entire Echo exam and measured LV diameter and wall thickness on appropriate LV views without operator involvement. LVM results from CT were supervised by an experienced radiologist (&gt;10 years) (Figure 1B). Pearson’s correlation coefficient (r), regression analysis, and mean absolute error (MAE) were used to assess agreement of measurement values between methods.

Results
The final cohort consisted of 164 patients, with complete LVM calculations by AI, human, and CT (feasibility: 91%, 95%, and 99%, respectively). LVM from AI and human correlated strongly (r=0.83, MAE=22 g), but AI exhibited higher agreement with CT (r=0.69, MAE=28 g) than human LVM measurement (r=0.62, MAE=37 g) (Figures 1C and 1D). AI and human measurements showed good correlation for IVSD (r=0.74, MAE=0.18 cm) and EDD (r=0.73, MAE=0.54 cm), but low correlation for PWD (r=0.48, MAE=0.23 cm).

Conclusion
The findings highlight the potential use of an AI-based application for fully automated view selection and measurement of LV wall thickness and diameter, demonstrating strong agreement of LV mass with CT and human measurements.
Improvement of right and left ventricular echocardiographic parameters in obese patients after bariatric surgery
Authors: Polewczyk A , Siudak Z , Cecha P , Bryk P , Nawacki Ł , Bociek A 
Published: January 2025

Abstract

Background
Severe obesity causes hemodynamic changes in the circulatory system, which leads to the development of heart failure with either preserved or reduced ejection fraction. Weight loss achieved through bariatric surgery is likely to possibly reverse many of hemodynamic and structural abnormalities caused by obesity.

Purpose
Assessment of left and right ventricular function in patients undergoing bariatric surgery.

Methods
Detailed echocardiographic parameters assessing left and right ventricular function in severely obese patients undergoing bariatric surgery were analyzed. The following parameters of left and right ventricular function were compared in the examinations performed before, 3 and 6 months after surgery: left ventricular ejection fraction (LVEF), LV and RV global longitudinal strain (GLS), peak early (e’) and late (a’) diastolic annular velocities (lateral and septal) with calculation of E/e’ ratios, left atrium volumeindex ( LAVI), TRV (tricuspid regurgitation velocity), tricuspid annular plane systolic excursion (TAPSE), maximum systolic velocity of the lateral part of the tricuspid annulus-s’ and accelerated pulmonary time (AcT).

Results
Forty obese patients (76% women) with mean BMI 40.3 (SD 5.6) and mean age of 42.4 (SD 11.9) years were enrolled. BMI as 6 months was 31.2 (SD 5.1). Baseline and follow-up results of echocardiography are presented for both left and right ventricular parameters in Table 1 and Table 2.

Conclusions
Only GLS for right and left ventricle, FWS and TRV improve significantly within 6 months from bariatric surgery. On the other hand, these changes are significant as early as 3 months after bariatric surgery.
Left ventricular parameters
Right ventricular parameters
Cardiac systolic and diastolic function in relation to cardiovascular risk factor distribution: a comparison of strain-rate imaging in Russian and Norwegian populations
Authors: Roesner A , Kornev M , Caglayan H A , Malyutina S , Ryabikov A , Schirmer H , Kudryavtsev A V 
Published: January 2025

Abstract

Background and Purpose
Cardiovascular morbidity and mortality rates are high in Russia and it is likely that this reflects a similar impact on the general cardiac health of the population. The current study seeks to compare standard echocardiography and strain-based measurements between Russian and Norwegian populations, while also exploring their links to hemodynamic and risk factors.

Methods
This study included echocardiographic measurements of 1,192 participants from Russia, and 917 from the Study population, Norway. The sample included men and women aged 40–69 years. Normalcy, defined as the absence of hypertension or indicators of CVD, was observed in 840 individuals. We performed conventional echocardiography and analysed two-dimensional speckle-tracking longitudinal strains, including systolic, early-, and late-diastolic SR values. The study population was divided into four groups: normal, controlled hypertension, hypertensive blood pressure, and cardiac disease. Echocardiographic parameters were compared between the Russian and Norwegian populations, adjusted for age, sex, height, body mass index, blood pressure, heart rate (HR), atrial fibrillation (AF), smoking, pulmonary hypertension, and serum values for total, LDL (low density lipoprotein), and HDL (high density lipoprotein) cholesterol; triglycerides; creatinine; high-sensitivity C-reactive protein; and HbA1C.

Results
Russians showed a tendency towards lower longitudinal systolic functional parameters, which were most prominent in the normotensive group. However, these differences became insignificant after adjusting for parameters that influence pre- and after-loads. Russians also had a lower stroke volume, higher HR, higher left atrial volume, lower A, and higher E/A ratio, indicating a higher incidence of diastolic dysfunction in the Russian population that persisted after adjustments.

Conclusion
After adjusting for factors that influence cardiac function, there were no differences in systolic functional parameters between the Norwegian and Russian populations. However, differences in diastolic parameters, which persisted after adjusting for conventionally influential factors, indicated unexplained underlying causes of diastolic dysfunction in the Russian population.
Figure 1
Table 1
Prognostic significance of predischarge echocardiography in acute decompensated heart failure
Authors: Krawczyk M , Brzostowicz M , Ponikowski P , Kosmala W 
Published: January 2025

Abstract

Introduction
Current guidelines do not specify the timing of echocardiography during acute decompensation of heart failure (HF). In particular, the question of the usefulness of an echocardiographic imaging immediately before discharge from the hospital, i.e. after achieving hemodynamic stabilization, remains unresolved.

Aim
To compare the prognostic value of echocardiography performed on admission and discharge in patients hospitalized due to acute HF decompensation, and to identify which echocardiographic markers may predict a poor early outcome after discharge.

Methods
A complete echocardiogram, comprising assessment of myocardial deformation and myocardial work: global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) was performed twice- upon admission and upon discharge from the hospital in 130 patients (67±15 years of age, mean EF 35±15%) with decompensated HF (NYHA class III or IV). HFpEF was diagnosed in 26, HFmrEF in 19, and HFrEF in 85 enrollees. Participants were followed over 6 weeks after discharge for death and HF hospitalization (composite end-point).

Results
HF hospitalization or death occurred in 18 patients (13 and 5, respectively). Among echocardiographic parameters of left ventricular (LV), left atrial and right ventricular (RV) function, only E/e’ and GWW measured at pre-discharge were associated with the composite end-point, and the significance of these associations was retained when both predictors were included in the bivariable model. (Table). No associations with the study endpoint were found for any of the echo parameters measured at admission.

Conclusions
In patients with acute decompensated HF: 1) predischarge echocardiography after achieving hemodynamic stabilization can provide more short-term prognostic information than admission echocardiography during hemodynamic worsening; 2) in addition to LV filling pressure estimation (E/e’), measurement of LV myocardial work may improve the prediction of early mortality and HF readmission after hospital discharge.
Table
Double-blind comparison study on the reliability of binary assessment of left ventricular systolic function and dimensions between standard echocardiogram and handheld echocardiogram
Authors: Bia E , Cristiano E , Ignatiuk B , Graniero A , Pedrigi C , Previtali I , Marvelli A , Nudi A , Poloni C L , Passaretti B , Toscano O , Gad A , Brscic E , Licastro M , Celentano E 
Published: January 2025

Abstract

Rationale
Left ventricular systolic function parameters have considerable prognostic importance, but demand for echocardiographic examinations is greater than supply. The market availability of handheld echographs provides greater access to low-cost summary echocardiographic evaluation.

Purpose of the study
The purpose of the study is to compare in a double-blind manner the binary concordance ( yes/no) of an examination done with a handheld ultrasound and a standard echocardiographic examination on four parameters referred to the left ventricle ( LV) on the same patient 4 days apart.

Method
Thirteen volunteer cardiologists who had performed at least 1000 echocardiograms blindly performed on patients not known to them an evaluation with a handheld ultrasound machine and reported the result on a card stating the presence or absence in an eye-based manner of 4 conditions: LV dilatation, reduced LV systolic function ( left ventricular ejection fraction LVEF&lt; 55%), presence of left ventricular segmental kinetics alterations. The two echocardiographic examinations were performed at a maximum time interval of two days and in the absence of any new procedures on the patient between the two examinations.
The time taken for each examination was timed.
A statistical analysis with Choen’s Kappa test was performed.

Results
A total of 107 examinations were performed on 86 patients, whose characteristics are shown in Table Number 1. The average number of examinations per cardiologist was 8.9 with a minimum of 5 examinations and a maximum of 10. There was excellent concordance on the VS dilatation parameter ( kappa 0.85, SE 0.05, 95% CI 0.77 to 0.99), with a number of 4 false positives and 0 false negatives; the ability to detect the presence of reduced global left ventricular systolic function was also excellent ( kappa 0.9 SE 0.04 95% CI 0.82 to 0.99). Concerning left ventricular hypertrophy there was a high percentage ( 22%9 of false negatives), referring to mild degree of LV hypertrophy, with concordance however ( kappa 0.42 SE 0.08 CI 95% 0.26 to 0.59); on segmental kinetics there was 9% false positives and no false negatives with fair concordance ( kappa 0.55 SE 0.09 95% CI 0.37 to 0.73). Results are summarized in table 2.

Conclusions
Qualitative assessment on left ventricular systolic function parameters with a handheld ultrasound machine compared with a standard echocardiographic examination is reliable for the recognition of left ventricular dilatation and dysfunction. This may have considerable use of the examination as a filter or screening for the recognition of relevant heart disease.
Sex-related effect of exercise on RV-PC coupling in asymptomatic patients with significant primary mitral regurgitation
Authors: Koukos M , Ververeli C L , Sakalidis A , Dimitroglou Y , Beneki E , Dritsa P , Kouremeti M , Tsartsalis D , Patsourakos D , Tolis E , Kalompatsou A , Gialeli F , Tsioufis K , Aggeli C 
Published: January 2025

Abstract

Background
Right ventricular–pulmonary circulation (RV-PC coupling) serves as an index to evaluate RV function in relation to underlying RV afterload. Although impaired RV-PC coupling has been proposed as a predictor of adverse outcomes in heart failure (HF) patients with secondary mitral regurgitation (MR), there is limited data available for patients with primary MR and moreover, if there is a sex-related trend.

Purpose
This study aimed to assess RV-PC coupling at rest and during exercise with bicycle stress echocardiography in patients with asymptomatic moderate to severe primary MR and compare these alterations between men and women.

Methods
All patients and controls underwent stress echocardiography with a supine bicycle. RV systolic function was evaluated with TAPSE and S’. The non-invasively measured RV-PC coupling was evaluated by indexing TAPSE to right ventricular systolic pressure (RVSP) during baseline echocardiogram and peak workload stages of bicycle SE.

Results
Among the 48 patients, 28 (58%) were women and 20 (42%) were men (mean age 54.07+14.16 and 52.7±16.81 years, p. NS, respectively). 39 patients had moderate MR (81.3%), 5 patients had moderate-to-severe MR(10.4%), and 4 patients had severe MR(8.3%). The duration of stress echocardiogram was significantly longer in the male MR group (9.32+1.62 min vs 7.22+2.50 min, respectively; p .001). Left Ventricular Ejection Fraction (LVEF) was within normal limits in both groups {67.59+13.71 % vs 72.93+10.21 %(p=NS)} and the dimensions of left ventricular cavity (end-diastolic and end-systolic diameters) were significantly larger in the male group compared to female group (51.5+5.10 mm vs 47.64+4.73mm (p .011) and 34.00+4.06mm vs 30.25+3.74mm (p .002) respectively}.
TAPSE and RVSP increased from baseline to peak dose for both men [Rest: 22.95±2.93mm and 14.13±1.99cm/sec (p. NS) respectively, Peak exercise: 29.55 ±3.41mm and 20.84±2.00cm/sec (p. NS) respectively] and women [Rest: 23.86±3.13 and 14.54±1.88cm/sec (p.NS), Peak: 30.21±3.56mm and 20.07±2.60cm/sec (p. NS) respectively].
Moreover, a steady decrease was observed in TAPSE/RVSP from baseline to peak workload both in men (0.81±0,13mm/mmHg to 0.75±0.21mm/mmHg) and women (0.86±0.16mm/mmHg to 0.69±0.16mm/mmHg, respectively). Interestingly, a significant change was observed between men and women in TAPSE/RVSP (-0.05±0.17 and -0.16±0.17, p .029 respectively).

Conclusions
RV-PC coupling decreases during exercise in asymptomatic men and women with moderate to severe MR. Therefore, future studies should aim to evaluate the incremental role of this novel index not only in the assessment and evaluation of men and women with MR but also as a potential prognostic marker between them.
TAPSE/RVSP change Graph
Impact of right ventricular function on outcome in low-risk secondary tricuspid regurgitation according to effective regurgitant orifice area
Authors: Pece C , Tomaselli M , Penso M , Badano L P , Clement A , Radu N , Heilbron F , Gavazzoni M , Springhetti P , Oliverio G , Caravita S , Baratto C , Buta A , Parati G , Muraru D 
Published: January 2025

Abstract

Background
The threshold value of the effective regurgitant orifice area (EROA) that identifies patients with secondary tricuspid regurgitation (STR) at high risk of events during follow-up remains unclear.

Purpose
Our study aimed to identify the threshold value of the EROA defining patients with STR at high-risk of events during follow-up and to evaluate the impact of right ventricular (RV) remodeling in modulating the outcome of low-risk STR patients according to EROA.

Methods
513 consecutive outpatients with STR were included. Using the threshold value derived by spline curves, we divided our cohort into two groups: low- (EROA≤ 0.47cm2) and high- (EROA&gt; 0.47cm2) risk STR patients. The endpoint was a composite of heart failure hospitalization and death.

Results
At 18±15 months from enrolment, 195 patients (38%) reached the endpoint. The Kaplan-Meier curves demonstrated a higher rate of events for high-risk patients (54±6% vs 30±7%, p &lt;0.0001). EROA&gt; 0.47 cm2 was associated with a 2-fold increased risk of experiencing the outcome (Hazard Ratio [HR]: 2.08, 95% Confidence Interval [CI] 1.56-2.77, p&lt;0.0001). Patients with atrial STR had a significantly lower threshold value (0.44 cm²) than patients with ventricular STR (0.49 cm²). In multivariate Cox regression analysis, EROA remained independently associated with the composite endpoint (adjusted HR: 1.01, 95% CI 1.00-1.02, p&lt;0.0001) both in the entire cohort and in high-risk patients. Patients with low-risk STR were associated with a dismal prognosis only if they had dilated or dysfunctioning RV. In patients with EROA≤ 0.47cm2, the event rate at two years for RV end-diastolic volume &gt;90 mL/m2, RV end-systolic volume (RV ESV) &gt;46 mL/m2, RV ejection fraction &lt;45% and RV forward stroke volume/RV ESV&lt; 0.40 were respectively: 42±4%, 51±4%, 44±4%, and 47±4%).

Conclusions
Our results refine the independent association between STR severity assessed by EROA and outcomes. In patients with low-risk STR, the assessment of RV function and RV-PA coupling may improve the patient’s risk prediction, demonstrating a clinically relevant link between STR severity and RV geometry and function.
Comparison of quantitative echocardiographic parameters for grading of mitral regurgitation severity for prediction of clinical outcome
Authors: Ambrozic J , Prodanova D , Starc A , Cvijic M 
Published: January 2025

Abstract

Introduction
Current recommendations favour the use of quantitative parameters for the assessment of mitral regurgitation (MR) severity and the effective regurgitant orifice area (EROA) derived from the proximal isovelocity surface area (PISA) method has been demonstrated as a predictor of outcome.

Purpose
The aim of our study was to compare the long-term predictive value of quantitative echocardiographic parameters, derived from the PISA method and volumetric method on clinical endpoints.

Methods
We retrospectively analysed 298 patients who consecutively underwent echocardiographic examination at out department in 2018 and had been diagnosed with more than mild MR. From the echocardiographic measurements we calculated the quantitative parameters (EROA, regurgitant volume (Rvol) and regurgitant fraction (RF)) by the PISA method and volumetric method (based on the Rvol calculated as a difference between total left ventricular stroke volume derived from the Simpson’s biplane planimetry and forward stroke volume assessed by the pulsed-wave Doppler left ventricular outflow tract method). The clinical outcome was death from any cause, hospitalization due to heart failure or mitral valve intervention in the period from the echocardiographic examination to the end of 2022.

Results
The study cohort comprised 169 (56%) patients with secondary MR, 103 (35%) with primary MR and 26 (9%) with combined etiology. Clinical endpoints were observed in 198 (66%) patients. Median time to the event was 732 (121-1578) days. Quantitative parameters by the PISA method better predicted the clinical outcome compared to quantitative parameters by the volumetric method (Figure A). RF-PISA had the biggest area under the curve (AUC 0.633, p &lt; 0.001), followed by the EROA-PISA (AUC 0.626, p &lt; 0.001), while the predictive values of quantitative parameters by the volumetric method were not significant (EROA: p= 0.109, Rvol: p=0.153, RF: p=0.156). By the PISA method, patients with RF≥50% had more adverse outcome compared to those with RF&lt;50% (Figure B). By the volumetric method, however, the outcome was similar for both patients with RF≥50% or &lt;50% (Figure B). In our cohort, the best cut-off value for the prediction of the clinical event was RF-PISA &gt;46% (sensitivity 48%, specificity 76%) and EROA-PISA &gt; 0.24 cm2 (sensitivity 41%, specificity 78%).

Conclusions
Quantitative parameters for grading MR severity by the PISA method provide better diagnostic accuracy for predicting the clinical outcome in comparison to quantitative parameters by the volumetric method. RF-PISA turned out as a good predictor for clinical outcome. Our results show that the fraction of regurgitation better defines the clinical significance of MR than the absolute values of quantitative parameters. Therefore, the RF should be reported as part of the quantitative assessment of MR severity.
The impact of severe tricuspid regurgitation on quality of life among patients with atrial fibrillation
Authors: Vijan A , Ablachim T , Daha I , Delcea C , Iliesiu A M 
Published: January 2025

Abstract

Introduction
Atrial fibrillation (AF) is a widespread arrhythmia that influences the quality of life (QOL) and tricuspid regurgitation (TR) frequently occurs alongside AF in these patients.

Aim
The goal of the study was to assess the quality of life in patients with AF and severe TR.

Material and methods
In this prospective study AF patients admitted consecutively to a tertiary clinical hospital, between January 2021 and July 2022, were included irrespective of the cause of hospitalization. QOL was measured using the validated AFEQT questionnaire with the cutoff value set by the mean value. The severe TR at echocardiography was defined according to current european guidelines. Patients with AF were divided into four categories: patients with paroxysmal, persistent, long-standing persistent, and permanent AF. Right ventricular dysfunction was defined using the tricuspid annular plane systolic excursion (TAPSE) less than 17mm, peak systolic velocity of the tricuspid annulus (s'RV) less than 10cm/s, with cutoff values in accordance with the EACVI-ASE guidelines. High arrhythmic burden was determined by the number of AF episodes (more than 5 episodes per month) and by the type of AF (long-standing persistent or permanent AF).

Results
117 patients with AF and TR, 57.26% women, mean age 71±10 years , were included in the study. 41.03% patients had a poor QOL and were significantly older (p 0.002). Severe TR was present in 13.68% AF patients. Mean AFEQT score was significantly lower in patients with severe TR (42.88±12.68 vs 35.45±18.08, p 0.02).
Right atrial volume index (HR 6.72, 95%CI 1.63-27.63, p 0.008) and systolic pulmonary artery pressure (HR 1.1, 95%CI 1.03-1.20, p 0.001) were independent predictors for severe TR.
AFEQT score was directly correlated with left ventricle ejection fraction (r 0.508, p 0.001), TAPSE (r 0.456, p 0.001), S’RV (r 0.486, p 0.001) and inversely correlated with NTproBNP values (r -0.570, p 0.001), age (r -0.462, p0.001), CHA2DS2-VASC score (r -0.493, p 0.001), right atrial volume index (r -0.405, p 0.001) and left atrial volume index (r -0.428, p 0.001)
In multivariable analysis, after adjusting for age and sex, severe TR was an independent predictor of poor QOL (HR 3.83, 95%CI 1.09-13.46, p 0.035), alongside high arrhythmic burden (HR 3.06, 95%CI 1.15-8.14, p 0.025), CHA2DS2-VASC score (HR 1.37, 95%CI 1.07-1.75, p 0.01), increased NTproBNP (HR 1.83, 95%CI 1.10-3.05, p 0.020), non-paroxysmal AF (HR 4.01, 95%CI 1.34-11.90, p 0.012) and right ventricle dysfunction (HR 6.41, 95% CI 2.66-15.42, p&lt;0.001)

Conclusion
In patients with atrial fibrillation the association of severe tricuspid regurgitation was an independent predictor for reduced quality of life.