bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evolution of primary mitral regurgitation during echocardiographic follow-up
Authors: Surakka M , Hirvonen R , Vasankari T , Airaksinen J , Ukkonen H , Saraste A 
Published: January 2025

Abstract

Background
Routine echocardiographic follow-up of patients with mitral regurgitation (MR) is common practice recommended by clinical practice guidelines. However, there is limited contemporary data on the natural course of primary mitral regurgitation, particularly in those without severe regurgitation at presentation.

Purpose
To evaluate outcomes in patients undergoing repeated echocardiograms due to mild, moderate and severe primary mitral regurgitation.

Methods
We identified all patients at a tertiary referral center who were in follow-up due to MR between the years 2004-2019. Patients with a history of heart failure or secondary MR were excluded. Additional age and sex matched individuals without history of cardiac disease and in whom echocardiography showed no valvular heart disease were included as a control group. Data on echocardiographic severity of mitral regurgitation, all-cause mortality, stroke, myocardial infarction, diabetes mellitus and mitral valve interventions were collected from electronic medical records. Primary endpoints were all-cause mortality and survival free from intervention.

Results
The study cohort consisted of 614 patients with a mean follow-up duration of 6.1 ± 3.8 years. At baseline, 275 (45%) had mild (age 65 years, 58% men), 221 (36%) moderate (age 68 years, 66% men) and 118 (19%) severe (age 65 years, 85% men) MR. The control group consisted of 647 individuals (age 66 years, 66% men). Compared to patients with moderate MR at baseline, significantly fewer patients with mild MR at baseline progressed to severe MR during follow-up (27% vs. 4%, p&lt;0.001). Out of patients with mild MR at baseline, 9 (3.3%) underwent mitral valve intervention (surgical mitral valve repair in 7 and implantation of mitral valve prosthesis in 2) during follow-up. Out of these, referral for intervention was based on development of symptoms in 7 (acute heart failure in 2 and atrial fibrillation in 1), endocarditis in 1, whereas 1 patient was operated due to asymptomatic severe MR. All 9 patients had an uncomplicated course of intervention and post-operative left ventricular ejection fraction was &gt;50%. Out of patients with moderate and severe MR at baseline, 47 (21%) and 77 (64%) underwent intervention during follow-up, respectively. Based on a Kaplan-Meier analysis adjusted for stroke, myocardial infarction and diabetes mellitus, survival of patients with mild MR did not differ from control patients without valvular heart disease (Figure).

Conclusions
Our findings indicate that only few patients with mild MR progress to severe MR during 6 years of follow-up and out of these only one asymptomatic patient had surgery. The likelihood of left ventricular function remaining normal in those who have had mitral valve intervention triggered by MR related symptoms seems high.
Survival by time in follow-up (years)
A novel staging system of cardiac damage in aortic stenosis based on multi-chamber myocardial deformation
Authors: Tomaselli M , Springhetti P , Clement A , Benfari G , Radu N , Ciceri L , Pilan M , Scarsini R , Calin A , Nitu C , Penso M , Ribichini F , Popescu B , Muraru D , Badano L P 
Published: January 2025

Abstract

Background
In patients with moderate-to-severe aortic stenosis (AS), the assessment of extravalvular cardiac damage has improved risk stratification and identify candidates for early intervention.

Objectives
To evaluate whether multi-chamber myocardial deformation analysis by speckle tracking echocardiography could improve the existing staging systems in moderate-to-severe.

Methods
We analyzed 2D, Doppler, and STE data obtained from two cohorts: derivation (654 patients, median age: 82 years; 51% men) and validation (237 patients, median age: 77 years; 55% men) with at least moderate AS (aortic valve area&lt; 1.5 cm2). The receiver operator characteristic curve analysis resulted in the following cut-off values associated with outcomes: 15% for left ventricular global longitudinal strain (LVGLS), 13% for peak atrial longitudinal strain (PALS), and 19% for right ventricular free-wall strain (RVFWS). Patients have been divided into five stages: Stage 0 - no left-side damage (LVGLS ≥15% and PALS ≥13%); Stage 1 - partial left-side damage (LVGLS &lt;15% or PALS &lt;13%); Stage 2 - definite left-side damage, (LVGLS &lt;15% and PALS &lt;13%); Stage 3, right-side damage by conventional parameters, with RVFWS ≥19%; and Stage 4, right-side damage including RVFWS &lt;19%.

Results
In a multivariable Cox regression analysis, the new staging scheme remained independently associated with an increased risk of all-cause death (adjusted hazard ratio [aHR]: 1.28; 95%CI: 1.10–1.48; p= 0.001). The new staging classification showed incremental value to conventional 2D echocardiographic variables and exhibited a significantly higher predictive power (ROC AUC: 0.67; 95%CI: 0.62-0.73) compared to those proposed by Généreux et al. (1) (AUC 0.62; 95% CI 0.56-0.67; p=0.002) and Tastet et al. (2) (AUC 0.64; 95% CI 0.58-0.70; p=0.041) at 2-years for all-cause death in the derivation cohort (Figure 1). Similar results were obtained in the validation cohort.

Conclusions
Our staging system for detecting cardiac damage, incorporating multi-chamber myocardial deformation, exhibits a stronger association with outcomes than previously validated systems.
ROC curve across stagin systems
Prognostic significance of left atrial volume index in patients with severe aortic stenosis after transcatheter aortic valve
Authors: Wei X , Yang Y Q , Li X I , Zhou W X , Zhao Z G , Feng Y , Chen M 
Published: January 2025

Abstract

Background
Transcatheter aortic valve replacement (TAVR) is an important approach for patients with severe aortic stenosis (AS), but its mortality remains high and its prognostic factors are not fully understood.

Methods
This single-center retrospective cohort study enrolled 553 consecutive severe AS patients who underwent TAVR between April 2012 and October 2019. Patients with biological valve decay after surgery, moderate to severe mitral stenosis, and inadequate echocardiographic image were excluded. The primary outcome was mortality at 4 years after TAVR.

Results
Over the follow-up time, 64 patients (12.8%) died. Compared to the Survivors, the Non-survivors were older, less females, higher STS scores, larger left atrial volume index (LAVi) and lower serum albumin level. Results from univariate and multivariate cox regression analysis showed that the age (HR, 1.072; 95% CI 1.023-1.124, p =0.004), the LAVi level (HR, 1.023; 95% CI 1.013-1.033, p &lt;0.001) and the serum level of albumin (HR, 0.862; 95% CI 0.796-0.934, p &lt;0.001) were the independent risk factors for estimation of 4-year mortality after TAVR. Moreover, the mortality in patients with the highest category of LAVi (&gt;48 ml/m2) was significantly higher than others, and its multivariable HR was 4.796 (95% CI, 1.137-20.238). In addition, Kaplan-Meier analysis revealed a reduced survival probability according to the highest category of LAVi (p =0.003).

Conclusion
LAVi was an independent predictor of mortality in patients with severe AS after TAVR, and LAVi could be used as a risk stratificationtool for long-term clinical outcome of post-TAVR patients.
Impact of mitral regurgitation in patients undergoing transcatheter aortic valve replacement: imaging predictors and prognosis
Authors: Bravo Martinez I , Florido J , Ullate A , Urkullu A , Rodriguez I , Onaindia J J , Cacicedo A , Sanz I , Candina R , Subinas A , Sadaba M , Armendari K , Velasco M S 
Published: January 2025

Abstract

Backgorund
Mitral regurgitation (MR) is a frequent finding in patients with severe aortic stenosis but usually left untreated at the time of transcatheter aortic valve replacement (TAVR). There is controversial evidence on the prognostic impact of the presence of concomitant MR in patients undergoing TAVR.

Purpose
The objective of the study was to assess the evolution of MR after TAVR, imaging and clinical predictors on its evolution and the impact on the prognosis of the baseline degree of MR and its response after TAVI.

Methods
This is a retrospective observational study. Mitral regurgitation was graded by transthoracic echocardiography before and after TAVR in 67 patients with severe aortic stenosis. 1-year mortality and admissions for heart failure were related to the degree of baseline MR and improvement of MR after TAVR. Morphological echo analysis was performed to determine predictors of MR improvement.

Results
32% of patients presented with baseline moderate or severe MR (MR grade &gt;2). MR improved in 62% of patients with moderate or severe MR. The echocardiographic parameters that were associated with an improvement in MR were left ventricular (LV) ejection fraction (45.3±16 vs. 60±12, p&lt;0.001), LV end-diastolic (5.7±1 vs. 5.1±1cm, p=0.045) and end-systolic diameters (4.11±1 vs. 3.36±1cm, p=0.006), LV volume (128±51 vs. 98±49ml, p=0.01), LV mass (182±40 vs. 163 ±53 gr/m2, p= 0.02), mitral annulus diameter (38±6 vs 35±4mm, p= 0.01) and the functional etiology of MR (p= 0.01). Patients with improved MR had a significant reduction in admissions for heart failure (p=0.04), with no differences in mortality at one year follow-up. Significant baseline MR (MR grade &gt;2) was not associated with a higher risk of mortality (p= 0.42) or admissions for heart failure(p=0.25) at one year of follow-up.

Conclusions
There is a high prevalence of MR associated with severe aortic stenosis. There can be an improvement in MR after TAVR. Improvement in MR was associated with significantly better survival and a lower risk of admissions for heart failure. There are echocardiographic parameters that can predict a significant reduction in MR after TAVR. The baseline grade of MR did not influence the prognosis of the patients at one year of follow-up.
Echocardiographic parameters associated
MR improvement after TAVR
Impact of TAVI on left ventricular mass and function in a cohort of elderly patients with severe aortic stenosis.
Authors: Perez Barquin R , Ruisanchez Villar C , Santiago Setien I , Veiga Fernandez G , Lerena Saenz P , Cuesta Cosgaya J M , Coroas Pascual C , Serrano Lozano D , Llano Cardenal M , Zarauza Navarro J M , Sainz Laso F , Lee Hwang D H , Garcia Camarero T , Gil Ongay A , De La Torre Hernandez J M 
Published: January 2025

Abstract

Introduction
TAVI implantation is currently indicated as a therapeutic alternative for an increasingly broad cohort of patients with aortic valve disease. Myocardial mass regression appears to be a constant in follow-up studies of these patients. However, there is no consensus on the evolution of systolic function in these patients after TAVI.

Purpose
The objective of our study was to analyze the 6-month effect of TAVI implantation on myocardial mass and left ventricular systolic function, measured through the usual estimation parameter—left ventricular ejection fraction (LVEF)—and left ventricular global longitudinal strain (GLS).

Methods
Patients diagnosed with symptomatic severe aortic stenosis who received a TAVI between February 2018 and February 2020 were included. Baseline echocardiogram studies (performed on the day of the implant, prior to the intervention) were analyzed and compared with examinations at medium-term follow-up, established at six months. Variables of systolic function (LVEF and GLS) as well as left ventricular mass (total and indexed) were detailed.

Results
We analyzed 180 patients (mean age 80.2 years, SD 9.02), of whom 98 (54.4%) were women. At the time of data collection, 58 deaths (32.6%) had been recorded, 17 (29.3%) of which occurred during the first year after TAVI implantation. The baseline and follow-up echocardiogram data obtained are summarized in Table 1. A statistically significant reduction (p&lt;0.0001) in total left ventricular mass of 44.3g (33.2-55.5) and indexed mass of 24.9 g/m² (18.6-31.2) at six months post-intervention was observed. Parallel to this, left ventricular systolic function showed a significant improvement at medium-term follow-up, both estimated by left ventricular longitudinal strain (GLS -14.1 (SD±4.5) at baseline and GLS -16.1 (SD±11.6) at follow-up, p 0.0001) and by LVEF (baseline 54.9% (SD±12.9) and follow-up 58.8% (SD±11.6); p 0.0014)). Statistical significance in the analysis of this parameter had not been achieved in other studies by this working group until now.

Conclusions
Correction of aortic valve disease via percutaneous approach through TAVI implantation results in significant improvement in medium-term systolic function, as estimated by the classical parameter, LVEF, as well as in subclinical myocardial function measured through GLS. Similarly, in accordance with current evidence, the left ventricular mass (total and indexed) regresses in medium-term follow-up.
Table 1.
Utility of the average pixel intensity method for the detection of moderate-severe mitral regurgitation in comparison with the area of the regurgitant orifice
Authors: Calvo-Asensio M , Lozano-Edo S , Buendia-Fuentes F , Osa-Saez A , Rodriguez-Serrano M , Sanz-Ros J , Martinez-Dolz L , Maceira A , Calvillo-Batlles P , Fonfria-Esparcia C , Arnau-Vives M A , Aguero J 
Published: January 2025

Abstract

Background and purpose
The "average pixel intensity" (API) method, which is applied to the continuous Doppler spectral signal in mitral regurgitation (MR), has been proposed as a new method for automated MR grading. The objective of this study is to compare the API method with the effective regurgitant orifice area (EROA) for the detection of moderate-severe or severe MR (grades III or IV/IV) using open-source software (ImageJ).

Methods
Prospective single-center study (n=267) including patients with different degrees of MI, with a subgroup with cardiac magnetic resonance (CRM, n=55). Of the total sample, API was measured in 148 patients, and EROA in 159. Significant MR by echocardiography was defined according to a multiparameter criterion (American Society of Echocardiography - ASE algorithm), and by CRM according to regurgitant volume (≥50 ml) or regurgitant fraction (≥40%). The association between quantitative parameters (API and EROA) and the diagnosis of moderate-severe MI according to each imaging technique (echocardiography vs CMR) was evaluated using ROC curves.

Results
The prevalence of significant MR was 34.1% by echocardiography, and 21.8% by CMR. In 24% of cases the MR mechanism was functional. The median [Q1-Q3] API was 112 [141-166] units, and EROA 0.17 [0.10-0.30] cm2. The correlation between API and EROA was low (r = 0.34; p &lt; 0.01). For the diagnosis of moderate-severe MR, EROA performed better than API taking the ASE algorithm as a reference (AUC 0.89 vs 0.75; Figure 1A), but both parameters showed a similar performance when compared to the CMR criterion ( AUC 0.80 vs 0.75; Figure 1B).

Conclusions
The low correlation between the API method and EROA raises their potential complementarity in the diagnosis of MR. Regarding the ASE multiparametric criterion by echocardiography, the EROA is superior to the API (being a key element in this algorithm). However, both methods present a similar association with the diagnosis of moderate-severe MR by CMR, and the assessment of both parameters could improve the agreement between echocardiography and CMR.
Right ventricle pulmonary artery coupling in patients with aortic stenosis.
Authors: Oikonomidis D , Tasoulis A , Tatsis E , Kouloulias I , Papadopoulos C 
Published: January 2025

Abstract

Right Ventricle (RV) –Pulmonary Artery (PA) Coupling refers to the relationship between RV contractility and RV afterload. It is estimated as the ratio of RV free wall tissue Doppler imaging (TDi) and Pulmonary Artery Systolic Pressure (PASP) . This index has shown a prognostic value in patients with cardiovascular diseases. The aim of the current study is to investigate the current index in patients with various grades of aortic stenosis.
We enrolled 60 subjects to our study (20 with severe aortic stenosis, 20 with symptomatic moderate aortic stenosis without other significant valve pathology, 20 contol group- aged matched). All patients underwent transthoracic echocardiography study.
Statistical analysis revealed a significant deference within 3 groups regarding RV –PA Coupling (RV-STDi /PASP, mean ± sd : 0.2595 ± 0.11718 vs 0.4305 ± 0.07416 vs 0.5820 ± 0.04275 , p – value = &lt;0,001)

Conclusions
RV –PA Coupling index is significally associated with the grade of aortic stenosis.
RV PA coupling vs stenosis
Left ventricular pressure-strain-volume-loop and myocardial work patterns in asymptomatic severe aortic regurgitation with early disease decompensation
Authors: De Oliveira E K , Buytaert D , Moya A , Shumkova M , Mistrulli R , Ghare S , Fialova M , Medilek K , Van Camp G , Kockova R , Penicka M 
Published: January 2025

Abstract

Background
Severe aortic regurgitation (AR) is associated with left ventricular (LV) pressure and volume overload, leading to irreversible myocardial damage often before the onset of guidelines triggers for aortic valve surgery. Therefore, the development of sensitive imaging markers to detect the early impact of pressure-volume overload imposed by AR on LV geometry and function is needed.

Aim
To describe patterns of LV pressure-strain-volume loops, their components and myocardial work in asymptomatic patients with significant AR and preserved LV ejection fraction with early disease progression.

Methods
This multicenter study consisted of 95 consecutive patients (84.1% male, 45±14 years) with asymptomatic significant AR, in sinus rhythm, and preserved LV ejection fraction (EF) &gt;50%, who did not have any indication for aortic valve surgery as per current guidelines. Comprehensive echocardiography was analyzed by an experienced operator blinded to clinical outcome. Pressure-strain-volume loops (PSVL), their components, and myocardial work were analyzed using customized software.

Results
During a median follow-up of 1375 [interquartile range 1041-1783] days, a total of 34 (36%) patients developed the class I indication for aortic valve surgery, i.e. either symptoms or LV dysfunction (AVsurg group). At baseline, LVEF (64±5% vs. 64±7%;p=0.748), global longitudinal strain (-17.6 ± -2.4% vs. -18.5 ± -2.4%; p=0.112), global myocardial work index (1963±429 vs.1900±340 mmHg%; p=0.429) or global constructive work (2371±495 vs. 2287±368 mmHg%; p=0.390) did not differ significantly between groups. In contrast, global wasted work was significantly higher (149[90-204] vs.106[80-152] mmHg%; p=0.031) in the Avsurg group compared to the patients without progression for AV surgery indication (CON group). Moreover, the AVsurg group showed a larger PSVL area than the CON group probability due to the larger strain-volume (234 [129-380] vs.155 [88-216] %mL; p=0.021) and pressure-volume (12504 [9318- 15073] vs. 10192 [8004-11918] mmHg.mL; p=0.002) component, while the pressure-strain loop was similar between groups (Figure 1).

Conclusions
Non-invasive pressure-strain-volume loop reflects early changes in LV geometry and function due to chronic pressure-volume overload in significant AR. Patients with early disease decompensation show larger PSVL than stable individuals. The clinical utility of this index needs to be investigated in future studies.
Figure 1
Accuracy of echocardiographic parameters in the diagnosis of severe mitral regurgitation as determined by cardiac magnetic resonance imaging.
Authors: Auberson D , Soylemez N , Arangalage D , Tzimas G , Antiochos P , Rutz T , Hugelshofer S , Monney P 
Published: January 2025

Abstract

Background
Echocardiographic grading of mitral regurgitation (MR) relies on the interpretation of both quantitative and qualitative parameters. Contemporary societal guidelines suggest a diagnostic approach that primarily favors quantitative parameters.1 We aimed to assess the diagnostic accuracy of such an approach in comparison to grading by cardiac magnetic resonance (CMR).

Methods
Patients with primary mitral regurgitation were assessed by transthoracic and transesophageal echocardiography (TTE, TOE), as well as cardiac magnetic resonance. Mitral regurgitation was considered severe if the regurgitant fraction by CMR was ≥40%.2

Results
A total of 77 patients were included, severe mitral regurgitation was diagnosed in 53 patients (69%) by CMR. Effective regurgitant orifice (ERO), regurgitant volume (RVol) and regurgitant fraction (RF) were assessed by TTE. ERO, RVol and 3D vena contracta area (VCA) were assessed by TOE.
On TTE, as standalone parameters, ERO ≥40mm2 (Se 72%/Sp 67%) and RVol ≥60mL (Se 65%/Sp 81%) had higher diagnostic accuracies than RF ≥50% (Se 65%/Sp 67%). On TOE, ERO (Se 85%/Sp75%) had the highest sensitivity and specificity, followed by the RVol (Se 73%/Sp71%) and VCA (Se 89%/Sp42%). When the presence of at least one quantitative parameter is considered diagnostic, the sensitivity is highest, more so by TOE than TTE (Se 94%/Sp 42% and Se 83%/Sp 56%, respectively) (Figure 1).
On the other hand, semi-quantitative parameters such as vena contracta ≥7mm (VC) and E-wave dominant mitral inflow (E &gt;1.2m/s) had high specificities, but low sensitivities (TEE: VC Se 59%/Sp 79%, E &gt;1.2m/s Se 49%/Sp 90%; TOE: VC Se 62%/Sp 87%, E &gt;1.2m/s Se 24%/Sp 85%) (Figure 2).

Conclusion
For MR severity assessment, ERO and RVol by TEE and TOE exhibit the highest diagnostic accuracy as stand-alone parameters. VCA by TOE is highly sensitive for severe MR, but with a low specificity. Semi-quantitative parameters such as E-wave dominant mitral inflow and VC were highly specific of severe MR and may be used as additional parameters to confirm MR severity.