bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic estimation of pulmonary artery wedge pressure: invasive derivation, validation, and prognostic association beyond diastolic dysfunction grading
Authors: Lindow Thomas , Manouras Aristomenis , Lindqvist Per , Manna Daniel , Wieslander Björn , Kozor Rebecca , Strange Geoff , Playford David , Ugander Martin 
Published: November 2023

Abstract

Aims
Grading of diastolic function can be useful, but indeterminate classifications are common. We aimed to invasively derive and validate a quantitative echocardiographic estimation of pulmonary artery wedge pressure (PAWP) and to compare its prognostic performance to diastolic dysfunction grading.

Methods and results
Echocardiographic measures were used to derive an estimated PAWP (ePAWP) using multivariable linear regression in patients undergoing right heart catheterization (RHC). Prognostic associations were analysed in the National Echocardiography Database of Australia (NEDA). In patients who had undergone both RHC and echocardiography within 2 h (n = 90), ePAWP was derived using left atrial volume index, mitral peak early velocity (E), and pulmonary vein systolic velocity (S). In a separate external validation cohort (n = 53, simultaneous echocardiography and RHC), ePAWP showed good agreement with invasive PAWP (mean ± standard deviation difference 0.5 ± 5.0 mmHg) and good diagnostic accuracy for estimating PAWP &gt;15 mmHg [area under the curve (95% confidence interval) 0.94 (0.88–1.00)]. Among patients in NEDA [n = 38,856, median (interquartile range) follow-up 4.8 (2.3–8.0) years, 2756 cardiovascular deaths], ePAWP was associated with cardiovascular death even after adjustment for age, sex, and diastolic dysfunction grading [hazard ratio (HR) 1.08 (1.07–1.09) per mmHg] and provided incremental prognostic information to diastolic dysfunction grading (improved C-statistic from 0.65 to 0.68, P &lt; 0.001). Increased ePAWP was associated with worse prognosis across all grades of diastolic function [HR normal, 1.07 (1.06–1.09); indeterminate, 1.08 (1.07–1.09); abnormal, 1.08 (1.07–1.09), P &lt; 0.001 for all].

Conclusion
Echocardiographic ePAWP is an easily acquired continuous variable with good accuracy that associates with prognosis beyond diastolic dysfunction grading.
Eccentric remodeling in patients undergoing mitral valve repair due to severe degenerative mitral regurgitation: impact of relative wall thickness on clinical outcomes
Authors: Kim M , Lee S A , Lee S M , Song J M , Kang D H , Song J K , Kim D H 
Published: November 2023

Abstract

Background
Left ventricular (LV) volume overload in mitral regurgitation (MR) leads to a progressive increase in LV mass. Eccentric hypertrophy is defined as the relative wall thickness (RWT) &lt;0.43, and LV hypertrophy is a frequently observed LV remodeling phenotype in patients with severe MR. However, the prognostic impacts of RWT in these patient groups are not well known. We tested the relationship between RWT and clinical outcomes in severe MR patients undergoing MV repair (MVR).

Methods
A total of 979 consecutive adult patients with severe degenerative MR and eccentric hypertrophy (55 ± 13 years, 616 males) who underwent MVR were retrospectively analyzed. The study population was stratified by the median RWT value (RWT=0.34) on baseline echocardiography [the lesser RWT group (RWT&lt; 0.34 (n=651)) and the greater RWT group (RWT ≥0.34 (n = 328)).

Results
The patients in the lesser RWT group were younger (54±13 vs. 57±13, p&lt;0.001) and had a significantly higher prevalence of hypertension and diabetic mellitus than those in the greater RWT group. The greater RWT group had significantly lower indexed LV systolic dimension, thicker ventricular walls, and higher LV ejection fraction as compared with those in the lesser RWT group. In Kaplan-Meier analysis, the greater RWT group had a significantly higher incidence of all-cause death (6.4% vs. 2.3%; log-rank p&lt;0.001) and cardiac death (3.0% vs. 0.9%; log-rank p = 0.01) at five years after MVR than in the low RWT group. RWT≥0.34 was independently associated with higher all-cause and cardiac mortality in the multivariate Cox regression analysis. In subgroup analysis, RWT≥0.34 was associated with worse outcomes in men (P &lt;0.001) but not in women (P = 0.23). Moreover, hypertensive patients in the greater RWT group showed the worst outcomes as compared with the three other groups.

Conclusions
We concluded that excessive ventricular hypertrophy, manifested as an increased relative wall thickness, is associated with a significantly increased risk of postoperative mortalities after mitral valve repair in patients with severe degenerative MR and eccentric hypertrophy. We also found that eccentric remodeling patterns and clinical outcomes differ according to sex and the presence of hypertension.
Increasing left ventricular mass and mortality in 303,548 men and women investigated with echocardiography
Authors: Playford D , Strange G , Joseph M , Perry R , Chan Y K , Harris S , Stewart S , Selvanayagam J 
Published: November 2023

Abstract

Background and Aims
Left ventricular hypertrophy (LVH) categories are based on left ventricular mass index (LVMi). This study aimed to generate sex-stratified, statistically-derived thresholds of mortality according to LVMi within a large, real-world patient cohort.

Methods and Results
Echocardiographic and linked mortality data were extracted from the National Echocardiography Database of Australia. LVH categories were first defined according to American Society of Echocardiography (ASE) criteria in 303,548 adults comprising 155,668 men (aged 61.3±17.3 years) and 147,880 women (61.8±18.3 years). Sex-specific mild to severe thresholds of increasing 5-year mortality based on LVMi increments were generated. Overall, 36,198 men (23.3%) and 38,898 women (26.3%) had LVH. Actual 5-year mortality rose from 16.9%-38.3% and 11.9%-31.2% in men and women with no LVH versus LVH, respectively. The statistical threshold at which LVMi was associated with increased mortality was lower than traditional LVH criteria in both men (Figure A, ≥88g/m2 versus ≥115g/m2) and women (Figure B, ≥82g/m2 versus ≥95g/m2). For men versus lowest-risk LVMi, the fully adjusted risk of 5-year mortality was 14% (95%CI 1.03-1.25) and 68% higher (95%CI 1.49-1.90) when LVMi levels were mildly (88 to &lt;116) to severely (≥140g/m2) increased, respectively. In women, the equivalent LVMi thresholds of 82 to &lt;112 and ≥140g/m2 were associated with a 13% (95%CI 1.03-1.24), and 81% higher (95%CI 1.58-2.08) 5-year mortality risk.

Conclusion
A high proportion of men and women have LVMi levels associated with elevated mortality risk that are lower than those traditionally used to diagnose or manage LVH. Such individuals may benefit from more proactive recognition and clinical management.
Diastolic dysfunction and its association to renal outcomes in patients with chronic kidney disease
Authors: Zeuthen M , Landler N E , Olsen F R , Christensen J , Skaarup K G , Lassen M C H , Christoffersen C , Ballegaard E L F , Soerensen I M H , Bjergfelt S S , Bro S , Feldt-Rasmussen B , Hansen D , Biering-Soerensen T 
Published: November 2023

Abstract

Background
Left ventricular diastolic dysfunction is frequent in chronic kidney disease (CKD) and is suspected to be linked to a worse renal prognosis.

Purpose
To investigate the association between the ratio of early mitral inflow velocity to early diastolic tissue velocity (E/e') measured by Doppler echocardiography and development of end-stage kidney disease in patients with non-dialysis-dependent CKD.

Methods
This prospective cohort study included individuals with non-dialysis-dependent CKD with previous nephrology-related hospital contact. All participants underwent thorough, protocolized echocardiographic examination. Exclusion criteria were inadequate image quality for E/e'-assessment and prevalent heart failure at baseline. The primary endpoint was the composite outcome of time to dialysis treatment and/or kidney transplantation. The association between E/e' and the composite outcome was assessed with multivariable Cox proportional hazards regression models adjusted for age, sex, estimated glomerular filtration rate (eGFR), diabetes, Body Mass Index, albuminuria, systolic blood pressure, heart rate, coronary artery disease, and left ventricular ejection fraction.

Results
A total of 731 participants were included in the final study sample. Mean age was 57 ± 13 years and 61% were male. Median E/e' was 7.8 (IQR: 6.4; 9.5), median eGFR was 43 mL/min/1.73 m² (IQR: 28; 62), and 36% had a urine albumin/creatinine ratio &gt;300.
During a median follow-up of 3.8 years (IQR: 3.3; 4.5), 102 individuals met the composite outcome. In univariable Cox regression both continuous E/e' and elevated E/e' (E/e' &gt;14) were significantly associated with the outcome (P&lt;0.001). Following multivariable adjustments, increasing E/e' remained significantly associated with the outcome (HR = 1.09, 95% CI [1.03; 1.15], P=0.004, per 1 unit increase) (Figure 1A). Elevated E/e' also remained significantly associated with the outcome following adjustments (HR = 2.95, 95% CI [1.33; 6.53], P=0.008), and more than 40% of patients with E/e' &gt;14 were estimated to have reached the primary endpoint after 4 years (Figure 1B).

Conclusion
In patients with non-dialysis dependent CKD increasing E/e' and E/e' &gt;14 were both associated with worse renal prognosis.
Left atrial coupling index and undiagnosed atrial fibrillation in elderly high-risk individuals
Authors: Ravnkilde K , Olsen F J , Skaarup K G , Landler N E , Graff C , Brandes A , Krieger D , Haugan K , Koeber L , Diederichsen S Z , Hoejberg S , Svendsen J H , Biering-Soerensen T 
Published: November 2023

Abstract

Background
Left atrial volumetric/mechanical coupling index (LACi) is a novel measure, which combines information on LA size and function in one variable and may therefore be capable of predicting atrial fibrillation (AF). Its association to undiagnosed AF has not yet been investigated.

Purpose
We aimed to investigate the association between LACi and undiagnosed AF in an elderly population.

Methods
This was a substudy based on a large, randomized, clinical trial of elderly population (≥ 70 years), no history with AF, with a CHA2DS2-VASc score≥2 (at least one of the risk factors: DM, hypertension, heart failure or previous stroke). Participants were randomized (1:3) to implantable loop recorder (ILR) screening for AF or usual care. This analysis presents findings for participants randomized to an ILR and with available echocardiographic left atrium (LA) measures (n=1020). LACi was calculated as the ratio of left atrial maximal volume index (LAVI) and mean peak tissue velocity at late diastole measured using tissue Doppler of the left ventricle. The outcome assessed was AF episodes lasting ≥6 minutes and ≥24 hours. Regression models were adjusted for CHARGE-AF, a risk score based on clinical parameters developed to predict risk of AF in the general population.

Results
A total of 955 individuals were included in the analysis. The mean age was 74 ± 4 years, 44% were female, and median LACi was 3.0 (IQR: 2.3, 3.9). During a median follow-up of 35 (20-40) months, a total of 277 participants were diagnosed with AF. In unadjusted analysis, LACi was significantly associated with both AF ≥6 minutes and ≥24 hours (Figure 1 and 2, respectively). Multivariable regression models adjusted for CHARGE-AF risk score revealed LACi to be independently associated with AF ≥6 minutes (HR 1.16, 95% CI [1.11-1.20], p&lt;0.001, per 1 unit increase) and ≥24 hours (HR 1.14, 95% CI [1.08-1.20], p&lt;0.001, per 1 unit increase). Participants with a LACi above 3.0 had a significantly increased risk of AF ≥6 minutes (HR 1.82 95% CI [1.42-2.33]) and ≥24 hours (HR 2.71 95% CI [1.29-5.26]).

Conclusion
In elderly high-risk individuals, increasing LACi was significantly associated with incident AF as detected by continuous long-term monitoring.
Standardized longitudinal strain curves stratified by age and sex in healthy individuals: The Copenhagen City Heart Study
Authors: Christensen J , Simonsen J O , Modin D , Skaarup K , Lassen M C H , Johansen N D , Sanchez-Martinez S , Claggett B L , Marott J L , Jensen G B , Schnohr P , Moegelvang R , Biering-Soerensen T 
Published: November 2023

Abstract

Introduction
Speckle-tracking echocardiography has gained widespread use, and strain parameters such as global longitudinal strain (GLS) and strain rates are strongly associated with risk of heart failure and cardiovascular death. Such strain measures, however, only represent limited features of the complete longitudinal strain (LS) curve. Thus, interpretation of entire curves might provide additional insight.

Purpose
To establish normal standardized LS curves over an entire heart cycle for healthy subjects stratified by age and sex. Furthermore, to assess how these curves vary with age and to compare this with conventional strain measures.

Methods
The study population consisted of 1790 healthy subjects free of cardiovascular disease and risk factors including diabetes mellitus and hypertension at baseline. Subjects were stratified by sex and further by age in groups as defined in the SCORE risk chart. Subjects underwent echocardiography, and LS curves from the apical four-chamber view were derived and standardized in length using linear interpolation. Terms to describe qualitative findings in the standardized strain curves were established (Figure 1). Early diastolic strain (EDS) was defined as the difference in strain from peak LS to maximal curvature after early diastolic filling, while late diastolic strain (LDS) was defined as the difference in strain from the plateau phase in late passive diastole to maximal curvature in active diastole. Conventional strain measures included GLS, systolic strain rate (SRS), early diastolic strain rate (SRE), and late diastolic strain rates (SRA). The association between these and age group were investigated using univariable linear regression for each sex.

Results
In the study population, 1101 (61.5%) subjects were female. The standardized strain curves (Figure 2) showed that aging primarily manifested in the diastolic part of the strain curve. Decreasing EDS was associated with increasing age group, while the opposite was true for LDS. In linear regression, both SRE (female: beta=-0.13; p&lt;0.001, male: beta=-0.1; p&lt;0.001) and SRA (female: beta=0.09; p&lt;0.001, male: beta=0.09; p&lt;0.001) were associated with age group for both sexes. Peak LS did not change notably with age, and in linear regression, GLS and SRS were only significantly associated with age for women (GLS: beta=0.12; p&lt;0.001, SRS: beta=0.01; p&lt;0.001).

Conclusion
We derived normal standardized LS curves for healthy individuals stratified by age and sex, which can serve as normal values in future studies. In addition, these showed that age was primarily associated with changes in the diastolic part of the strain curve in both sexes, which was consistent with conventional strain measures.Figure 1:Overview of termsFigure 2Standardized longitudinal strai
Preprocedural global myocardial work index independently predicts NT-proBNP in patients undergoing transcatheter aortic valve replacement: a prospective study
Authors: Ruppert M , Lakatos B K , Ladanyi Z , Fabian A , Turschl T , Balint T , Fejer C , Molnar L , Apor A , Molnar A A , Kovacs A , Merkely B 
Published: November 2023

Abstract
Global myocardial work index is a novel echocardiographic parameter of the left ventricular (LV) function, which may overcome the load-sensitvity of the traditional functional measures by measuring LV deformation in the context of simultaneous pressures. This approach may gain particular importance in pressure overload states, such as patients with severe aortic stenosis. However, the longitudinal changes of this recently introduced measure are scarcely investigated in this population, and data are also lacking about its association with functional improvement following transcatheter aortic valve replacement (TAVR).
Accordingly, our aim was to investigate the clinical determinants of preoperative and also postoperative GMWI in patients undergoing TAVR.
Eighty-four patients (54%% male, age: 79±6 years) were enrolled. Prior to the procedure, subjects underwent echocardiographic investigation and the detailed medical history was also recorded. Serum NT-proBNP levels were also measured. We calculated LV ejection fraction and LV end-diastolic volume (EDV), and speckle-tracking analysis was performed to measure global longitudinal strain (GLS). As an accepted method of its estimation, LV pressure curve was generated by adding the mean aortic valve gradient to the systolic blood pressure. Using these measures, global myocardial work index (GMWI) was quantified by commercially available software. 12 months after the procedure, the patients underwent a follow-up echocardiographic examination, and at that time point we determined the same measures.
At follow-up, GLS has significantly increased (-13.5±4.5 vs. -15.2±3.6%; p&lt;0.001), while GMWI was significantly lower at the follow-up assessment (1913±786 vs. 1666±594 mmHg%, p&lt;0.01). Compared to the preoperative values, LVEDV also showed a significant decrease at follow-up (115±46 vs. 105±41 mL, p&lt;0.01). Using multivariable analysis, atrial fibrillation (β=0.36; p&lt;0.001) ischemic heart disease (β=0.20; p&lt;0.05) and also GMWI (β=-0.22; p&lt;0.05) were found to be independent predictors of the postoperative NT-proBNP (R2=0.36; overall p&lt;0.001). Importantly, by replacing GMWI to GLS, the latter did not enter the model as a predictor (β=0.17, p=0.11).
TAVR significantly alters LV functional and morphological measures. Regarding the functional outcome of the patients, different clinical factors influence NT-proBNP after the procedure. Possibly due to its significant load dependency, preoperative GLS failed to predict NT-proBNP at follow-up, while GMWI was an independent precictor of NT-proBNP at follow up along with atrial fibrillation and ischemic heart disease. GMWI may serve as a useful imaging marker of preprocedural patient assessment before TAVR.
Left atrial stiffness and sex differences in atrial fibrillation recurrence after catheter ablation
Authors: Cifci G , Wen S , Pislaru S V , Pellikka P A , Kane G C , Asirvatham S J , Pislaru C 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) occurs more frequently in men, but women suffer more AF recurrence; mechanisms are not completely understood.

Purpose
To explore whether sex related differences in LA stiffness (LAstiffn) in patients with AF ablation could potentially explain differences in AF recurrence.

Methods
We screened patients with catheter ablation for AF, in sinus rhythm at 3 months post-ablation, with no significant mitral valve disease (&lt; moderate), and with prospectively measured LA volumes [maximum (LAVI) and minimum volume index] by echocardiography. LAStiffn index was estimated as (E/e’)/LA emptying fraction. Outcome endpoint was AF recurrence up to 14 years post ablation.

Results
A total of 591 patients with AF ablation were studied (mean age 60±10 years; 25% women; Table1). At 3 months post-ablation, LAVI was 36±10 mL/m2 and LAstiffn was 0.31±0.21 1/%. Compared to males, female patients were slightly older, had more frequently hypertension, congestive heart failure, prior stroke/TIA, higher CHA2DS2-VASc score; they less often had persistent AF, coronary artery disease, or dilated cardiomyopathy. Women also had higher LAstiffn (0.37±0.24 vs. 0.29±0.19, P &lt;.0001, Figure 1), despite similar indexed LA volumes (Table1). Rates of AF recurrence at follow-up (median 7.5 years; 347 patients with events) were higher in women vs. men (Figure 2, left; log-rank P&lt;.001) and persisted after adjustment for age, type and duration of AF, body mass index, cardiovascular risk factors and comorbidities, CHA2DS2-VASc score ≥2, LV ejection fraction, and LAVI (adjusted HR 1.58 [1.20-2.08], P=.001). Overall, LA volumes and LAstiffn were higher in patients with older age and more comorbidities (hypertension, congestive heart failure, coronary artery disease, persistent AF, CHA2DS2-VASc score ≥2, etc; P&lt;.01 for all). At multivariable regression analysis, LAVI and LAstiffn correlated with E/e’, LV size and mass, degree of mitral/tricuspid regurgitation, and LV stroke volume index (only LAVI). In addition, LAstiffn was higher in patients with elevated right ventricular systolic pressure (RVSP) &gt;35 mmHg and increase in RVSP more than 10 mmHg from pre-ablation (P&lt;.0001) (correlation R=0.44, P&lt;.0001). At follow-up, after adjusting for age and LAVI, higher LAstiffn remained associated with AF recurrence in women (P=.02, HR 2.82 per unit change, 95% CI, 1.08-6.72; Figure 2, right), but not in men (P=.30).

Conclusions
LAStiffn is higher in women vs. men and correlates with burden of comorbidities, aging, diastolic dysfunction and pulmonary hypertension, possibly reflecting more extensive LA myopathy, and potentially contributing to sex differences in AF recurrence.Figure 1Table 1
Echocardiographic probability of pulmonary hypertension: a real world audit comparing 2015 and 2022 ESC guidelines
Authors: Willis J , Henry F , Wild C , Slegg O , Rossdale J , Peacock O , Mackenzie Ross R , Suntharalingam J , Coghlan G , Augustine D X 
Published: November 2023

Abstract

Introduction
Transthoracic echocardiography (TTE) is an established screening tool used in the assessment of suspected Pulmonary Hypertension (PH). ESC guidelines released in 2015 recommend the use of specific echocardiographic parameters for the assessment of PH. Here, the tricuspid regurgitation velocity (TRV) together with echocardiographic markers of PH from three categories (the ventricles, the pulmonary artery, and the IVC/RA) are used to define the echocardiographic probability of PH being present (as either, low, intermediate or high).
In 2022, the ESC updated this algorithm to include a revised haemodynamic definition of PH and also additional parameters for estimating the echocardiographic probability of PH(1). New parameters include the TAPSE/sPAP ratio as well as the combined assessment of the pulmonary artery (PA) and aortic root diameter.
This retrospective audit evaluates the impact of the most recent 2022 ESC TTE PH algorithm in detecting PH in a real world cohort referred to a shared care PH centre.

Method
Between 2010 and 2020, a total of 306 patients referred for initial assessment of PH underwent TTE followed by RHC (mean interval 31±29 days). PH TTE probabilities were calculated using both 2015 and 2022 ESC guidance. The 2022 haemodynamic definition of PH was applied to both cohorts. The sensitivity and specificity of both 2015 and 2022 were calculated.

Results
The mean sample age is 67±14years (62% female). A summary of the TTE PH probability parameters is shown in Table 1. Using the 2015 ESC algorithm, the cohort comprised 24% (n=75), 23% (n=70) and 53% (161) for low, intermediate, and high TTE PH probability respectively. Within the low TTE probability group, 33% (n=25) had PH confirmed at RHC (see Figure 1). Sensitivity and specificity for the cohort is 88% and 65% respectively.
The same dataset analysed using the 2022 algorithm demonstrates that 23% (n=71) has a low TTE PH probability, 19% (n=58) intermediate and 58% (n=177) a high TTE PH probability. Within the low TTE group the percentage of patients with PH at RHC was 35% (n=25) (Figure 1). Sensitivity and specificity for the 2022 TTE PH probability algorithm was 89% and 62% respectively.
The introduction of the TAPSE/sPAP ratio (&lt;0.55 mm/mmHg) contributed to 16 patients changing from intermediate to high TTE PH probability. Two patients with a low TTE probability demonstrated a ratio &lt;0.55 mm/mmHg, of which one moved from low to intermediate probability. The PA/AR diameter led to 3 patients changing from low to intermediate TTE PH probability.

Conclusion
The sensitivity and specificity for the 2015 and new 2022 PH TTE probability algorithm are similar. Further developments in TTE algorithms are needed to improve the detection of PH in those thought to have a low TTE probability of PH.Table 1.0Figure 1.0