bluuebunny/crossref_metadata_2025_split huggingface dataset:
No impairment of cardiac function after mild SARS-CoV-2 infection in elite athletes
Authors: Schellenberg J , Matits L , Bizjak D , Kirsten J , Kersten J 
Published: January 2025

Abstract

Background
Possible mild myocardial involvement has been observed in the form of reduced left ventricular global longitudinal strain (LV GLS) in athletes after SARS-CoV-2 infection compared to healthy athletes. It is not yet clear whether these minor changes are caused by SARS-CoV-2 or are possibly due to detraining.

Purpose
This study investigates whether there are potential changes in LV and right ventricular (RV) GLS and global circular strain (GCS) in elite athletes (INFAt) before and after SARS-CoV-2 infection and whether there are differences in cardiac function between post-infection INFAt and healthy control athletes (CON).

Methods
In this single-center substudy, transthoracic echocardiography was performed in 32 elite athletes participating in endurance, strength and mixed sports. 16 INFAt (22.63±5.34 years, 10 male) were examined before (t0) and at a median of 52 days after (t1) SARS-CoV-2 infection and matched by gender, age and sport with healthy controls (CON). LV GLS and GCS were determined in four-, two-, and three-chamber views and RV free wall longitudinal strain/global longitudinal strain (RV FWSL/RV GLS) in RV focused four-chamber apical view. Left atrial strain was determined in form of left atrial reservoir strain (LASr), left atrial conduit strain (LAScd) and left atrial contraction strain (LASct) in the apical four-chamber view. Strain values were assessed offline by a blinded investigator.

Results
There was no change in LV GLS (t0 -21.8 vs. t1 -21.7, p=0.649), GCS basal (t0 -32.9 vs. t1 -26.6, p=0.403), GCS midventricular (t0 -23.7 vs. t1 -29.9, p=0.589) and RV FWSL (t0 -31.9 vs. t1 -33.0, p=0.326) or RV GLS (t0 -29.1 vs. t1 -28.7, p=0.626) in INFAt from from pre to post-SARS-CoV-2 infection. Overall LV GLS (-21.7 vs. -22.7, p=0.318), GCS basal (-26.6 vs. -25.8, p=0.409) and GCS mid-ventricular (-29.9 vs. -29.0, p=0.788) and routine echocardiography parameters were not different between INFAt and CON. Only left atrial parameters were significantly different with high normal values in INFAt for LASr (INFAt 47.8 (40.5 – 51.8) vs. CON 30.5 (27.7 – 32.9), p &lt; 0.001) and LASct (INFAt -12.8 (-17.9 – -6.7) vs. CON -4.9 (-14.25 – -1.8), p = 0.050).

Conclusions
We did not detect cardiac involvement in the form of a significant reduction of left or right ventricular strain within INFAt before and after SARS-CoV-2 infection nor between INFAt and CON. Cardiac function does not appear to be impaired in athletes with mild infection. Studies on left and right ventricular changes in athletes or in the general population with moderate and severe disease courses are required, as are studies on other viral infections, to issue a specific recommendation on return-to-play after viral infections.
The utility of right ventricular strain in assessing cardiac function in athletes
Authors: Baptista Carvalho A , Mendes L 
Published: January 2025

Abstract

Background
Athlete's heart can resemble changes seen in cardiomyopathies. Assessing right ventricular (RV) function is critical for overall cardiac evaluation. Traditional measures like Tricuspid Annular Plane Systolic Excursion (TAPSE) are widely used for their simplicity but may not fully capture global RV function or detect early myocardial dysfunction. More recently RV free wall strain (RVFWS) appears to offer a more comprehensive assessment of RV mechanics.

Aim
To evaluate the utility of RVFWS in evaluating athlete's heart, assessing its effectiveness as a diagnostic tool in distinguishing the athlete’s cardiac adaptations.

Methods
We did a retrospective analysis of right ventricle’s free wall longitudinal strain in a group of professional football players compared to healthy male individuals. A GE Vivid E95 echocardiographic ultrasound system and EchoPAC V.206 software (GE Vingmed Ultrasound AS, Horten, Norway) were used. The statistically analysis was performed on SPSS v.27.

Results
All athletes were male (N=107), with a median age of 24 years (range 21-30). The control group consisted of 71 healthy males with an average age of 26±4 years. Right ventricular free wall strain (RVFWS) did not significantly differ between groups (p = 0.898), measuring -23.4 ± 3.6% in athletes and -23.8 (-25.9 - -21.7%) in controls. However, both pulmonary acceleration time and indexed right atrium volume were significantly higher in athletes (p &lt;0.001).

Conclusion
This study revealed no significant difference in RV free wall strain (RVFWS) between athletes and healthy individuals, suggesting RVFWS could help detect pathological changes in athletes.
Descriptive analysis
RVFWS example
Efficacy of the party balloon inflation maneuver comparing with the valsalva maneuver for diagnosis of PFO and HOCM in transthoracic echocardiography
Authors: Kito K , Okamoto M , Shirakura K , Kobayashi H , Chikuda I , Nishikawa J , Iseki Y , Katayama T , Sajima T , Kawashima H , Yamamoto H , Watanabe Y , Yokoyama N , Kozuma K , Kataoka A 
Published: January 2025

Abstract

Background
Previously, we reported clinical cases where the party balloon inflation manoeuvre (PBIM) proved more effective than the conventional Valsalva manoeuvre (VM) in diagnosing patent foramen ovale (PFO) and hypertrophic obstructive cardiomyopathy (HOCM). Additionally, increased venous return with PBIM was observed using hepatic vein flow assessed by transthoracic echocardiography (TTE). PBIM may offer enhanced visualisation of provocation, especially in cases where VM is insufficient. However, the haemodynamic evidence for the efficacy of PBIM with the optimal protocol compared to VM for PFO and HOCM has not been established.

Purpose
This study aimed to demonstrate the superiority of PBIM over the conventional VM and establish the optimal PBIM protocol for diagnosing PFO and HOCM through two experiments.

Methods
(Experiment 1) To understand the characteristics of party balloons, we measured the diameters and corresponding pressures of two commercially available balloons of different sizes (23 and 30 cm, referred to as a smaller balloon (SB) and a larger balloon (LB), respectively). (Experiment 2) We studied 23 healthy adult volunteers (physicians or sonographers, mean age 36 ± 10 years, 78% male), to investigate the haemodynamic effects of PBIM using protocols derived from the results of Experiment 1. Haemodynamic parameters, such as right ventricular inflow-velocity time integral (RV inflow-VTI) representing PFO haemodynamics and left ventricular end-diastolic diameter (LVDd) representing HOCM haemodynamics, were assessed by TTE during (for HOCM) and after (for PFO) the manoeuvre. These parameters were compared among PBIM, rest, and VM.

Results
Experiment 1: Figure 1 shows that both the SB and LB reached their peak pressures at diameters of 5 cm and 7 cm, respectively, and the pressures stabilised around a diameter of 15 cm. Experiment 2: Based on Experiment 1, four different PBIM protocols were used, SB inflated to 5 cm and 15 cm, and LB inflated to 7 cm and 15 cm. RV inflow-VTI increased in all PBIM protocols compared to VM (p &lt;0.01). However, no significant differences were observed among all PBIM protocols (Figure 2A). LVDd decreased in all PBIM protocols compared to VM (p &lt;0.01). Specifically, LVDd was significantly smaller when the SB was inflated to a diameter of 15 cm compared to the LB inflated to a diameter of 15 cm (p &lt;0.05) (Figure 2B).

Conclusions
PBIM can effectively provoke the haemodynamic changes associated with PFO and HOCM compared to VM, potentially leading to a more accurate diagnosis. Notably, using a smaller balloon may be more advantageous for diagnosing HOCM.
Figure 1
Figure 2
Exploring stress echocardiography in coronary artery disease: insights from a tertiary echocardiography center
Authors: Gardikioti V , Kalesi A , Karakosta M , Archontikis A , Zampelis D , Ntiloudi D , Plaitis A , Skantzikas P , Tzinieris T , Kalivi A , Konstantara A , Destounis A , Theodosis-Georgilas A , Patsourakos N , Kasinos N 
Published: January 2025

Abstract

Background/ Introduction
Stress echocardiography (SE) is an established functional test with high sensitivity and specificity for diagnosing obstructive coronary artery disease (CAD).

Purpose
The present study aimed to document the experience of a tertiary hospital’s echocardiography center in using dynamic echocardiography to assess myocardial ischemia.

Methods
The study was performed retrospectively, including all patients who underwent SE at our center from January 2021 to December 2021. The goal for each test was to reach 85% of the age-predicted maximal heart rate (HR) (220 minus the subject’s age). The adopted Dobutamine stress protocol involved a continuous intravenous infusion of Dobutamine in 3-minute increments, starting at 10μg/kg/min and gradually increasing to 50μg/kg/min. Handgrip exercises were typically used, along with a small dose of intravenous atropine (0.25mg, up to a maximum of 1 mg) if the endpoint was not reached. Parasternal and apical echocardiographic views were obtained at all stages, and a contrast agent was used when appropriate. All tests were conducted under continuous 12-lead electrocardiographic (ECG) monitoring.

Results
Out of the 323 subjects [mean age 63.5 ± 10.5 years, 221 males (68.4%)], 123 (38.0%) underwent testing due to suspected CAD symptoms, while the remaining subjects (200 / 62.0%) were tested to reassess known CAD (with or without previous intervention). Twenty-one (7.0%) subjects had a left ventricular ejection fraction (LVEF) ≤40% at rest. The maximum dose of dobutamine most commonly administered was 30 μg/kg/min [137 subjects, (43.0%)], and atropine was given in 51 subjects (16.0%). The target HR was achieved in 291 (90.0%) tests. Eighty-seven (27.0%) SEs utilized a contrast agent in all stages, while in 177 (55.0%) a contrast agent was administered only at rest and peak HR. Major complications, such as acute myocardial infarction or persistent ventricular tachycardia, occurred in 6 patients (1.8%). Specifically, 5 (1.5%) experienced transient ST-segment elevation during the test, and one patient had a lateral myocardial infarction with ST-segment elevation after the test. No allergic reactions were reported. In 226 (70.0%) tests, results were classified as "negative for ischemia up to the achieved HR". In the remaining tests, classified as "positive for ischemia" (97/30.0%), the mean wall motion score index (WMSI) at peak HR was 1.3 ± 0.2 with a mean peak-to-rest ΔWMSI of 0.1 ± 0.1 (Table 1).

Conclusion
Of all the SEs performed at our center with an indication for assessing myocardial ischemia, 30.0% were positive, while major complications occurred in 1.8% of the subjects.
Relationship between left ventricular contractile reserve and vector flow mapping analysis in chronic aortic regurgitation
Authors: Amano M , Kubota Y , Moriuchi K , Kurashima S , Irie Y , Sakamoto T , Amaki M , Kanzaki H , Kitai T , Nakatani S , Izumi C 
Published: January 2025

Abstract

Background
When determining the optimal timing of surgery for aortic regurgitation (AR), evaluation of left ventricular contractile reserve (LVCR) using exercise stress echocardiography (ESE) is helpful. However, no previous studies have identified the relationship between LVCR and low energy efficiency in the left ventricle during exercise.

Purpose
We assessed the relationship between LVCR and the intraventricular flow dynamic parameters using vector flow mapping (VFM) in patients with chronic AR.

Methods
We retrospectively enrolled 44 consecutive asymptomatic or equivocally symptomatic patients undergoing ESE with more than moderate to severe chronic AR and a left ventricular ejection fraction (LVEF) of ≥50%. The patients were classified into two groups: ΔLVEF (peak workload − baseline) of ≥5% (LVCR(+)) and ΔLVEF of &lt;5% (LVCR(−)). In the VFM analysis, energy loss (EL) and wall shear stress (WSS) were evaluated at baseline, low workload, and peak workload during exercise.

Results
Among the 44 patients, 32 were LVCR(−) and 12 were LVCR(+). At baseline, no differences were revealed in interventricular EL and WSS between the two groups. During exercise, however, EL was higher in patients with LVCR(−) than LVCR(+) [16.2 (11.7–22.5) vs. 11.2 (9.3–15.6) mW/m, p=0.015 at low workload; 17.8 (15.4–22.3) vs. 13.3 (9.6–18.0) mW/m, p=0.027 at peak workload]. EL at low workload could predict patients with LVCR(−) (odds ratio: 1.18, 95% confidence interval: 1.02–1.37, p=0.025). No differences in WSS were shown between patients with LVCR(−) and LVCR(+) during exercise.

Conclusions
In patients with chronic AR and LVCR(−), EL during exercise increased, and evaluation of EL at low workload was useful for predicting impaired LVCR. Impaired LVCR may be attributed to not only a non-physiological regurgitant jet but also increased cardiac work due to subclinical LV damage.
Measurement of EL and WSS
Changes in EL and WSS
Influence of gender on the prognostic significance of the wall motion score index in Dobutama n stress echocardiography
Authors: Trninic D 
Published: January 2025

Abstract

Background/Aim
The dobutamine stress echocardiographic test (DSE) plays a significant role in the diagnosis of coronary artery disease (CAD). The aims of our stady were to examine the influence of gender on the prognostic significance of the wall motion score index (WMSI) in the dobutamine stress echocardiographic test for ischemia.

Methods
It is a prospective, observational study that was conducted at the Clinic for Cardiovascular Diseases of the University-Clinical Center of the Republic of Srpska. The study included 143 patients who, due to suspicion of coronary disease, underwent a dobutamine stress echocardiographic test in the period from 01.01. 2021. until 01.02.2022.

Results
Adverse cardiovascular events observed one year after DSE test were more frequent in men (43%) than in women (19%), this difference was statistically significant (p&lt;0.01). WMSI in men had sensitivity (96 %) and specificity (824%) in detection of adverse cardiovascular events. In women, the WMSI in detection of adverse cardiovascular events, sensitivity (93.3%) and specificity (90.6%).

Conclusion
Our results identified WMSI as a prognostic factor for adverse cardiovascular events in both sexes, with sensitivity being higher in men and specificity in women.
Adverse cardiovascular events in women
Adverse cardiovascular events in men
Prognostic value of right ventricular ejection fraction using three-dimensional echocardiography in patients with ischemic cardiomyopathy and dilated cardiomyopathy
Authors: Kitano T , Nagata Y , Nabeshima Y , Dohi K , Takeuchi M 
Published: January 2025

Abstract

Background
Prognostic value of right ventricular (RV) ejection fraction (EF) using three-dimensional echocardiography (3DE) in a diverse group of patients has been demonstrated in several studies [1-3]. However, little is known about its potential utility in patients with ischaemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM).

Purpose
To investigate the prognostic value of 3DE-RVEF in ICM and DCM.

Methods
We retrospectively selected ICM and DCM patients who had undergone 3DE from December 2007 to December 2018. 3DE analysis was performed using 3DE speckle tracking software. The primary end point was a composite of cardiac events, including cardiac death, heart failure hospitalization, myocardial infarction, or ventricular tachyarrhythmia.

Results
268 ICM and 127 DCM patients were included in this analysis. During a median of 33 and 51 months of follow-up, 84 and 43 patients reached a primary end point in ICM and DCM, respectively. Univariable analysis showed RVEF was significantly associated with cardiac events in both groups [ICM, hazard ratio (HR): 0.92, 95% confidence interval (CI): 0.90 – 0.94; DCM, HR: 0.91, 95% CI: 0.88 – 0.94, respectively]. In multivariable analysis, RVEF (HR: 0.91, both for p&lt;0.001) was significantly associated with cardiac events, after adjustment for age, chronic kidney disease, New York Heart Association function class (NYHA), Charlson comorbidity index (CCI), E/e', left ventricular (LV) EF or LV global longitudinal strain (GLS) in ICM. In DCM, RVEF (HR: 0.91 – 0.94, all for p&lt;0.001) was significantly associated with outcome, after adjusting clinical factors (age and CCI or NYHA) and echocardiographic parameters (E/e' or LVEF or LVGLS). Kaplan-Meier survival curves, divided into four groups by RVEF ≥ 45% and &lt; 45% and E/e' 14 ≥ and &lt; 14, showed significant risk stratification for both ICM and DCM (Log-rank: p&lt;0.0001, Fig 1). Crude Kaplan-Meyer survival analysis revealed there were no significant survival differences between ICM and DCM (p=0.36). However, ICM had a worse outcome than DCM after adjustment for age, NYHA, CCI, E/e', RVEF, LVEF or LVGLS (p=0.049 and p=0.028, respectively, Fig 2).

Conclusions
Our study confirmed the independent prognostic value of RVEF in patients with ICM and DCM and provided detailed risk stratification of cardiac events by E/e' and RVEF. In addition, ICM was associated with worse outcome than DCM after adjusting multiple covariates.
Dimensions and functional features of the mitral and tricuspid annuli in hemophilia - a three-dimensional speckle-tracking echocardiographic study
Authors: Nemes A , Racz G , Kormanyos A , Ambrus N , Marton I , Borbenyi Z 
Published: January 2025

Abstract

Introduction
Theoretically, heamophilia-related hypocoaguability and related changes in myocardial mechanics could affect valvular dimensions anf function.

Purpose
The present study aimed to determine mitral (MA) and tricuspid annular (TA) dimensions and functional properties by a three-dimensional speckle-tracking echocardiography (3DSTE)-based quantification method in hemophilia patients.

Methods
The study comprised 17 patients with hemophilia, all of them received treatment and were under regular care in a tertiary haematology center. Due to inferior image quality, 4 patients were excluded. The remaining group of patients consisted of 13 cases with hemophilia (mean age: 40.8±16.3 years, all males), from which 11 proved to be type A and 2 cases had type B disease. Their results were compared to 30 age- and gender-matched control subjects (mean age: 40.4±9.24 years, all males).

Results
Routine two-dimensional Doppler echocardiographic data proved to be similar between hemophilia patients and controls except for higher left ventricular ejection fraction and lower E/A values in hemophilia patients. Other echocardiographic parameters did not differ between the groups examined. None of the hemophilia patients and controls showed ≥ grade 1 valvular regurgitation or significant stenosis on any valves. Dilated end-diastolic and end-systolic MA diameters (2.47±0.35 cm vs. 2.79±0.25 cm, p=0.006 and 1.83±0.40 cm vs. 2.19±0.38 cm, p=0.01, respectively), areas (7.66±1.90 cm² vs. 10.70±2.55 cm², p&lt;0.001 and 4.02±1.34 cm² vs. 6.91±2.31 cm², p&lt;0.001, respectively), perimeters (10.46±1.22 cm vs. 11.30±3.33 cm, p&lt;0.001 and 7.48±1.28 cm vs. 9.99±1.71 cm, p&lt;0.001, respectively) and consequentially decreased MA fractional area change (47.17±15.91% vs. 35.57± 16.44%, p=0.042) were present in hemophilia patients compared to those of healthy controls. From tricuspid annular (TA) dimensions, only end-diastolic TA diameter (2.41±0.41 cm vs. 2.65±0.34 cm, p=0.071), area (7.68±1.94 cm² vs. 9.06±2.32 cm², p=0.050) and perimeter (10.68±1.25 cm vs. 11.54±1.32 cm, p=0.049) proved to be dilated with preserved end-systolic TA diameter (1.99±0.37 cm vs. 2.08±0.37 cm, p=0.438), area (5.92±0.78 cm² vs. 5.65±1.34 cm², p=0.628) and perimeter (9.34± 1.20 cm vs. 9.50±1.46 cm, p=0.709) in hemophilia patients. TA fractional area change proved to be reduced (23.75±9.42% vs. 36.57±12.01%, p=0.001).

Conclusion
Both MA and TA are dilated with functional deterioration in patients with hemophilia, although TA dilation seems to be less pronounced.
Left atrial function and left atrioventricular coupling indices for atrial fibrillation prediction in hypertrophic cardiomyopathy
Authors: Rella V , Delcea C , Clement A , Fisicaro S , Perelli F , Tomaselli M , Penso M , Parati G , Crotti L , Badano L , Muraru D 
Published: January 2025

Abstract

Background
In hypertrophic cardiomyopathy (HCM), atrial fibrillation (AF) is a marker of disease progression and worse outcome, increasing the risk of thromboembolic events. Identification of HCM patients (pts) at risk of AF is pivotal for their clinical management and follow-up.

Purpose
We aimed to explore whether a detailed echocardiographic evaluation of the left atrium (LA) remodeling and function in HCM pts might improve the predictive value for new AF compared to standard parameters.

Methods
In consecutive HCM pts referred to our Cardiomyopathy Clinic between 2020 and 2023, we assess left ventricular (LV) and LA volumes and strain by two-dimensional echocardiography (2DE), and LV and LA volumes and total LA emptying fraction (EF) by three-dimensional (3DE) echocardiography. 3DE left atrioventricular coupling index (LACI) was calculated as the ratio of respective LA to LV end-diastolic volumes and expressed as percentage %. Clinical, ECG, and 48h ECG Holter data were also collected.

Results
A total of 180 HCM pts (58±18 years, 55% men) were followed for 23±13 months. Twenty-seven patients experienced at least one episode of AF during follow-up. They were older and had more impaired LV global longitudinal strain (GLS) (-13±4% vs -15±4%, p=0.004), total LA EF (31±12 vs 42±11%, p=0.001) and LA reservoir strain (LASr, 10±6 vs 16 ±8%, p=0.001) compared to pts without AF. In addition, larger values of 3DE LACI (75±51% vs 43±25%p=0.009) were found in the HCM pts with new AF episode during follow-up.
At Cox univariable analysis, 3DE LACI, LA EF and LASr were associated with AF (AUC 0.68, 0.69 and 0.72, respectively, p&lt;0.001 for all). The optimal cutoffs for predicting AF were &gt; 59% for 3DE LACI and &lt; 26% for LA EF with significant discriminative value in Kaplan-Meier analysis. The addition of 3DE LACI and LA EF to a model including LV GLS and 2DE LA volume had a significant incremental value for predicting the occurrence of AF (Figure 1).

Conclusions
In HCM patients, the advanced evaluation of LA function and left atrio-ventricular coupling by 3DE may improve the identification of patients at risk for subsequent AF episodes within 1 year follow-up.
Predictive Model