bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac shear wave elastography: assessing the performance of different algorithms for shear wave speed estimation
Authors: Araujo Andrade Sousa A , Orlowska M , Wouters L , Youssef A , Caenen A , Hooge J D , Voigt J U 
Published: January 2025

Abstract

Introduction
Cardiac Shear Wave Elastography utilizes ultrafast echocardiographic imaging to assess myocardial stiffness through the propagation velocities of shear waves (SWs). Despite advancements, variability in SW speed measurements remains a challenge. Current assessment lacks a gold standard method and still relies on subjective visual assessment with manual measurements leading to inherent variability.

Purpose
Manual and nine semi-automatic algorithms for measuring SW speed were systematically tested, aiming to reduce variability and enhance reproducibility of the estimations.

Methods
High-frame-rate echocardiography images (1055±159 Hz) were acquired in parasternal long axis view. Anatomical M-modes were drawn along the septal wall. To visualize the SW, M-modes were color coded for tissue acceleration. SWs then appear as green bands, and their slopes correspond to tissue propagation velocity.
SW slopes from healthy volunteers (n=67) and patients (n=53) with different cardiac conditions, covering a wide age range (19-89 years-old) were included to evaluate the performance of the methods in a clinical context. Measurements were performed manually and with 9 automatic methods: Time-frequency correlation (TFC), Regression window (RW), Radon Transform (RT), and 6 segmentation-based methods (e.g. maximum value). Automatic algorithms were initiated by indicating the position of SW by a mouse click. To assess reproducibility, this procedure was repeated 3 times for different sites along the SW. Failure of SW detection was counted to assess feasibility. Since the visualization of the SW’s and segmentation threshold depends on the selected color scale limits, 3 scales (0.5, 1, 2 m/s²) were tested (Figure 1). Finally, manual measurements served as reference, and agreement analysis was conducted.

Results
When accessing reproducibility across different starting points, only TFC exhibited variability (SD ±0.3 vs ±0.0 m/s for others). In terms of the color scale settings, RW and RT showed no variability (SD ±0.0 vs ± 0.3 m/s for manual), while Regression Weighted Maximum Value (RMW), emerged as the segmentation method with the least variability (SD ±0.1 m/s). RMW also showed highest feasibility [99%, (RW: 76% and RT: 90%)], correlation (r=0.77, r= 0.72, and r= 0.76 resp.), and agreement with a manual measurements (Figure 2).

Conclusion
Among the tested algorithms, Regression Weighted Maximum Value (RWM) demonstrated the highest feasibility, correlation and agreement with manual measurements. Our findings suggest this semi-automatic method provides an objective alternative to manual SW velocity estimations.
Operational feasibility and reproducibility of serial echocardiographic parameters of left ventricular remodelling and function for evaluation of drug efficacy in multicentre clinical trial settings
Authors: Surkova E , Vavere A , Ely Pizzato P , Keck K , Weightman J , Matheson M , Aurell M , Marchong M , Collen A , Lima J 
Published: January 2025

Abstract

Background
Operational feasibility and reproducibility of echocardiographic (Echo) parameters are essential for planning interventional trials with surrogate imaging endpoints. Existing data from large cohort studies performed at institutions with high expertise in Echo may not be representative of the multicentre clinical trial settings where substantial variability in local standards and equipment exists.

Purpose
To assess feasibility of standardized Echo data acquisition, measurability, and reproducibility of key Echo endpoints in a large multicentre clinical trial.

Methods
ENDEAVOR was a phase 2b/3 multicentre, international, placebo-controlled trial investigating the effects of mitiperstat on symptoms and function in participants with heart failure (HF) and left ventricular ejection fraction (LVEF) &gt;40%. Echo was used for efficacy assessment at 3 time points (baseline, 16 and 24 weeks). Echo data were acquired according to the study protocol at sites with various equipment and expertise and analysed centrally by an academic core laboratory. Key Echo metrics were LVEF, LV global longitudinal strain (GLS), LV mass, E/E’ and left atrial volume (LAV). LVGLS was measured from three apical views (4, 2, and 3-chamber) by 2DSTRAIN TomTec software. All images were evaluated for image quality using the scale from 1 (Very poor) to 5 (Excellent) and measured by a single reader.

Results
711 participants at 142 sites in 18 countries were randomised in ENDEAVOR trial (mean age 72.4y, mean BMI 30.5kg/m2). A total of 2052 Echo exams were analysed: 735 at baseline, 661 at 16 and 656 at 24 weeks. Majority were of excellent to good (1282/62%) or adequate (732/36%) image quality. Doppler images and apical 4ch view were the most feasible to acquire, while apical 2ch view was the most challenging (Fig, A).
LVEF, LV mass, E/E’ and LAV were measurable in most studies (88-96%), however fewer studies were interpretable for LVGLS (61% at baseline to 70% at week 24). When matching echo exams at 2 or 3 visits were analysed, the number of interpretable matches dropped more significantly for LVGLS (to 47% for 2 and 41% for 3 time points), while the proportion of interpretable matches for standard echo endpoints remained acceptable (&gt;83% and &gt;75%, respectively).
A total of 82 scans were re-read for reproducibility. Most of the echo endpoints demonstrated good or excellent reproducibility, with LVGLS showing better reproducibility than LVEF (Fig, B).

Conclusions
We report feasibility of Echo data acquisition, measurability, and reproducibility of key parameters of LV remodelling and function in a large multicentre, international, placebo-controlled clinical trial in HF and EF&gt;40%. These data will help to inform future trial design to drive drug development decision making.
The relationship between circadian blood pressure profile and left atrial mechanics, arterial stiffness and left ventricular performance in hypertensive patients
Authors: Olszanecka A , Stopa M , Jamros J , Jakubowski W , Sordon K , Dadanski E , Rajzer M 
Published: January 2025

Abstract

Background
The left atrium plays a crucial role in managing left ventricular filling and contractility through its functions as a reservoir, conduit, and boost pump. Consequently, the interaction between the left atrium(LA), left ventricle(LV), and the arterial system appears as a critical determinant of comprehensive cardiovascular performance. Non-dipping profile of blood pressure(BP) in 24-hr monitoring(ABPM) is associated with increased cardiovascular mortality and morbidity, including atrial fibrillation and stroke.

Objective
We aimed to investigate the association between LA mechanics, LV performance, arterial stiffness and circadian rhythm of BP in essential hypertension.
Design and Methods: Hypertensive patients without overt cardiovascular disease were recruited. In all subjects 24-hr ABPM and extended echocardiographic image acquisition protocol were performed (Vivid E95, GE). Carotid-femoral pulse wave velocity (PWV) was measured with the SphygmoCor device (Atcor Medical). All analyses, including LV global longitudinal strain(GLS) and LA reservoir strain(LAR), LA conduit strain(LACD), LA booster pump strain(LACT) were performed off-line. The related factors were evaluated by multivariate linear regression analysis to find the independent factors. Statistical analysis was conducted using SPSS software.

Results
Study group included 219 patients(age 55.3±13.5 years, 55% females). According to BP patterns patients were divided into two groups: non-dippers(n=53), presenting with &lt;10% reduction in both systolic and diastolic BP at nighttime, and dippers(n=166). Non-dippers were older(61.3±11.3 vs 54.2±13.7 years, p&lt;0.01) and exhibited higher BMI(30.2±4.9 vs 28.6±4.5 kg/m2 p&lt;0.01). There were no differences between groups in office BP(non-dippers 128.3±13.3/72.9±9.5 vs 128.1±14.6/75.8±10.8 mmHg in dippers), neither 24hr BP(124.2±13.3/73.5±9.6 vs 121.4±11.5/74.2±7.1 mmHg, respectively). After adjustments for age and BMI, in the non-dipper group higher PWV(8.3±1.2 vs 7.9±1.2, p=0.05) and LACD(-14.7±5.7 vs -17.0±6.7, p&lt;0.001) were observed, with no-differences in LV GLS(-20.7±3.3 vs -19.8±3.9; NS). Multivariate linear regression analysis revealed that age(p&lt;0.001), office(p&lt;0.001) and nighttime SBP(p=0.008)(but not dipping status, p=0.50), diabetes(p=0.02) and creatinine level(p=0.02) were independently corelated with PWV. LACD was independently corelated with age(p&lt;0.001), LV mass(p=0.04) and LV GLS(p=0.03).

Conclusions
Arterial stiffness and left atrial performance are associated with circadian rhythm of BP. Nocturnal systolic BP but not dipping profile is the independent risk factor of worse arterial and left atrial performance.
Relationship between left atrial sphericity assessed by echocardiography and left atrial fibrosis in patients undergoing ablation for atrial fibrillation
Authors: Pilichowska E , Baran J , Kowalik I , Kulakowski P , Zaborska B 
Published: January 2025

Abstract

Purpose
The left atrial (LA) shape is the novel marker characterizing LA myopathy. Increased LA sphericity measured in magnetic resonance was shown to have relationship with LA fibrosis. Data on LA sphericity measured in echocardiography are sparse. The aim was to assess LA sphericity in relation to degree of LA fibrosis derived from electroanatomical mapping (EAM) in patients with atrial fibrillation (AF).

Methods
Patients (pts) with AF were studied with TTE before first ablation during sinus rhythm.
LA sphericity index (LASi) was calculated as the ratio of LA maximum volume (area-length method) to LA volume of sphere structured by maximum LA length from a 4- and 2-chamber views.
The EAM of LA was performed using Carto System. Low amplitude potentials area (LAPA) was quantitatively analysed and expressed as a percentage of LA surface using the cut-off &lt;0.05 mV to detect sites of fibrosis.
LA parameters were compared between mild (LAPA&lt;10%), moderate (LAPA 10-40%) and extensive (LAPA&gt;40%) degree of LA fibrosis.

Results
Study group consisted of 51 pts (74,5 % males, mean age 56±10 years).
The median [Q1-Q3] LA volume index (LAVi) was 37.1 [28.9 – 52.6] mL/m².
The median [Q1-Q3] LASi was 0.82 [0.71 – 1.06].
The LAPA ranged from 2 to 77 percent of LA surface.
The Spearman’s correlation analysis showed a significant correlation between LASi and LAPA (0.59, p&lt;0.001).
Increased LA sphericity was observed in LAPA≥10% whereas increased LAVi in LAPA≥40% subgroup (table).

Conclusion
The LASi derived from TTE correlates well with the extent of LAPA, thus might be a simple and useful parameter of LA geometric remodeling associated with increased LA fibrosis.
LA geometry in relation to fibrosis
Incremental prognostic value of echocardiography measures of right ventricular systolic function in patients with chronic heart failure
Authors: Gentile F , Chianca M , Bazan L , Sciarrone P , Chubuchny V , Taddei C , Poggianti E , Passino C , Emdin M , Giannoni A 
Published: January 2025

Abstract

Background
Tricuspid annular plane systolic excursion (TAPSE), DTI-derived tricuspid lateral annular systolic velocity wave (S′), and fractional area change (RV-FAC) are the most used echocardiographic measures of right ventricular (RV) systolic function.

Purpose
To compare the prognostic value of TAPSE, S’, and RV-FAC in a large cohort of patients with chronic heart failure (HF).

Methods
Consecutive out-patients with HF and left ventricular ejection fraction (LVEF) &lt;50% on guideline-recommended therapies undergoing echocardiography over a 6-year period were selected and followed-up for the endpoint of cardiac death.

Results
Among the 1,590 patients analyzed (71±12 years, 77% males, LVEF 34±9%), 202 (13%) died from cardiac causes during a median 28-month follow-up (range 14-40 months). According to the recommended cut-points for TAPSE (17 mm), S’ (9.5 cm/s), or RV-FAC (35%), RV systolic function was reduced in 37%, 40%, and 35% of patients. Among these, the attribution of RV dysfunction was discordant in 21%, 31%, and 33% of the cases considering TAPSE and S’, TAPSE and RV-FAC, or S’ and RV-FAC. While, taken alone, TAPSE &lt;17 mm and RV-FAC &lt;35% were more accurate than S’ &lt;9.5 cm/s in predicting the risk of cardiac death (p&lt;0.001), their combination provided incremental prognostic power (p&lt;0.001). No further incremental value was observed by adding S’ to the combination of TAPSE and RV-FAC (p=0.145).

Conclusion
In patients with chronic HF and LVEF &lt;50%, RV-FAC and TAPSE are more accurate than S’ in predicting the risk of cardiac death. The combination of RV-FAC and TAPSE provides incremental prognostic value and should be used in the clinical practice.
Validation of left ventricular filling pressure evaluation by order of tricuspid and mitral valve opening in patients with atrial fibrillation
Authors: Nishino H , Murayama M , Iwano H , Kagiyama N , Nakamura Y , Akama Y , Toki M , Takamatsu S , Okada T , Ishizaka S , Kaga S , Yamashita N , Nagai T , Teshima T , Anzai T 
Published: January 2025

Abstract

Introduction
Accurate assessment of the left ventricular (LV) filling pressure in patients with atrial fibrillation (AF) remains difficult. Novel echocardiographic scoring system, visually assessed time difference between mitral valve (MV) and tricuspid valve (TV) opening (VMT) score based on visual assessment of the time sequence of early-diastolic atrioventricular valves opening, is expected to be applied for these patients.

Purpose
This study aimed to test the diagnostic accuracy of the VMT score in patients with AF.

Methods
We analyzed 119 consecutive AF patients who underwent cardiac catheterization and echocardiography within 2 days as a derivation cohort. External validation was performed in 189 AF patients from 4 Japanese tertile hospitals. Elevated LV filling pressure was defined as mean pulmonary arterial wedge pressure (PAWP) ≥15 mmHg. The time sequence of MV / TV opening was visually assessed and scored (0: TV first, 1: simultaneous, 2: MV first). When the inferior vena cava was dilated, 1 point was added and the VMT score was finally graded as 0 to 3. Conventional Doppler parameters recommended by the guidelines to estimate LV filling pressure in AF were also measured.

Results
PAWP was elevated with increase in the VMT score (0: 10±3, 1: 13±5, 2: 22±7, 3: 27±6 mmHg, P &lt; .001) with a significant increase from VMT 1 to 2. VMT≥2 predicted elevated PAWP with an accuracy of 87%, and the diagnostic accuracy was significantly higher in VMT score than in conventional Doppler parameters (C index: 0.88 vs. 0.54 to 0.69; P &lt; .001). In addition, VMT≥2 showed an incremental predictive value over plasma brain natriuretic peptide levels (C index: 0.79 to 0.93; P &lt; .001). In the external validation cohort, VMT≥2 demonstrated acceptable accuracy (72%) to predict elevated PAWP.

Conclusions
VMT scoring was useful for prediction of elevated LV filling pressure and had an incremental benefit over the practical biomarker in patients with AF.
Role of ai model to predict the hfpef in patient with hypertension
Authors: Tselov N , Hristova K , Marinov R , Tsonev S V , Shahin T , Todorov I , Zlatancheva G 
Published: January 2025

Abstract

Arterial hypertension /AH/ affects around 50% of the population over 55 years and is the risk factor of cardiovascular diseases.
The aim of the study is to examine the feasibility, accuracy and reproducibility of fully automated 2D and 3DE TTE quantification software compared to board certified expert cardiologist and uncertified cardiologist in clinical settings.

Methods
Measurements were performed twice on asymptomatic 68 patients ( mean ages 68± 3.5 y )with AH and LV hypertrophy and with fully automated software using AI and manually using and semi-automated software for measurement and analysis.

Results
Both 2DE and 3DE TTE modalities demonstrated good correlation with excellent intra-observer and inter-observer variability for LV EF, volumes, GLS. 3DE measurements significantly underestimated LVEF and GLS./ p-Anova&lt; 0.001/
2DE fully automated , manual and semi-automated measurements reclassified asymptomatic patients with LVH in 40% with normal EF &gt;54% and normal GLS &gt;-21.3 %, 35% with normal EF and reduced GLS&lt;-19% , 11,3% with decreased EF b/n 50-54% and normal GLS , 8,1% with decreased both EF and GLS, and 5,6% reduced &lt; 49% EF and reduced GLS &lt;- 17%. (p &lt;0,01)&lt;O.OO1).&gt;

Conclusions
Fully automated 2D and 3D TTE measurements EF , volumes and GLS are feasible and yield results with a close agreement of results performed by expert reader measured manually. Automated GLS provides important predictive value and contribute to better screening for decision making in patients with AH and HFpEF&lt;/O.OO1).&gt;
The interplay between arterial stiffness and left ventricular diastolic dysfunction in systemic lupus erythematosus
Authors: Badea-Lupasteanu I , Delcea C , Vijan A , Cocolea S , Dima A , Buzea A , Badila E , Dan G A 
Published: January 2025

Abstract

Introduction
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients. Both arterial stiffness and left ventricular diastolic dysfunction have predictive value and have been reported as early markers of CVD in SLE. The link between arterial stiffness and diastolic dysfunction has been described in patients with established CVD and heart failure with preserved ejection fraction. Yet, it is underexplored in the setting of SLE.

Purpose
The study aims to investigate the relationship between arterial rigidity measured by cardio-ankle vascular index (CAVI) and left ventricular diastolic dysfunction in patients with SLE.

Methods
This is a prospective cross-sectional study of adult SLE patients from a single center. Clinical, biological, electrocardiographic, transthoracic echocardiographic and CAVI data were collected for each participant. CAVI and vascular age were calculated using a Fukuda Denshi device. Diastolic dysfunction was defined according to the 2016 ASE/EACVI guidelines. The ROC analysis used the Youden index-associated criterion to determine cut-off values.

Results
Our cohort included 70 patients, 97.1% female, with a mean age of 53.6±11.7 years and a disease duration of 15.7±10.9 years. All patients had preserved ejection fraction; 50% had diastolic dysfunction. CAVI and vascular age were inversely correlated with the E/A ratio, septal and lateral e’ and positively correlated with the E/e’ ratio, isovolumetric relaxation time and indexed left atrial volume. CAVI (AUC 0.815, 95%CI 0.714-0.915), vascular age (AUC 0.827, 95%CI 0.728-0.927), age (AUC 0.791, 95%CI 0.690-0.892), disease duration (AUC 0.749, 95%CI 0.633-0.864) and NTproBNP (AUC 0.794, 95%CI 0.676-0.912) were associated with diastolic dysfunction. In the univariate analysis the presence of traditional risk factors (any of the following: obesity, hypertension, dyslipidemia, diabetes, smoking), ischemic heart disease, peripheral arterial disease and valvular heart disease were also associated with diastolic dysfunction. In the multivariable regression analysis disease duration (HR 1.1, 95%CI 1.01-1.19), vascular age (HR 1.1, 95%CI 1.04-1.18) and CAVI (HR 3.79, 95%CI 1.78-8.10) were independently correlated with diastolic dysfunction. Patients with CAVI&gt; 8.1 and those with a vascular age&gt; 59 had a RR of diastolic dysfunction of 4.1 (95%CI 1.8-9.1) and 3.2 (95%CI 1.7-6.4), respectively.

Conclusions
Arterial stiffness, evaluated by CAVI and vascular age, was independently associated with diastolic dysfunction in a cohort of adults with SLE, potentially useful for early detection of functional cardiovascular alterations.
A novel imaging-based method to estimate left ventricular filling pressure
Authors: Fernandes J F , Smiseth O A , Othe N , Wakami K , Remme E , Lamata P 
Published: January 2025

Abstract

Background
There is a clinical need in heart failure diagnostics to have a non-invasive measure of left ventricular (LV) filling pressure. Echocardiographic parameters may be used to differentiate between normal and elevated left ventricular (LV) filling pressure, but do not provide a quantitative estimate of the filling pressure.

Purpose
To establish a non-invasive method for estimating LV filling pressure and construction of the LV diastolic pressure curve.

Methods
Retrospective study in 100 patients with suspected coronary artery disease. Ground truth filling pressure (i.e. LV pre-atrial contraction pressure, which is shown to approximate mean left atrial pressure) was measured by LV micromanometer-tipped catheters. Non-invasive filling pressure was estimated as the sum of minimum LV pressure (minPLV) and the maximum early-diastolic atrio-ventricular pressure difference (∆PA-V), as shown in Figure 1. MinPLV was estimated by a regression model trained in 81 patients, which included an estimate of the time constant of τ (Figure 1) and echocardiographic and demographic parameters. ∆PA-V was computed by a simplified Navier-Stokes momentum conservation equation. Accuracy of filling pressure estimate was evaluated in a test cohort of 19 patients.

Results
The strongest predictor of minPLV was τ (R=0.71) followed by LA reservoir strain (R=0.65), LV systolic pressure (R=0.23) and body mass index (R=0.37), all of them independent predictors. There was good agreement between estimated and measured τ (Bias -0.0069s and limits of agreement &lt;0.0195s). When combining estimated τ and the three other predictors in a regression model, there was good agreement between estimated and measured minPLV: Bias -0.5 mmHg, limits of agreement &lt;1.9 mmHg (±2SD). Estimated LV filling pressure also showed good agreement with measured values: Bias 0.0 mmHg, limits of agreement &lt;3.1 mmHg, shown in Figure 2. The diastolic pressure curve was estimated with good accuracy (diastolic meanPLV had bias and limits of agreement were respectively 0.2 and &lt;3.2mmHg).

Conclusions
The proposed non-invasive method estimated LV filling pressure with good accuracy in a population with coronary artery disease. The method also allowed approximation of the LV diastolic pressure curve. The method needs validation in larger populations and in other phenotypes.
Method to calculate LV filling pressure
LV filling pressure (pre-A) agreement