bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dynamics of the mitral valve annulus in hypertrophic obstructive cardiomyopathy patients undergoing septal myectomy: insights from 3D transesophageal echocardiography
Authors: Shaaban M , Emam A , Elgouhary M , Said F , Thabet N , Hekal S , Mahmoud-Elsayed H 
Published: January 2025

Abstract

Background
Mitral annulus (MA) dynamics in HOCM patients and the impact of surgical myectomy on them is not fully understood. This study aimed to evaluate the MA dynamics and their changes after septal myectomy in HOCM patients.

Methods
This prospective, single-center study included 26 HOCM patients undergoing septal myectomy. Intraoperative Three-dimensional Trans-Esophageal Echocardiography (3DTEE) for the mitral valve (MV) was performed pre- and post-surgery followed by offline analysis of the acquired volumes to assess MA dimensions and dynamics before and immediately after myectomy using a dedicated post-processing software (4D MV analysis, QLAB version 15, Philips Healthcare).

Results
Pre-operatively, throughout four phases of the cardiac cycle (late diastole, early systole, mid-systole, and late systole), there were no significant dynamic changes in MA dimensions, Specifically, the anteroposterior (AP) diameter (3.753 ± 0.48, 3.756 ± 0.48, 3.866 ± 0.49, and 3.997 ± 0.49 cm, respectively; P=0.286), inter-trigonal diameter (2.88 ± 0.59, 2.89 ± 0.58, 2.89 ± 0.58, and 2.93 ± 0.60 cm, respectively; P=0.982), inter-commissural diameter (3.52 ± 0.38, 3.519 ± 0.36, 3.509 ± 0.35, and 3.526 ± 0.37 cm, respectively; P=0.999), 3D saddle-shaped annulus area (11.336 ± 2.26, 11.346 ± 2.27, 11.599 ± 2.3, and 12.031 ± 2.41 cm², respectively; P=0.714), annulus height (1.135 ± 0.24, 1.154 ± 0.25, 1.164 ± 0.24, and 1.148 ± 0.24 cm, respectively; P=0.981), aorto-mitral angle (105.64 ± 11.7, 104.62 ± 11, 103.8 ± 9.4, and 104.9 ± 10.40, respectively; P=0.949), and saddling (0.322 ± 0.06, 0.328 ± 0.06, 0.33 ± 0.06, and 0.326 ± 0.07, respectively; P=0.231).
Post-operative comparisons revealed a notable _yet not statistically significant_ increase in the intercommissural and intertrigonal diameters in the mid systolic phase after myectomy that may be related to the relief of the obstruction. However, no statistically significant changes in MA dynamics throughout the four phases of the cardiac cycle regarding the AP diameter (P=0.939, 0.914, 0.965, and 0.505, respectively), inter-trigonal diameter (P=0.709, 0.701, 0.797, and 0.710, respectively), inter-commissural diameter (P=0.597, 0.990, 0.396, and 0.328, respectively), 3D saddle-shaped annulus area (P=0.854, 0.828, 0.880, and 0.619, respectively), annulus height (P=0.344, 0.318, 0.27, and 0.342, respectively), aorto-mitral angle (P=0.756, 0.702, 0.320, and 0.255, respectively), and saddling (P=0.1, 0.2, 0.062, and 0.067, respectively).

Conclusion
In HOCM patients, MA exhibits reduced dynamic motion, with a notable loss of normal systolic AP contraction and saddling. Immediate postoperative assessments did not demonstrate significant improvements in MA dynamics. Therefore, further longitudinal studies are necessary to assess long-term changes in MA dynamics due to LV remodeling following septal myectomy procedures.
Additive diagnostic value of 3D transesophageal echocardiography (3DTOE) in diagnosis of Infective endocarditis (IE)
Authors: Mladenovic Z , Milic M G , Djuric D J P , Jovic J Z , Djuric D J I , Ciric C N 
Published: January 2025

Abstract

Introduction
The clinical manifestations of infective endocarditis (IE) are highly polymorphic, complicating the diagnostic process and leading to delays in treatment, particularly in elderly or immunocompromised patients. Recent studies advocate for early surgery to improve prognosis in IE patients. Advanced surgical planning for the complex pathomorphological spectrum of IE lesions requires detailed anatomical visualization, which is enhanced by three-dimensional transesophageal echocardiography (3DTOE).

Purpose
This study analyzed the echocardiographic characteristics of complex IE patients referred for additional evaluation in a tertiary center and assessed the role of 3DTOE in their evaluation.

Methods
This prospective study included all consecutive patients hospitalized in a tertiary clinical center, referred for IE in Serbia from November 2017 to October 2023. Blood cultures, serological assessment, transthoracic echocardiography (TTE), 2D/3DTOE, abdominal sonography, and cerebral CT or MRI scans were systematically performed within 72 hours of admission. Fifty-nine patients with a definitive diagnosis of IE, according to Duke University criteria, who underwent 2D and 3DTOE at the initial diagnostic examination were analyzed. Echocardiographic findings were defined according to current guidelines, with destructive lesions including abscess, pseudoaneurysm, valve dehiscence, perforation, or chordal rupture.

Results
Echocardiographic findings (Table 1) revealed statistically significant differences between different echocardiography modalities. The most significant difference was observed between TTE and 3DTOE. However, results between 2D and 3DTOE did not reach statistical significance. TOE provided a more detailed description with a higher number of detected lesions, and 3DTOE was even more precise in identifying destructive lesions, particularly perforations (p&lt;0.001). Concerning, Native Valve IE (NVE), Prosthetic Valve IE (PVE), and Cardiac Device IE (CD IE) groups (Table 2), vegetations were most frequently detected in the NVE and CD IE groups, while destructive lesions were predominant in the PVE group. 3DTOE detected longer vegetations and a higher number of destructive lesions, particularly in the PVE group.

Conclusion
3DTOE provides a more detailed and precise morphological description of complex destructive lesions of IE compared to TTE and 2DTOE, which is particularly important for patients with PVE.

Table 2
Role of 3D echocardiography for assessment of right ventricle -right atrial coupling in patients with pulmonary hypertension
Authors: Hristova K , Tselov N , Marinov R , Shahin T , Todorov I , Zlatancheva G , Tsonev S 
Published: January 2025

Abstract

RV function is of diagnostic and prognostic purpose in patients with pulmonary hypertension.
The aim of the study was to evaluate the ventricular -arterial coupling in patients with pulmonary hypertension , using 3D echocardiography/ 3DE/.

Methods
3D echocardiography was performed in total 85 patients - 20 normal volunteers, 33 patients with pulmonary hypertension and moderate TR and 32 with ASD / mean age 63 +/- 3.5 y/o/ for evaluation of RV global and regional EDV and EF. Conventional echo parameters as TAPSE, tricuspid annular peak systolic velocity S', FAC and pulmonary vascular resistance and mean PASP are also included, and blood analysis of NT -pro BNP as well, to describe better condition of presence of heart failure.

Results
RV global and regional EDV were significantly higher in group with ASD and heart failure and EF lower, comparable with patient with moderate TR and without heart failure and normals.
Groups with ASD and TR with HF shown lower ratio of EF/PASP, FAC/PASP, TAPSE/PASP, S'/PASP and higher mPAP. (p&lt;0.05) RV global and regional EF/PASP and FAC/PASP are negatively correlated with mPAP, p&lt;0.01.
RV global EF was correlated with mPAP and PVR in all groups./p&lt;0.01/. Ratio of RV inflow, EF/PASP, FAC/PASP, TAPSE /PASP, S'/PASP is more significantly related with the condition of heart failure./p,0.05/. Fig 1.

Conclusions
RV ventricular-arterial coupling was associated with increased RV afterload in patients with pulmonary hypertensions. Regional RV systolic function in the inflow tract is more related with RV ventricular -arterial coupling in patients with pulmonary hypertension and heart failure and can be used as good prognostic marker for worsening of the prognosis.
Exploring three-dimensional right ventricular shape and function in tetralogy of fallot patients
Authors: Zwaan R R , Chen Y , Schneijdenberg J W , Bowen D J , Van Burken G , Bosch J G , Van Den Bosch A E 
Published: January 2025

Abstract

Background
Tetralogy of Fallot (ToF) accounts for approximately 7 to 10 % of all CHD and is commonly associated with failure of the right ventricle (RV). Parameters providing more insight into the mechanics of RV failure are needed to guide clinical decision making. As advancements in Three-Dimensional (3D) echocardiography (3DE) have enabled more detailed analysis of RV volume and function, the way is paved for new 3D derived parameters. We developed a custom software to assess 3D RV shape and function.

Purpose
The aim of this study was to evaluate the differences of 3DE derived RV geometry (curvature) and deformation parameters in adults with ToF and controls.

Methods
In 50 patients with ToF and 50 controls 3DE RV images were acquired. RV geometries from 3D datasets were segmented using commercially available RV analysis software (TomTec 4D-RV function 2.0) and processed using custom software (RV-dynamics) to calculate Curvature, Area Strain (AS) and Longitudinal Strain (LS). Parameters were measured globally and over different segments of the RV (i.e. septal body (SB), inferior free wall (IFW), anterior free wall (AFW), lateral free wall (LFW), apex (Ax), RV inflow tract (RVIT), RV outflow tract (RVOT), anterior boundary (AB) and posterior boundary (PB)).

Results
Globally and for all independent regions of the RV, AS was significantly reduced in patients with ToF as compared with healthy controls. Except for AFW, global and all regional values of LS were significantly reduced in patients with ToF as compared with healthy controls. Global AS and LS were strongly correlated with RVEF with values for r of -0.9 and -0.6 respectively. RV curvature differed over multiple segments, predominantly in the end-diastolic Ax and end-systolic PB and Ax regions.

Conclusion
The RV-dynamics software gives the opportunity to analyze 3D RV morphology and RV deformation parameters in the diseased RV in more detail. AS and LS may provide more detailed assessment of the functional condition of the diseased RV in ToF whereas curvature provides an interesting method for the quantification of RV remodeling. Further insight in the different mechanisms of dysfunction of the RV may improve clinical decision making.
Improving risk stratification in heart failure with reduced ejection fraction by using three-dimensional right ventricular ejection fraction
Authors: Dodita D , Memis H , Andreescu A , Mihalcea D , Velcea A , Spataru B , Hasouna E , Mihalache A , Badano L , Mihaila S , Vinereanu D 
Published: January 2025

Abstract

Background
In patients hospitalized for heart failure with reduced ejection fraction (HFrEF), the occurrence of right ventricular (RV) dysfunction emerged as a prognostic factor for morbidity and mortality. Standard two-dimensional echocardiographic (2DE) parameters have been utilized to assess risk of cardiac death in these patients, but their predictive accuracy varies across different cardiac conditions. This underscores the necessity for more reliable novel parameters, to improve prognosis and to guide therapeutical and interventional management.

Purpose
To assess independent and comparative prognostic utility of three-dimensional (3D) against standard 2D parameters of RV function in predicting mortality and HF hospitalization (HFH).

Methods
We prospectively enrolled 366 patients hospitalized for HFrEF (60±13 years, 81% men), of ischemic and non-ischemic etiology (51% vs. 49%). Patients underwent comprehensive 2D and 3D echocardiography, including full volume acquisition of the right (RV) and left ventricles (LV). By 2DE, we measured TAPSE, RV fractional area change (FAC), S’ systolic velocity, and RV global (GLS) and free wall longitudinal strain (FWLS). By 3DE, we measured RV volumes and RVEF, and derived RVFAC and TAPSE. Primary outcome was cardiac death (CD). Secondary outcome was heart failure hospitalization (HFH). Follow up was 24±8 months.

Results
Mean 3D LVEF was 31±10%, while mean 3D RVEF was 39±10%. Binary logistic regression identified 3D RVEF as an independent significant predictor of CD (β=-0.16, OR 0.84, 95%CI 0.81-0.89, p&lt;0.001) and HFH (β=-0.09, OR 0.92, 95%CI 0.88-0.95, p&lt;0.001), better than standard 2DE parameters, such as 2D RVFAC (β=-0.04, OR 0.96, 95%CI 0.93-0.98 for CD and β=-0.02, OR 0.97, 95%CI 0.96-0.99 for HFH, both p&lt;0.05) and 2D TAPSE (β=-0.13, OR 0.88, 95%CI 0.82-0.95 for CD and β=-0.08, OR 0.92, 95%CI 0.86-0.99 for HFH, both p&lt;0.05). Comparative ROC analysis showed that 3D RVEF was superior for predicting CD (Fig. A) and HFH (AUCs of 0.82 and 0.71, respectively) to 2D TAPSE (AUCs of 0.63 and 0.60, respectively), 2D RVFAC (AUCs of 0.62 and 0.60, respectively), and S’ (AUC 0.56 and 0.50, respectively), all p&lt;0.05. Kaplan-Meier survival analysis (Fig. B) showed that a 3D RVEF of 35% (χ²=25.1, p&lt;0.001) differentiates the best between survivors and non-survivors.

Conclusion
3D RVEF provides superior prognostic information for mortality and heart failure hospitalization in patients with HFrEF, better than 2D echo parameters. Inclusion of 3D RVEF in routine clinical assessment of patients with HFrEF might improve risk stratification and targeted interventions in this population.
Immediately improved diastolic function as determined by pulmonic vein Doppler-intraoperative TEE in TAVR patients and the impact of valvulo-arterial impedance
Authors: Rawangban P , Wuttichaipradit C 
Published: January 2025

Abstract

Background
A recent study demonstrates that most TAVR patients experience immediate improvement in diastolic function as determined by pulmonic vein Doppler (PvD) measurements. Valvulo-arterial impedance (Zva) is a marker of global LV load and represents both valvular and arterial load. Zva &gt; 3.5 has been shown as a predictor of poor adverse outcomes. We hypothesize that Zva might have an effect on the change in pulmonic vein Doppler after TAVR.

Purpose
This study aims to demonstrate the impact of valvulo-arterial impedance and the immediate improvement of diastolic function in TAVR patients as assessed by pulmonic vein Doppler-intraoperative TEE.

Materials and Methods
Patients who underwent TAVR from January 2020 to September 2023 and were performed pulmonic vein Doppler by intraoperative TEE (right upper pulmonic vein from 90-110° mid-esophageal view) during TAVR and measured S-, D-, and A- wave velocity. We obtained the blood pressure and transthoracic echocardiographic parameters to calculate the Zva [(systolic blood pressure + mean pressure gradient across the aortic valve)/stroke volume index by LVOT doppler]. To compare the PvD change between Zva &lt; 3.5 and Zva ≥ 3.5, use chi-square for categorical data and a paired t-test for continuous data.

Results
79 patients (mean age was 80.6 ± 5.6 years, 43 female) were enrolled in this study. S-wave was the only parameter with significantly increased velocity from baseline (33.2 ± 13.8 cm/s vs. 49.1 ± 18.6 cm/s, p &lt; 0.001), whereas D-wave and A-wave did not significantly change from baseline (33.1 ± 14.5 cm/s vs. 33.3 ± 12.0 cm/s, p = 0.88; and 12.7 ± 7.8 cm/s vs. 13.3 ± 7.3 cm/s, p = 0.52, respectively). Of the 37 patients who had an S/D ratio &lt; 1 at baseline, 26 of them converted to an S/D ratio &gt; 1 immediately post-TAVR (Figure 1). In the group of Zva &lt; 3.5, the number of patients who had PvD changed significantly compared with the group of Zva ≥ 3.5 (Figure 2).

Conclusion
The majority of patients in this study demonstrated that diastolic function improved immediately following TAVR using a pulmonic vein Doppler. S/D &gt; 1 has improved significantly in the group with normal valvulo-arterial impedance (Zva &lt; 3.5).
Figure 1
Figure 2
Tricuspid valve annulus remodeling and regurgitation analysis with 3-D transesophageal echocardiography after percutaneous transcatheter edge-to-edge repair
Authors: Maranzano G , Gripari P , Mantegazza V , Fusini L , Garlasche' A , Brusamolino M , Amelotti N , Ianniruberto M , Fazzari F , Cannata F , Ferrari C , De Marco F , Pepi M , Muratori M , Pontone G 
Published: January 2025

Abstract

Introduction
Tricuspid transcatheter edge-to-edge repair (Tr-TEER) is becoming an effective treatment for severe tricuspid regurgitation (TrR) in symptomatic patients who are high-risk candidates for surgery.

Purpose
Aims of the study were to assess immediate changes in tricuspid valve (TV) anatomy following Tr-TEER and to investigate the relationship between baseline geometry and residual intraoperative TrR.

Methods
Thirty-one consecutive patients (average age 77.3 years) with symptomatic severe TrR (≥ grade 4) underwent Tr-TEER. Intraoperative transesophageal echocardiographic 2D and 3D images were obtained before and immediately after the procedure. 3D datasets were analyzed offline using specialized software for 3D TV morphology analysis.

Results
All patients successfully underwent Tr-TEER: 24 patients (77%) achieved an optimal result with residual regurgitation ≤ 2, while 7 patients (23%) had a residual grade 3 or 4. The 3D datasets were suitable for analysis in 29 patients. Anatomic parameters of the TV, obtained via intraoperative transesophageal echocardiography before and after Tr-TEER, are presented in Table 1. The 2D and 3D annulus area, perimeter, diameter in the 2- and 4-chamber view, and minor and major diameter of the tricuspid annulus significantly decreased post-procedure. A significant reduction in TrR was noted regardless of annulus changes.

Conclusions
Tr-TEER is linked to a significant decrease in TrR and notable changes in TV geometry, particularly a substantial reduction in annulus area and perimeter. This may contribute to the effectiveness of Tr-TEER in promptly reducing TrR.
Intracardiac or transesophageal echocardiography for left atrial appendage occlusion? an updated systematic review and meta-analysis
Authors: Beneki E , Dimitriadis K , Theofilis P , Pyrpyris N , Kalompatsou A , Kostakis P , Koukos M , Tzimas G , Tsioufis K , Lancellotti P , Aggeli C 
Published: January 2025

Abstract

Background
Percutaneous left atrial appendage occlusion (LAAO) is typically performed under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. Intracardiac echocardiography (ICE) appears to be a potential alternative to guide implantation.

Purpose
We sought to perform a meta-analysis comparing ICE vs TEE for the guidance of percutaneous LAAO.

Methods
A comprehensive literature search was performed using MEDLINE, Scopus and Web of Science electronic databases from their inception to November 2023 regarding published abstracts and manuscripts. Studies reporting clinical outcomes comparing ICE vs TEE for percutaneous LAAO were included. Primary efficacy and safety outcomes included technical success and the occurrence of any reported procedure-related and device-related complication. Secondary outcomes included procedural characteristics such as procedural time, fluoroscopy time and the volume of contrast agent used.

Results
A total of 18 studies with 124,230 patients fulfilled the criteria. Outcomes assessed including procedure time between ICE vs TEE (risk ratio [RR], 1.01; 95% CI, 1.00-1.01), fluoroscopy time (MD: 1.45 minutes, 95% CI -1.32 to 4.22, p=0.30) and contrast medium volume (SMD: 0.02, 95% CI -0.23 to 0.26, p=0.89) were found to be similar between both groups. Technical success with higher odds was found with the use of ICE (OR: 1.36, 95% CI 1.14 to 1.63, p=0.006) and fewer devices employed in cases of ICE guidance (SMD: -0.22, 95% CI -0.43 to -0.01, p=0.04, I2=62%). There was also no significant difference in procedure- or device-related adverse events between both groups. Interestingly, patients undergoing LAAO under ICE guidance had higher risk for pericardial effusion/tamponade and iatrogenic residual shunts compared to those in the TEE group (11 studies, RR: 1.66, 95% CI 1.13 to 2.43, p=0.014) and (4 studies, RR: 1.53, 95% CI 1.12 to 2.09, p=0.02, I2=1%), respectively. More vascular complications were noted in cases of ICE (RR: 1.56, 95% CI 1.06 to 2.32, p=0.03).

Conclusions
Although TEE is the gold standard for perioperative guidance of LAAO, imaging with ICE is an effective alternative to TEE in LAAO procedures. However, further studies are needed to clarify safety of this new perioperative imaging technique.
Comparing fully automated 3DE quantification and cardiac magnetic resonance imaging for left ventricular volume and function evaluation in patients with dilated cardiomyopathy
Authors: Zoroufian A , Sheikh M , Asl Fallah S , Moradi M , Jalali A , Vakili-Basir A , Sahebjam M , Ashraf H 
Published: January 2025

Abstract

Background
Integration of artificial intelligence enhances precision, yielding dependable evaluations of left ventricular volumes and ejection fraction despite image quality variations. Dilated cardiomyopathy patients have low ejection fraction with dilated left ventricular volumes, which affect the diagnostic accuracy of automated 3D echocardiography. Establishing the diagnostic accuracy of fully automated 3DE quantification software, simplify and accelerate the measurement of left chamber volumes and ejection fraction.

Objective
In this manuscript, we present a cross-sectional study to assess and compare the diagnostic accuracy of automated 3D transthoracic echocardiography (3D TTE) to the standard cardiac magnetic resonance (CMR) imaging in patients with dilated cardiomyopathy.

Methods
In this cross-sectional study, 30 dilated cardiomyopathy patients with CMR imaging and comprehensive 3D TTE were included. 3D TTE and CMR imaging were performed within 24 hours. All 3D volume analyses were performed with fully automated quantification software using 3D images of 2,3, and 4-chamber views at the end of systole and diastole.

Results
Excellent Inter- and Intra-observer correlation coefficient was reported for automated 3D TTE software for all indexes. Automated 3D TTE software underestimated the mean value of LVESVI and LVESDI compared to the CMR. On the contrary, LVEF, LV Mass, LV Mass Index, and SV were overestimated. Contour correction was needed in 8 cases. In cases needing contour editing, no statistically significant difference was demonstrated except for LVEF and SV. Semiautomated 3D TTE software showed similar findings as automated, except that SV was underestimated. Correlation analysis demonstrated significant agreement between Automated 3D TTE software and CMR measurements for all indexes. Fully automated measurements exhibited excellent agreement for LVESVI (r=0.918) and LVEDVI (r=0.911), good agreement for SV (r=0.811), and acceptable agreement for LVEF (r=0.744). However, despite being significantly correlated, it did not reveal acceptable agreement for LV Mass (r= 0.498) and LV mass index (r=0.421). Semiautomated 3D TTE software revealed improved correlation for all indexes, except for LVEDVI and SV. Nevertheless, no significant difference was observed between the CMR agreement correlations with automated and semiautomated 3D TTE software measurements.

Conclusion
Automated 3D TTE software emerges as a rapid and viable imaging approach for evaluating the left ventricle's structure and function. Nevertheless, its volume assessments demonstrate a stronger correlation with CMR imaging compared to its functional assessments.
Agreement between 3D TTE and CMR
Inter- and Intra-observer correlation