bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial strain and risk of atrial fibrillation post-aortic valve replacement surgery
Authors: Sulemane S , Youssef H , Aziz R , Rahman-Haley S , Silverman B 
Published: January 2025

Abstract

Background
Post-operative atrial fibrillation (POAF) occurs in approximately 30% of patients following aortic valve replacement (AVR) surgery. Left atrial dilatation has been proposed as a predictor of POAF. However, very little is known about the predictive value of left atrial strain analysis, which is a surrogate of left atrial mechanical function. This study evaluates the strength of association between left atrial function, assessed using strain echocardiography, and the occurrence of POAF after AVR.

Methods and materials
Perioperative data was collected retrospectively for patients undergoing surgical aortic valve replacement (n=100) who had appropriate pre-operative echocardiographic characterization, including echocardiography measures of LA strain (Fig. 1). Patients with pre-operative AF (n=3) were excluded. Patients were categorised according to the development of POAF.

Results
28 (29%) of 97 patients developed POAF. Initial univariate analysis suggested an association between POAF and increased age, larger LA and LV volumes, diastolic dysfunction, mitral valve E and A values, and lower LA and LV strain. Univariate analysis suggested post-operative associations between POAF and longer durations of intubation, longer durations of noradrenaline requirement, and longer stays in ICU and hospital. Multivariate analysis demonstrated that lower pre-operative left atrial reservoir function had a very strong independent association (mean 12.0% vs 41.5%, odds ratio 0.007, 95% CI 0.0001-0.33, p=0.01) with POAF. Longer post-operative duration of intubation also had a strong association (mean 10hr vs 8hr, odds ratio 67.5, 95% CI 1.1-41.5, p=0.04) with POAF.

Conclusion
Left atrial reservoir function, a surrogate of left atrial compliance, has a strong independent association with POAF post-AVR. This suggests that patients with underlying mechanical atrial dysfunction are at increased risk of developing POAF. This study supports the inclusion of left atrial reservoir function in any predictive tool for POAF post-AVR. The longer duration of post-operative intubation in the AF group supports the negative impact of POAF.
Figure 1. Example of speckle tracking analysis and strain measurements during the three phases of left atrial (LA) cycle using R-R ECG gating with the zero-baseline strain reference. Reservoir strain (yellow line) is the peak strain before mitral valve opening (positive value). Conduit strain (red line) is calculated as difference of the strain value at the onset of atrial contraction minus the peak strain value (negative value). Contraction strain is calculated as difference of the strain value at baseline (0) minus the strain value at onset of atrial contraction (negative value).
The use of myocardial global longitudinal strain to evaluate the effectiveness of reperfusion in acute myocardial infarction
Authors: Doniyorov D , Atamuratov B R , Fozilov K H G , Bekmetova F M , Abdullaeva S Y A , Tursunova N B 
Published: January 2025

Abstract

Introduction
Global longitudinal deformation is a good predictor of LV ejection fraction independence and shows areas of myocardial damage

Purpose
The purpose of this study was to evaluate global longitudinal strain (GLS) in groups of patients with acute myocardial infarction who received primary thrombolysis, primary percutaneous coronary intervention (PCI) and life-saving PCI.

Methods
The study included 200 patients with acute myocardial infarction. The patients were divided into 3 groups, depending on the method of reperfusion: primary thrombolysis (62 patients), primary PCI (106 patients) and life-saving PCI performed after unsuccessful thrombolysis (32 patients). All patients received standard therapy, which included acetylsalicylic acid, ticagrelor, enoxaparin, beta blockers and ACE inhibitors. The assessment of GLS was performed before reperfusion, on the 14th day after reperfusion and 6 months later. The modular values of GLS were compared.

Results
Baseline values did not differ significantly between the groups. On day 14 after reperfusion, a significant increase in GLS was observed in the first and second groups (primary thrombolysis and PCI, respectively) (10.9 ± 2.95 vs 12.7 ± 1.98, p = 0.00001; 11.8 ± 2.41 vs 13.1 ± 1.92, p = 0.00001), while in the third group (rescue PCI) the values increased slightly but not significantly (11.3 ± 1.63 vs 11.6 ± 1.95, p = 0.17). At 6 months after reperfusion, the values of GLS significantly increased in all three groups, with the best results in the primary PCI group: 15.9 ± 2.08 vs 14.8 ± 1.81 in the first group and 13.6 ± 2.07 in the third group (p = 0.01). Regarding clinical outcomes, no cases of early post-infarction angina or left ventricular aneurysm were observed in the primary PCI group, but this group had a higher incidence of mild to moderate chronic heart failure (10.38% vs 0% and 29.25% vs 6.45% and 34.8%, respectively, p = 0.01).

Conclusion
The conducted study in patients with acute myocardial infarction who underwent various methods of reperfusion therapy revealed significant differences in the dynamics of recovery of longitudinal deformation of the left ventricular myocardium. It has been established that the assessment of this parameter can serve as an additional diagnostic and prognostic criterion in this category of patients. The data obtained indicate the advantages of primary PCI over thrombolytic therapy and life-saving PCI in terms of restoring myocardial contractile function. Thus, early primary PCI should be considered as the preferred method of reperfusion therapy in acute myocardial infarction.
Is dyspnea the new angina?
Authors: Rodriguez D , Cano R , Casanova C , Velez A , Martin Penato A , De La Cruz E , Martinez V , Iglesias D , Lareo A , Cadenas R , Paredes B , Aguilera M C , Garcia A 
Published: January 2025

Abstract

Introduction
The exercise stress echocardiogram is a highly valuable tool for evaluating patients with dyspnea as the main symptom (without angina) and suspected coronary artery disease (CAD). This involves a large volume of patients in daily practice, and etiological orientation is often difficult, especially in patients with high cardiovascular risk.

Objective
This study aims to define the likelihood of inducible ischemia in this population concerning their pretest probability described in the literature, as well as to compare the exercise workload achieved during the test with the predicted workload.

Methods
We performed a retrospective analysis of 116 consecutive diagnostic exercise stress echocardiograms (2021-2023) conducted on patients with dyspnea as the main symptom (14.55% of the total exercise stress echocardiograms).

Results
The average age was 67.93 years (standard deviation [SD] 9.99), and the average body mass index (BMI) was 28.87 (SD 4.37). Baseline characteristics included hypertension (79 patients, 68.1%), diabetes (39 patients, 33.6%), dyslipidemia (76 patients, 65.5%), smoking (46 patients, 39.7%), and known pulmonary disease (21 patients, 18.1%). Among the patients, 104 (89.7%) had an intermediate pretest probability of CAD. The main reason for test termination was dyspnea in 78 patients (67.2%). The average maximum workload achieved was 7.28 METs (SD 2.34), compared to a predicted maximum workload of 6.58 METs (SD 1.78), resulting in an actual/predicted METs ratio of 1.14. The stress echocardiogram was positive for inducible ischemia in 8 cases (6.9%), with no significant differences between diabetic and non-diabetic patients (6.49% positive in non-diabetics, 7.89% positive in diabetics, p = 0.781).

Conclusions
Patients referred for dyspnea as the main symptom demonstrated greater functional capacity than predicted, suggesting both a challenging assessment of functional class in clinical consultations and a possible underestimation of age-predicted functional capacity formulas in the current population. Additionally, the positivity rate for ischemia was lower than described in the literature for a population with predominantly intermediate pretest probability of CAD.
Salgo le characteristics
Pressure-volume analysis by three-dimensional echocardiography: a novel and superior method to predict response following cardiac resynchronization therapy
Authors: Hammersboen L E R , Remme E W , Aalen J M , Larsen C K , Donal E , Duchenne J , Penicka M , Kongsgaard E , Galli E , Voigt J U , Stugaard M , Smiseth O A , Boe E A 
Published: January 2025

Abstract

Introduction
Long-term response to cardiac resynchronization therapy (CRT) is primarily assessed by 2D echocardiography. The combination of 3D echocardiography and left ventricular (LV) pressure curve estimation allows for pressure-volume (PV) analysis and LV work efficiency (LVWE) estimation which may be superior to today’s methods.

Aim
To investigate if PV-analysis by 3D echocardiography is superior to 2D volumes at predicting long-term survival in CRT.

Methods
In a recent prospective multicenter study, non-invasive PV-analysis (n=106) and 2D volume analysis by biplane Simpson’s method (n=195) were performed, before and 6 months after CRT. The LV pressure curve was estimated by aligning a reference pressure curve with mitral and aortic valve events obtained from echocardiography. The amplitude of the curve was adjusted to brachial systolic cuff pressure and combined with 3D volumes for PV-analysis. As shown in figure 1, LVWE was calculated as the ratio of estimated stroke work (red area) to total mechanical energy (red + blue areas). The cutoff value for change in LV end-systolic volume (ESV) was set at 15% and at &gt;35% for LVWE using Receiver Operator Curve analysis. Volumetric non-responders were subdivided into response based on LVWE.

Results
After 6±2 years follow-up, 47 (23%) patients had died. Relative change in 3D and 2D LV ESV showed similar ability to predict long-term all-cause mortality (log rank p&lt;0.001 for both) (Figure 2). However, LVWE identified patients with a positive effect of CRT who were volumetric non-responders. These patients had similar outcomes as volumetric responders (HR 1.91, 95% CI: 0.54-6.81) (Figure 3). LVWE also identified non-responders with particularly adverse outcomes (HR 3.46, 95% CI: 1.32-9.10 vs volumetric non-response and LVWE &gt;35%).

Conclusions
PV-analysis by 3D-echoardiography identifies a new group of patients who respond to CRT without a 15% reduction in ESV who have similar outcomes to volumetric responders. In our data, 3D echocardiography was superior to 2D volumes at predicting long-term all-cause mortality after CRT.
LV work efficiency before and after CRT
LV work efficiency and survival
Prognostic implications of secondary tricuspid regurgitation dynamic trends in acute heart failure
Authors: Anastasiou V , Peteinidou E P , Daios S D , Fardoulis E F , Gogos C G , Moysidis D V M , Papazoglou A S P , Didagelos M D , Giannakoulas G G , Karamitsos T K , Ziakas A Z , Kamperidis V K 
Published: January 2025

Abstract

Background
The response of secondary tricuspid regurgitation (STR) to therapeutic management in acute heart failure (HF) is variable. STR improvement may indicate reverse right ventricular remodeling and response to treatment. The dynamic trends of STR during HF hospitalization and their prognostic relevance remain unexplored.

Methods
All consecutive patients hospitalized for acute HF underwent echocardiographic assessment within 24 hours from admission and 24 hours prior to discharge. Patients were divided into 3 groups; No/mild STR on admission, significant STR on admission that improved on discharge (Improved TR), and significant STR on admission without improvement on discharge (Non-improved TR). All-cause death and HF hospitalization was the composite primary end-point.

Results
Out of 401 patients, 285 (71.1%) presented with significant STR on admission; of these 136 (33.9%) demonstrated TR improvement on discharge (Figure 1A). Chronic HF, RV free wall longitudinal strain (LS) and effective regurgitant orifice area (EROA) on admission were independent predictors for TR improvement (Figure 1B). Spline curve analyses indicated that the STR subgroup with RV free wall LS &lt;-14.2 % and EROA &lt;0.34 cm2 on admission were most likely to achieve TR improvement on discharge. After a median follow up of 6 months (interquartile range, 2.3-9.8), 141 (35.2%) patients reached the primary endpoint. Patients with Non-improved TR showed higher cumulative event rates compared to the other 2 groups (No/mild TR: 20.7%, Improved TR: 28.7%, Non-improved TR: 52.3%, Log-rank p &lt;0.001) (Figure 1C). Non-improved TR was independently associated with the composite outcome (hazard ratio 2.15 [95% CI, 1.37–3.38]; p &lt;0.001).

Conclusion
The dynamic trends of STR carry a clinically relevant value in acute HF. Absence of STR improvement during hospitalization indicates worst long-term survival.
Figure 1: Graphical Abstract
Association with outcomes of the planimetry of vena contracta area by 3-dimensional color Doppler echocardiography in patients with secondary tricuspid regurgitation
Authors: Gavazzoni M , Benzoni G , Penso M , Tomaselli M , Gagliardi M F , Fisicaro S , Clement A , Radu N , Buta A , Rella V , Kawada Y , Parati G , Badano L P , Muraru D 
Published: January 2025

Abstract

Background
The cut-off value for defining severe secondary tricuspid regurgitation (STR) using the planimetry of color Doppler three-dimensional echocardiography (3DE) vena contracta area (VCA) has been determined in previous studies based on its correlation with the values of the effective regurgitant orifice area (EROA), obtained using the proximal isovolumic surface area (PISA) method, in patients with severe STR. However, the association of VCA with outcomes has not been examined in these studies.

Purpose
We sought to 1) identify the cut-off value of 3DE VCA associated with an increased risk of death for any cause or heart failure hospitalizations (HF) in patients with STR; 2) test if the planimetry of 3DE VCA may improve the risk stratification over the quantitative parameters of STR severity.

Methods
Retrospective analysis of patients with STR consecutively enrolled in the FUTURE 3DECHO study who had good quality 3DE dataset for VCA planimetry.

Results
We selected 184 patients (76±13 years, 43% women). According to the guideline-recommended multiparametric approach, 15% of the patients had mild, 51% moderate, 22% severe, and 12% massive STR. The mean 3DE VCA was 0.72±0.41 cm2 and it increased significantly with the severity of STR. Among all the quantitative parameters of STR severity, the strongest correlation of 3DE VCA was found with EROA by PISA (Spearman: 0.63, p &lt; 0.001). Using spline curve analysis, a 3DE VCA of 0.65 cm2 was identified as the threshold value associated with increased risk of experiencing the composite endpoint in the whole population (Figure 1A). At univariate analysis, a 3DE VCA &gt; 0.65 cm2 carried a 4-fold increased risk of combined events and it also stratified the risk in patients with EROA &lt; 0.4 cm2 (Figure 1B). When added to a multivariable model including right atrial volume, right ventricular ejection fraction, pulmonary arterial systolic pressure, STR EROA and regurgitant volume, VCA increased significantly the predictive power of the model and mainteined its independent correlation with outcomes (HR: 1.011, CI 95%: 1.003-1.019, P=0.007; X2 of models: 44 vs 39, p value &lt;0.001) (Figure 2).

Conclusion
3DE VCA has independent and incremental value over the other parameters of severity for predicting the risk of events in patients with STR. 3DE VCA&gt; 0.65 cm2 identified STR patients with EROA&lt; 0.4 cm2 at higher risk of experiencing the composite endpoint of death and HF.
Figure 1 A and B
Figure 2. Cox Regression multivariate
Relationship between position, shape and deformation of papillary muscles and mitral regurgitation after transcatheter aortic valve replacement
Authors: Li X , Wei X , Chen F , Zhou W X , Liang Y J , Zhao Z G , Li Q , Wei J F , Tang H , Feng Y , Chen M 
Published: January 2025

Abstract

Background
Previous studies have shown that preoperative co-existing moderate/severe mitral regurgitation (MR) and postoperative persistent MR can affect the prognosis of patients with transcatheter aortic valve replacement (TAVR). However, most studies only focus on mitral valve leaflets and annulus, and few touches on papillary muscle.

Purpose
To explore the relationship between the shape, position and deformation of papillary muscles and MR outcome after TAVR.

Methods
This retrospective cohort study included 1159 consecutive patients who underwent TAVR between April 2012 and September 2021. The 141 patients who met the inclusion and exclusion criteria and have MR≥3+ grade were divided into improved MR (IMR) group and non-improved (NMR) group according to the grading of MR at 1 month after operation. MSCT and 18-segments method were used to analyze the shape and locate the attachment of papillary muscle. The deformation and synchrony of the papillary muscle attachment were analyzed using two-dimensional speckle tracking. Associations with MR improvement after TAVR were explored.

Results
A total of 141 patients (mean age, 73 years ± 8; 94 men) were included. IMR was observed in 104 patients, and NMR was seen in the remaining 37. There was no significant difference in the deformation and synchrony of myocardium at attachment and in the papillary muscle morphology between groups. However, the range of papillary muscle attachment was increased in the NMR group compared to the IMR group (2.08±0.92 vs. 1.36±0.61, p&lt;0.001; 2.32±0.88 vs. 1.76±0.77, p&lt;0.001). Inferior displacement of papillary muscle (OR: 14.151; 95% CI: 2.90, 69.045; P = .001) was found to be an independent predictor of less MR improvement after TAVR.

Conclusion
The papillary muscles in the NMR group had no significant morphological tendency, but their attachment range was significantly increased and more towards apical. Inferior displacement of papillary muscles was an independent risk factors for unalleviated MR.
Prognostic value of dynamic changes in right ventricular-pulmonary arterial coupling in acute heart failure
Authors: Anastasiou V , Daios S D , Peteinidou E P , Fardoulis E F , Gogos C G , Didagelos M D , Giannakoulas G G , Karamitsos T K , Ziakas A Z , Kamperidis V K 
Published: January 2025

Abstract

Background
Right ventricular-pulmonary arterial (RV-PA) coupling is a powerful prognosticator in heart failure (HF). However, acute HF treatment may improve the connection of RV to the PA circulation for some patients. Whether the dynamic changes of RV-PA coupling during hospitalization for acute HF carry a prognostic value remains unexplored.

Methods
TAPSE/PASP was measured in all consecutive patients hospitalized for acute HF using echocardiography within 24 hours from admission and within 24 hours before discharge. TAPSE/PASP ≥0.36 mm/Hg was considered RV-PA coupling and TAPSE/PASP &lt;0.36 mm/Hg RV-PA uncoupling. Patients were divided into 3 groups; RV-PA coupling on admission, RV-PA uncoupling on admission that improved to RV-PA coupling on discharge (Improved RV-PA uncoupling), and RV-PA uncoupling on admission without improvement on discharge (Non-improved RV-PA uncoupling). All-cause death and HF hospitalization was the composite primary endpoint.

Results
Of the 401 patients 185 (46.1%) had RV-PA coupling on admission, 93 (23.2%) had Improved RV-PA uncoupling, and 123 (30.7%) had Non-improved RV-PA uncoupling. After a median follow up of 6 months (interquartile range, 2.3-9.8), 141 (35.2%) patients reached the primary endpoint. Patients with Non-improved RV-PA uncoupling showed higher cumulative event rates compared to the other 2 groups (RV-PA coupling: 24.3%, Improved RV-PA uncoupling: 24.7%, Non-improved RV-PA uncoupling: 59.3%, Log-rank p&lt; 0.001) (Figure 1). In multivariate cox-regression analysis Non-improved RV-PA uncoupling was independently associated with the composite outcome (hazard ratio 2.54 [95% CI, 1.45–4.46]; p =0.001), and provided incremental prognostic information over a baseline clinical and echocardiographic model and RV-PA uncoupling on admission (Figure 2).

Conclusion
Absence of improvement in RV-PA uncoupling in response to acute HF treatment is associated with worst event-free survival and may indicate advanced RV failure and PA remodeling not amenable to medical management.
Figure 1: Event-free survival
Figure 2: Incremental prognostic value
Inodilators in acute heart failure: what about the right ventricle?
Authors: Carvalho M , Cabral M , Goncalves C , Vazao A , Martins A , Ruivo C 
Published: January 2025

Abstract

Objectives
This research examines the impact of levosimendan on right ventricular (RV) function in patients with cardiovascular conditions, aiming to evaluate enhancements in crucial echocardiographic indicators of RV systolic performance.

Methods
A total of 54 patients hospitalized for acute heart failure were enrolled in the study and divided into two groups: 25 patients received 12.5 mg of levosimendan over 24 hours, while the remaining 29 patients served as the control group. Echocardiographic parameters were measured at baseline and after treatment for both groups.

Results
In the levosimendan group, the post-treatment S' tissue velocity increased significantly from 9.48 ± 1.06 cm/s to 10.43 ± 1.28 cm/s (p=0.025), whereas the control group exhibited a change from 9.31 ± 0.93 cm/s to 9.53 ± 1.11 cm/s. The fractional area change (FAC) showed a notable improvement in the levosimendan group from 20 ± 3% to 27 ± 2% (p &lt; 0.0001), compared to a minor change in the control group. Tricuspid annular plane systolic excursion (TAPSE) significantly increased in the levosimendan group from 13.8 ± 0.4 mm to 15.6 ± 0.36 mm (p &lt; 0.0001), while the control group displayed minimal change. Systolic pulmonary artery pressure (SPAP) reduction was more significant in the levosimendan group (from 58.67 ± 7.28 mmHg to 47.22 ± 5.6 mmHg) compared to the control group (from 60.5 ± 9.34 mmHg to 55.85 ± 7.41 mmHg) (p=0.012). Additionally, RV strain improved considerably in the levosimendan group from -20 ± 3% to -23 ± 3% (p=0.03), while the control group changed from -19 ± 3% to -20 ± 3%.

Conclusion
Levosimendan markedly enhances right ventricular function, as demonstrated by significant increases in S' velocity, FAC, RV strain, and TAPSE, along with a notable reduction in SPAP. These results indicate that levosimendan is a promising therapeutic agent for improving RV function.