bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advanced mechanical analysis in STEMI in the pharmacoinvasive strategy era
Authors: Garcia Villarejo M , Latapi Ruiz Esparza X , Santos Alfaro H A , Cuellar Vargas J , Araiza Garaygordobyl D , Gopar Nieto R , Neri Bale R , Adib Gracia A E , Arias Mendoza M A , Sierra Lara Martinez J D 
Published: January 2025

Abstract

Background
Global Longitudinal Strain (GLS) and left ventricular-arterial coupling (VAC), calculated as the ratio between arterial elastance (Ea) and left ventricular end-systolic elastance (Ees), are part of modern non-invasive indices of left ventricular (LV) and arterial system function. Their interaction in determining prognosis in post-STEMI patients with acute coronary syndrome (ACS) is not well established, particularly in relation to reperfusion strategies.

Purpose
It aims to demonstrate through multiple mechanisms (and advanced mechanics analysis) that gaining reperfusion time has clinical benefits, and once again, pharmacoinvasive strategy (PhI) proves it is not inferior than percutaneous coronary intervention (PCI).

Methods
Echocardiography was performed on 144 post-STEMI patients who were followed up for 750 days after hospitalization. Each baseline characteristic variable was analyzed using Wilcoxon and Shapiro-Wilk tests. Kaplan-Meier methods with log-rank tests were employed to assess the presence of MACE (including heart failure, cardiogenic shock and death) in two main variables across four groups. The first compared VAC within the parameter range of 0.95-1.1 and reperfusion strategy (PhI vs PCI), while the second analyzed GLS &lt;-18 and reperfusion strategy (PhI vs PCI).

Results
We included 144 patients, with 87% (n=125) being male, and a median age of 60 years. The most common comorbidities were hypertension (52%) and type 2 diabetes (40.3%). In our initial comparison between VAC and reperfusion strategy, Kaplan-Meier curves demonstrated significant differences in the presence of major adverse cardiovascular events (MACE) between VAC and the reperfusion strategy. There was a better prognosis observed in both PhI groups, particularly in the VAC 0.95-1.1 group (p-value &lt; 0.032). Conversely, the group with the highest number of events included those with VAC outside the 0.95-1.1 range and PCI strategy. Furthermore, in the GLS analysis, the PhI-based reperfusion strategy yielded superior results in terms of MACE outcomes (p-value &lt;0.041). Nonetheless, GLS remained significant with a value of &lt;-18 for predicting the presence of MACE

Conclusions
Both GLS and VAC, as advanced mechanical analyses, serve as affordable predictors of MACE in post-STEMI patients. More importantly, our findings demonstrate that pharmacoinvasive therapy (PhI) offers superior prognosis for our patients. Therefore, prioritising early reperfusion treatment, whether pharmacoinvasive or primary, is imperative.
Fig 1. GLS and reperfusion strategy
Fig 2. VAC and reperfusion strategy
Beyond heart rhythm: 12 months in the echocardiographic evaluation of cardiac resynchronization
Authors: Mauricio A N A , Goncalves S U S A N A , Prata S A R A , Santos L A U R A , Bernardes A N A , Ribeiro F , Marques P E D R O , Sousa C , Pinto F A U S T O 
Published: January 2025

Abstract

Introduction
Cardiac resynchronization therapy (CRT) is recommended in patients with heart failure (HF), but 1/3 of patients are "non-responders". More recent resynchronization algorithms promote electrical optimization by dynamically adjusting atrioventricular intervals, reducing QRS duration. However, their impact on left ventricular function parameters remains unclear.

Objectives
The following echocardiographic parameters were evaluated and compared pre-CRT and at 12 months follow-up: left ventricular (LV) diastolic and systolic volume; ejection fraction (LVEF), global longitudinal myocardial strain (GLS), left atrial (LA) volume; and analytical parameters: NT-ProBNP.

Methods
Retrospective, comparative study of patients who underwent CRT. All patients underwent echocardiographic study and clinical analysis before CRT implantation and at 12 months follow-up. The following echocardiographic parameters were assessed post-procedure: LVEF (Simpson biplane method); LV volumes and LA volumes indexed to body surface area and GLS (GE Echopac). NT-ProBNP values were collected.

Results
50 patients (74 ± 1.3 years, 66% men) were studied, 50% with ischemic heart disease. In the comparative analysis before CRT and at 12-month follow-up, statistically significant differences were observed in LV diastolic and systolic volumes (96.5 ± 4.3 ml/m2 vs. 78. 2 ± 4 ml/m2, p=0.001; 65 ± 3 ml/m2 vs. 48 ± 3 ml/m2, p=0.001), with a significant improvement in LVEF at follow-up (33% ± 1.1 vs. 40% ± 1.4, p=0.001) as well as GLS (-7.8% ± 0.3 vs. -11.5% ± 1, p=0.003). LA volume also showed a significant decrease at follow-up (87 ± 4 ml vs. 71 ±3.8 ml). Reverse remodeling was more evident in patients without a history of ischemic heart disease, with a decrease in LV volumes, improved LVEF and GLS. NT-ProBNP levels also decreased significantly at follow-up (1945 ± 294 pg/mL vs. 783 ± 134 pg/mL, p=0.001).

Conclusions
CRT implantation is a therapeutic option for patients with HF refractory to medical treatment. Recent resynchronization algorithms show good results in reducing LV volumes as well as improving left ventricular function, and the prognosis of these patients.
What happens to myocardial work after transcatheter aortic valve replacement?
Authors: Carvalheiro R , Barbas De Albuquerque F , Lacerda Teixeira B , Galrinho A , Valentim Goncalves A , Rodrigues I , Grazina A , Mendonca T , Ramos R , Fiarresga A , Cacela D , Cruz Ferreira R 
Published: January 2025

Abstract

Background
Novel echocardiographic speckle-tracking techniques such as global longitudinal strain (GLS) and myocardial work (MW) have been used in many cardiac conditions for myocardial functional assessment. In severe aortic stenosis (SAS) this evaluation is more challenging since left ventricular (LV) systolic pressure (SP) does not equal non-invasive systolic pressure (NISP) owing to the fixed obstruction of a stenotic valve. Few studies have evaluated the immediate impact of transcatheter aortic valve replacement (TAVR) in patients with SAS on GLS and MW parameters.

Aim
To assess differences in GLS and MW parameters values, pre- and post-TAVR, in patients with SAS.

Methods
One-single center retrospective analysis of consecutive patients with SAS submitted to TAVR, between January 2018 and December 2021, who performed transthoracic echocardiography (TTE) bfore and after the procedure (within the same hospital admission).
NISP was determined at TTE performance. For pre-TAVR assessment, corrected SP by adding the mean aortic gradient was introduced in the software for MW parameters calculations, namely global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE).
Continuous variables were assessed for normality using Shapiro-Wilk test. Normal variables were represented as mean and standard deviation (SD) and compared using a paired-sample t-test. Non-normal variables were represented as median and interquartile range (IQR) and compared using a Wilcoxon-Signed rank test. Statistical significance was defined as two-sided p value &lt; 0.05. All statistical analysis were done with JASP (version 0.16.0.0).

Results
50 patients entered the primary analysis. Mean age was 82 years and 56% were female sex.
Before TAVR, mean aortic gradient was 49 ± 15 mmHg, mean aortic valve area was 0.76 ± 0.22 cm2 and LV ejection fraction was 52 ± 11%.
Table 1 represents the mean GLS and MW parameters values pre- and post-TAVR from our study population. Patients had significant lower values of GWI (1764.4 ± 704.9 vs. 1197 ± 372.6, p &lt; 0.001) and GCW (2309.5 ± 810.9 vs. 1627.8 ± 488.5, p &lt; 0.001) post-TAVR when compared with the pre-TAVR values. There were no significant differences in GLS (p=0.837), GWW (p=0.055) and GWE (P=0.438) values pre- and post-TAVR.

Conclusion
In our study population, GLS was impaired in patients with SAS and it remained identical after TAVR, suggesting un underlying myopathy that does not reverse immediately after the procedure. Furthermore, MW as assessed by GWI was significantly reduced after TAVR, which may reflect the reduced workload needed after the procedure due to acute afterload reduction. Further studies with longer follow-up are needed to acess the long term impact of TAVR in MW.
TAVR MW
Global longitudinal strain during stress echocardiography predicts major adverse cardiovascular events in patients with suspected chronic coronary syndrome.
Authors: Sanchez Nieto J , Millan Vela J , Arias Godinez J A , Fritche Salazar J F , Posada Martinez E L , Ortiz Leon X A , Ruiz Esparza Duenas M E , Rodriguez Esparza J D , Suarez Lara N N , Rodriguez Zanella H 
Published: January 2025

Abstract

Background
Global longitudinal strain (GLS) is a robust prognostic marker in patients with coronary artery disease. The ABCDE stress echocardiography protocol has emerged as a novel tool for prognostic risk stratification beyond wall motion abnormalities. However, GLS during stress has not been incorporated in this protocol and its prognostic value remains to be confirmed.

Purpose
To assess the prognostic value of GLS during stress echocardiography to predict major adverse cardiovascular events in patients with suspected chronic coronary syndrome.

Methods
We recruited patients aged 18 years or older from 2017 to 2023 with suspected chronic coronary syndrome, who underwent clinically indicated stress echocardiography. Semiautomatic GLS of the LV was measured at rest and during stress. We included all types of stress: semi-supine bicycle, dobutamine, and dipyridamole. Logistic regression analysis was performed to assess the association between GLS and major adverse cardiovascular events (MACE).

Results
Eighty-one patients were included, age 61 (28-86) years, 52 were male (64 %), 60% had history of hypertension, 40% diabetes, 27% obesity and 14% previous acute coronary syndrome. Resting LVEF was 57% (± 11) and GLS 16% (± 4). After a mean follow up of 34 months, 24 patients (29%) presented MACE. Patients with MACE had lower LVEF 53 ± 13% vs 59% ± 10% (p&lt;0.0328) and lower GLS 13.9± 4.5% vs 16.9 ± 3.9% (p&lt;0.0029) at baseline. On univariate logistic regression analysis stress GLS was related to the occurrence of MACE, p=0.04. ROC curve analysis using Youden index identified that a cut off value of stress GLS &lt;17% had a 47% sensitivity, 87% specificity. The survival analysis showed a 77.7% survival rate for those with GLS &lt;17% than for those with GLS &gt;17% (p=0.044) over 34 months of follow-up.

Conclusion
In patients with suspected chronic coronary syndrome undergoing stress echocardiography GLS during stress is a predictor for MACE. The survival of patients with less of 17% of GLS was significantly minor with a sensitivity of 47.37% and a specificity of 87.5%.
ROC curve(Above) and Kaplan Meier Curve.
Table 1.
Long-term outcomes after stress echocardiography in real-world practice: five year follow-up of the EVAREST study
Authors: Woodward W , Johnson C L , Krasner S , O'driscoll J , Balkhausen K , Chandrasekaran B , Firoozan S , Kardos A , Sabharwal N , Sarwar R , Senior R , Sharma R , Wong K , Augustine D X , Leeson P 
Published: January 2025

Abstract

Background/Introduction
Stress echocardiography is widely used to assess patients with chest pain. The clinical value of a positive or negative test result to inform on likely longer-term outcomes when applied in real-world practice across a national healthcare system has not been previously reported.

Purpose
We report patient outcome up to five years after stress echocardiogram for patients undergoing a clinically-indicated stress echocardiogram for ischaemic heart disease in a real-world, multi-centre national healthcare system and determine the event-free ‘warranty’ period following a normal stress echocardiogram.

Methods
Patients participating in the EVAREST/BSE-NSTEP (Echocardiography: Value and Accuracy at Rest and Stress/ British Society of Echocardiography National Review of Stress Echo Practice) prospective cohort study were recruited from 32 UK NHS hospitals between 2018 and 2022. Medical outcome data up to 2023 was available from NHS England. Stress echocardiography results were related to outcomes, including death, procedures, hospital admissions and relevant cardiovascular diagnoses, using Kaplan-Meier analysis and Cox proportional hazard ratios. Warranty period following a negative stress echocardiogram was defined as time the cumulative event rate of myocardial infarction or cardiac-related death remained below 5%.

Results
5503 patients were included in the analysis with a median follow-up of 829 days (IQR 224 – 1434). A positive stress echocardiogram was associated with a greater risk of myocardial infarction (HR 2.71, 95% CI 1.73 – 4.24, P&lt;0.001), revascularisation (HR 10.52, 95% CI 8.26 – 13.42, P&lt;0.001) and reaching a composite endpoint of cardiac-related mortality and myocardial infarction (HR 2.04, 95% CI 1.41 – 2.93, P&lt;0.001). Hazard ratios for all events increased with ischaemic burden identified at stress echocardiography (Figure 1). A negative stress echocardiogram identified an event-free ‘warranty period’ of at least five years in patients with no prior history of coronary artery disease, and four years for those with disease (Figure 2).

Conclusions
In real-world practice, the degree of ischaemia recorded by clinicians at stress echocardiography correctly categorises risk of future events over the next five years. Reporting a stress echocardiogram as negative correctly identifies patients with no greater than a background risk of cardiovascular events over a similar time period.
Figure 1
Figure 2
Does ischemic stress echocardiography study in subjects with non-obstructive coronary artery disease predicts worse cardiovascular prognosis?
Authors: Kobal S , Murninkas M , Zeldetz V , Shmueli H , Shitrit A 
Published: January 2025

Abstract

Background
Many patients with signs of ischemia in stress echocardiography (SE) do not have obstructive coronary artery disease (CAD). There is concern that subjects with abnormal SE results without significant CAD have a worse prognosis than patients with normal SE.

Purpose
The aim of this study was to examine the cardiovascular prognosis and mortality of patients with ischemic SE test and normal or non-obstructive CAD.

Methods
A retrospective cohort study of patients with ischemic SE test who demonstrated a normal coronary arteries or non-significant CAD by coronary catheterization or computerized tomography angiography were compared to patients with normal SE study, matched by distribution of age, gender, and by the year that the test was performed for the rate of all-cause mortality and mayor adverse cardiac events (MACE).

Results
There were 55 out of 168 patients with ischemic SE that had normal or non-significant CAD (64 ± 9 years, 54% females). During a mean follow up of 7.9 ± 2.6 years, MACE was higher in ischemic SE group than the non–ischemic group (15% and 7%, respectively). The most common MACE component in the ischemic SE subjects was heart failure (11% and 2% for ischemic SE group and non-ischemic SE group, respectively) (HR 2.854). The rate of all-cause mortality was also higher in the ischemic SE group than the non-ischemic SE group (3.1% and 2.1%, respectively) By multivariate analysis the most powerful parameter that predicted all-cause mortality was hypertension (HR 1.195) and diabetes mellitus (HR 1.548).

Conclusions
The outcome of patients with ischemic SE and normal coronary arteries or non-obstructive CAD is worse for patients with normal SE. According to these findings patients with ischemic SE results and normal coronary arteries or non-obstructive CAD may benefit from different management that should include frequent medical follow up and tight control of risk factors.
Left anterior descending velocity reserve by supine ergometry in asymptomatic severe aortic stenosis: evidence for relationship with the valvuloarterial impedance
Authors: Armenis I , Leontiadis E , Tsiapras D , Kyrzopoulos S , Iakovou I , Athanassopoulos G D 
Published: January 2025

Abstract

Introduction
Myocardial perfusion is impaired in aortic stenosis (AS) due to microvascular dysfunction and exhaustion of autoregulation following the increased left ventricular (LV) afterload. Distal left anterior descending blood flow velocity (LAD-vel) and the respective reserve (CVR) during supine ergometry (Ex) represent a surrogate for the interrogation of the underlying perfusion pathophysiology.

Purpose
Purpose of the study was to assess the relationship between LAD profile and CVR with the LV functional capacity and valvuloarterial impedance (Za) in the context of asymptomatic severe AS and to evaluate the potential prognostic implications.

Method
Fifty four patients with asymptomatic severe AS, followed-up on valve clinic in a tertiary center (age 66±12 years), were referred for Ex. AS related cardiac events (independent decision for surgery, occurrence of AS-related symptoms) during a follow-up of 24±23 months occurred in 18 patients (EV group).
CVR at the distal LAD was estimated during Ex at the latest possible timing (time from onset Ex: 3.0±2.7 minutes, workload: 48±22 Watts (W), respective heart rate (HR): 92±17 (82±16% of the maximum achieved HR).
The following parameters were estimated both at rest-R/Ex: LV ejection fraction (EF:%), longitudinal strain (SR:%), transmitral E/e ratio, peak transtricuspid systolic pressure (TRPG: mmHg), AV mean gradient (meanGR: mmHg) and valvuloarterial impedance (Za: mm Hg·ml-1m2).

Results
EV and non EV groups had similar LAD-vel (26±9 vs 26±10cm/s). LAD-vel and CVR were not affected by sex (women/men=18±36 vs 26±9cm/s and 2.09±0.54 vs 2.25±0.45 respectively). LAD-vel was higher in the 24 patients with age&gt;70years (28±9 vs 21±7cm/s p=0.03), implying relative autoregulatory dysregulation, whereas CVR was similar (2.18±0.46 vs 2.11±0.60, p&gt;0.05).
CVR was not affected by the workload achieved [50W (10patients): 2.0±0.5 vs 75W (23patients): 2.3±0.6 vs 100W (19patients):2.1±0.5 vs 125W (2pts):1.9±0.2]
Linear regression analysis did not show any relationship of CVR with EF- R/Ex, SR-R/Ex, meanGR-R/Ex, E/e-R/Ex and %target HR. CVR had a weak negative relationship with age (r=-0.27 p=0.05).
However, CVR was related with Za at R (r= 0.5 p=0.008) and modestly at Ex (r=0.35 p=0.08, figures).

Conclusion
Despite the absence of obvious relationships with LV functional reserve and clinical outcome, perfusion reserve in asymptomatic severe AS, estimated by supine ergometry-induced CVR, compensates efficiently for the imposed valvuloarterial impedance at rest but with a less consistent support for the exercise induced increase in the LV afterload.
Non-invasive assessment of arterial elastance using three-dimensional echocardiography: an accurate alternative to invasive methods
Authors: Hammersboen L E R , Boe E A , Aalen J M , Odland H H , Kongsgaard E , Villegas-Martinez M , Frostelid V C , Khan F H , Sletten O J , Witsoe M , Skulstad H , Smiseth O A , Stugaard M , Re E W 
Published: January 2025

Abstract

Introduction
Assessing arterial elastance (Ea) is crucial for understanding vascular properties and managing conditions such as hypertension, heart failure, and valvular heart disease. While invasive pressure-volume (PV) analysis provides precise measurements, the procedures involved pose significant risks and limitations. Three-dimensional (3D) echocardiography, combined with non-invasive LV pressure curve estimation, however, offers a highly accurate method for generating non-invasive PV-loops. Thus, this approach has the potential to provide a safe and widely accessible means of assessing Ea.

Aim
Validate non-invasive Ea by PV analysis using 3D echocardiography, comparing it to gold-standard Ea derived from invasive measurements.

Methods
In 10 open-chest canines, invasive pressure was measured using a micromanometer, and volume determined from subendocardial piezoelectric crystals, using a three-axis ellipsoid model (Figure 1). Echocardiography provided non-invasive 3D LV volumes and valve event timings. The LV pressure curve was estimated by adjusting a reference curve to the valve events and measured peak LV pressure, which in clinical practice would be approximated as systolic brachial cuff pressure. Arterial elastance (Ea) was defined as the absolute slope of the line from volume axis interception at end-diastolic volume to the point on the PV-loop in the upper left quadrant with the longest normalized distance from the loop center. Recordings were performed at baseline and during aortic constriction.

Results
Panel A in Figure 2 illustrates how tightly non-invasive (dotted lines) followed invasive (solid lines) pressure-volume curves both during baseline (left) and aortic constriction (right) in a representative experiment. As can be seen, this resulted in very similar Ea. Panel B shows pooled data from all experiments, demonstrating that indeed, the non-invasive method captured similar changes in Ea during aortic constriction compared to the invasive method. Furthermore, as shown in panel C, there was an excellent correlation (r = 0.91, p &lt; 0.0001) and good agreement (mean difference 0.3, SD 0.3) between the non-invasive and invasive Ea.

Conclusions
Three-dimensional echocardiography provides an accurate and non-invasive method for assessing arterial elastance, with excellent agreement with gold standard invasive method.
Ultrasound crystals placement
Invasive vs non-invasive Ea