bluuebunny/crossref_metadata_2025_split huggingface dataset:
Descriptive analysis of portal vein flow variations in patients with tetralogy of Fallot
Authors: Lozano-Edo S , Calvo-Asensio M , Buendia-Fuentes F , Rodriguez-Serrano M , Osa-Saez A , Martinez-Dolz L , Rueda-Soriano J , Aguero J 
Published: January 2025

Abstract

Background and purpose
Patients with repaired Tetralogy of Fallot (TOF) develop significant pulmonary regurgitation (PR) as a main sequel in the adulthood, leading to right ventricular (RV) dilatation and dysfunction.
Our objective was to evaluate in adult patients with repaired TOF, the differences in portal venous flow pulsatility (PVFP) compared to controls without structural heart disease, and the relationship between PVFP with the severity of PR and tricuspid regurgitation (TR), as well as parameters of right chamber remodeling and inferior vena cava (IVC) dilation.

Methods
Single center, observational study. Sixty-seven patients with repaired TOF (prosthetic pulmonary valve: n=27) were included. TOF patients were compared with a control group (n=74). PVFP was assessed using maximum (Vmax) and minimum (Vmin) Doppler velocities in portal vein flow: (Vmax-Vmin)/Vmax.

Results
There were no differences in age and sex between the two groups. A higher PVFP was observed in the group of patients with TOF compared to the control group (0.4 vs 0.22, p &lt; 0.001; Figure 1A). Pulmonary valve intervention in adulthood was non-significantly associated with an increase in PVFP (intervention vs no intervention 0.46 vs 0.37, p=0.1, Figure 1B).
Regarding PR severity, we observed that the 33 patients with severe PR showed a trend to higher PVFP values in relation to patients with moderate PI (n=5); 0.37 vs 0.26, p=0.06 (Figure 1C). No relationship was observed between PVFP and the severity of TR: absence of TR (n=9) 0.36, mild TR (n=49) 0.41, moderate TR (n=7) 0.45, severe TR (n=2) 0.43, p=0.84 (Figure 1D).
In patients with TOF, PVFP was not correlated with right atrial area (R=0.02), RV end-diastolic area (R=0.23), RV strain (R=0.36), or with IVC dimensions (R=-0.1).

Conclusions
In this descriptive study, we identified an altered pattern of portal venous flow in patients with repaired TOF compared to subjects without structural heart disease. This increase in PVFP did not show an evident association with right valvular heart disease associated with TOF, nor with other markers of volume overload, suggesting the influence of multiple determining factors and a potential incremental value over standard measurements in these patients.
The efficacy of party balloon inflation maneuver to detect masked patent foramen ovale
Authors: Horita R , Kasai Y , Otake R , Shitan H , Hachinohe D , Fujita T 
Published: January 2025

Abstract

Background
The efficacy of transcatheter closure for patent foramen ovale (PFO) , which is considered a cause of cerebral infarction, has been reported. PFO often becomes apparent only during the Valsalva maneuver, making its diagnosis sometimes challenging. As a method to overcome inadequate Valsalva maneuvers, cases using the party balloon inflation maneuver have been reported. However, there are no verified reports on its actual effectiveness in daily clinical practice.

Purpose
To investigate the efficacy of party balloon inflation maneuver for revealing " masked " PFO.

Methods
We conducted a retrospective study to evaluate the efficacy of party balloon inflation maneuver during microbubble test transthoracic echocardiography in our hospital cases, which were diagnosed with embolic stroke of undetermined source and underwent the microbubble test with party balloon maneuver inflation between June 2023 and June 2024.

Results
A total of 74 patients（age 67 ± 15 years, 41 female) underwent microbubble test with party balloon inflation maneuver and were included. The average Rope score was 3.4 ± 1.9 because of high average age of patients.
The party balloon inflation maneuver increased the grade of right to left shunt in 12 cases, leading to a diagnosis of a large right-to-left shunt.
Moreover, the diagnosis rate of PFO and presence of the Eustachian valve with party balloon inflation maneuver were significantly higher than the conventional Valsalva maneuver with abdominal compression (diagnosis rate: 83.3 % vs 32.2 % ; p &lt; 0.01 , Eustachian valve: 50.0 % vs 16.1 % ; p &lt; 0.01) , but the rate of atrial septum aneurism was equivalent (17.7 % vs 25.0 % ; p = 0.69).

Conclusions
The party balloon inflation maneuver is an effective and excellent method to reveal " masked " PFO in dairy clinical practice.
Complications in transesophageal echocardiography: a prospective observational study.
Authors: Spinka F , Sokour S , Dreger H , Morris D A , Schneider-Reigbert M 
Published: January 2025

Abstract

Background
Transesophageal echocardiography (TEE) is a routine examination that serves to answer various clinical questions. Due to the nature of the procedure, mechanical complications of the probe as well as complications due to administered sedation are rare but possible. Previous investigations have particularly focused on complications in long-lasting intraoperative TEE and TEE in critically ill patients in the intensive care setting. Little data exists on complications of TEE in non-critically ill patients.

Methods
From January until Juli 2024, consecutive patients with indication for TEE were included at our tertiary university center for this prospective observational study. Critically ill patients were not included. The patients were divided into a high-risk cohort (received oral anticoagulation on the day of the procedure, known esophageal varices) and a low-riskcohort (all other patients). A questionnaire investigating complications was performed via telephone interview 1-4 weeks after the examination.

Results
A total of 101 patients (54% male) with a mean age of 66 years (range 26-86) were included in this preliminary analysis. Most common indication for TEE was to exclude intracardiac thrombi before ablation therapy (32%) or cardioversion (18%), evaluation of valvular heart disease (32%), search for source of embolism (9%), and suspicion for endocarditis (6%).Mean time of examination was 5 minutes and 49 seconds. Sixty-four patients (63%) were in the low-risk cohort, thirty-two patients (32%) were in the high-risk cohort. No major complications occurred. A total of 25% of patients reported slight discomfort of the throat lasting for 1-2 days. A total of 11% reported bloody tinged sputum and/or coughing for 1-2 days. Two patients consulted their general practitioner due to these symptoms.

Conclusion
No serious complication occurred in this prospective investigation. However, discomfort of the throat for a few days after examination was frequent and even resulted in further medical consultations at the general practitioner. This needs to be addressed in the pre-examination consultation.
Left atrial and ventricular deformation coupling in mitral regurgitation
Authors: Verbeke J , Kamoen V , De Buyzere M , Claessens T , Timmermans F 
Published: January 2025

Abstract

Aims
This study aimed to evaluate left atrial (LA) and left ventricular (LV) deformation coupling in patients with degenerative (DMR) and functional mitral regurgitation (FMR). For this purpose, we analyzed the effect of MR on the relationship between LA and LV global longitudinal strain (GLS) independent of LA and LV geometry.

Methods and Results
The investigation was conducted in two patient cohorts. Cohort A included 60 patients with severe MR (30 with DMR and 30 with FMR), compared to 30 healthy controls. Cohort B comprised 60 patients (30 with mild MR and 30 with severe MR) matched for LA and LV volumes and ejection fraction. Using speckle tracking-based strain imaging, simultaneous LA and LV deformation was assessed. LA GLS was more impaired than LV GLS in severe MR, with increased area and decreased slope of the LA-LV strain-strain loop, but these findings were no longer present when correcting for LA and LV volumes and ejection fraction.

Conclusion
Our findings indicate that the LV-LA deformation coupling in MR is mainly driven by chamber dimensions and (the forces driving the) displacement of the mitral annular plane, rather than the regurgitant volume load itself. Despite the presence of severe MR, the relationship between LA and LV strain is maintained, emphasizing the need for interpreting LA GLS in the context of both LV GLS and the geometrical properties of the chambers.
Graphical abstract
Reverse structural and functional left atrial remodeling after successful catheter ablation for paroxysmal atrial fibrillation.
Authors: Uzieblo-Zyczkowska B , Kiliszek Marek M K , Potapowicz Krysztofiak Magdalena M P K , Maciorowska Malgorzata M M , Krzyzanowski Krystian K K , Krzesinski Pawel P K 
Published: January 2025

Abstract

Background
Catheter ablation is considered the most effective method for restoring sinus rhythm in patients with atrial fibrillation (AF). However, data on the reverse structural and functional remodeling of the left atrium (LA) after a successful procedure are still inconclusive, especially in patients with sinus rhythm during catheter ablation. The aim of the present study was to investigate echocardiographic parameters indicating the presence of reverse LA remodeling, following a successful procedure and long-term follow-up of sinus rhythm maintenance.

Methods
Of the 106 patients who had undergone successful catheter ablation (between January 2021 and May 2023) for paroxysmal AF (with sinus rhythm on echocardiography during ablation), 49 patients were included in the study up to now. The absence of AF recurrence was assessed during a follow-up consisting of outpatient visits/televisits and 7-day Holter monitoring (at 6 and 12 months after ablation). All patients underwent conventional and 2D speckle tracking echocardiography on the day of ablation and after the long-term of follow-up period of maintanance of sinus rhythm.

Results
A total of 48 patients were included in the study. The mean age of the study population was 60±11 years, of which 62.5% were male. The follow-up period was 17 ± 4month. A significant increase in LA reservoir strain (LASr) (median 23 vs. 25%, p&lt;0.001) and e’ average (median 7.5 vs. 8.5 cm/s, p=0.02) was noted from baseline to follow-up. LA stiffness index (defined as E/e’average/LASr ratio) (median 0.33 vs. 0.28, p=0.001), LA area (median 23.8 vs. 22.1cm2, p=0.003) and LA volume index (median 35.9 vs. 32.9ml/m2, p&lt;0.001) showed significant reduction over the same time period. In addition, left ventricular (LV) end-diastolic diameter, indexed LV mass index and right atrial area, decreased significantly (51 vs. 49 mm, p&lt;0.001; 123 vs. 109g/m2, p&lt;0.001, 17.2 vs. 15.5cm2, p=0.02, respectively). Left ventricular function parameters, such as LV ejection fraction or global LV longitudinal strain, remained unchanged.

Conclusions
During the long-term follow-up period after restoration and maintenance of sinus rhythm following catheter ablation for AF, both structural and functional echocardiographic parameters of the LA improved. Our preliminary results also suggest the possibility of reverse structural LV and RA remodeling after successful AF treatment.
Exploring the inter-vendor variability of GLS: a myocardial deformation analysis on a cohort of healthy volunteers.
Authors: Ciaramella P , Ciuffreda A , Monosilio S , Netti L , Paladino V , Rubino G , Angotti D , Galea N , Marchitelli L , Cimino S , Vizza D C , Maestrini V 
Published: January 2025

Abstract

Background
Global longitudinal strain (GLS) by Speckle-tracking Echocardiography (STE) has emerged as the most sensitive marker of myocardial function with a prognostic value in many cardiac diseases. GLS could also be calculated by cardiac magnetic resonance (CMR) which is the gold standard method for LV morph functional evaluation, applying the feature-tracking (FT) technique. However, there are still difficulties related to the lack of interchangeability between STE and FT techniques and the inter-vendor variability of myocardial deformation parameters.

Aim
To assess the variability of transmural GLS measurements using different analysis software packages from three different specific vendors (Echo 1-2-3) and to compare the variability of endocardial GLS measurements using an independent vendor software between cine-loops obtained by three different echo machines and CMR.

Methods
We enrolled 50 healthy volunteers (age 29 ± 3 years, males 60%, BSA 1.7±0.2 m2) without cardiovascular risk factors. All the subjects were in sinus rhythm (HR 69 ± 12 bpm) and had a good acoustic window. Each volunteer underwent an echocardiographic study on three different echo machines on the same day (Echo 1, Echo 2, Echo3). Over the course of a week, 11 patients also underwent a CRM without contrast administration. The images were acquired on each echo machine by an expert operator. All transmural GLS measurements were performed by a single observer using the dedicated post-processing software package of the respective vendor that were based on a semi-automatic method with possible manual adjustments by the operator. The same operator analyzed the cine-loops obtained from the three echo machines and CMR with an independent software which performed the analysis of STE/FT parameters with a semi-automatic method. The following parameters were obtained: left ventricular (LV) Circumferential Global Strain (GCS), GLS, EF, end-diastolic volume (EDV) and end-systolic volume (ESV).

Results
Comparing the parameters obtained by the three specific software vendors of the echo machines, there were no statistically significant differences in transmural GLS values (p=0.313); (Picture 1). Comparing the parameters obtained by an independent software vendor, there were no statistically significant differences between the endocardial GLS, GCS and EF computed by the software (respectively p=0.290, p=0.655 and p=0.51; (Table 1).

Conclusions
In clinical practice, transmural GLS do not differ using specific vendor software of different echo machines on a cohort of healthy volunteers. At the same time, endocardial GLS, GCS and EF values calculated by an independent multivendor software using echo cine-loops of three different echo machines do not differ between them and from CMR-FT obtained GLS and GCS values.
Picture 1 Table 1
Performance of fully automated AI-based left ventricular strain measurement in cancer patients treated with immune checkpoint inhibitors
Authors: Tzuberi M , Laufer-Perl M , Merin R , Khoury S , Ben-Shoshan J , Kapusta L , Topilsky Y , Flint N 
Published: January 2025

Abstract

Background
Immune checkpoint inhibitors (ICIs) have improved clinical outcomes for various types of cancer. However, their use is associated with cardiotoxicity. Left ventricular global longitudinal strain (LV-GLS) is considered the standard of care for detecting early myocardial damage in patients treated with anti-cancer drugs. However, the routine use of LV-GLS is limited by its time-consuming nature, and the need for expert cardiologists. AI-based LV-GLS applications may offer a cost-effective alternative to conventional methods.

Purpose
To compare standard, semi-automated LV-GLS analysis to a fully-automated AI-based LV-GLS software, and to evaluate its performance in predicting cardiovascular (CV) events in patients treated with ICIs.

Methods
We retrospectively analyzed consecutive cancer patients who underwent baseline transthoracic echocardiography before the initiation ICIs therapy. All echocardiographic studies were performed by experienced sonographers. LV-GLS analysis was conducted using both standard semi-automated, vendor-independent software (TomTec) and fully-automated AI-based software (Us2.AI). CV events were defined as a composite of myocarditis, acute coronary syndrome, heart failure and arrhythmia. We examined the correlation between the two techniques and their ability to predict future CV events using logistic regression and receiver operating characteristic (ROC) curves. For simplicity, we report LV-GLS as a positive value.

Results
Out of 183 patients (mean age 65±12 years, 43% females) who underwent echocardiography assessment, 157 (86%) had adequate image quality for strain analysis. During a median follow up period of 48 months (IQR: 34-61), 23 (13%) patients experienced CV events. A significant difference was observed between the baseline mean standard LV-GLS and AI-based LV-GLS (18±2.9 vs. 20±2.9, P&lt;0.001), with a moderate positive correlation between the two techniques (r=0.38, P&lt;0.001). Lower standard LV-GLS was predictive of CV events (OR = 0.83, 95% CI 0.71-0.98, P=0.03), whereas AI-based LV-GLS did not (OR = 0.96, 95% CI 0.82-1.14, P=0.686). In ROC analysis, standard LV-GLS showed superior area under the curve compared to AI-based measurements, but the difference was not statistically significant (AUC 0.62 vs. 0.53, P=0.275).

Conclusions
Among cancer patients treated with ICIs, fully automated AI-based LV-GLS provided higher values compared to standard, semi-automated LV-GLS, with a moderate correlation between the two techniques. Only standard LV-GLS was predictive of future CV events. Further validation and specific cut-offs are required to enhance the predictive accuracy of AI-based LV-GLS.
Correlation between atrial strain and outcome in brugada syndrome
Authors: Diomede D , Conte G , Santoro F , Bergonti M , Ragnatela I , D'alessandro D , Niglio F P , Margaglione A , Leo L A 
Published: January 2025

Abstract

Introduction
Brugada Syndrome (BrS) is an hereditary channelopathy which can induce malignant arrhythmias that may lead to syncope or sudden cardiac death. The electrical substrate can be studied with an electrophysiological study in order to assess the risk of ventricular arrhythmias, but the role of echocardiography in this setting is still unclear.

Purpose
The primary aim of this study is to assess peculiar echocardiographic features in BrS patients vs healthy controls and their correlation with an high risk clinical setting.

Methods
We enrolled 153 patients affected by BrS (95 outpatients from Institute Cardiocentro Ticino of Lugano, and 58 outpatients from the arrhythmology clinic of Ospedali Riuniti of Foggia). The control group was composed of 57 healthy subjects with a negative provocative drug test. 100 out of the 153 affected patients have received a genetic testing for BrS associated genes. All patients have undergone a complete cardiologic examination, EKG, and echocardiography. The gathered data comprehend medical history, basal EKG, Shangai Score, clinical evaluation, genetic test, response to provocative test, 24-hrs holter EKG and ecocardiographic parameters: chambers quantification, ejection fraction, transmitralic doppler parameters, right ventricle function parameters, and longitudinal strain values.

Results
Atrial fibrillation (AF) was reported in 16 out of 153 (10.5%) BrS patients and in 2 out of 57 (3.5%) healthy controls. Among BrS patients, 15 (9.8%) reported major ventricular arrhythmias (VA). The analysis showed a significant divergence in BrS patients compared to healthy controls with regard to the following measurements: RAVI (23.8 ± 6.6 vs 20.7 ± 6.7); E/A (1.2 ± 0.4 vs 1.6 ±0.6); A wave (64.6 ± 18.7 vs 53.4 ± 16.9); DTE (215.4 ± 49.7 vs 190.4 ± 43.5); LASr-ED (44.5 ± 12.6 vs 50.8 ± 13.8); LAScd-ED (-27.5 ± 10.7 vs -33.8 ± 11.4); RASr-ED (39.5 ± 10.6 vs 47.9 ± 9.5); RAScd-ED ( -25.1 ± 8.7 vs -31.9 ± 8.3). Among BrS patients, at the univariate analysis the onset of atrial fibrillation was correlated to the following parameters: LAVI (p 0.001); RAVI (p 0.015); LASr-ED (p 0.013); LASct-ED (p 0.029). LAVI was also correlated to atrial fibrillation at the multivariate analysis (p 0.02). Ventricular arrhythmic episodes were correlated, among BrS patients, to RASct-ED (p 0.004) and LV-GLS (p 0.042) at the univariate analysis. RASct-ED was also correlated to ventricular arrhythmias at the multivariate analysis (p 0.011) and could predict VAs with a cut-off value of -10.85% (sensibility 0.75; specificity 0.79).

Conclusions
When compared to healthy controls, atrial reservoir and conduit phase are altered in BrS for both left and right atrium. AF episodes are correlated with atrial volumes and LA strain. VA episodes correlate with RASct-ED, which may be helpful as a prediction parameter (cut-off -10.85%). These features could help to better stratify high risk patients.
Left atrial mechanics and left ventricular function in cardiac amyloidosis patients treated with tafamidis
Authors: Carvalheiro R , Marques Antunes M , Cardoso I , Ferreira A , Viegas J , Bras P , Almeida I , Galrinho A , Cruz Ferreira R , Aguiar Rosa S 
Published: January 2025

Abstract

Introduction and aims
Patients with amyloid cardiomyopathy (ATTR-CM) present with a restrictive phenotype characterized by decreased ventricular compliance and increased filling pressures, with progressive loss of atrial function and increased stiffness, which are associated with poor clinical outcomes. Tafamidis improves clinical outcomes and slows disease progression but its effects in left ventricle (LV) and atrium (LA) mechanics are still unclear, with recent studies (reference 1.) suggesting improvement of LA function (as assesses by LA strain [LAS]) in patients with sinus rythm (SR). Our study aimed to characterize the 1-year evolution of LV function and LA mechanics in ATTR-CM patients treated with tafamidis.

Methods
We prospectively evaluated a cohort of patients with ATTR-CM treated with tafamidis in a single-centre.

Results
Out of 41 patients treated, 13 were excluded due to incomplete follow-up or poor quality of echocardiographic images that precluded LAS analysis. A total of 28 patients (75% male) were included, with a mean age of 80 ± 10 years at the start of treatment and a median follow up of 14 months. 11 pts (39%) were in sinus rhythm (SR group) and 17 (61%) were not (non-SR group). At the start of the treatment with tafamidis, mean LV ejection fraction (LVEF) was 55.5 ± 11.4%, GLS was -10.7 ± 4.3%, E/e’ 17.2 ± 5.4 and indexed LA volume (LAVi) 47.4 ± 15.3 mL/m2. Median NTproBNP was 2031 (3143) pg/mL and pts walked 313 ± 121m on the 6-minute walk test (6MWT). Regarding LAS, there was significant reduction in all atrial functional components in both SR (LAS reservoir 13.1 ± 12, LAS conduit -6.5 ± 4.2, LA contraction -6.6 ± 3.6) and non-SR groups (LAS reservoir 5.1 ± 3.6) as well as significantly increased LA stiffness (SR – 1.4 ± 0.9, non-SR – 6.1 ±6.0). Our analysis showed stabilization, with no statistically significant differences in LVEF, GLS, diastolic function parameters, LAS or LA stiffness, as well as NTproBNP and 6MWT after 1-year treatment with tafamidis (tables 1 and 2). We found a moderate correlation between LAS contraction and NTproBNP in the SR group (r=0.650, p=0.031) – meaning that worse (less negative) LAS contraction associated with higher NTproBNP values – despite there being no correlation between other echocardiographic variables ante NTproBNP or 6MWT.

Conclusions
In our cohort of patients, patients presented with significantly reduced atrial function and increased stiffness. 12-month treatment with tafamidis allowed stabilization of LA and LV performance, as well as of NTproBNP and 6MWT. We found a moderate correlation between LA contraction objectively evaluated by strain analysis and NTproBNP in SR patients, highlighting the importance of LA mechanical contraction preservation in patients with a restrictive cardiomyopathy phenotype.