bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unfavorable systemic and coronary hemodynamic profile of left ventricular hypercontractile phenotype in hypertrophic cardiomyopathy
Authors: Wierzbowska-Drabik K , Palinkas E D , D'alfonso M G , Mori F , Del Franco A M , Peteiro Vazquez J , Tesic M , Djordjevic-Dikic A , Re F , Palinkas A , Aguiar Rosa S , Ciampi Q , Pellikka P , Olivotto I , Picano E 
Published: January 2025

Abstract

Background
The left ventricular (LV) hypercontractile phenotype (HP) plays a critical role in hypertrophic cardiomyopathy (HCM) and is usually identified with the left ventricular outflow tract gradient (LVOTG).

Purpose
To assess the systemic and coronary hemodynamic profile associated with HP identified with increased LV elastance (also known as force) at rest in patients with HCM.

Methods
We enrolled 1248 HCM patients (age 50 ± 15 years, 798 males, 64%) with ejection fraction (EF) ≥50%, referred for rest transthoracic echocardiography (TTE) in 14 quality-controlled sites from 7 countries TTE assessment included LVOTG, EF, and LV force (systolic blood pressure + LVOTG/LV end-systolic volume, mmHg/mL). Volumetric echocardiography with Simpson’s method was used to measure EF from end-diastolic volume (EDV) and end-systolic volume (ESV), stroke volume (SV), arterial elastance (AE) and ventricular-arterial coupling (VAC). We also assessed resting peak diastolic coronary flow velocity (D-CFV) in the mid-distal left anterior descending artery in a subset of 275 patients.

Results
EF equaled 68 ± 7%, force = 6.8 ± 5.3 mmHg/ml and LVOTG = 22 ± 28 mmHg. HP was identified as the highest quartile of force (&gt; 7.85 mmHg/ml, mean value= 13.3 ± 7.0). HP showed the lowest SV (46 ± 18 ml) and EDV (61 ± 20 ml), with the highest AE (3.19 ± 1.35 mmHg/ml) and VAC (3.46 ± 1.59) compared to other quartiles (p&lt;0.001) ( see Picture) . D-CFV was not higher in patients with HP (n = 65) compared to those (n = 210) without HP (41± 11 vs 38 ± 14 cm/s, p=ns, but higher in comparison to joint first and second Force quartile (n=122) vs 37 ±14 p =0.0472). Table displays the demografic, clinical and TTE parameters related to HP (Table). In multivariate logistic analysis 4 independent predictors of HP were identified: SBP &gt;130 mmHg with OR 2.5, female sex with OR 5.4, LV EF &gt;70% with OR 6.1 and LVOTG &gt;30 mmHg with the highest OR = 6.3. Conclusion: HCM patients with HP exhibit a distinctive systemic hemodynamic and coronary physiology profile, characterized by low SV, high VAC, and supranormal baseline D-CFV compared to non-HP patients. These findings suggest reduced cardiovascular efficiency and increased myocardial oxygen demand, possibly detrimental over time.
Aorto-mitral angle: an emerging indicator for successful alcohol septal ablation in hypertrophic obstructive cardiomyopathy - a pilot study
Authors: Sosdean R , Pascalau L , Mircea M , Pescariu S A , Voinescu O , Lazar M A , Sturza A , Ionac A , Luca C T , Mornos C 
Published: January 2025

Abstract

Background
Approximately 10-20% of patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing alcohol septal ablation (ASA) exhibit a suboptimal response, despite accurate targeting of the septal artery. This suboptimal response may be due to structural and functional factors related to the mitral valve and left ventricular (LV) dimensions. Currently, there is a lack of specific parameters or cutoffs to predict ASA success. The aorto-mitral angle is crucial for predicting systolic anterior motion (SAM) in mitral valve repair surgery, but its relationship with ASA outcomes remains underexplored.

Purpose
This study aims to investigate the relationship between aorto-mitral angle values and the success of alcohol septal ablation, and to assess the impact of this parameter on ASA outcomes.

Methods
The study retrospectively included 23 HOCM patients who underwent ASA in our clinic, with data collected from thorough evaluations conducted before and at least six months after the procedure. The left ventricular outflow tract pressure gradient (LVOT PG) and other standard parameters were measured using transthoracic echocardiography. The aorto-mitral angle was assessed through three-dimensional data acquisition during transoesophageal echocardiography, analyzed offline using specific software (zoom 3D of the mitral valve, MVQ).

Results
Nineteen patients experienced successful ASA, defined as a &gt;50% reduction in LVOT PG compared to baseline, while four patients had suboptimal results. There were no significant differences in baseline LV dimensions, LVOT PG, age, or comorbidities between the groups. The aorto-mitral angle was significantly higher in patients with successful ASA (138.21 ± 7.6 versus 115 ± 9.2 degrees, p&lt;0.001). This angle correlated with the percentage decrease in LVOT PG (R = 0.59, p = 0.02), though the correlation with the absolute decrease was not statistically significant (R = 0.38, p = 0.06). After further validation, the aorto-mitral angle may be useful for predicting ASA success (logistic regression odds ratio 1.37, 95% confidence interval (1.01, 1.86), p = 0.04). Additionally, significant differences were found between redundant anterior mitral leaflet (AML) length, anterior displacement of the coaptation point, and ASA success in this cohort (p = 0.04 for both).

Conclusion
The aorto-mitral angle appears to play a role in the obstruction mechanism of HOCM and could serve as a valuable predictor for ASA success. These findings may prompt further investigation and potential inclusion of this parameter in a prediction model alongside other mitral valve and LV size parameters.
Influence of ROI width in evaluation of regional and global longitudinal strain in patients with hypertrophic cardiomyopathy
Authors: Matsutani H , Izumi C , Amano M , Sakai Y , Kuwano K , Shimada M , Kamioka M , Miyake M 
Published: January 2025

Abstract

Background
Longitudinal strain (LS) is useful in evaluating global and regional left ventricular function in patients with hypertrophic cardiomyopathy (HCM), but it is not fully investigated the influence of the ROI width on LS value in patients showing localized or asymmetrical hypertrophy.

Purpose
The purpose of this study is to evaluate regional and global LS in patients with HCM showing localized or asymmetrical hypertrophy, compared with hypertensive patients with diffuse and symmetrical hypertrophy as control, and to clarify the influence of ROI width on LS value.

Methods
We retrospectively investigated LS in patients with apical hypertrophy (APH), asymmetrical septal hypertrophy (ASH) and hypertension (control group). LS in hypertrophic region (APH: apical 6 segments, ASH: basal and mid septal 4 segments) and global LS (GLS) were compared with control group. LS was measured with uniform ROI width by default (D method) and after manual adjustment of ROI width as covering the whole thickness in the hypertrophic region (A method) (Figure).

Results
LS in hypertrophic region was decreased in patients with APH and ASH compared with control group. LS was decreased in A method than D method in patients with APH (Table).

Conclusions
We should consider the setting of ROI width in evaluating regional myocardial systolic function by LS in patients with HCM showing localized or asymmetrical hypertrophy.
Figure
Sarcomere gene mutations leading to lower myocardial work values in hypertrophic cardiomyopathy
Authors: Takacs H , Racz G , Nagy V , Boda K , Vidacs D , Csanyi B , Hategan L , Borbas J , Kormanyos A , Polestyuk B , Schvartz N , Szili-Torok T , Sepp R 
Published: January 2025

Abstract

Background
Sarcomere gene mutations is hypertrophic cardiomyopathy (HCM) can have prognostic value and role in risk assessment, according to numerous studies. In our previous investigations, we confirmed that echocardiographic parameters of left ventricular (LV) myocardial work (MW) derived from the non-invasive pressure-strain curve were reduced in patients with HCM, especially in the case of clinical features with advanced disease. The aim of our present work was to investigate the MW parameters in genotyped HCM patients.

Patients and Methods
We examined 75 genotyped HCM patients [48 men (64%), age 51±12 years], who underwent standard and 2D-speckle tracking echocardiography. The patients were divided into sarcomere mutation positive (P/LP+, n=32) and mutation negative (P/LP-, n=43) groups based on carrying a pathogenic/probably pathogenic (P/LP) sarcomere gene variant. Later we extended our examination to patients with variants of unknown significance (VUS).

Results
There was no significant difference between the demographic (age, gender, BMI, BSA) and laboratory (troponin T, NTproBNP) parameters of the P/LP+ and P/ LP- groups. Also, no significant difference was found in most echocardiographic parameters (LAV, LAVI, LVmax, EF, SV, SV index, TAPSE) between the two groups, except that the proportion of obstructive patients was higher in the P/LP group (p=0.026) and the resting (p= 0.004) and provoked (p=0.0082) LVOT gradients were higher. Despite of no difference in the GLS value in the two groups (p=0.850), the P/LP+ group had lower global work index [GWI: p=0.0035), global constructive work (GCW: p=0.0006), and global wasted work (GWW: p=0.0098), while global work efficiency (GWE: p=0.485) did not differ. The differences remained even when patients carrying variants of unknown significance (VUS+) were examined in a separate group (GWI: p=0.013; GCW: p=0.001; GWW: p=0.005).

Summary
These results indicate that the pathological gene mutation underlying HCM, leads to lower myocardial work values, even with a similar morphological or functional appearance. The latter observation further confirms the possible role of MW parameters in the prognosis of HCM.
a comparative study to evaluate radiation exposure in patent ductus arteriosus device closure by conventional method and echocardiography guided method- an experience from eastern India
Authors: Ghosh S , Majumdar I S H I T A 
Published: January 2025

Abstract

Background
PDA constitutes 5-10% of all congenital heart defects, with a prevalence of symptomatic PDA being 0.5/1000 live births. Percutaneous PDA device closure has the advantage of early discharge and less anesthesia - related complications. However, during the procedure, the operators and patients are exposed to radiation. Use of transthoracic echocardiogram (TTE) for imaging during trans-catheter PDA closure reduces the dose of radiation, complications related to femoral arterial access and procedural time. In our institution we planned to compare the radiation exposure and procedural time of PDA device closure by transthoracic echocardiography with the use of minimal fluoroscopy(case) compared to conventional method(control) in pediatric patients.

Purpose
i)To compare the radiation exposure and procedural time of PDA device closure by transthoracic echocardiography with the use of minimal fluoroscopy(case) to conventional technique(control) in a tertiary care hospital.
ii) To compare the complications between the two groups.

Methods
This was a single-centre prospective randomized case control study. Children between 6 months -12 years with an indication for percutaneous PDA device closure were selected after concsent. A six month post-operative follow up was planned. 106 patients were included in the study from July 2018 to January 2020. The first patient was selected through lottery who underwent the procedure under echocardiographic guidance with minimal fluoroscopy use and thereby every alternate patient was selected as case (n=51). 51 patients underwent closure following the conventional method(control). Each group were selected with comparable age group and other characteristics. 4 patients in the case arm had to undergo aortogram, so excluded from the study.

Results
Patients were equally distributed in both groups. There was statistically significant difference in the procedural time, fluoroscopy time and radiation dose in terms of total kerma, dose area product and dose area product/kg among the two groups, all of them were lower in the echocardiography group compared to fluoroscopy group.The least fluoroscopy time, radiation exposure and procedural time in the echocardiography group were 43 seconds, 1mGy, 20minutes respectively.

Conclusion
In both the groups the patient characteristics, defect size and device used was comparable. The fluoroscopy group had a single case of groin hematoma, managed conservatively. Fluoroscopy time, procedural time and amount of radiation exposure in TTE guided group was significantly less than the control group. In echocardiography group, no contrast was used and all the possible arterial access related complications were easily prevented. Above results show that it is safe and feasible to perform PDA device closure with TTE-guided percutaneous PDA occlusion as compared to conventional method with minimal fluoroscopy exposure.
Marantic endocarditis in patients with malignant disease and stroke: a prospective, observational study.
Authors: Frydas A , Zach V , Schoels M N , Rakhimov K , Schmidt W U H , Kemna C P , Pfaefflin F , Doehner W , Dreger H , Morris D A , Schneider-Reigbert M 
Published: January 2025

Abstract

Background
Non-bacterial thrombotic "marantic" endocarditis (NBTE) is characterized by sterile platelet–fibrin vegetations on normal cardiac valves in patients with malignant disease. Common complications of the disease include cerebrovascular or systemic thromboembolism. Systematic prospective data on this disease is missing. We sought to prospectively investigate prevalence and outcome of marantic endocarditis in patients with active malignancy who present with stroke.

Methods
At our tertiary university center, we prospectively included all patients from 12/2023 to 06/2024 who were admitted with stroke and had active malignant disease. All patients received transthoracic and, if indicated and tolerated, transesophageal echocardiography. Comprehensive interdisciplinary work-up of neurology, infectious diseases, hematology/oncology, and cardiology was performed.

Results
For this preliminary analysis, a total of 8 patients were included. The median age was 62 years, 6 were female. The underlying malignant diseases included carcinoma of the ovaries in two patients, and melanoma, lung carcinoma, breast carcinoma, oropharynx carcinoma, pancreatic carcinoma, carcinoma of the esophagogastric junction, acute myeloid leukemia, and carcinoma of the thyroid gland in one patient each. Three patients (37.5%) had NBTE: one involving the mitral valve, one involving the aortic valve, and one involving both the mitral and aortic valves. At the time of stroke, one of these patients was receiving anticoagulation therapy with apixaban, one with prophylactic doses of enoxaparin. Two of the patients with NBTE were switched to anticoagulation with low-molecular-weight heparin (LMWH) after the diagnosis of NBTE and one of them continued the anticoagulation therapy with apixaban. One patient was switched to rivaroxaban after the resolution of the lesions and showed a re-occurrence in the follow-up visit.

Conclusion
NBTE is common in patients who have active malignant disease and present with stroke which therefore must be included in the list of likely differential diagnoses. Consistent with previously published case reports, we observed another case where NBTE lesions resolved under LMWH therapy and originated and even reoccurred under NOAK therapy.
Low probability of pulmonary hypertension: a novel tricuspid regurgitation velocity threshold
Authors: Sciarrone P , Giannoni A , Santi G , Savonitto G , Chubuchny V , Airo' E , Bauleo C , Monti S , Formichi B , Gentile F , Lund L , Passino C , Emdin M , Manouras A , Stolfo D 
Published: January 2025

Abstract

Background
The diagnosis of pulmonary hypertension (PH) relies on measuring pulmonary artery pressures at right heart catheterization (RHC). Echocardiographic tricuspid regurgitation velocity (TRV) is a screening tool to define PH probability. While latest guidelines reduced RHC threshold for PH diagnosis, TRV thresholds were not. We aimed to update TRV thresholds for PH probability according to the novel RHC criteria.

Methods
Patients undergoing RHC for suspected PH were prospectively enrolled. A retrospective cohort was used for external validation. All patients underwent echocardiography and RHC within 6-hours under stable conditions.

Results
In the derivation cohort (n=400), 85% of patients had PH at RHC. However, only 68% had intermediate or high PH probability with the conventional 280 cm/s TRV threshold (76% sensitivity, 24% false-negative rate). The optimal threshold for low probability was 250 cm/s, with higher sensitivity (90%, 10% false-negative rate). In the validation cohort (n=1,348), 76% of patients had PH. In this cohort, the proposed 250 cm/s low probability threshold was confirmed to hold high sensitivity (97%, 3% false-negative rate).

Conclusions
This large multicenter derivation-validation study supports lowering the TRV threshold from ≤280 to ≤250 cm/s to decrease false-negative rate and missing referral to RHC in patients with suspected PH.
Graphical abstract
Transcatheter treatment of severe mitral regurgitation in high surgical risk patients: analysis of clinical and echocardiographic data from a referral center
Authors: Pinheiro Junior J A , Galuban A C F , Pires C R T , Koroishi J H Y , Holanda L M , Guimaraes L F C , Abizaid A A C , Siqueira D A A 
Published: January 2025

Abstract

Introduction
Mitral regurgitation (MR) is the most common valvular heart disease, affecting 2-3% of the population, with a prevalence of around 10% in individuals over 75 years old. It is a frequent cause of decompensation in patients with heart failure (HF), associated with unfavorable clinical outcomes, including increased morbidity and mortality. Transcatheter mitral valve repair using an edge-to-edge mitral valve leaflet repair technique has become a therapeutic option for patients with severe MR who are considered high surgical risk. Transesophageal echocardiography (TEE) is crucial for determining eligibility, guiding the procedure, monitoring potential complications, and assessing the final result.

Objectives
To analyze data related to etiology (primary, secondary, and mixed), number of clips used, average age, severity of MR, and the final procedure outcome.

Methods
We conducted a descriptive analysis of a series of 43 cases of high surgical risk severe mitral regurgitation from 2019 to 2024 at a referral hospital in São Paulo, indicated for transcatheter treatment by a "heart team". We described the prevalence of etiologies, average age, pre-procedure MR severity, and final echocardiographic outcome. Continuous variables were described as mean and standard deviation.

Results
We analyzed 43 cases of transcatheter mitral valve implantation from 2019 to 2024. One patient died on the first day post-procedure. Of the total cases, 42% had primary MR, 38% secondary MR, and 20% mixed etiology. The average age of the patients was 79.8 years and the number of implanted clips was 1.62 ± 0.72, considering all the cases. A decrease in the average number of clips implanted is observed When analyzed separately by year: in 2019, na average of 2.3±1, and in 2023/2024, 1.8±0.7. All procedures were performed in a catheterization or hybrid room, guided by TEE with the addition of three-dimensional technology. Using a grading scale for MR from mild (1+) to severe (4+), evaluated by TEE, the average after clip implantation was 1.27 ± 0.59. Regarding the mean gradient, the average post-procedure was 3 ± 1.2 mmHg.

Conclusion
The use of the transcatheter mitral valve implantation, following anatomical criteria for mitral valve selection, proved to be an effective and safe therapeutic option for reducing MR in high-risk patients. TEE is an essential tool in patient eligibility, guiding the procedure, evaluating the final result, and identifying potential complications.
The patient's perspective on transesophageal echocardiography - a prospective observational study.
Authors: Sokour A , Spinka F , Schulz M , Dreger H , Morris D A , Schneider-Reigbert M 
Published: January 2025

Abstract

Background
Transesophageal echocardiography (TEE) is a common methodology regularly performed in every echocardiography laboratory. Naturally, the procedure requires inserting the probe into the patient’s esophagus, which can cause worries about the examination. We sought to prospectively investigate how patients feel who are referred for TEE.

Methods
From January until Juli 2024, consecutive patients with indication for TEE were included at our tertiary center for this prospective observational study. Critically ill patients were not included. A questionnaire investigating anxiety and previous TEE experiences was performed before 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%).
Sixty-three patients (62%) had had previous TEE examinations, 83% under sedation. Good past experiences were reported by 71% of those who had been sedated, compared to 64% who had received TEE without sedation. Forty-two patients expressed worries before the procedure, mainly about gagging (n=12), sore throat (n=6), sedation effects (n=7), and death or respiratory arrest (n=5).

Conclusion
In echocardiography, TEE is a common, quick, and low-risk procedure which adds incremental information in numerous diseases. With our data we discovered that patients who are referred for TEE express a diverse range of worries before the examination. Satisfaction with previous examinations was moderate, both in those who had and who had not received sedation. This needs to be addressed by thorough consultation before the procedure, and a calm and professional atmosphere in the examination room.
Impact of obesity when associated with gestational diabetes on fetus heart
Authors: Zairi I , El Bardi M , Msaad H , Echaieb W , Bouzidi H , Mzoughi K , Kraiem S 
Published: January 2025

Abstract

Background
Obesity increases the metabolic effect of diabetes, which has a teratogenic impact on the fetus, including the heart. The aim of this study was to investigate the impact of obesity, when associated with gestational diabetes mellitus (GDM), on fetus’s heart systolic function using conventional fetal echocardiography and speckle-tracking technique.

Methods
This was a prospective mono-centric study. Standard fetal echocardiography and speckle-tracking technique were performed in 43 fetuses of mothers with GDM. Two groups were later compared: fetuses of non-obese women with GDM(G1)(n=25) and those of obese women with GDM(G2)(n=18).

Results
There was no significant difference between the two groups regarding mitral and tricuspid annular plane systolic excursion MAPSE(p=0,757) and TAPSE(p=0,554) or left ventricular ejection fraction(p=0,138). On the other hand, fetuses of women with GDM had a lower left ventricle global longitudinal strain (LV-GLS) (p=0,014; G1:-20,03 ± 0,94%, G2: -19,42 ± 1,08% )

Conclusion
Our study suggests that the association of obesity and GDM may increase fetus’s systolic function impairment demonstrated by using speckle-tracking technique.