bluuebunny/crossref_metadata_2025_split huggingface dataset:
Usefulness of left atrial strain in detection of left ventricular diastolic dysfunction in patients with first acute myocardial infarction.
Authors: Sikora-Frac M , Pilichowska-Paszkiet E , Smarz K , Maciejewski P , Kokowicz P , Przadka M , Budaj A , Zaborska B 
Published: January 2025

Abstract

Background
Left ventricular (LV) diastolic function is an important prognostic marker in acute myocardial infarction (AMI) but detection and classification of the dysfunction grade remains still difficult. The 2021 EACVI document provides recommendations on how to use left atrial (LA) strain to assess elevated LV filling pressure when HFpEF is suspected but the role of LA strain in the diagnosis of LV diastolic dysfunction (LVDD) in patients (pts) with AMI is not well documented.

Aim
The aim of this study was to analyse the usefulness of adding LA strain to the assessment of the degree of LVDD based on the 2016 ASE/ECVI guidelines in pts with first AMI.

Methods
Consecutive pts with first AMI undergoing percutaneous coronary intervention (PCI) were prospectively studied. Echocardiography was performed between 3-7th day after PCI. Assessment of LV diastolic function and classification of LVDD were based on 2016 ASE/ECAVI document. To assess systolic LV function, LV ejection fraction (LVEF) and global longitudinal strain (GLS) were calculated. LA strain in following phases: LA reservoir (LARs) and LA pump (LASp) strain and LVGLS were measured by speckle tracking echocardiography. The cut-off values for reduced LARs was based on the NORRE study results (≤27.7%) and for elevated filling pressure on the 2021 EACVI document (&lt;18%).

Results
92 pts were included in the study (71 males, 52 STEMI pts, 42 NSTEMI pts), age 60±11 years, LVEF 52.5±9.5% (31 pts with LVEF &lt; 50%), LVGLS -15±3.8%, NT-proBNP median 433 pg/mL (144-1416), Troponin T median 1160 ng/L (322-4586). Normal diastolic function was found in 16.3% pts, LVDD grade I in 52.2%, grade II in 7.6% pts, no patient had grade III and in 23.8% pts the degree of LVDD could not be determined based on the ASE/ECVI 2016 criteria. LARs and LASp were significantly different between groups and lower in pts with LVDD grade I, II, and indeterminate group than in normal subjects (table). Adding abnormal LARs to the diagnosing of LVDD resulted in an increase in the diagnosis of LVDD from 59.8% to 78.2% respectively without and with LARs. 24% pts had LARs &lt;18%. LARs values presented highly statistically significant correlation with GLS, LVEF, Troponin T, and NT-proBNP (r=-0.60, r=0.58, r= -0,41 and r= -0.39, P&lt; 0.001, respectively).

Conclusions
The findings from this study provide insights regarding the potential usefulness of adding LA strain in the detection of LVDD in pts with early phase STEMI and NSTEMI. Lower LARs values were associated with greater LV damage.
LA strain and the severity of LVDD
Influence of right ventricular function on medium and long-term mortality after percutaneous aortic valve implantation in elderly patients with severe aortic stenosis.
Authors: Ruisanchez Villar C , Perez Barquin R , Santiago Setien I , Veiga Fernandez G , Cuesta Cosgaya J M , Lerena Saenz P , Coroas Pascual C , Serrano Lozano D , Llano Cardenal M , Zarauza Navarro J M , Sainz Laso F , Lee Hwang D H , Garcia Camarero T , Gil Ongay A , De La Torre Hernandez J M 
Published: January 2025

Abstract

Background
Right ventricular (RV) function is a potent marker of morbidity and mortality in heart failure and other cardiovascular diseases. However, the prognostic value of right myocardial function in aortic stenosis (AS) treated with a percutaneous aortic valve implantation (TAVI) is not well defined.

Objetive
In the present study, we aim to analyze the impact of two relevant RV function parameters, TAPSE and right ventricular longitudinal strain, measured in the pre-TAVI study, on medium- and long-term mortality in elderly patients with severe AS.

Methods
We included 180 consecutive patients with severe AS who underwent TAVI implantation between February 2018 and February 2020. We analyzed the pre-TAVI echocardiogram (TTE) performed on the same day as the procedure. The variables analyzed were TAPSE and free wall right ventricular strain (FW-RVS). We studied the implications of both parameters on medium-term (the first year after the intervention) and long-term (2 years after TAVI implantation) mortality.

Results
We analyzed 180 patients (mean age 80.2 years, SD 9.02), of whom 98 (54.4%) were women. At the time of data collection, 58 deaths (32.6%) had been recorded, 17 (29.3%) of which occurred during the first year after TAVI, and 22 (37%) in the second year; 3 died immediately post-procedure and 7 before 6 months. The average TAPSE in the baseline TTE was 21.7 mm +/- 4. FW-RVS could be analyzed in 150 patients (83%), with an average value of 20.5 +/- 6 in the pre-TAVI study. Neither TAPSE nor FW-RVS showed statistical significance in 1-year mortality (p&gt;0.5; p=0.19, respectively). However, RV strain demonstrated an impact on 2-year follow-up mortality (OR 1.14; p=0.014), while TAPSE did not reach significance (p=0.59).

Conclusions
In our study, in an elderly population of patients with severe AS treated with TAVI, free wall RV strain, a sensitive marker of subclinical myocardial dysfunction, proved to be a predictive parameter of long-term mortality, once the first year of follow-up was overcome. The poor influence of RV function within the first year of follow-up may be related to aspects of futility and other conditions of interest during this specific follow-up period (coronavirus pandemic).
Effect of apical foreshortening and transducer angulation on strain measurements: a quantitative investigation
Authors: Pasdeloup D , Ostvik A , Smistad E , Nyberg J , Jakobsen E O , Grenne B L , Holte E , Lovstakken L , Dalen H 
Published: January 2025

Abstract

Background
Two-dimensional echocardiographic strain measurements have limited reproducibility, hampering the ability to detect subtle changes in repeated examinations. This is partly related image acquisition, including apical foreshortening and suboptimal transducer rotation and/or tilt, resulting in non-standardized imaging planes. However, the impact of image acquisitions on measured global longitudinal strain (GLS) values has not been quantified in large studies due to the labor-intensive task of measuring apical foreshortening and characterizing the imaging plane. Recent advances in echocardiographic image analysis based on deep learning (DL) may shed new light on this problem by enabling measurements of apical foreshortening and estimation of transducer angulation without human intervention.

Purpose
To quantify the effect of apical foreshortening and transducer rotation/tilt on GLS values.

Methods
To isolate the effect of foreshortening and transducer rotation/tilt on GLS values, 1395 patients without cardiac pathology were included in the analysis. For each patient, GLS was measured in the three apical views (four chamber, two chamber, long-axis) using commercial software. The same recordings were automatically analyzed using DL to obtain indicators of apical foreshortening (apex displacement in the long axis and short axis directions) and of the transducer rotation and tilt relative to the heart. Correlations between strain values and the foreshortening/rotation/tilt indicators were calculated. When significant correlation was detected, a regression analysis was performed to quantify the absolute change in GLS that can be related to foreshortening and transducer rotation/tilt. The first and last 5% quantiles of each DL indicator were excluded from these analyses.

Results
For each view, GLS was significantly correlated (p&lt;0.05) with at least one of the foreshortening or transducer angulation indicators (Fig. 1). The regression analyses suggested that apical foreshortening and suboptimal transducer rotation/tilt can cause GLS variations up to 1.3 percentage points, representing a relative change of 6.5%.

Conclusions
Apical foreshortening and transducer rotation/tilt quantified using automatic DL methods were related to GLS values in a large dataset. The magnitude of the relationship suggests that apical foreshortening and transducer rotation/tilt can limit the usefulness of GLS measurements, especially in the context of repeated examinations where detecting small relative changes is important. Overall, this retrospective analysis confirms the importance of minimizing apical foreshortening and of standardizing transducer angulation to reduce minimal detectable changes in GLS and improve its reproducibility.
E-point septal separation (EPSS) for diagnosing reduced left ventricular ejection fraction (LVEF): a systematic review and meta-analysis
Authors: Kirkovski A , Lee J , Lickfett L 
Published: January 2025

Abstract

Background/Introduction
The estimation of LVEF with the standard quantitative methods is a difficult and time-consuming process, which requires experience and relies on the ability of the physician. An alternative method for a rapid assessment of LVEF could be EPSS, which measures the distance between the anterior mitral valve leaflet and septum in early diastole, demonstrated on a parasternal long axis view with M-Mode.

Purpose
To determine how accurate EPSS is for diagnosing reduced LVEF in adult patients.

Methods
We used the Cochrane methods for diagnostic test accuracy (DTA) reviews. We searched Pubmed, Ovid, CENTRAL, OATD, ClinicalTrials.gov and WHO-ICTRP up to 21 June 2024.
We included studies that assess the accuracy of EPSS against an acceptable reference standard (Biplan Simpson’s method, angiographically determined, or visually determined ejection fraction) in adult patients.The articles were screened and data from the articles was extracted using the Metagear package in R Studio. We extracted data into a 2 x 2 table (true positives, true negatives, false positives, and false negatives). We used GetData Graph Digitizer to extract numbers from the histograms in studies where direct data wasn't available. We synthesized and summarized the data into a forest plot and a summary receiver operating characteristic (SROC) plot. We used a bivariate meta-analysis model to synthesize the meta-analysis in RevMan.

Results
We identified 757 titles and abstracts and after removal of duplicates, we assessed 730 unique studies. After exclusion, 14 studies were deemed eligible for inclusion in the meta-analysis (914 patients). EPSS with a threshold of &gt; 7 mm showed a summary sensitivity of 84% (95% CI 81% to 88%) and a summary specificity of 88% (95% CI 77% to 85%). If we take the median prevalence of reduced LVEF in the included studies (48%) and apply it to a cohort of 1000 patients, 480 patients will have a reduced LVEF. Of these, 403 (84%) would be correctly diagnosed and 77 (16%) would be misdiagnosed and not receive appropriate treatment. 520 of the 1000 patients will have a normal LVEF. Of these, 421 (81%) would be correctly deemed to have a normal LVEF, and 99 (19%) would be falsely diagnosed with reduced LVEF and undergo inappropriate treatment.

Conclusion
The findings of this review provide evidence to suggest that EPSS is an accurate diagnostic tool compared to reference standards and it could be used to provide a quick initial assessment of the LVEF as a precursor to the standard quantitative methods.
Summary of findings
Forest plot
Oxidative stress biomarkers and myocardial dysfunction in a doxorubicin- and trastuzumab-induced rat model of cardiomyopathy
Authors: Cho D H , Kim S R , Kim M N , Park S M 
Published: January 2025

Abstract

Background
Chemotherapy, although improving survival rates in breast cancer patients, is associated with heightened risks of myocardial dysfunction and heart failure. This study explores the association of oxidative stress biomarkers with myocardial dysfunction in a rat model induced by doxorubicin and trastuzumab.

Methods
Forty-two rats were allocated into groups receiving various treatments including control, doxorubicin only, and doxorubicin plus trastuzumab. Doxorubicin and trastuzumab were sequentially administered over 28 days at 2-week intervals. Echocardiography with speckle-tracking was utilized to measure left ventricular end-systolic dimension and longitudinal strain (LS). Blood samples were collected from the inferior vena cava before sacrifice for biomarker analysis, focusing on oxidative stress indicators including superoxide dismutase (SOD) and glutathione (GSH). Myocardium fibrosis area was measured using Masson's trichrome staining.

Results
The combination of doxorubicin and trastuzumab significantly increased the LV end-systolic dimension and worsened LS compared to the control group (all P &lt; .05). Levels of oxidative stress biomarkers, including SOD and glutathione, were significantly deteriorated in the chemotherapy groups. Oxidative stress biomarkers demonstrated a strong correlation with measures of myocardial dysfunction. SOD showed a correlation coefficient of 0.609 with LS (P = 0.0056). Glutathione (GSH) showed a correlation coefficient of -0.477 with LS (P = 0.0388). Additionally, LS was well correlated with fibrosis area, showing a correlation coefficient of -0.487 (P = 0.0347).

Conclusions
In a doxorubicin- and trastuzumab-induced rat model of cardiomyopathy, oxidative stress biomarkers were correlated with myocardial dysfunction, as represented by LS. The findings suggest that monitoring these biomarkers could enhance early detection and prevention strategies for chemotherapy-induced cardiomyopathy.
A representative image of strain
Correlation between parameters
Heart failure by ventricle-arterial coupling in STEMI
Authors: Garcia Villarejo M , Latapi Ruiz Esparza X , Dominguez Garciduenas B , Amaro Palomo E J , Gopar Nieto R , Araiza Garaygordobil D , Arias Mendoza M A , Sierra Lara Martinez J D 
Published: January 2025

Abstract

Background
Left ventricular-arterial coupling (VAC), calculated as the ratio between arterial elastance (Ea) and left ventricular end-systolic elastance (Ees), is part of contemporary non-invasive indices of left ventricular (LV) and arterial system function. It may assist in identifying post-STEMI patients at risk of major adverse cardiovascular events, including heart failure.

Purpose
To analyse the development and applicability in routine clinical practice of simplified echocardiographic methods for calculating left VAC and predicting the risk of heart failure post-STEMI.

Methods
Echocardiography was performed on 144 post-STEMI patients who were followed up for 750 days after hospitalisation. Each baseline characteristic variable was analysed using the Wilcoxon and Shapiro-Wilk tests. Kaplan-Meier methods with log-rank tests and Cox regression were employed to assess the risk of heart failure based on two main variables: VAC values within the range of 0.95-1.1, and values outside this range. VAC was measured using Chen’s method, which includes systolic and diastolic pressure, preejection time, total ejection time, ejection fraction, and stroke volume. All analyses were conducted using StataMP 14.1.

Results
We enrolled 144 patients, of whom 87% (n=125) were male, with a median age of 60 years. Initially, 76.3% (n=106) of patients had reduced ejection fraction at the first echocardiography. The most common comorbidities were hypertension (52%) and type 2 diabetes (40.3%). In our initial comparison of VAC values, Kaplan-Meier curves demonstrated significant differences in the incidence of heart failure between VAC 0.95-1.1 and values outside this range. The VAC 0.95-1.1 group showed a better prognosis (p-value &lt; 0.0312), with no occurrences of heart failure during the 750-day follow-up.

Conclusions
Established parameters for VAC vary across different scenarios, but conclusive information is lacking for patients in acute myocardial infarction. We propose that enhancing the Ea/Ees ratio (measured by Chen’s method) and thereby VAC could provide clinicians with detailed prognostic information, potentially preventing heart failure.
Heart failure and VAC
Prognostic value of left ventricular global longitudinal strain in patients with moderate ischemic mitral regurgitation who underwent coronary revascularization
Authors: Comia M A F , Tucay E S , Mendoza-Reyes M C , Ladlad-Pua E V , Flores V B , Santos R J 
Published: January 2025

Abstract

Background
Patients with severe ischemic mitral regurgitation are indicated to undergo mitral valve surgery during CABG. For moderate ischemic mitral regurgitation, however, doing mitral valve intervention during revascularization is still controversial. Guidelines recommend the use of LVEF as a parameter for LV dysfunction as an indication to do intervention, but studies have showed that LV GLS is a sensitive tool to detect even subclinical left ventricular dysfunction. This study aimed to determine the prognostic value of left ventricular global longitudinal strain in patients with moderate ischemic mitral regurgitation who underwent coronary revascularization without mitral valve surgery in predicting MACE.

Methodology
Baseline clinical and echocardiographic characteristics were retrospectively studied among patients with moderate ischemic mitral regurgitation who underwent surgical revascularization without mitral valve surgery. Speckle tracking using VVI was done on pre-operative echocardiograms to determine the left ventricular global longitudinal strain and intraoperative transesophageal echocardiograms were reviewed to assess for persistence of moderate mitral regurgitation. Occurrence of major adverse cardiovascular events during the hospital stay were reviewed in the medical records as well.

Results
Among the 36 patients with moderate ischemic mitral regurgitation, 16 (44.4%) had persistent moderate mitral regurgitation. There was no statistical difference in the outcome of moderate mitral regurgitation postoperatively between LV GLS &gt;7% and &lt;7%. In terms of major adverse cardiovascular events, 58% (21/36) had occurrence of MACE. There was no significant difference in the occurrence of MACE between patients with LV GLS of &gt;7% and &lt;7%. However, it was noted that for every unit decrease in LV GLS, the odds of having MACE increases by 17.02% with crude odds ratio of 1.17 (p-value 0.041). Patients with history of ACS were 11.69 times more likely to have MACE with odds ratio of 11.69 (p-value of 0.002). Ejection fraction was not found to be a significant factor associated with MACE.

Conclusion
Left ventricular global longitudinal strain can be used as an additional parameter in prognosticating patients with moderate ischemic mitral regurgitation who will undergo revascularization. Patients with more impaired LV GLS would have higher odds of having MACE.
Methodology
Factors Associated with MACE
External validation of two different cardiac damage staging systems for aortic stenosis in a surgical cohort of patients who underwent surgical aortic valve replacement
Authors: Roman R , Olmos C , O'neill P , Gil C , Carnero M , Rivadeneira M , Luque M , Bassa R , Gil-Abizanda S , Perez-Camargo D , Pozo E , Mahia P , Montero L , De Agustin J A , Islas F 
Published: January 2025

Abstract

Purpose
In recent years, several cardiac damage staging systems for severe aortic stenosis (AS) have been proposed. These systems may help to stratify patients’ risk and select the adequate timing for intervention. Our aim was to perform an external validation of two staging systems (1,2) in patients who underwent surgical aortic valve replacement (SAVR).

Methods
Retrospective analysis of a prospective cohort of patients with AS who underwent SAVR in a tertiary care center from 2017 to 2022. Echocardiographic parameters measured prior to surgery were analyzed, and patients were classified into the different stages of two published staging systems.
The area under the ROC curve (AUC ROC) was used to measure the discriminatory capacity of the two staging models to predict the primary endpoint of 1-year mortality after SAVR.

Results
244 patients were analyzed. Mean age was 69 (9.5) years, and 37.7%f were female. Mean EuroSCORE II was 2.6 (3.3). The primary endpoint occurred in 11 (4.5%) patients.
The distribution of patients in the different stages of cardiac damage is displayed in Figure 1. According to Staging system 1, the majority of patients (50%) were intervened on in a Stage 1 of cardiac damage (left ventricular subclinical damage, considered when global longitudinal strain [GLS] was ≥ −17%). In the case of Staging system 2, 29% of patients were classified as left ventricular damage and 47.9% as left atrium or mitral damage.
The area under the ROC curve of Staging system 1, which incorporated cardiac mechanics, was 0.688 (95% CI: 0.510-0.865), and showed better predictive performance than Staging system 2 [0.593 (95% CI 0.432–0.736)] (Figure 2).

Conclusions
In a surgical cohort of patients with AS, a cardiac staging system that include GLS and right ventricular-arterial coupling showed better discriminatory yield for one-year mortality. Therefore, when available, assessing LV mechanics and the interrelation between right ventricular function and afterload could help in better risk stratification and prognostic assessment in this context.
Cardiac damage staging systems
AUC curve for 1-y mortality
Mechanism of mitral regurgitation in Fabry disease: a detailed study of mitral leaflet morphology and severity in a cohort of symptomatic patients
Authors: Vecerova A , Linhart A 
Published: January 2025

Abstract

Introduction
Fabry disease, stemming from mutations in the alpha-galactosidase A gene, manifests in the buildup of globotriaosylceramide (Gb3), inducing systemic complications, notably cardiac issues such as mitral regurgitation (MR). This research delves into the mechanisms underlying MR development in Fabry disease. A group of 38 symptomatic patients with moderate or substantial MR were monitored. Mitral leaflet morphology was classified as normal, displaying fibrodegenerative changes, or exhibiting leaflet thickening. The severity of MR varied, primarily attributed to leaflet restriction. Moreover, left ventricular outflow tract obstruction (LVOTO) and annular dilatation were identified. The study indicates that MR in Fabry disease chiefly results from leaflet restriction caused by degenerative changes or leaflet thickening. Echocardiographic assessment involved detailed measurements of various parameters, including leaflet height, annulus size, coaptation height and depth, tenting area, coaptation to septum distance, and angles of the anterior and posterior mitral leaflets.

Methods
A cohort of 38 symptomatic Fabry disease patients with moderate or significant MR were longitudinally examined. Echocardiographic evaluations were employed to assess MR severity and classify mitral leaflet morphology. Statistical analyses were conducted to explore the link between MR severity and leaflet morphology. Critical components of the mitral valve were measured, and specific angles were determined to comprehensively assess each mechanism.

Results
The study showed that the primary cause of MR in most patients was leaflet restriction, with varying severity levels. Mitral leaflet morphology was categorized as normal in 15.8%, fibrodegenerative changes in 31.5%, and leaflet thickening in 52.7%. Additionally, LVOTO was observed in 15.7%, albeit without systolic anterior motion (SAM), and annular dilatation was present in 66%.

Conclusion
The research suggests that MR in Fabry disease primarily stems from leaflet restriction, whether due to degenerative changes or leaflet thickening. The presence of anteroposterior annular dilatation, although not always anticipated, was identified in some cases, adding depth to the understanding of MR mechanisms in Fabry disease patients.
Mitral valve in systole in Fabry disease
Leaflet morfology and the degree