bluuebunny/crossref_metadata_2025_split huggingface dataset:
Would the addition of three more views to the standard echocardiographic examination add important non cardiac findings and change the management plan?
Authors: Farouk H , El-Chilali K , Schoene D , Witt C , Ronge R , Kloppe A 
Published: January 2025

Abstract

Background
Routine and rapid screening of the liver, pleura, and abdominal aorta during standard transthoracic echocardiographic (TTE) studies might result in better management of patients referred for echocardiographic assessment.
A total of 7000 cases referred from different departments between 2022 to 2024 were enrolled, non-cardiac findings were documented in 589 cases (8.4%). We screened rapidly the liver, pleura, and aorta in all these patients as a part of our policy in performing the standard echocardiographic examination. The most detected abnormalities were pleural effusion in context of heart failure (88%), left sided pleural effusion following cardiac surgeries (coronary bypass graft, valve replacement) in 20 cases (3%), and first diagnosis of malignancies (liver metastases, non-small cell lung carcinoma, suprarenal metastasis, renal carcinoma, and ascites in 3%). Most cases were referred from the cardiology ward (88%) and chest ward (10%). Patients were commonly admitted because of dyspnea, tachycardia, chest pain, or lower limbs edema. The most common referring diagnoses were heart failure (87%), pneumonia (5%), and lower limbs edema for further investigations (4%). In 3% of cases, echocardiography was the first clue to a malignancy with further work-up confirming the diagnosis while empyema was suggested by echocardiography in 1% of cases necessitating surgical intervention. Aortic abnormalities namely descending aortic aneurysms with superimposed thrombus were detected in 4 patients (0.6%).

Conclusion
Routine rapid screening of the liver, pleura, and aorta could add an important clinical piece of information, detect possible malignancy (mainly liver metastases), infected pleural effusion, and aortic dilatation necessitating further assessment and management in hospitalized patients with various cardiopulmonary symptoms.
Learning objectives: Spending few minutes more in standard echocardiography could change the plan, direct the treating physician to the problem, and spare performing unnecessary investigations.
Learning more skills makes the echocardiography a part of the clinical assessment of patients rather than a pure cardiac investigation.
Limitations: Screening should never replace a detailed abdominal sonography or further comprehensive studies (computed tomography or angiography in patients suspected having pleural or aortic diseases).
Accidental Findings
A novel handheld ultrasound device equipped with spectral doppler- efficacy of left ventricle diastolic function parameters assessment
Authors: Filipiak D , Kasprzak J D , Lipiec P 
Published: January 2025

Abstract

Background
Echocardiographic assessment of left ventricular (LV) diastolic function is an essential part of the routine evaluation of patients presenting with dyspnea or impaired effort tolerance. Diagnostic algorithm of diastolic dysfunction involves pulsed and continuous wave Doppler measurements, which were not within the range of capabilities of previous generations of handheld ultrasound devices (HUD). However, implementing new modalities into HUD expanded the area in which they may thrive.

Aim
To verify and validate the reliability of diastolic function parameters acquired during the HUD echocardiographic examination

Methods
Study population consisted of the consecutive 100 pts admitted to Cardiology Emergency Room due to the dyspnea and/or impaired effort tolerance. All patients underwent brief bedside echocardiographic screening with HUD which involved the assessment of mitral inflow velocities- early (E) and late (A), septal and lateral mitral annular peak early diastolic velocity (e')- measured with the pulsed wave Doppler modality, E/E’ ratio, E/A ratio, and tricuspid regurgitation velocity (measured with the continuous wave Doppler modality). Within the next 24 hours all patients underwent full echocardiographic examination performed with the use of stationary ultrasonographic station, which results were treated as reference.

Results
Septal E’ did not exceed 7cm/s in 22 patients, lateral E’ was lower than 10cm/s in 24 patients. Correlation between the measurements from HUD and full echocardiography was 0,84 for septal E’ and 0,44 for lateral E’; for both parameters agreement for detection of incorrect, lowered values between methods was high (Kappa coefficient 0,751 i 0,8 respectively). E/E’ was significantly increased in 6 patients, which was detected with high agreement in HUD examination (Kappa coefficient 0,73). Correlation coefficient for E/A parameter was 0,77 and agreement categorized for each group (E/A≤0,8; E/A &gt;0,8 & &lt;2; E/A ≥2 ) was high (kappa coefficient 0,75; 0,74; 1,0 respectively); it is worth noting that all cases with E/A ≥2 were identified in HUD examination. TR velocity exceeded 2,8 m/s in 11pts, in this aspect the agreement between HUD and full examination was 0,65. However the positive predictive value of this parameter was 100%.

Conclusion
HUD equipped with a spectral doppler modality enables for reliable echocardiographic screening of LV diastolic function. Introducing the elements of imaging diagnostics to the initial assessment might markedly hasten the establishing of the final diagnosis.
E/A ratio- HUD & full echocardiography
HUD/fullECHO derived values correlation
Diastolic function in patients with preserved left ventricle ejection fraction: prognostic value and added role of left atrial strain
Authors: Rodriguez-Sanchez I , Onaindia J J , Cacicedo A , Ullate A , Urkullu A , Bravo I , Florido J , Sanz I , Villanueva I , Aguirre U , Salcedo A , Velasco Del Castillo S 
Published: January 2025

Abstract

Background
Few studies have evaluated the prognostic value of diastolic function in patients with preserved left ventricular ejection fraction (LVEF) according to the 2016 ASE/EACVI guidelines, regardless of the specific type of heart disease. Our aim was to evaluate the ability of diastolic function to predict a composite event of heart failure (HF), atrial fibrillation (AF) or ischemic stroke and to determine the added value of left atrial reservoir strain (LARS).

Methods
We performed a retrospective analysis of 364 patients with preserved LVEF and sinus rhythm referred for transthoracic echocardiography and categorized them into four groups based on their diastolic function status according to the 2016 ASE/EACVI guidelines: normal diastolic function (NDF), indeterminate diastolic function and diastolic dysfunction with indeterminate filling pressure (IDT), grade 1 diastolic dysfunction (DD1), and diastolic dysfunction with elevated filling pressure (DD-EFP). The primary endpoint was a composite of AF, HF or ischemic stroke. LARS was measured by 2D speckle tracking. Clinical parameters and specific cardiac diseases were also assessed.

Results
After a mean follow-up of 2.4 years, diastolic function was an independent predictor of events, with patients with DD-EFP having the highest risk (HR 12.73 (95% CI, 1.50-108.17), P=0.02). The addition of LARS improved risk stratification, especially in IDT patients, with a cut-off of ≤24% identifying a high-risk population. Patients at high risk, defined as those with DD-EFP and IDT with LARS ≤24%, had a high event rate of 34% and 46%, respectively.

Conclusions
In patients with preserved LVEF and sinus rhythm, patients classified with DD-EFP have the highest risk for the composite event. LARS improves risk stratification and also identifies IDT patients with LARS≤24% as a high-risk population. High-risk patients (DD-EFP and IDT with LARS ≤24%) had a high event rate (34% and 46%, respectively). Future studies are needed to further confirm these findings.
Survival according to diastolic function
Survival (diastolic f and LARS combined)
Sex-related differences in cardiac damage associated with severe primary mitral regurgitation: impact on surgical outcomes
Authors: O'neill P , Barriales L , Islas F , Parraga R , Gutierrez E , Carnero M , Rivadeneira M , Perez-Camargo D , Mahia P , Montero L , Campelos P , Gil-Abizanda S , De Agustin J A , Olmos C 
Published: January 2025

Abstract

Background and Aim
Previous research has shown that women with primary mitral regurgitation (MPR) have worse surgical outcomes, compared with men.
Our aim was to evaluate whether cardiac damage prior to intervention for severe MPR differs according to gender.

Methods
Retrospective analysis of a prospective cohort of patients with PMR who underwent mitral valve surgery in a tertiary care center from 2014 to 2022.
Echocardiographic parameters measured prior to surgery as well as outcomes at 1-year follow-up (all-cause mortality and heart failure admissions) were analyzed, and potential differences by sex were evaluated.

Results
349 patients were included. The mean age was 69 (12) years and 154 (44%) were female.
Women were older and had a history of atrial fibrillation more frequently than men. Regardind morphological echocardiographic parameters, left ventricular (LV) dimensions were slightly larger in male patients, as expected, and there were no significant differences in left atrial (LA) volume index (Table).
Significant differences were found in functional echocardiographic parameters: women had more impaired LV and LA strain, higher values of LA stiffness, and worse right ventricular-arterial coupling. In addition, concomitant significant tricuspid regurgitation was significantly more frequent in female patients.
At one-year follow-up, the incidence of heart failure hospitalization was significantly higher in women (1% vs 7%; p=0.005) and there was a non-significant trend towards higher all-cause mortality (6.2 vs 11%; p=0.101).

Conclusions
In our cohort of patients with severe PMR who underwent surgery, women had worse biventricular function and more impaired LA function. At one-year follow-up, heart failure hospitalizations rates were significantly higher in female patients.
Earlier indication of surgical timing in women with PMR, taking into account deformation parameters, could improve surgical outcomes in this population.
Clinical and echocardiographic features
Correlation of pulmonary artery systolic pressures derived from echocardiography and hemodynamic catheterization in patients with tricuspid regurgitation: a large single-center study
Authors: Pugliesi G M , Pislaru S , Kane G C , Miranda W R , Frantz R P , Anand V 
Published: January 2025

Abstract

Introduction
Echocardiography is the recommended modality for non-invasive assessment of pulmonary pressures. However, in patients with severe tricuspid regurgitation (TR), the reliability of echocardiographically derived systolic pulmonary artery pressure (sPAP) is questioned. Limited data exists on the correlation between echocardiography and right heart catheterization (RHC) in selected group of patients with severe TR.

Purpose
To evaluate the correlation between echocardiographic and RHC measurements for sPAP in patients with varying TR severity.

Method
Patients who underwent echocardiography and RHC within three days at a large single referral center were retrospectively included. Exclusion criteria included incomplete echocardiographic and RHC data, ≥moderate pulmonary stenosis, low-quality images, and pregnancy. Echocardiographic sPAP was calculated using simplified Bernoulli equation. Echocardiographic right atrial pressure (RAP) was assessed by evaluating inferior vena cava (IVC) dimension and collapsibility. A difference of ≥10 mmHg between the two modalities for sPAP was considered clinically significant.

Results
Of 3696 patients included, mean age was 64±14 years, 1689 (46%) were females, 1659 (45%) had systemic hypertension, and 582 (16%) had atrial fibrillation. TR was &lt;moderate in 2475 (67%) patients, moderate in 499 (14%), moderate-severe in 277 (7%), and severe in 445 (12%). Pulmonary hypertension (PH) was diagnosed in 3079 subjects (83%). A good correlation was found between sPAP derived by echocardiographic and RHC in the whole cohort (correlation coefficient (LCC) 0.79, CI 0.78-0.80), in severe TR subgroup (LCC 0.78, CI 0.75-0.82), and in severe TR with PH subgroup (LCC 0.76, CI 0.71-0.79). The mean echocardiographic misestimation for sPAP in severe TR was 3.97 mmHg (CI -5.24 to -2.71). The correlation between the two modalities for RAP was moderate in the whole cohort (LCC 0.59, CI 0.57-0.61) and fair in severe TR (LCC 0.35, CI 0.27-0.42). A clinically significant difference between the two modalities for sPAP was found in 1504 patients (41%), predominantly due to the right ventricle-right atrium gradient misestimation, rather than RAP misestimation, in patients with no PH (67% vs 33%), patients with mild-moderate PH (mean Pulmonary Artery Pressure (mPAP) 21-34 mmHg) (67% vs 33%) and severe PH (mPAP ≥35 mmHg) (76% vs 24%).

Conclusion
The correlation between echocardiographic and RHC measurements is good for sPAP, even in severe TR patients, while it is only fair to moderate for RAP. A clinically significant difference between echocardiographic and RHC sPAP is more commonly observed in patients with PH, with right ventricle-right atrium gradient misestimation being the most common cause.
Echocardiographic predictors of left ventricular interstitial fibrosis in chronic primary mitral regurgitation with preserved ejection fraction: the underrecognized role of diastolic dysfunction
Authors: Pype L L , Van Laer S L , Paelinck B P , Sturkenboom N , Van Craenenbroeck E M , Van De Heyning C M 
Published: January 2025

Abstract

Background
Myocardial fibrosis is a well-known risk factor for morbidity and mortality in patients with chronic primary mitral regurgitation (MR). Extracellular volume (ECV), a marker of interstitial fibrosis assessed with cardiovascular magnetic resonance imaging (CMR), was correlated with echocardiographic markers of left ventricular (LV) systolic and diastolic dysfunction in a previous study cohort of patients with severe primary MR. In addition, diastolic dysfunction has recently been recognized as a distinct phenotype in patients with primary MR associated with similar prognosis compared to patients with systolic dysfunction.

Purpose
To investigate whether echocardiographic parameters of subclinical LV systolic function, diastolic dysfunction or MR severity are correlated with interstitial fibrosis in chronic primary MR patients with a preserved ejection fraction (EF).

Methods
Prospective inclusion of patients with chronic primary MR and a LVEF&gt;50%. All patients underwent transthoracic echocardiography and CMR scan (1.5T). Echocardiographic assessment of LV systolic and diastolic function was performed, including global longitudinal strain (GLS). MR severity was assessed using a multi-integrative approach. Extracellular volume (ECV) was calculated from the native and post-contrast T1 times.

Results
A total of 50 patients with primary MR were included (58% males, age 56 ± 16 years old). CMR and transthoracic echocardiography were performed within 30 ± 65 days. MR severity was variable with 20% mild, 32% moderate, 12% moderate-severe and 36% severe MR. Mean LVEF and GLS were within normal range (59.1% ± 5.3% and –19.8% ± 2.9% respectively). Mean ECV was 27.8% ± 2.5%. ECV did not show a significant correlation with MR severity grade or markers of LV systolic function like LVEF (Rho=-0.121, p=0.42) or GLS (Rho=0.089, p=0.59). However, we did observe a statistically significant correlation between ECV and markers of LV diastolic dysfunction such as mean E/e’ (Rho=0.291, p=0.050) and deceleration time (Rho=-0.308, p=0.037). Even in patients with non-severe MR (grade 1 to 3), the correlation between ECV and E/e’ remained significant (Rho=0.438, p=0.017). In a multivariate regression analysis E/e’ and MR grade were associated with ECV, even after correction for age and gender (R squared 0.248, p=0.017 and p=0.044 respectively).

Conclusion
In patients with chronic primary MR and a preserved LVEF, the presence of interstitial fibrosis, measured as ECV, was associated with echocardiographic parameters of diastolic rather than systolic dysfunction, independent of MR severity. These findings suggest that diastolic dysfunction can be a subclinical marker of myocardial fibrosis (and subsequently adverse outcomes) in patients with primary MR.
Correlation ECV and E/e'
Left atrial assessment improves prediction of incident atrial fibrillation beyond CHARGE-AF risk score
Authors: Hasegawa R , Fujiwara N , Kato Y , Suzuki S , Oikawa Y , Uejima T 
Published: January 2025

Abstract

Background
Atrial fibrillation (AF) is associated with substantial mortality and morbidity, even when it is asymptomatic and/or remains undetected. Clinical predictive models such as Charge-AF are not robust enough to be used in the clinical practice. We investigated the benefits of adding echocardiographic risk variables to Charge-AF risk model for its potential use in targeted screening for AF.

Methods
This study included 1108 consecutive patients aged 60±14 years old without a previous diagnosis of AF referred for echocardiographic assessment. Left atrial and ventricular functions were measured using strain analysis. Five-year predicted risk for AF was estimated, using Charge-AF risk model. The incidence of AF was ascertained from resting and exercise stress electrocardiograms and Holter recordings. Sequential Cox models were used to identify echocardiographic variables for predicting the incidence of new onset AF.

Results
The overall incident rate of AF was 3.1%, 5.5% and 7.2% at 1 year, 3 year and 5 year, respectively. Left atrial volume index (LAVi) predicted the incidence with a hazard ratio of 1.06 (p&lt;0.001), that was independent of and increment to Charge-AF risk estimates (figure A). The addition of E/e’ (hazard ratio=1.064, p=0.001), left atrial reservoir strain (hazard ratio=0.98, p=0.034), left atrial booster strain (hazard ratio=0.97, p=0.048) to the baseline model including Charge-AF risk estimates also showed a significant, but less incremental benefit for AF prediction, compared with LAVi. When all these echocardiographic variables were added to a stepwise nested Cox model, only LAVi was significantly and independently predictive of AF incidence beyond Charge-AF risk estimates. This finding was confirmed by Kaplan-Meier curves showing that an increase in LAVi was progressively associated with increased risk for AF (figure B). When the cumulative AF incidence was analyzed separately between patients with higher (predicted risk &gt;= 1.5%/year) and lower (predicted risk &lt; 1.5%/year) Charge-AF risk estimates, LAVi was able to sub-stratify only patients with higher Charge-AF risk estimate (figures C and D).

Conclusion
LAVi provided incremental value in predicting incident AF in hospital patients. The inclusion of LAVi to the diagnostic algorithm may help guide screening and further monitoring for AF risk in this population.
Assessment of cardiac reverse remodeling in patients with LV systolic dysfunction receiving vericiguat in addition to optimal GDMT
Authors: Lara Delgado G D , Carrillo Aleman L , Guillamon Sanchez A , Martinez-Perez V , Yepez Naranjo F , Palacio Solis M , Leon Allocca R , Solano Hernandez C , Sanchez Fernandez M J , Cano Alvarez S , Centurion Inda E R 
Published: January 2025

Abstract

Background and Objective
Vericiguat is a soluble guanylate cyclase stimulator which has demonstrated significant clinical and survival benefits in patient with heart failure and reduced ejection fraction (HFrEF) following acute decompensation. We present data on cardiac reverse remodeling assessed by echocardiography in ‘real-world’ patients receiving this therapy in addition to optimal guideline-directed medical therapy (GDM) for at least 6 months prior to initiation.

Material and method
Patients with a clinical indication for Vericiguat therapy were retrospectively analysed from a local registry between December 2022 and September 2023. A comprehensive echocardiography evaluation was performed at baseline (i.e. prior to initiation of this medication), and at 3 months after Vericiguat treatment.

Results
A total of 44 patients were included in this observational study, of which 32 patients were men (77.3%), and 10 patients were women (22.7%). With regards to baseline comorbidities, 17 patients had arterial hypertension, 12 patients had type-2 diabetes mellitus, 21 patients had hypercholesterolaemia, and 6 patients were newly diagnosed with HFrEF. The aetiology of HFrEF was ischaemic in 25 patients, and non-ischaemic in 19 patients. A total of 40 patients were on ARNI therapy prior to initiation of Vericiguat, 40 patients were on beta-blockers, 39 patients were on MRAs, 44 patients were on SGLT2-inhibitors, 18 patients were of loop diuretics, 15 patients had an ICD in situ, and 6 patients had a CRT device implanted. The mean initial LVEF was 31%, with a mean initial end-diastolic volume (EDV) of 178 mL. At 3-month follow-up, the mean LVEF was 39%, which represents an improvement of 9 percentage points; the mean EDV at 3-month follow-up was reduced up to 157 mL.

Conclusions
Vericiguat therapy may exhibit additional anti-remodelling benefits in patients with HFrEF when in combination with optimal GDMT in ‘real-world’ populations. Large randomized and prospective trials are needed to explore this hypothesis.
Echocardiographic estimate of pulmonary capillary wedge pressure improves outcome prediction in chronic heart failure
Authors: Bazan L , Gentile F , Sciarrone P , Buoncristiani F , Panichella G , Gasparini S , Fabiani I , Petersen C , Lio G E , Lancellotti P , Passino C , Emdin M , Chubuchny V , Giannoni A 
Published: January 2025

Abstract

Background
An echocardiographic algorithm to estimate pulmonary capillary wedge pressure (ePCWP) and pulmonary vascular resistance (ePVR) has been recently validated versus right heart catheterization (1).

Purpose
The aim of this study was to assess the prognostic significance of these measures in heart failure (HF) patients.

Methods
Consecutive outpatients with HF and left ventricular ejection fraction (LVEF) &lt;50% undergoing echocardiography were selected and followed-up for the composite endpoint of cardiac death or HF hospitalization.

Results
Out of 2,214 patients (71±12 years, 76% males, LVEF 35±9%), ePCWP (16±6 mmHg) was elevated (&gt;15 mmHg) in 52% of cases and ePVR (1.7±0.7 WU) was elevated (&gt;2 WU) in 25% of cases. Patients with increased ePCWP were older, had a higher NYHA class, more pronounced cardiac remodeling, systo/diastolic dysfunction, and neurohormonal activation, particularly when ePVR was also elevated (p&lt;0.001). Over a median follow-up of 33 (17-48) months, both measures stratified patients for the risk of the primary endpoint (Log-Rank 152 for PCWP, and 44 for ePVR, p&lt;0.001). At adjusted regression analysis, ePCWP (hazard ratio for 1 mmHg increase 1.03 [95%CI 1-01-1-05], p&lt;0.001) but not ePVR (p=0.584) predicted the primary endpoint, even in the subpopulation of patients with atrial fibrillation (p=0.003). ePCWP outperformed current diastolic dysfunction grading (Δ C-statistics 0.068 [95% CI 0.045-0.093], p&lt;0.001), and stratified patients’ risk across each diastolic dysfunction grade at univariate analysis (Grade I: p=0.002; Grade II-III: p&lt;0.001; Indeterminate cases: p=0.010). The addition of ePCWP to a multivariable prognostic model, including patients’ age, NYHA class III-IV, chronic obstructive pulmonary disease, estimated glomerular filtration rate, NT-proBNP, and LVEF, improved the accuracy of risk prediction (Δ C-statistics 0.008 [95% CI 0.002-0.014], p=0.007).

Conclusion
The echocardiographic estimates of PCWP retained clinical and prognostic significance in a large contemporary cohort of patients with chronic HF and LVEF &lt;50%. This algorithm could facilitate early identification of high-risk patients, possibly reducing the need of right heart catheterisation, and allowing a tailored therapeutic approach.
Graphical abstract
KM curves for the primary endpoint - AF