bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying echocardiographic predictors of late gadolinium enhancement in severe aortic stenosis patients undergoing transcatheter aortic valve implantation: insights from cardiac MRI
Authors: Hirata K , Kuwabara K , Matsuo Ý , Yokoi Ý 
Published: January 2025

Abstract

Background
Aortic stenosis (AS) is prevalent among the elderly. Accurate prognostic assessment in AS is crucial for optimizing patient management and outcomes. Identifying factors associated with Late Gadolinium Enhancement (LGE), a cardiac MRI marker, can help in risk stratification. LGE-positive individuals have a poorer prognosis, including a twofold increased risk of mortality and adverse cardiovascular events.

Purpose
The purpose of this study was to identify echocardiographic predictors of LGE in patients with severe AS.

Methods
Data from 58 patients with severe AS scheduled for transcatheter aortic valve implantation (TAVI) were analyzed. Echocardiograms and MRI scans were performed within two weeks before TAVI. The average age of the patients was 81.5 years, and 60% were male. LGE was present in 16 patients (27.6%). Univariate logistic regression identified significant echocardiographic factors associated with LGE, which were then included in a multivariate analysis.

Results
Univariate analysis showed significant echocardiographic factors: large left atrial volume (LAD &gt;34 ml/m²) (P = 0.0116), septal mitral annular velocity (e' septal) (P = 0.0281), left ventricular mass index (LVMi) (P = 0.0350), and left atrium size (P = 0.0453). Multivariate analysis indicated large left atrial volume (Coeff = 0.636), septal mitral annular velocity (Coeff = -0.563), left ventricular mass index (Coeff = 0.126), and left atrium size (Coeff = 0.345) were associated with LGE. Measures of AS severity, including aortic valve area (AVA), peak aortic velocity (Vmax), and mean pressure gradient (mean PG), were not significantly associated with LGE.

Conclusion
Large left atrial volume, septal mitral annular velocity, left ventricular mass index, and left atrium size are echocardiographic factors associated with LGE in patients with severe AS. These predictors could assist clinicians in identifying high-risk patients and improving management strategies.
Abnormal strain pattern in arrhythmogenic mitral valve prolapse, the importance of the basal inferolateral myocardial wall
Authors: Nagy A , Czimbalmos C S , Herczeg S Z , Bor A , Apor A , Lakatos B , Toth A , Geller L , Vago H , Merkely B 
Published: January 2025

Abstract

Introduction
The rare, but clinically relevant arrhythmogenic form of mitral valve prolapse (MVP) can lead to malignant arrhythmias and sudden cardiac death. The aim of our study was assessing the characteristics of arrhythmogenic mitral valve prolapse (AMVP), especially regarding the parameters that could be used in risk stratification.
Patients and methods: Thorough examinations were performed on 44 patients living with mitral valve prolapse and mitral annular disjunction, including their medical history and symptoms, blood pressure measurement, 12-lead ECG, 24-hour Holter monitoring, transthoracic echocardiography with 2D strain measurement and cardiac magnetic resonance imaging (CMR). The patients were divided into an arrhythmogenic and a non-arrhythmogenic group, according to the criteria determined in the consensus statement of the ESC. For the strain measurement, we included a control group of 20 patients matching in age and gender.

Results
53% of patients had inferior ST-T abnormalities and 74% reported palpitation. The prevalence of syncope was higher in the arrhythmogenic group (42,1% vs. 12,5% vs.; p=0,038). In 86,4% of patients the degree of mitral regurgitation was mild or moderate. Left ventricular volumes measured by 3D echocardiography exceeded the upper limit of the normal range with normal left ventricular ejection fraction. The global longitudinal strain (GLS) value was significantly lower in the MVP patients than GLS in the healthy control group (-21,9±2,0 % vs. -20,3±2,4 %; p=0,019). Compared to the control group the longitudinal strain values of the inferolateral (-22,2±8,8 vs. -28,8 ± 7,0; p=0,008) and inferior (-13,2±6,3 vs. -20,9±4,1; p=0,001) basal segments were significantly reduced. In 47% of the patients, late gadolinium enhancement (LGE) could be detected in the inferolateral region with CMR.

Conclusions
Inferior ECG abnormalities and palpitations are common among patients with MVP, but due to their low specificity they are not suitable for risk stratification. However, syncope can be considered an alarming sign. The typical pattern of segmental longitudinal strain abnormalities and the similar localization of LGE on CMR indicate the importance of the basal inferolateral segment in AMVP.
Multi-modality non-invasive assessment of cardiopulmonary haemodynamics using cardiovascular magnetic resonance pulmonary transit time and echocardiography
Authors: Haaf P , Segeroth M , Winkel D J , Kaufmann B A , Strebel I , Yang S , Cyriac J , Wasserthal J , Lopez-Ayala L , Sauter A , Mueller C , Bremerich J , Zellweger M 
Published: January 2025

Abstract

Introduction
Pulmonary transit time (PTT) is the time it takes blood to pass from the right ventricle to the left ventricle via the pulmonary circulation, making it a potentially useful marker for heart failure. We assessed the association of PTT with diastolic dysfunction and mitral valve regurgitation.

Methods
We evaluated routine stress perfusion cardiovascular magnetic resonance (CMR) scans in 83 patients including assessment of PTT with simultaneously available echocardiographic assessment. Relevant diastolic dysfunction (DD) and mitral valve regurgitation (MVR) were defined as exceeding grade I (impaired relaxation, mild regurgitation). PTT was determined from CMR rest perfusion scans. Normalized PTT (nPTT), adjusted for heart rate, was calculated using Bazett's formula.

Results
Higher PTT and nPTT values were associated with higher grade DD and MVR. The diagnostic accuracy for prediction of DD as quantified by the area under the ROC curve (AUC) was 0.73 (CI 0.61 to 0.85; p=0.001) for PTT and 0.81 (CI 0.71 to 0.89; p&lt;0.001) for nPTT. For MVR the diagnostic performance amounted to an AUC of 0.80 (CI 0.68 to 0.92; p&lt;0.001) for PTT and 0.78 (CI 0.65 to 0.90; p&lt;0.001) for nPTT. PTT values &lt; 8 s rule-out presence of DD and MVR with a probability of 70% (Negative predictive value 78%).

Conclusion
CMR-derived PTT is a readily obtainable hemodynamic parameter. It is elevated in patients with DD and moderate to severe MVR. Low PTT values make the presence of DD and MVR - as assessed by echocardiography - unlikely.
Pulmonary Transit Time
Pulmonary Transit Time
Prognostic value of echocardiography-based right ventricular-pulmonary artery coupling estimation in acute decompensated heart failure
Authors: Safarova N , Islamova M , Safarova A , Kobalava Z H 
Published: January 2025

Abstract

Background
Right ventricular-pulmonary artery coupling (RV-PA coupling) represents the relationship between RV contractility and RV afterload. RV-PA uncoupling occurs when RV contractility cannot increase to match RV afterload. This leads to RV dysfunction and right heart failure in the end. The value of RV-PA uncoupling in patients with chronic heart failure with reduced and preserved ejection fraction as a determinant of clinical status and strong predictor of cardiovascular death, rehospitalization for heart failure was demonstrated by literature worldwide. However, there are few studies estimated RV-PA uncoupling prognostic value in patients with acute decompensated heart failure (ADHF) upon admission.

Purpose
To assess echocardiographic parameter of RV-PA coupling and its prognostic value in patients with ADHF.

Methods
A single-centre observational study included 171 patients admitted to the city clinical hospital with ADHF (51.5% male, 70 (62;80) years old, arterial hypertension 93%, previous myocardial infarction 39.8%, HF with preserved ejection fraction (HFpEF) 36.8% (n=63), HF with reduced EF (HFrEF) 41.5% (n=71), HF with mid-range EF (HFmrEF) 21.6% (n=37), diabetes 36.8%, NYHA functional class III – 52.1%, class IV – 40.2%, NTproBNP 1683 (830;2944) pg/ml, serum creatinine 105 (86;126.4) µmol/l, eGFR 54.2 (44.1;67.8) ml/min/1.73 m2, potassium 4.5 ± 0.7 mmol/l, echocardiography parameters - left ventricle ejection fraction (LVEF) 44 (30;55)%, pulmonary artery systolic pressure (PASP) 51.2±17.3 mmHg, tricuspid annular plane systolic excursion (TAPSE) 15.4±4.7mm. RV-PA coupling estimated by the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) ratio was evaluated upon admission using two-dimensional echocardiography. TAPSE/PASP &lt; 0.36 mm/mmHg was considered as RV-PA uncoupling. Survival analysis was perfomed using Kaplan-Meier curves. Differences were considered statistically significant when p &lt;0.05.

Results
A statistically significant impact of RV-PA uncoupling on hospitalization, estimated by echocardiography, for heart failure (HF) and for all-cause hospitalization was revealed. Among patients with RV-PA uncoupling the risk of hospitalization for HF increased by 25% (RR 1.251; 95%CI: 1.020-1.539, p=0.042), and the risk of all-cause hospitalization - by 20-24% (RR 1.240; 95% CI: 1.001-1.537; p=0.049). Hospitalization rates for HF (OR 2.07; 95%CI: 1.02–4.02; p=0.042) and all-cause hospitalization (OR 1.96; 95%CI: 1.00–3.86; p=0.049) were 2 times higher.
Conclusion: The identified prognostic value of echocardiography-based RV-PA uncoupling estimation in ADHF regardless of phenotype indicates the advisability of its assessment upon hospitalization. TAPSE/PASP can serve as an important simple tool for risk stratification of patients, optimizing their management and improving the long-term survival of patients.
Utilizing echocardiographic findings and machine learning to predict elevated left ventricular filling pressures in patients with preserved ejection fraction
Authors: Andersson P , Lindow T , Lindqvist P , Venkateshvaran A 
Published: January 2025

Abstract

Background
Estimation of left ventricular filling pressures (LVFP) is important for accurate diagnosis and prognosis of heart failure (HF). The current ASE/EACVI algorithm for identifying elevated LVFP shows modest performance in the setting of preserved ejection fraction (EF) (1). Left atrial reservoir strain (LASr) has been proposed as a novel and additional diagnostic marker to identify elevated LVFP in HF with preserved EF (HFpEF) (1). While machine learning has shown good diagnostic performance utilising conventional echocardiographic findings (2), the incremental value of LASr has not been adequately explored using ML models.

Purpose
This study aimed to evaluate the performance of a machine learning (ML) model that integrates clinical and echocardiographic data including LASr to identify elevated LVFP in the setting of suspected HF with preserved EF.

Methods
Patients with dyspnoea, EF ≥50% and sinus rhythm undergoing right heart catheterisation (RHC) and near-simultaneous echocardiography were selected from the KARUM database. Patients with atrial fibrillation, pacemakers, significant valvular disease or infiltrative cardiomyopathy were excluded. Elevated LVFP was defined as invasive pulmonary artery wedge pressure (PAWP) ≥15 mmHg.
The dataset was split into 75% for model development (training set) and 25% for unbiased testing of model performance (test set). Missing numerical and categorical variables were imputed based on the training data using Bayesian Ridge regression and K-Nearest Neighbours, respectively. Recursive Feature Elimination (RFE) was used to reduce the number of variables. A comprehensive grid search with repeated 10-fold cross-validation was employed to optimise hyperparameters for an XGBoost (Xtreme Gradient Boosting) ML model.
The model with the highest mean area under the receiver operating characteristic curve (AUC) across cross-validation folds was reported and selected as the final model, with its performance reported on the independent test set. Finally, we applied SHapley Additive exPlanations (SHAP) to evaluate and rank the individual variable importance.

Results
Of 210 patients, 157 were allotted for model development (training set) and 53 for reporting model performance (test set). Ten significant variables were identified through RFE. The best-performing XGBoost model achieved a mean AUC of 86.6 % across the cross-validation folds and maintained good diagnostic performance in the test set with an AUC of 89.4% (95% CI: 79.1-99.7%) (Fig 1). Applying SHAP ranked the variables and found LASr the most important variable (Fig 2).

Conclusion
An ML model based on clinical and echocardiographic data, including LASr, demonstrated good diagnostic performance in identifying elevated LVFP in the setting of suspected HF with preserved EF.
ROC Curve for XGBoost Model
SHAP summary plot
Peak atrial longitudinal strain identifies patients with acute decompensated heart failure at high risk of cardiac death
Authors: Millan Vela J , Arias Godinez J A , Fritche Salazar J F , Beltran Ontiveros L D , Tobias Morales A K , Ortiz Leon X A , Posada Martinez E L , Ruiz Esparza Duenas M E , Rodriguez Zanella H 
Published: January 2025

Abstract

Background
Heart failure (HF) is an increasing health problem with high morbidity and mortality. Left atrial function has prognostic relevance in long-term survival of patients with HF. However, its prognostic value in patients with acute decompensated heart failure (ADHF) is less well studied.

Objective
The main objective of this study was to assess the association between PALS (peak atrial longitudinal strain) and cardiovascular (CV) death in patients ADHF.

Methods
A prospective single center study was performed. We enrolled patients admitted with ADHF according to the current European guidelines criteria. Clinical and biochemical data were collected. Echocardiography was performed during the first 24 hours of admission including quantification of left ventricular, right ventricular and left atrial function. Patients were followed up during hospitalization and at discharge. PALS was quantified by a single vendor equipment, using four and two chamber dedicated left atrial views and semi-automated software. The primary outcome was cardiovascular death at 3 years of follow-up. Variables were compared between patients with and without cardiovascular death. A ROC curve was constructed to define the best cut-off point, sensitivity, and specificity of PALS to predict the primary outcome.

Results
Sixty patients were included. The median age was 58 (24-90) years, 26% were female. Median NT-PRO BNP 5168 (186-70000) pg/mL, Creatinine clearance 70.6 ± 31.1 ml/min, hemoglobin 14.6 (1.5-19.3) g/dL. Left ventricular indexed end-diastolic volume 74.8 (26.8-181) ml/m2, left ventricular indexed end-systolic volume 51.4 (6.7-170.6) ml/m2, left ventricle ejection fraction 62.2 ± 13.6 %. Patients with cardiovascular death during follow-up, had lower LVEF 24 ± 8.3 vs 33.9 ± 13.8 % (p&lt;0.033) and lower PALS 7.2 (4-14) vs (17 (3-39) %;(p&lt; 0.002). In the ROC curve analysis, in the best-case scenario, an atrial strain value lower than 12% had a sensitivity of 72% and 90% of specificity for predicting cardiovascular death. Survival analysis demonstrated better survival in patients with PALS higher than 12%.

Conclusions
Left atrial strain is useful in patients with ADHF to identify patients at higher risk of cardiac death. According to our results, patients with PALS lower than 12% constitute a high-risk group in whom a closer follow-up and intensive treatment might be needed. Future studies are needed to confirm our findings.
Survival according to PALS in ADHF
Cardiac reverse remodeling after SGLT2i therapy: beyond the sex
Authors: Prosperi S , Monosilio S , D' Amato A , Angotti D , Tonti G , Pedrizzetti G , Cimino S , Filomena D , Netti L , Badagliacca R , Severino P , Vizza C D , Maestrini V 
Published: January 2025

Abstract

Background
Sodium-Glucose Transport Protein 2 Inhibitors (SGLT2i) have proven beneficial cardiac reverse remodeling effects in heart failure (HF) regardless the ejection fraction (EF). The imaging studies focus mainly on the left ventricle (LV) or atrium (LA) remodeling, with an existing lack in knowledge regarding the right ventricle (RV). In addition, there are no studies analysing the effect of sex on SGLT2i’s cardiac remodelling.

Purpose
To explore the cardiac reverse remodeling in a group of HF patients before and after 6 months from SGLT2i therapy initiation and to investigate the influence of sex on cardiac reverse remodeling.

Methods
We enrolled HF patients naive to SGLT2i prior therapy commencing (on top to the maximum of HF tolerated therapy). Data were collected before therapy (T0) and at 6 months (T1). The LV, LA and RV dimensions and function were evaluated with both standard and advanced echocardiographic parameters, including ejection fraction (EF), fractional area change (FAC), global longitudinal and circumferential strain (GLS and GCS). The LV filling pressure were estimated basing on the ratio between mitral pulse Doppler E wave velocity and the mean of e’ tissue Doppler velocity between septum and lateral wall (E/e’). The NYHA Class and pro-BNP values were also collected. Patients were then divided according to sex.

Results
Forty-nine patients were recruited (mean age 73±12 y.o., 69% male and 31% female). Comparing echocardiographic parameters at T0 and T1, a significant reduction in both systolic and diastolic LV volumes along with a significant improvement in LV EF, GLS and GCS were detected. Furthermore, we found a significant increase of LA-EF and GLS, RV-GLS and FAC. A significant reduction of NYHA Class (NYHA &gt; 2 = 35,7% at T0 vs 20,7% at T1; p 0,006) and pro-BNP values were observed (pro-BNP median value 912 (425 – 2308) pg/ml at T0 vs 556 (271 - 915) pg/ml at T1 (p =0,039). The analysis based on sex revealed a similar improvement of the LV volumes, EF, GLS and GCS. Regarding LA and RV, male showed a reverse remodeling comparable to the entire population, while female, although confirming a similar trend, did not reach the statistical significance (limited cohort).

Conclusions
After 6 months of therapy with SGLT2i, HF patients showed a significant improvement in LV, LA and RV function, and a decrease of pro-BNP values. The sex analysis showed a similar tendency of reverse cardiac remodeling in the two sexes, although in female LA and RV improvement did not reach statistical relevance. These data suggest that SGLT2i determined a global cardiac reverse remodeling, regardless of sex.
Table 1
Table 2
Simple exercise echocardiography parameters can enhance diagnosis of early heart failure with preserved ejection fraction (HFpEF)
Authors: Ng S , Pan J , Xavier R , Lewis A J M , Rider O J 
Published: January 2025

Abstract

Background
Early heart failure with preserved ejection fraction (HFpEF) is characterised by exertional dyspnoea or intolerance. The non-specific nature of these symptoms and a lack of accurate diagnostic tools leave many undiagnosed and untreated. Whilst exercise right heart catheterisation is the recommended gold-standard, it is not widely available owing to technical challenges and its invasive nature. Exercise echocardiography offers a pragmatic compromise but its evidence-base in HFpEF diagnosis remains scarce, with significant variation in exercise protocols and assessment criteria.

Purpose
Using multimodality exercise imaging, the study aims to (1) correlate current recommended echocardiographic parameters at rest and exercise with functional capacity, symptom burden and adverse haemodynamic features (2) identify other echocardiographic parameters that interrogate mechanisms of exertional dyspnoea, thus improving early HFpEF diagnosis.

Method
Symptomatic patients with confirmed HFpEF or intermediate (INT) risk of HFpEF (as defined by the HFA-PEFF diagnostic algorithm) were prospectively enrolled alongside age-matched healthy control subjects. All participants underwent rest and 35W exercise echocardiography, exercise cardiac magnetic resonance imaging (e-CMR), 6-minute walk test (6MWT) and a Kansas City Cardiomyopathy Questionnaire (KCCQ-CSS).

Results
46 HFpEF patients, 39 INT and 19 controls were recruited. The HFpEF and INT groups had similarly reduced functional capacity (6MWT HFpEF 363 vs. INT 384 vs. Control 492m) and worse patient-reported outcomes (KCCQ-CSS HFpEF 70 vs. INT 73 vs. Control 97) compared to age-matched controls. Despite more favourable serum NTproBNP, rest and stress E/e’ in the INT group, cardiac output augmentation during 35W exercise (ΔCI) on e-CMR was similarly blunted when compared to the HFpEF cohort (Table 1). Importantly, echocardiographic parameters in the current HFpEF diagnostic algorithm such as E/e’ and indexed left atrial volume (LAVI) do not correlate with 6MWT distance, KCCQ-CSS or ΔCI after adjusting for age, hypertension and body mass index (Figure A). Across this heterogeneous study cohort, rest and exercise LV septal S’ and RV S’ better correlated with 6MWT distance, KCCQ-CSS score and adverse haemodynamic features (ΔCI and right ventricular-pulmonary artery coupling) (Figures B-C).

Conclusion
Symptomatic patients at intermediate-risk of HFpEF share adverse haemodynamic features and functional impairment to those with diagnosed HFpEF. Using multimodality exercise imaging, we propose simple tissue doppler imaging parameters and assessment of cardiac reserve during exercise echocardiography better elicit mechanisms of exertional dyspnoea, beyond current recommendations. Further validation studies exploring these parameters are needed to advance the role of non-invasive imaging in early HFpEF diagnosis.
Table 1
Figure 2