bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left ventricular global longitudinal strain (LV-GLS) by speckle-tracking echocardiography (STE) predicts appropriate defibrillator therapy in patients with dilated cardiomyopathy (DCM)
Authors: Omran H , Rudolph T , Lucas P , Reil J , Ivannikova M , Sommer P , Friedrichs K , Rudolph V 
Published: January 2025

Abstract

Background
Patients with dilatied cardiomyopathy (DCM) have an increased risk for sudden cardiac death (SCD) which may be prevented by an implantable cardioverter-defibrillator (ICD). Current guidelines set the indication to implant an ICD in DCM patients based on a left ventricular ejection fraction (LVEF) of ≤ 35 %. However, this approach has been questioned by recent research in non-ischemic DCM. Left ventricular global longitudinal strain (LV-GLS) as assessed by speckle-tracking-echocardiography (STE), directly measuring myocardial deformation in the longitudinal dimension, is a new method to characterize global LV function. Data is scarce regarding the diagnostic value of LV-GLS in predicting sudden cardiac death (SCD) events.

Purpose
The aim of this study was to assess whether LV-GLS measurements predict the rate of appropriate ICD therapies in DCM patients better than LVEF.

Methods
Patients with DCM who underwent primary prophylactic ICD implantation from 2011-2016 at our hospital, who had baseline echocardiographic data adequate for STE analysis, and a follow-up duration of &gt; 6 months were included. ICD interrogation data were retrieved from hospital electronic records. Patients with secondary preventive ICD indication were excluded.

Results
115 patients were included (26% females, age: 61.3 ± 12.4 years, LVEF 27.9 ± 5.4%, NYHA functional class 2.7 ± 0.5). During a follow-up time of 35.2 ± 12.3 months 30 patients had at least one appropriate ICD therapy (25 patients had anti-tachycardia pacing (ATP), 8 patients had ICD-shocks). Mean LV-GLS in patients with ICD therapy was significantly worse than in those without ICD therapy (-6.4% vs. -7.8%, p=0.018). Multivariate logistic regression analysis showed that LV-GLS (odds ratio 1.31, 95% confidence interval: 1.07-1.60, p= 0.01) but not LVEF (OR 0.97, p= 0.47) was an independent predictors of appropriate ICD therapy. Using ROC analysis, we found a cut-off value of -9,7% for LV-GLS to best predict ICD therapy over follow-up with a sensitivity of 93.3% sensitivity (c-statistic 0.64).

Conclusion
Our findings indicate that LV-GLS is a useful marker to risk stratify patients with DCM, outperforming the current standard LVEF. LV-GLS should be implemented in the standard echocardiographic assessment of patients with cardiomyopathy.
Left atrial stiffness index by three-dimensional speckle tracking echocardiography:association with exercise capacity in hypertension-related heart failure with preserved ejection fraction patients
Authors: Zhang Q , Wang Y , Yin L X 
Published: January 2025

Abstract

Objective
The purpose of this study was to analyze the characteristics of left atrial function and its utility compared with exercise E/e’(Ex-E/e’). To explore the diagnostic value of three dimensional left atrial stiffness index(3D-LASI) in predicting exercise ability in hypertension(HT) and hypertension-related heart failure with preserved ejection fraction (HT-HFpEF) patients.

Methods
The study population consisted of 62 healthy subjects and 163 patients with hypertension (112 patients in the simple HT group and 51 patients in the HT-HFpEF group) from July 1, 2022 to July 31, 2023. Standard two dimensional and three dimensional ultrasonic images were collected and analyzed, especially the 3D left atrial function were evaluated.Treadmill exercise stress test was performed, and hemodynamic parameters were recorded.To evaluate the diagnostic value of 3D-LASI (E/e’/LASr and E/e’/LASr-c) in HT and HT-HFpEF patients’ exercise capacity.

Results
Compared with the healthy subjects, the HT group’s left atrial volume of different phase increased and strain value decreased (p &lt; 0.05). In HT-HFpEF group, the longitudinal strain of reserve phase(LASr),circumferential strain of reserve and contraction phase(LASr-c,LASct-c) furtherd decreased. The E/e’/LASr and E/e’/LASr-c were significantly correlated with METs (r=-0.498, p &lt; 0.001;r=-0.412, p &lt; 0.001) , through multiple regression model analysis, E/e’/LASr and E/e’/LASr-c remained independent predictors of metabolic equivalents(METs) .The E/e’/LASr and E/e’/LASr-c(AUC, 0.845;AUC,0.809) demonstrated great value for identify HT-HFpEF with reduced exercise capacity by receiver operating characteristic curves and E/e’/LASr had similar diagnostic efficacy compared with Ex-E/e’(AUC: 0.845 vs 0.876, p=0.239 dron test)).

Conclusion
The left atrial stiffness in HT-HFpEF patients can be evaluated by 3D speckle tracking technology, including rapid acquisition of different phase parameters.The E/e’/LASr and E/e’/LASr -c as indicators of atrioventricular compliance plays key role in maintaining left atrial function, and E/e’/LASr is an independent predictor of exercise ability and with similar diagnostic value to Ex-E/e’ in HT-HFpEF patients.
correlation analysis heat map
ROC for identify HT-HFpEF
Abnormal left ventricular and left atrial mechanics in patients with resistant hypertension
Authors: Akhmimi A , Sprung V S , Lip G Y H , Oxborough D , Shantsila A 
Published: January 2025

Abstract

Introduction
Patients with resistant hypertension (RH) suffer from a high rate of cardiovascular (CV) complications and have poor prognosis. Given the poor prognosis in RH patients, early identification of subclinical myocardial abnormalities is of clinical importance to allow for timely preventive therapeutic interventions. Speckle tracking echocardiography (STE) is a valuable technique to detect subclinical myocardial dysfunction in hypertensive patients and, therefore, could assist in clinical risk stratification and provide important therapeutic implications.

Purpose
The study aimed to investigate whether left ventricular (LV) and left atrial (LA) myocardial mechanics are impaired in patients with RH compared to controlled hypertension (CH) patients and normotensive controls (NC).

Methods
This was a prospective cross-sectional study in which 54 age and sex-matched participants: 17 with RH (mean age 60.5±12.4 years), 18 with CH (57.7±12.2 years), and 19 NC (54.7±11.9 years) were consecutively recruited. Clinical and conventional echocardiographic measurements were obtained, followed by a two-dimensional STE analysis to assess LV and LA strain. Stepwise multivariable linear regression analysis was performed to identify independent predictors of LV and LA strain indices.

Results
The demographical characteristics were similar across the three groups (Table 1). Patients with RH had elevated BP readings and pronounced cardiac remodelling compared to CH and NC (p&lt;0.001). Peak systolic global longitudinal strain (GLS) was lower in RH and CH groups compared to NC (RH: -16.7±1.9% and CH: -19.8±1.4% vs NC: -21.4±1.3%; p&lt;0.001 and p=0.005, respectively), and being lower in RH compared to CH (p&lt;0.001). Peak systolic global circumferential strain (GCS) was lower between RH and NC (RH: -18.3±3.6% vs NC: -21.7±2.2%, p=0.004) but not between RH and CH (RH: -18.3±3.6% vs CH: -20.3±2.9%, p=0.13). Peak systolic global radial strain (GRS) was lower in RH than in CH and NC (RH: 32.8±8.1% vs CH: 45.0±8.9% and NC: 49.1±5.2%, p&lt;0.001 for all). LV twist was similar amongst the three groups (p&gt;0.05). For the LA longitudinal strain indices, patients with RH had significantly lower reservoir, conduit, and pump strains than NC (p&lt;0.001, p&lt;0.001 and p=0.04, respectively) and CH (p=0.01, p=0.02 and p=0.02, respectively). Of note, the presence of RH remained independently associated with worse GLS (β=3.1, p&lt;0.001), GRS (β= -8.6, p&lt;0.001), LA reservoir (β= -6.0, p=0.005) and pump strains (β=3.5, p=0.007) after adjusting for demographical and clinical variables (Table 2).

Conclusion
Patients with RH show evidence of greater cardiac remodelling with subclinical impairment of their LV and LA mechanics when compared to CH and NC. The subclinical identification of myocardial abnormalities in patients with RH may provide a therapeutic window of opportunity for their reversal and potentially mitigate the occurrence of accompanied CV complications.
Utility of left atrial strain to volume relationship during passive leg lift to identify elevated left ventricular filling pressure - a proof-of-concept study
Authors: Venkateshvaran A , Wiklund U , Lindqvist P , Lindow T 
Published: January 2025

Abstract

Background
Assessment of left ventricular (LV) filling pressure in heart failure (HF) poses a diagnostic challenge, particularly when patients display normal LV filling pressures at rest but elevated LV filling pressures during exercise. Rapid preload increase during passive leg lift (PLL) has displayed promise to unmask HF in such challenging scenarios. Novel echocardiographic variables that identify patients with elevated LV filling pressures during PLL are of important clinical value. We explored the dynamic interplay between left atrial (LA) function and volume using LA strain/volume loops during PLL and compared their diagnostic performance to detect elevated LV filling pressure with conventional echocardiographic surrogates.

Methods
We retrospectively reviewed 39 patients with a clinical HF that underwent simultaneous echocardiography and right heart catheterization before and immediately after PLL. Patients with atrial fibrillation (n=4) were excluded. LA-strain volume dynamics at rest and at PLL were also evaluated in 20 age-matched, healthy controls. LA reservoir strain (LASr) was analyzed using speckle-tracking echocardiography. LA strain-volume loops were generated including the best-fit linear regression line employing simultaneous LASr and LA volume.

Results
LA strain-volume slope was lower for HF patients when compared with controls (0.71 vs. 1.22 %/mL, p&lt;0.001). During PLL, LA strain-volume slope displayed a moderately strong negative correlation with invasive pulmonary arterial wedge pressure (PAWP) (r = -0.71, p&lt;0.001) (Fig. 1). At a 0.74 %/mL cut-off, LA strain-volume slope displayed 88% sensitivity and 86% specificity to identify elevated PAWP (AUC 0.89 [0.76–1.00]). In comparison, LASr displayed strong but numerically lower diagnostic performance (AUC 0.83 [0.67–1.00]) and mitral E/e’ demonstrated poor performance (AUC 0.68 [0.40–0.96]) to identify elevated PAWP either at rest or at PLL (Fig 2).

Conclusions
In this proof-of-concept study, LA strain-volume characteristics display potential to provide incremental diagnostic value compared to conventional echocardiographic measures at rest in identification of elevated LV filling pressure. Our preliminary findings need validation in larger cohorts.
Figure 1
Figure 2
Left atrial stiffness index estimated by echocardiography is an independent predictor of mortality in non-ischemic dilated cardiomyopathy
Authors: Sanchez Sanchez I , Islas F , Zulet P , Gil-Abizanda S , Ferrandez-Escarabajal M , Davila C , Poveda V , Restrepo A , Goirigolzarri J , De Agustin J A , Olmos C 
Published: January 2025

Abstract

Introduction and Objectives
Left atrial function parameters have been shown to be important prognostic markers in different clinical settings. Our objective was to evaluate the prognostic role of a non-invasive estimation of left atrial stiffness index using echocardiography in patients with non-ischemic dilated cardiomyopathy (NIDCM).

Methods
Prospective cohort study of patients with NIDCM evaluated at a tertiary Spanish hospital between 2017 and 2022. Clinical and cardiac imaging variables were collected in a multipurpose registry, and the incidence of clinical events was recorded during follow-up. Left atrial stiffness index was estimated non-invasively as the ratio between E/e' and left atrial strain in the reservoir phase.

Results
Mean age of patients in our cohort (n=200) was 61 (14) years, and 68 (34%) were women. During a mean follow-up of 3.6 years, 33 (16.5%) patients died, and 54 (27%) were hospitalized for heart failure.
Mean left ventricular ejection fraction (LVEF) was 31% (9.5), and mean left atrial stiffness index was 1.3 (0.9), with significant differences between patients with and without events (1.68 (1.1) vs 1.21 (0.8); p=0.005) (Figure).
In a logistic regression analysis, the variables significantly associated with all-cause mortality during follow-up were LVEF, E/e' ratio, and left atrial stiffness index (Table). In a multivariable analysis, left atrial stiffness index emerged as an independent predictor of mortality (OR 1.79, 95% CI 1.19-2.69; p=0.005).

Conclusions
In our cohort of patients with NIDCM, the left atrial stiffness index, which combines information related to filling pressures with left atrial function, was an independent predictor of mortality and could be useful as an additional tool for risk stratification in this setting.
Differences in LA stiffness index
Logistic regression analysis (mortality)
Echocardiographic predictors of atrial fibrillation recurrence after catheter ablation in patients with heart failure.
Authors: Uzieblo-Zyczkowska B , Kiliszek Marek M K , Maciorowska Malgorzata M M , Krzyzanowski Krystian K K , Potapowicz Krysztofiak Magdalena M P K , Krzesinski Pawel P K 
Published: January 2025

Abstract

Background
Atrial fibrillation (AF) and heart failure (HF) often occur together. Restoring and maintaining sinus rhythm in these patients appears to be beneficial, however difficult.

Purpose
The aim of the study was to assess AF recurrence after catheter ablation and its predictors in patients with diagnosed HF.

Methods
Consecutive patients with AF undergoing first-time AF ablation in 2019-2022 were enrolled. Comprehensive echocardiography was performed in all patients on the day of ablation. AF recurrence was assessed during a follow-up consisting of outpatient visits/televisits and 7-day Holter monitoring (at 6 and 12 months after ablation and annually thereafter).

Results
Out of total 293 patients enrolled in the study (7 of whom were excluded due to poor image quality), 27.6% (n=81) were diagnosed with HF (12.3% with reduced ejection fraction – HFrEF; 27.2% with mildly reduced EF – HFmrEF, and 60.5% with preserved EF – HFpEF). Median follow-up was at 12 months (IQR 6–16). The incidence of AF recurrence did not differ between the group with and without HF (33.3% vs. 30.7%, p=0.67). There were no differences in AF recurrence rate between the different types of HF (30% AF recurrence rate in HFrEF, 31.8% in HFmrEF and 34.7% in HFpEF, p=0.75). The AF recurrence rate did not vary between patients with AF during echocardiography and those with sinus rhythm (p=0.24), so therefore a combined analysis of them was performed. The groups of HF patients with and without AF recurrence did not differ in terms of demographic data, comorbidities, or results of baseline laboratory tests. In a univariable Cox regression analysis only echocardiographic parameters (left atrial (LA) volume index, LA reservoir strain, LA emptying fraction - LAEF, E wave, e’average, E/e’ average ratio, LA appendage velocity) correlated significantly with AF recurrence in the group of patients with HF. In a multivariable Cox regression analysis, after exclusion of interdependent values, only LAEF (determined automatically using automated functional imaging of the LA) remained significant predictor of the AF recurrence (hazard ratio (HR) 0.962, 95% confidence interval (CI) 0.926-0.998, p=0.043). An LAEF threshold of 35% presented with 62% sensitivity and 85% specificity in predicting AF recurrence (with area under curve 0.733).

Conclusions
AF recurrence rate after ablation was similar in AF patients with and without diagnosed HF as well as in the different types of HF. LAEF was found to be the best predictor of AF recurrence in patients with AF and HF undergoing catheter ablation.
Left atrial strain as the predictor of subclinical atrial fibrillation using speckle-tracking echocardiography: a systematic review and meta-analysis
Authors: Jain H , Singh J , Jain J , Goyal A , Odat R M , Yadav A , Patel N , Passey S , Scott I , Ahmed R 
Published: January 2025

Abstract

Background
Subclinical atrial fibrillation (AF) is defined as an episode of clinically undetected AF that is associated with adverse cardiovascular outcomes. The pathophysiological mechanisms underlying subclinical AF are poorly understood. Estimates of clinical AF risk have previously been based on the left atrial (LA) structure, which can be assessed using echocardiography. Newer echocardiographic parameters, such as LA strain obtained using two-dimensional speckle-tracking echocardiography (STE), have shown promising results. However, the current data are limited, which prompted this study.

Purpose
This meta-analysis aimed to evaluate whether LA strain measured using STE can independently predict subclinical AF.

Methods
A comprehensive systematic literature search was conducted using PubMed/MEDLINE, Embase, and Cochrane Library from their inception until June 10, 2024. The search aimed to retrieve studies assessing LA strain using STE to predict subclinical AF. We pooled multivariate regression log-transformed hazard ratios (HR) with 95% confidence intervals (CIs) using the inverse variance random-effects model. A forest plot was generated to depict the effect estimates visually. Statistical significance was set at p&lt;0.05.

Results
Thirteen studies with 12,388 participants were included in this meta-analysis. The pooled analysis demonstrated that LA strain was an independent predictor of subclinical AF after multivariate adjustments [pooled HR: 1.55; 95% CI: 1.33, 1.80; p&lt;0.00001].

Conclusion
LA strain obtained by STE was an independent predictor of subclinical AF. Assessment of LA strain can aid in prognostication and risk stratification for future AF. Further large-scale prospective studies are required to validate the findings of this meta-analysis.
Figure 1
Effects of mavacamten on left atrial function in hypertrophic obstructive cardiomyopathy
Authors: Ozbay B , Venkatesan N , Wong T C , Sade L E 
Published: January 2025

Abstract

Background
Mavacamten, a cardiac myosin inhibitor, reduces actin–myosin cross-bridge formation in hypertrophic obstructive cardiomyopathy (HOCM). Mavacamten has been shown to reduce left ventricular (LV) systolic performance. However, scarce data exist about its impact on left atrial (LA) function.

Aim
This study aimed to investigate the effects of mavacamten on LA function.

Method
We consecutively reviewed 32 patients’ echocardiograms before and 2-12 months after mavacamten treatment. LA function was assessed by using speckle tracking echocardiography. Patients were monitored for atrial fibrillation (AF) development.

Results
Among 32 patients (mean age 60.5 ± 13.5 years, 11 female) maintenance mavacamten dose was 5 mg/day in 91%, 2.5 mg/day in 9% of the subjects. Mavacamten treatment reduced the LV outflow tract gradient from 71 (44-125) mmHg to 10 (7-24) mmHg (p&lt;0.001). However, some impairment was observed in LV ejection fraction (LVEF) and global longitudinal strain (GLS) after Mavacamten treatment (LVEF; from 66±4% to 59±5%, p&lt;0.001 and in GLS; from -14.3±3.2% to -12.5±2.9%, p=0.038). Also, LA reservoir strain (LASr) and LA contraction strain (LASct) reduced significantly (LASr, from 21.0±6.8% to 16.5±5.6%, p=0.012 and LASct; from 10.2±4.0% to 7.4±3.9%, p=0.011), whereas maximal LA volume index did not change (38.8±10.0 ml/m² vs 36.1±9.2 ml/m², p=0.360). During follow-up (median 8, range 2-21 months), 2 patients developed AF. In patient 1; LASct decreased from 10% to 6%, in patient 2; LASct decreased from 7% to 1% with mavacamten treatment.

Conclusion
Mavacamten appears to have a negative effect on LA function in patients with HOCM. Further studies are needed to investigate its impact on AF development.
Low myocardial work assessed by echocardiography is associated with prolonged ICU-Stay in CABG patients
Authors: Politz C , Hedwig F , Nymchena O , Stein J , Abd El Al A , Hagendorff A , Schoenrath F , Falk F , Knierim J , Merke N 
Published: January 2025

Abstract

Objectives
The aim of this study was to investigate whether echocardiographic assessment of myocardial work is a predictor of outcome in patients undergoing operative revascularization.

Background
Global work index (GWI) is calculated by means of speckle tracking, blood pressure measurement at the moment of strain analysis, and a normalized reference curve. The prognostic value of GWI in patients who are scheduled for bypass surgery is unknown.

Methods
In this retrospective analysis, 193 patients scheduled for a bypass operation were tracked using echocardiographic strain measurement and calculation of the Global Longitudinal Strain (GLS), the GWI and ejection fraction concerning outcome parameters. The primary endpoint was the occurrence of intrahospital major cardiac events (MACE). As secondary endpoints, prolonged ICU stay (more than 24 hours), requirement for catecholamines (more than 12 hours) and duration of mechanical ventilation (mora than 12 hours) were defined as well as all-cause mortality within a year. Both GWI, EF, and Strain were examined for their validity with respect to the primary and secondary endpoints.

Results
The mean patient age was 63.41 years (SD 8.67). The median left ventricular ejection fraction was 53.78 % [IQR 48.30, 57.46] and the median global longitudinal strain -14.73 % [IQR-17.20, -11.87]. The median GWI was 1428.00mmHg% [IQR 1074.00, 1725.00]. Regarding the primary endpoint, no statistically significant differences were found between patients with a GWI of over 1000 mmHg% and those with a GWI of under 1000 mmHg% (p=0.281), which can be attributed to the low number of MACE events (n=13). For the secondary endpoints, there was no significant difference in terms of the duration of mechanical ventilation between patients with a GWI of under or over 1000 mmHg% (p= 0.879). However, there was a significantly higher risk for a longer stay in the ICU (OR 3.44, 95%CI [1.54, 8.33], p=0.004) among patients with a GWI of under 1000 mmHg%, and furthermore, a higher requirement for catecholamines was observed (p= 0.007).

Conclusion
GWI is associated with prolonged ICU Stay above 24 hours and requirement for catecholamines, but not for mace or ventilation time.