bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contribution of rotational mechanics to the differential echocardiographic diagnosis of myocardial hypertrophy versus myocardial infiltration
Authors: Garcia Martin G , Queipo Rodriguez A , Geraldo Martinez J , Galiana Talavera E , Hidalgo Mateos A , Gramage Sanchis P , Callizo Gallego R , Valls Serral A , Roldan Torres I , Mora Llabata V 
Published: January 2025

Abstract

Introduction
Increased left ventricular (LV) wall thickness can be caused by myocardial hypertrophy or infiltration. It is important to reach the correct diagnosis because of the major differences in prognosis and specific treatment.

Purpose
Our objetive was to analyze the contribution of LV rotational mechanics to the echocardiographic differential diagnosis between muscular hypertrophy versus myocardial infiltration.

Methods
We analyzed 107 patients with left ventricular hypertrophy [75 with myocardial hypertrophy secondary to hypertensive heart disease (HHD) and 32 patients with myocardial infiltration due to cardiac amyloidosis (CA)] using 2D-Echo speckle tracking. All patients had preserved LV ejection fraction (LVEF &gt; 50%). We measured structural 2D-echocardiographic parameters, global longitudinal strain (GLS), and rotational parameters such as "Rotational Gradient" (°) between the LV basal rotation (°) and apical rotation (°) (twist if basal and apical rotations in opposite directions, or rigid rotation if basal and apical rotations in same directions) and "Wringing" as a normalized measure of Rotational Gradient per unit of longitudinal shortening (Rotational Gradient/GLS (°/%)), which includes the two movements that simultaneously occur during ventricular systole. SLG was obtained from 4-, 3- and 2-chamber apical planes, while basal and apical rotations were obtained from parasternal short-axis planes at these LV levels.

Results
Characteristics of study population are shown in Table 1. No differences in ventricular mass were observed between groups. The GLS was lower in the group of patients with CA, in addition to higher apical LS/basal LS+medial LS ratio. Twist Rotational Gradient showed no differences between the two groups, but its normalization according to ventricular shortening (Wringing) showed significant higher values in the group of patients with CA. Besides GLS &lt;13.9% (AUC 0.92, p&lt;0.0001, CI 95% 0.86-0.97), which is highly indicative of CA, wringing &gt;1,39°/% (AUC 0.72, p &lt;0.0001, CI 95% 0.61-0.82) proved to be a good supportive marker for CA diagnosis exhibiting a sensitivity of 75.0% and a specificity of 62.7%.

Conclusion
In patients with LV thickening and preserved LVEF, in addition to the information provided by myocardial longitudinal strain, the increase in ventricular wringing &gt;1.39°/% is a useful parameter in the differential diagnosis of ventricular hypertrophy for CA.
A strain-based classification is associated with therapy success in cardiac resynchronization therapy-eligible patients
Authors: Duchenne J , Calle S , Stankovic I , Aalen J , Galli E , Larsen C , Puvrez A , De Buyzere M , Kongsgard E , Voros G , Penicka M , Donal E , Smiseth O , Timmermans F , Voigt J U 
Published: January 2025

Abstract

Introduction
Echocardiography-derived septal strain patterns stages are associated with a stepwise increase in survival for each increment in strain stage among patients treated with cardiac resynchronization therapy (CRT). However, it is unknown whether the strain stages could also predict survival in conservatively-treated (i.e. not CRT-implanted) patients.

Purpose
This study aims to investigate the interplay between septal strain patterns and long-term survival in both CRT- and conservatively-treated patients.

Methods
In this multicentre study, CRT-eligible patients from six European centres underwent speckle-tracking strain analysis on echocardiography. CRT-treated patients (CRT) were enrolled prospectively and assessed prior to device implantation. Conservatively-treated patients (CON) were assessed retrospectively. Dyssynchrony was graded through analysis of septal strain curves, categorizing patients into five distinct patterns, denoted as strain Stage-0 (no dyssynchrony) through strain Stage-4 (severe dyssynchrony) (Fig. A). The study endpoint was all-cause mortality.

Results
A total of 267 CRT patients (69% males, 89% left bundle branch block (LBBB) and QRS 166±20 ms) and 167 CON patients (69% males, 87% LBBB, QRS 155±25 ms) were included. Median follow-up time was 49 (40-57) months. CON patients within the highest strain stages had the worst outcome, whereas CRT-treated patients within the highest strain stages had the best survival (Fig. B). A stepwise increase in survival difference was observed between CRT and CON patients for each increment in strain stage (Fig. B-F). Hazard ratios (HR) were: Stage-0: 1.42 (95% CI: 0.59-3.44, p=0.436) / Stage-1: 2.63 (95% CI: 1.19-5.82, p=0.017) / Stage-2: 3.93 (95% CI: 1.20-12.83, p=0.024) / Stage-3: 5.74 (95% CI: 1.72-19.19, p=0.005) and Stage-4: 16.49 (95% CI: 4.84-56.21, p&lt;0.001).

Conclusions
The strain stages demonstrated a strong survival benefit for CRT-treated compared to conservatively-treated, but CRT-eligible patients. Patients with more severe dyssynchrony (highest strain stages) have most benefit from CRT implantation. These findings underscore the potential value of the strain stages in refining risk stratification and patient selection of CRT.
Changes in left atrial strain in patients undergoing cardiotoxic anticancer treatment: a literature review and meta-analysis
Authors: Bombace S , De Luca V M , Farmakis I T , Laux G S , Hobohm L , Karbach S , Lurz P , Sannino A 
Published: January 2025

Abstract

Background
LA strain is an important marker of diastolic dysfunction, with increasing evidence supporting its role in various clinical conditions. While left ventricular global longitudinal strain (LVGLS) is well-established for clinical management and detecting cancer therapy-related cardiac dysfunction (CTRCD), the role of LA strain remains unclear.

Aim
This meta-analysis aimed to investigate the changes in left atrial (LA) strain in patients undergoing cardiotoxic anticancer treatment.

Methods
We conducted a systematic search of the MEDLINE, ISI Web of Science, and SCOPUS databases for studies reporting data on LA strain before and after cardiotoxic anticancer treatment (anthracycline and/or trastuzumab) and published up to April 2024. The study design adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results
In total, 413 studies screened, 9 met the inclusion criteria, enrolling 1504 subjects with a mean age of 53.8 ± 11 years. Eight of nine studies focused exclusively on female patients with breast cancer exclusively, while the remaining study included 7% male patients and 19.6% with other types of cancer. Echocardiograms were performed before and 1 and 6 months after treatment initiation. There was a LVGLS change of 2.0% (95% CI 0.8 to 3.1) and a LVEF change of -1.3% (95% CI -1.9 to -0.6). Significant changes in LA strain parameters were observed, including an LA reservoir strain change of -3.2% (95% confidence interval [CI] -4.5 to -1.9) and an LA contraction strain change of 0.6% (95% CI 0.1 to 1.0). However, no significant change was noted for LA conduit strain with 1.3% (95 % CI -1.3 to 4.0).

Conclusions
Cardiotoxic anticancer treatment is associated with a significant decline in LA strain parameters. Further research is warranted to understand the implications of these changes, including their correlation with diastolic dysfunction, CTRCD, and clinical outcomes.
Changes in strain parameters
Enhancing left ventricular filling pressure estimation in patients with asymptomatic severe aortic stenosis patients, integration of left atrial reservoir strain analysis
Authors: Kaya E , Skulstad H , Kvaslerud A B , Broch K , Edvardsen T 
Published: January 2025

Abstract

Introduction
Estimating left ventricular filling pressure (LVFP) by echocardiography is challenging in patients with asymptomatic severe aortic stenosis (ASAS). The European Association of Cardiovascular Imaging has proposed an algorithm utilizing left atrial reservoir strain analysis (LARS) in patients with what was previously described as "undetermined LVFP". We aimed to validate this algorithm in patients with ASAS.

Methods
We performed right heart catheterization in 50 patients with ASAS. An end-expiratory pulmonary artery wedge pressure (PAWP) ≥ 15mmHg was used as a reference for increased LVFP. We compared indices of LVFP by echocardiography with invasive measurements to validate the algorithm in patients with ASAS.

Results
Nine patients (18%) had increased LVFP by RHC while 8 (16%) had increased LVFP by echocardiography. Only 2 of the 9 patients with invasively elevated LVPF were identified by echocardiography. On the other hand, among the 41 patients with normal LVFP, 35 (85%) were accurately identified as having a normal LVFP by echocardiography. Consequently, the echocardiographic algorithm had a sensitivity of 22% and a specificity of 85% in patients with ASAS (Table). As depicted in the figure, 9 patients were initially labelled as having undetermined LVFP. The addition of LARS, correctly excluded increased LVFP in 7 of these 9 patients (78 %).

Conclusion
LVFP estimation by echocardiography has low sensitivity for increased filling pressure in patients with ASAS. However, the inclusion of LARS significantly improves LVPF estimation correctly, particularly in patients initially classified as having undetermined pressure by conventional echocardiography.
The implication of left ventricular mechanical dispersion as a risk predictor for ventricular arrhythmia in patients with mitral valve prolapse
Authors: Alshehristani R , Al Hashimi A , Abdulhamza R 
Published: January 2025

Abstract

Background
Mitral valve prolapse (MVP) is considered a benign disorder, though it can be accompanied by ventricular arrhythmias. Speckle Tracking Echocardiography can be a promising tool for detecting early derangement.

Objectives
To determine whether the left ventricular (LV) mechanical dispersion derived by speckle tracking echocardiography can be considered a predictor for occurrence of ventricular arrhythmias in patients with MVP.

Materials and Methods
A cross-sectional study conducted on 63 MVP patients (37 females and 29 males) presented with palpitation, who were divided into two groups: Group 1 Arrhythmic patients with ventricular arrhythmias and Group 2 Non-Arrhythmic patients. All of them underwent comprehensive clinical and electrocardiographic examination, cardiac rhythm assessment by Holter monitoring, and comprehensive echocardiographic evaluation including speckle tracking technique.

Results
Ventricular arrhythmias (VA) were detected in 32 out of 63 patients. Ventricular bigeminy was the most common type of VA in arrhythmic patients. Unlike other echocardiographic parameters, the LV mechanical dispersion (MD) and the mitral annular disjunction (MAD) were found to be significantly higher in arrhythmic versus non-arrhythmic MVP patients (P&lt;0.001). Furthermore, the mean LV MD was higher in patients with frequent ventricular ectopics versus infrequent ones (P= 0.003). The cut-off value for LV MD was 35.1 ms or higher (sensitivity 87%, specificity 71%) and for MAD was 2.7 mm or higher (sensitivity 82%, specificity 60%) in predicting VA in MVP patients.

Conclusions
LV mechanical dispersion in addition to MAD can be implemented in risk prediction for ventricular arrhythmias in patients with MVP presenting with palpitations.
Correlation of left ventricular global longitudinal strain by speckle-tracking echocardiography with invasive LV filling pressure
Authors: Nakhaee A , Sardari A , Larti F , Vahidi H , Mehrpooya M , Geraiely B 
Published: January 2025

Abstract

Introduction
The left ventricular (LV) systolic function can affect diastolic relaxation. The interaction of systolic and diastolic myocardial function resembles the mechanism of "coil compression and relaxation." This concept has gained significant attention in recent years, challenging the notion of "isolated diastolic dysfunction." Speckle tracking echocardiography (STE) is a sensitive and innovative method for evaluating global myocardial function beyond LVEF. This study examined the possible correlation between left ventricular longitudinal strain (GLS) and different LV filling pressures.

Method
Patients scheduled for diagnostic coronary angiography and left heart catheterization were included. The exclusion criteria were any degree of mitral stenosis, more than moderate mitral regurgitation or aortic stenosis, left bundle branch block, or atrial fibrillation. Measurements of LV end-diastolic pressure (LVEDP), LV min diastolic pressure (LVMDP), and LV pre-A diastolic pressure (LV pre-A) were taken via cardiac catheterization. On the same day, LV global longitudinal strain (LV GLS) was assessed using the EPIQ 7 Philips vendor.

Results
A total of seventy patients were studied (mean age: 50.24 ± 12.6 years; 60% male). The mean LVEF was 46.8% (SD:10.3), and the mean E/e’= 11.1 (SD:4.1). Pearson’s correlation coefficient showed a moderate negative relationship between LV GLS and LVEDP (R=-0.45, p&lt;0.001), LVMDP (R=-0.44, p&lt;0.001), and LV pre-A (R=-0.43, p&lt;0.001).

Conclusion
The correlation of multiple invasive LV filling pressure parameters (LVEDP, LVMDP, and LV pre-A pressure) with LV GLS signifies the possible role of systolic parameters in predicting diastolic dysfunction. Integrating LV GLS with conventional algorithms may improve the non-invasive assessment of diastolic dysfunction.
Score-based or left atrial strain based assessment of heart failure with preserved ejection fraction in transcatheter aortic valve replacement
Authors: Von Roeder M , Rommel K P , Dumpies O , Maeder M , Wahl V , Rotta Detto Loria J , Kresoja K P , Richter I , Desch S , Lurz P , Thiele H , Abdel-Wahab M 
Published: January 2025

Abstract

Background
Heart failure with preserved ejection fraction (HFpEF) has recently been proposed as important comorbid condition in patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS). The H2FPEF-score and the HFA-PEFF-score are used to diagnose HFpEF, but their use might be hampered by lack of specificity in TAVR-populations. Left atrial reservoir strain (LARS) emerged as a powerful predictor of outcomes in patients with AS irrespective of ejection fraction (EF).

Purpose
To assess the prognostic value of the H2FPEF-score, the HFA-PEFF-score and of LARS for the prediction of outcomes after TAVR.

Methods
All consecutive patients undergoing TAVR with an LVEF was ≥50% between 01/2018 and 12/2018 were included if discharge echo and follow-up were available. The primary endpoint was all-cause death and readmission for decompensated HF. HFpEF was defined as an H2FPEF-score of ≥6 or an HFA-PEFF-score of ≥5 points. LARS was derived from 2-D-speckle-tracking and patients were divided in two groups according to LARS-median.

Results
Overall, 499 patients were available (Age 80 years (IQR 77-84)), including 58% woman. The H2PEFF-score was available in 92% and classified 204 patients (45%) as HFpEF with significant prediction of the primary endpoint (log-rank p=0.04). The HFA-PEFF-score was available in 91% and classified 414 patients (91%) as HFpEF with, but lacked prognostic significance (log-rank p=0.47). LARS was available in 100% of patients (median 13.9% [IQR 9.2-19.0%]). Patients with LARS ≤13.9% experienced worse outcomes (log-rank p&lt;0.001).

Conclusion
H2PEFF-score and LARS might be used for risk-prediction post TAVR with LARS being applicable for more patients in our cohort.
Exercise echocardiography in octogenarian patients: a valid and feasible tool for diagnostic and prognostic assessment in ischemic heart disease
Authors: Casanova Rodriguez C , Cano Carrizal R , Velez Salas A , Rodriguez Alcudia D , Martin Penato Molina A , De La Cruz Berlanga E , Cadenas Chamorro R , Iglesias Del Valle D , Paredes Gonzalez B , Martinez Dosantos V , Aguilera Martinez M C , Lareo Vicente A , Garcia Garcia A 
Published: January 2025

Abstract

Background
The increase in life expectancy in general population is leading to a rise in the number of elderly patients visiting cardiology clinics. Often, the reason for these visits is the diagnostic suspicion or follow-up of patients with ischemic heart disease. Furthermore, elderly patients are often underdiagnosed and undertreated and they are a population poorly represented in clinical trials for coronary artery disease (CAD). Exercise echocardiography (EE) is a fundamental test in the evaluation of patients with diagnostic suspicion or prognostic assessment of CAD. However, there is limited evidence in the literature regarding its usefulness in elderly patients.

Purpose
The aim of our study is to analyze the usefulness of EE in octogenarian patients referred for diagnostic or prognostic assessment of CAD.

Methods
Retrospective analysis of consecutive patients aged 80-89 years referred for treadmill EE for diagnostic suspicion or prognostic assessment of CAD between January 2021 and December 2023.

Results
Ninety three octogenarian patients (aged 80-89 years) were included, representing 5.3% of the total patients who underwent EE during the analyzed period. The average age was 83.1 years, 40% were women and 41.9% had a previous history of CAD. Bruce protocol was performed in 87.1% of the cases. A mean METs level significantly higher than predicted by age and sex was achieved (6.6 vs. 4.9 METs, p&lt;0.001). The test was negative for ischemia in 48.4%, positive in 24.7%, and inconclusive in 26.9%. 5.4% of the studies were considered non-assessable. There were no complications resulting from the test.

Conclusions
EE is an appropriate and feasible diagnostic and evaluative test that is valid and safe for octogenarian patients who do not have a limitation in walking on a treadmill. The vast majority of the studies (95%) were considered assessable.
changes in coronary disease management in real world practice in the united kingdom: insights from the multi-centre EVAREST/BSE-NSTEP study
Authors: Johnson C , Krasner S , Woodward W , Mao E , Mccourt A , Dockerill C , Senior R , Augustine D , Paton M , O'driscoll J , Oxborough D , Pearce K , Robinson S , Willis J , Leeson P 
Published: January 2025

Abstract

Background/Introduction
Recent guidelines and randomised controlled trials have proposed less frequent use of invasive strategies for patients with stable chest pain, and demonstrated the non-inferiority of an initial medical management strategy. However, the impact of these updates on clinical practice in the United Kingdom has not been previously reported.

Purpose
We aimed to identify if recent guidelines and literature have changed the management of patients being referred for stress echocardiography to assess inducible ischaemia in a real-world, multi-centre national healthcare system, and determine if this has significantly impacted patient outcomes.

Methods
Patients were recruited to the EVAREST/BSE-NSTEP prospective cohort study between 2015 and 2023 across the UK as part of two phases (phase 1: Mar 2015-Sep 2020; phase 2: Oct 2020-Sep 2023). Patient demographics, and stress echocardiogram procedural details were collected by study team members at each participating hospital, and 1 year medical outcome data was collected via the Data Access Request Service from NHS England. Patient management decisions and outcomes including referral for invasive coronary angiography, mortality, and cardiovascular events were compared between recruitment phases using Kaplan-Meier analysis and Cox proportional hazard ratios.

Results
5,082 participants were included in this analysis of patient management and outcomes (2,613 in phase 1, and 2,469 in phase 2), with a consistent age, sex, and BMI between recruitment cohorts. There was a higher rate of smoking and hypercholesterolaemia in phase 2 participants, but a decrease in hypertension and peripheral vascular disease (Table 1). There was a decrease in referral rate for invasive angiography for participants with a positive stress echocardiogram in phase 2 (p&lt;0.05; Fig. 1B). Overall, participants in phase 2 had a higher rate of mortality (p&lt;0.01) than those in phase 1, but there was no difference in cardiac event rate between phases (Fig. 1C-F). These results remained consistent after adjusting for covariates, with a reduced hazard ratio for invasive angiography in phase 2 participants who had a positive stress echocardiogram (HR 0.78, 95% CI 0.66-0.92, p&lt;0.01). Additionally, phase 2 participants had an increased hazard ratio for mortality (HR 1.93, 95% CI 1.05-3.55, p&lt;0.05), but no significant increase in risk of cardiac event (HR 0.69, 95% CI 0.43-1.12, p=0.13).

Conclusions
Since 2020, participants are being less frequently referred for invasive coronary angiography after stress echocardiography possibly in favour of an initial medical management strategy. However, this reduction in referral to coronary angiography does not appear to have a negative impact on patient health as measured by cardiac event rate.
Septum displacement implications in the limited cardiac reserve, RV to pc uncoupling and oxygen uptake during exercise in heart failure
Authors: Serrantoni V , Crisci G , Losito M , Ginelli D , Bursi F , Guazzi M 
Published: January 2025

Abstract

Background
Exertional dyspnea is crucial in heart failure (HF) and may be determined by an unfavorable dynamic of ventricular interaction. This concept has been poorly addressed over time and we hypothesized that a careful study of the interventricular septum adaptations during maximal exercise in HF might be implicated in the limited cardiac reserve, uncoupling of right ventricular (RV) to pulmonary circulation (Pc), both yielding to a limited O2 uptake.

Aim
To address the pathophysiology behind biventricular interaction during exercise in HF, studying the role of l septum displacement during exercise and how and whether it would affect peak exercise oxygen consumption (VO2 peak). Through a limited cardiac output (CO) increase and some degrees of RV to PC uncoupling assessed by TAPSE/PASP.

Methods
22 HF underwent a combined cardiopulmonary exercise testing imaging (CPET imaging) with RV 3D-imaging analysis and were compared with a control population.
3D imaging of the RV chamber was examined off-line using the 4D RV TomTec software and obtained 3D mesh of the RV model using custom software to obtain the mean curvature value of IVS in 4 regions of: inflow tract (RVIT), outflow tract (RVOT), apical and body. We acquired measurements of curvature during end-diastole (ED) and at end systole (ES) phases and obtained a parametric curvature map.

Results
HF patients (mean age 72±12, 27% female) typically exhibited an abnormal septal curve, with a more leftward configuration either at rest and under exercise (rest =−0.01±0.007 at ED, and −0.01±0.009 at ES; peak exercise= −0.01±0.006 at ED, and −0.01±0.007 at ES) compared to controls (rest =−0.02±0.002 at ED, and −0.02±0.006 at ES; peak exercise −0.02±0.0.006 at ED, and −0.02±0.01 at ES, Figure). Notably, the degree of the IVS curvature was found to linearly correlate with an impaired gas exchange performance as showed by a lower peak VO2, a limited CO and impairment of TAPSE/PASP in HF (respectively, r=0.64, p&lt;0.001, r=0.5, p&lt;0.001, r=0.53, p&lt;0.001 at ED during exercise; r=0.61, p&lt;0.001 at ES during exercise; Figure).

Conclusions
In HF, the occurrence of right to left IVS displacement appears worth of investigation, tightly contributing to a reduced CO response, and RV-PA uncoupling during exercise. These findings clearly point to the utility of assessing how therapeutic strategies may modulate the negative septum displacement and overall cardiac mechanics.
RV colorimetric curvature map
Septal curvature correlations