bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term changes in myocardial function after CABG assessed by speckle tracking echocardiography
Authors: Braun C , Weijner-Mik P , Szymczyk E , Kasprzak J D , Lipiec P 
Published: January 2025

Abstract

Introduction
Speckle-tracking echocardiography (STE) is an advanced imaging technique for assessing myocardial function, which is more sensitive and specific than standard parameters in detecting subtle changes in myocardial function.

Purpose
We evaluated global and regional left ventricular (LV) and left atrial (LA) function changes in patients undergoing coronary artery bypass grafting (CABG) using standard and advanced echocardiographic techniques.

Methods
The study group included 83 patients (72 men, 11 women; mean age 65,1±8,4 years) scheduled for CABG due to multivessel coronary artery disease (CAD). All patients underwent pre- and postoperative transthoracic echocardiographic examinations (TTE). Offline analysis of global functional parameters was performed, including left ventricular ejection fraction (LVEF), global systolic longitudinal strain (GLS), and global peak longitudinal strain (GPLS). Regional systolic and diastolic left ventricular function was analyzed by measuring peak systolic strain rate (SRS), peak diastolic longitudinal strain rate in the early (SRe) and late phase (SRa), and the post-systolic index (PSI). LA strain was also assessed. During the 2nd examination (7,9±3 days), 68 patients had sufficient image quality for analysis. 42 patients attended the 3rd examination (9±2,3 months). 30 patients attended the 4th examination (60,3±5,1 months). Results were compared to the 1st examination. Nine deaths were recorded in the study group.

Results
The mean baseline LVEF was 46±10%. During 2nd TTE, we noticed a reduction of LVEF to 41±10% (p=0.0016). LVEF remained reduced during the 3rd TTE, but returned to baseline at the 4th examination (50±8%). There was a significant decrease in global strain parameters observed during 2nd TTE. GLS decreased from -12,63±3,5% to -10,61±5,25% (p&lt;0.0001), and GPLS from -13,46±3,4% to -11,77±4,52% (p&lt;0.0001). Global strain parameters recovered at the 3rd and 4th examinations, with no significant differences from the 1st examination. Regional systolic and diastolic deformation parameters followed a similar trend, though only SRS showed a significant persistent reduction during the 4th TTE (0,73±0,15/s) compared to the 1st (0,82±0,17/s, p=0.0290). CABG did not impact LA function.

Conclusion
CABG leads to a significant postoperative decrease in global longitudinal LV deformation, which recovers over the long term. Revascularized territories show a similar trend. Recovery of global and regional strain parameters occurs earlier than LVEF recovery. CABG does not significantly impact LA function as assessed by STE.
Right ventricular strain as prognostic marker in patients with heart failure receiving sacubitril/valsartan: a sub-analysis of DISCOVER-ARNI, a multicenter Italian study
Authors: Pastore M C , Mandoli G E , Giannoni A , Ginetti F R , Correale M , Brunetti N D , Guaricci A I , Piscitelli L , Degiovanni A , Patti G E , Malagoli A , Moderato L , Carluccio E E , Cameli M 
Published: January 2025

Abstract

Background
Angiotensin receptor/Neprilysin inhibitors (ARNI) have shown to considerably improve the clinical outcome of patients with heart failure and reduced ejection fraction (HFrEF). Identifying individuals who may benefit from ARNI the most could markedly enhance patient management. The aim of this sub-analysis of DISCOVER-ARNI was to evaluate the prognostic significance of speckle tracking echocardiography (STE) parameters in patients undergoing ARNI.

Methods
DISCOVER-ARNI multicenter Italian register retrospectively enrolled 341 patients with HFrEF referred for ARNI. Clinical, biohumoral and echocardiographic evaluation was performed at baseline. Among those with available right ventricular STE data, long-term follow-up was conducted by telephone interview or on-site visits. The primary composite endpoint included all-cause or cardiovascular mortality, HF hospitalization, heart transplantation, left ventricular assist device (LVAD) implantation.

Results
Overall, 136 HFrEF patients were included (mean age 65±10 years, 82% male). Mean follow up was 40±18 months: 32 patients reached the primary endpoint (14 deaths of which 10 cardiovascular deaths, 22 hospitalization, 3 heart transplantation, 1 LVAD implantation). Patients with events had higher LV volumes and EF, lower but preserved tricuspid annular plane systolic excursion (TAPSE) and higher systolic pulmonary artery pressures, reduced LV, left atrial (LA) and free wall right ventricular longitudinal strain (fwRVLS). Using Cox Proportional Hazard Model including LVEF, TAPSE, LV strain, LA strain, fwRVLS, the latest emerged as the sole independent predictor of the combined endpoint(odds ratio=1.12 [1.05;1.2], p=0.001). Receiver operating characteristic (ROC) curves determined that fwRVLS=-20% was the optimal prognostic cut-off(AUC=0.70). Kaplan Meier survival curves, demonstrated effective risk stratification of fwRVLS&gt;-20% for the primary endpoint.

Conclusions
fwRVLS by STE holds promise as a valuable parameter to assess response to ARNI therapy in terms of overall survival, HF hospitalizations, heart transplantation or LVAD implantation.
Association between left atrial mechanics parameters and thromboembolic risk at 10 years in a cohort of patients with atrial fibrillation
Authors: Islas F , Molina-Merlos P , Gutierrez E , Gil-Abizanda S , Perez De Isla L , De Agustin J A , Olmos C 
Published: January 2025

Abstract

Background
Atrial fibrillation (AF) is a significant risk factor for the occurrence of stroke. Thromboembolic risk in patients with AF is estimated using the CHADS2 and CHA2DS2-VASc scales. In previous studies, a correlation was observed between different echocardiographic parameters of left atrium mechanics and thromboembolic risk in patients with AF. Our main objective is to evaluate the association between atrial strain measured and the occurrence of thromboembolic events in patients with AF.

Methods
Prospective cohort of patients with AF, who underwent a transthoracic echocardiogram with 3D wall-motion tracking (3DWMT) in 2014 and who were followed up between 2014 and 2022. The association of different clinical and echocardiographic variables, including left atrial strain, with the occurrence of embolic events was analyzed.

Results
Of the 102 patients studied in 2014, 99 had follow-up recorded and were finally included in the study. The mean age of our population was 78.7 ± 9.9 years, and 49 (49.5%) are women. The incidence of embolic events at 10 years was 34.3%. Patients with thromboembolic events had significantly higher CHADS and CHA2DS2-VASc scores (Figure). No significant association was found regarding biventricular systolic and left atrium morphological parameters and thromboembolic events (Table). However, we observed lower left atrium reservoir strain values in patients with embolic events, compared to those without embolisms (7.19% (3.54) vs 8.97% (5.15), p = 0.055) (Figure).

Conclusions
In our cohort of patients with AF, we found a statistically significant association between CHADS and CHA2DS2-VASc and the incidence of embolic events at follow-up. Left atrial reservoir strain was the only echocardiographic parameter significantly associated with the occurrence of thromboembolic events.
The incorporation of atrial mechanics parameters to traditional thromboembolic risk scales could provide additional value for the prediction of events in patients with AF.
Table Figure
Mechanical dispersion predicts long-term survival of dialysis-dependent patients with preserved ejection fraction
Authors: Stankovic I , Stefanovic M , Vranic I , Jemcov T , Maksimovic A , Zec N , Markovic R , Kusic Milicevic J , Neskovic A N 
Published: January 2025

Abstract

Background
Since cardiovascular disease is a major cause of death in patients with chronic kidney disease (CKD), echocardiographic risk stratification of CKD patients may be clinically important, especially if left ventricular (LV) systolic function is still preserved.

Purpose
To investigate the prognostic implications of conventional (LV mass) and advanced echocardiographic parameters [global longitudinal strain (GLS) and mechanical dispersion] in dialysis-dependent patients with preserved left ventricular ejection fraction (LVEF).

Methods
A total of 78 patients with LVEF≥50% were prospectively enrolled and followed for 60 months for all-cause death. LV mass was calculated using the ASE/EACVI recommended formula for estimating LV mass from LV linear dimensions and indexed to body surface area (LVMI). Longitudinal myocardial strain was measured by speckle-tracking echocardiography. The duration of mechanical contraction was determined as the time from the ECG R-wave to peak longitudinal strain in each of 18 LV segments. Mechanical dispersion was defined as the difference between the longest and shortest time intervals.

Results
In univariable analysis, age [hazard ratio (HR) 1.04, 95% confidence interval (CI) 1.01-1.07, p=0.014], diabetes mellitus (HR 2.16, 95%CI 1.03-4.52, p=0.042), LVMI (HR 1.02, 95%CI 1.01-1.03, p=0.001), GLS (HR 0.77, 95%CI 0.66-0.88) and mechanical dispersion (HR 1.01, 95%CI 1.01-1.02, p&lt;0.001) were all predictive of all-cause mortality. The results of the multivariable Cox regression model are shown in the Figure: in addition to age, mechanical dispersion, LVM and GLS were found to be independent predictors of death from any cause. Patients with mechanical dispersion ≥260 ms had worse survival (HR 3.74, 95% 1.51-9.27) than those with a lesser degree of dispersion (p=0.004).

Conclusions
In dialysis-dependent patients with preserved LVEF, higher extent of mechanical dispersion is associated with worse long-term survival. Higher LV mass and reduced GLS were also identified as independent predictors of survival. Echocardiography-derived parameters may be useful for risk stratification in this vulnerable patient population.
Utility of left atrial strain in differentiating between cardiac amyloidosis and hypertrophic cardiomyopathy
Authors: Serrano Lozano D , Margarida De Castro A , Cuesta Cosgaya J M , Santiago Setien I , Lerena Saenz P , Fernandez-Valls Gomez M , Llano Cardenal M F , Zarauza Navarro J , Coroas Pascual C , Rodriguez De Rivera Socorro M , Abia Sarria L , Munoz Prejigueiro L , Carreiro Da Cunha E , Alarcos Blasco H , Ruisanchez Villar C 
Published: January 2025

Abstract

Introduction and Objectives
Cardiac amyloidosis (AL) is a disease characterized by the abnormal accumulation of anomalous proteins in cardiac tissue, while hypertrophic cardiomyopathy (HCM) is a hereditary cardiac disease characterized by abnormal thickening of the cardiac muscle, associated with tissue fibrosis and cardiac dysfunction in its natural progression. The echocardiogram has emerged as a fundamental tool in the diagnosis and follow-up of these patients, and strain analysis techniques can provide highly useful additional information on cardiac function in these patients, especially in the early stages of the disease. We questioned whether it might be useful in differentiating between these two diseases.

Methods
This retrospective analysis included adult patients who had undergone echocardiography at our center during the years 2023-2024. A total of 52 patients with a confirmed diagnosis of transthyretin AL confirmed by scintigraphy and/or biopsy, and another group of 51 patients with a confirmed diagnosis of HCM and ICD carriers for being high-risk patients were included. Various left atrial strain values (Reservoir, Conduit, and Pump) were analyzed. Descriptive statistics were calculated for each group and segment, and the Mann-Whitney U test was used to compare the groups.

Results
Patients with AL showed significantly lower absolute strain values compared to patients with HCM in all three analyzed varieties (Reservoir, Conduit, and Pump) with p&lt;0.01 for all comparisons. The mean strain in the HCM group was 18.57 for reservoir strain, -11.85 for conduit strain, and -6.94 for pump strain; while the mean in the AL group was 9.28, -6.93, and -3.10, respectively.

Conclusions
Our study found significant differences in left atrial strain values between patients with HCM and patients with transthyretin AL. These findings suggest that left atrial strain analysis could be useful in evaluating cardiac function, follow-up, and differential diagnosis between patients with AL and HCM, especially in the earlier stages of the disease, where it is more challenging to establish a reliable diagnosis.
HCM Vs amyloidosis
Global longitudinal strain as a prognostic index of significant coronary artery disease
Authors: Koulaouzidis G , Kalaitzoglou M , Kleitsioti P , Xanthopoulou S , Mourvetidis P , Kaimakami M , Tsaousidis A , Tzalamouras V , Giannakopoulou P , Mavrogianni A D , Henein M Y , Zarifis J 
Published: January 2025

Abstract

Introduction
Speckle tracking Echocardiography (STE) has recently gained significant value in echocardiography practice. Its role in stable coronary artery disease, however, remains controversial.

Purpose
The purpose of this study is to assess the diagnostic value of Global Longitudinal Strain (GLS) in predicting significant Coronary Artery Disease (CAD).

Methods
This is a prospective study of 103 symptomatic patients who were referred to our hospital for invasive coronary angiography to exclude CAD. An initial echocardiogram including GLS was performed in all. Patients with acute coronary syndrome, history of CAD, heart failure, left ventricle wall motion abnormalities or significant valve disease were excluded. Patients were diagnosed as having significant CAD if the angiogram confirmed ≥50% stenosis in one or more of the coronary branches. The sensitivity and specificity of GLS in predicting the presence of CAD was assessed.

Results
The study included 103 patients (with a mean age of 63.8 ± 9.3 years), 78.6% were males. A history of arterial hypertension was present in 63.1% of the patients, dyslipidemia in 77.7%, diabetes in 22.3% and peripheral arterial disease in 11.7%. 71.9% of the subjects smoked and 24.3% had family history of premature CAD. Finally, 8.7% had atrial fibrillation and 5.8% had chronic kidney disease. Among the 103 patients, 47 (45.6%) were found to have significant CAD, while the remaining 56 (54.3%) had either non-significant CAD or normal coronary arteries. Patients with significant CAD had lower GLS values than those with non-significant CAD (-15.73 ± 2.64% vs. -17.6 ± 1.85%, p=0.001). GLS values ranging from -16.25 to -14.45 can predict significant CAD. Sensitivity and specificity values ranged from 56%-75% and 69%-83% respectively, considering the type of the coronary lesion, as it is demonstrated in Table 1.

Conclusions
Resting myocardial GLS can be considered a predictive index of significant CAD in symptomatic patients, for better stratification. These findings need to be confirmed in larger multicenter setting.
Haemodynamic and cardiac mechanical adaptations following isometric exercise training in patients with heart failure with preserved ejection fraction.
Authors: Edwards J , Jalaludeen N , Marciniak A , Sharma R , O'driscoll J 
Published: January 2025

Abstract

Background
Heart failure with preserved ejection fraction (HFpEF) is a complex clinical condition associated with impaired haemodynamics and subclinical cardiac dysfunction. Aerobic exercise training is a viable intervention to improve outcomes; however, adherence is poor. Isometric exercise training (IET) is a time-efficient exercise mode that has been demonstrated to produce significant cardiovascular adaptations. However, no research to date has investigated the effects of IET in patients with HFpEF.

Purpose
This study aimed to perform the first randomised controlled trial on the effects of IET on resting blood pressure and cardiac mechanics in patients with HFpEF.

Methods
38 medically optimised HFpEF patients were randomised to a 4-week IET intervention (wall squat or handgrip), or a non-intervention control group. Resting clinic systolic (sBP), mean (mBP) and diastolic (dBP) blood pressure and cardiac mechanics were recorded pre and post the 4-week study period. We measured global longitudinal strain (GLS) and left atrial reservoir strain (LAr) via 2D speckle tracking echocardiography. Data is reported as mean±standard error.

Results
Thirty-three participants completed the study (18 IET, 15 control). Following the 4-week intervention, there was a significant reduction in resting sBP (-8.52±2.7mmHg, p=0.003), mBP (-4.94±2mmHg, p=0.018) and dBP (-4.62±1.8mmHg, p =0.016) in the IET group compared to the control group. There was a significant improvement in GLS (1.98±0.8%, p=0.015) and LAr (4.59±1.7%, p=0.012) following IET compared to the control group.

Conclusion
This novel study supports IET as an effective therapeutic intervention to improve cardiovascular modulation in patients with HFpEF. Larger-scale, multi-centre research is needed to establish the wider utility of IET in HFpEF with potential for future guideline implementation.
Myocardial work in patients with dilated cardiomyopathy and advanced stage of heart failure
Authors: Toader D M , Paraschiv A , Munteanu O , Craciun-Mirescu A , Hadareanu D , Stanisor R , Chitu M , Donoiu O , Militaru S , Istratoaie O , Militaru C 
Published: January 2025

Abstract

Background
Left ventricular myocardial work (MW) assessed by echocardiography is a new index of myocardial performance. This imaging tool incorporates afterload determination using cuff blood pressure and thus provides a more load-independent measure compared with GLS.

Purpose
The study aimed to find a link between MW indices at discharge and complications like cardiac rehospitalization and death two tears follow-up in patients with dilated cardiomyopathy (DCM) and advanced stage of heart failure.

Methods
The study included 76 patients with dilated DCM(50% of ischemic etiology), left ventricle ejection fraction (LVEF) below 40%, and NYHA class IV of heart failure (HF). All the patients underwent a complex echocardiographic evaluation according to the latest guidelines. We used an E95 machine for image acquisition and an ECHOPAC 204 for image postprocessing, using the automated functional imaging (AFI) technique. The noninvasive systolic cuff pressure measurement was performed during image acquisition. Four indices were calculated: global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). The patients were followed for two years.

Results
1. 24 patients presented rehospitalization for HF decompensation (31.57%), and 23 (30.26%) patients died during follow-up. 2. The patients with ischemic etiology of DCM presented lower values of MW parameters compared with patients without coronary artery disease: GWI: 653.92 (SD 330.58) vs. 586,89 (SD 284.48), GCW 937.81 (SD 388.15) vs. 849.6 (SD 349.86), GWW 244.81 (SD 121.29) vs 203.23 (SD 97.16), GWE 74.89 (SD 9.45) vs 75.78 (SD 9.01). 3. The MW parameters in DCM patients with cardiovascular death and rehospitalization were lower compared with DCM patients without rehospitalization and cardiovascular death were GWI: 455.3 (SD 285.14) ( P = 0.0001) and 555.33 (SD 210.42) (P = 0.0002); GCW: 700.69 (SD 353.104) ( P = 0.0001) and 826.875 (SD 291.29) (P = 0.0031); GWW: 215.87 (SD 88.96) (P = 0.8771) and 248.45 (SD 108.03) (P = 0.2517); GWE: 71.39 (SD 8.77) (P = 0.0005) and 73.45 (SD 7.19)(P=0.0031).

Conclusion
1. MW indices values were comparable in patients with ischemic and nonischemic DCM and advanced stage of heart failure. 2. GWI, GCW, and GWE at discharge were significantly lower in DCM patients with rehospitalization and cardiac death compared with DCM patients without complications during two years of follow-up.
MW indices calculation
Right ventricular strain as a predictor of trastuzumab-induced chemotherapy-related cardiac dysfunction: a meta-analysis
Authors: Jain H , Goyal A , Singh J , Jain J , Odat R M , Patel N , Khan S , Mallik S , Scott I , Ahmed R 
Published: January 2025

Abstract

Background
Trastuzumab (TZ) is an effective chemotherapeutic drug associated with left ventricular dysfunction, leading to cardiotoxicity. Two-dimensional speckle-tracking echocardiography has demonstrated efficacy in predicting TZ-induced cardiotoxicity; however, its role using right ventricular (RV) strain parameters remains unclear.

Purpose
The current meta-analysis compared pre- and post-TZ RV strain parameters measured on two-dimensional speckle-tracking echocardiography.

Methods
A systematic search was conducted across PubMed/MEDLINE, Embase, and Cochrane Library from inception until June 2024. The outcomes of interest were the RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWLS). RevMan version 5.4 was used to pool standardized mean differences (SMD) with their corresponding 95% confidence intervals (CI) using the inverse-variance random-effects model. Statistical significance was set at p&lt;0.05.

Results
Four studies involving 275 patients with cancer were included in this meta-analysis. The mean age of the patients was 53.35 ± 11.1 years. Pooled analysis demonstrated that TZ-based chemotherapy resulted in a statistically significant reduction in RV GLS [SMD: -0.58; 95% CI: -0.94, -0.22; p=0.001] and RV FWLS [SMD: -0.54; 95% CI: -0.99, -0.08; p=0.02].

Conclusion
Following TZ-based chemotherapy, RV subclinical damage ensues, leading to the deformation of RV mechanics. This meta-analysis demonstrated a reduction in RV GLS and RV FWLS following TZ-based chemotherapy, as detected by speckle-tracking echocardiography. Further multicenter randomized studies are required to validate the findings of the present meta-analysis.