bluuebunny/crossref_metadata_2025_split huggingface dataset:
The prevalence of indeterminate diastolic function in hypertensive women: 2024 BSE guidelines versus 2016 ASE/EACVI guidelines
Authors: Kolesnyk M , Sokolova M V 
Published: January 2025

Abstract

Background
There is a significant number of patients with indeterminate diastolic function (DF) using 2016 ASE/EACVI guidelines. The left atrial (LA) longitudinal strain could provide additional information in case of inconclusive results. Recently, a new 2024 BSE guidelines incorporated LA strain as routine measure of DF. However, there is still a grey-zone within a range of 18–29% for LA reservoir strain (LARs). The purpose of this study was to compare the prevalence of indeterminate DF based on the 2016 ASE/EACVI and 2024 BSE guidelines.

Methods
The study enrolled 100 postmenopausal women (mean age 57 ± 4 years) with uncomplicated arterial hypertension and normal systolic function. The cohort was divided into 3 groups (normal DF, indeterminate DF, diastolic dysfunction). The DF was assessed with both 2016 ASE/EACVI and 2024 BSE algorithms. The initial assessment of DF included average E/e' ratio, left atrial volume index and tricuspid regurgitation velocity with BSE algorithm. LARs was analyzed, when only 2 criteria were available (1 positive and 1 negative). The LARs ≥ 30 % or pump strain ≥ 14 % were considered normal. The LARs &lt; 18 % was abnormal. The range between 18-29 % was a grey-zone area.

Results
The prevalence of indeterminate DF was significantly lower with assessment by 2024 BSE versus 2016 EACVI/ASE algorithm (21 % vs 53 %). The proportion of patients with normal DF was significantly higher with BSE guidelines (72 % vs 40 %). Surprisingly, the presence of DD was the same (7 % using both algorithms) (Table). The tricuspid regurgitation was absent in 75 % of patients, leaving only 2 initial criteria for DF assessment with BSE guidelines. Among these patients 40 % had 2 negative criteria and 3 % had 2 positive criteria. 32 % had 1 positive and 1 negative criteria. Thus, a third of patients required additional evaluation with LA strain. 21 % of patients had LARs in a range between 18% and 29 % or pump strain &lt; 14 % with indeterminate DF status. These patients need further evaluation.

Conclusions
Adding LA strain to the 2024 BSE DF assessment algorithm significantly reduced the number of indeterminate results. However, one fifth of hypertensive women had left atrial strain values in the gray zone area.
Diastolic function assessment
Overexpression of triadin in adipose tissue causes cardiac dysfunction
Authors: Singh S , Konja D , Velayutham Sampath K , Sun Q , Xu A , Wang Y 
Published: January 2025

Abstract

Introduction
As a member of the protein complex that regulates the ryanodine receptor (RyR) , triadin plays a critical role in intracellular calcium homeostasis. Our previous results demonstrate that the NAD-dependent deacetylase sirtuin-1 (SIRT1) downregulates the expression of triadin isoform Trisk 51 in adipose tissue. A transgenic mouse model with adipose tissue selective overexpression of Trisk 51 (Adipo-TRDN) was established.

Aim
The present study is designed to investigate the role of SIRT1-triadin signalling in the development of dilated cardiomyopathy/heart failure with reduced ejection fraction.

Methods
Wild type (WT) littermates, Adipo-TRDN without or with human SIRT1 overexpressed in adipose tissue (Adipo-TRDN/SIRT1) were used for this study. All mice were provided with standard chow diet, normal drinking water and kept in a 12/12 light-dark cycle. Echocardiography was performed in 30 weeks old male mice using Visual Sonics Vevo 2100 Imaging System to measure systolic and diastolic function using B-mode, M-mode, Color Doppler and Tissue Doppler parameters.

Results
Systolic cardiac impairment was present in the Adipo-TRDN mice compared with their littermate controls. Left ventricular internal diameter during systole (LVID, s) was increased in Adipo-TRDN compared with WT littermates (3.0031 vs. 2.1878 mm, p-value: 0.0059). Changes in the Left ventricular anterior wall thickness (LVAW) during systole and diastole were found to be non-significant (1.6180 vs. 1.3530 mm, 1.1443 vs. 1.0455mm). Although fractional shortening (FS %) differences were non-significant (27.64% vs. 34.83%), there was a significant reduction in ejection fraction (EF %) in Adipo-TRDN mice compared with their WT controls (49.41% vs. 64.73%, p-value: 0.0472). No differences were found in the Left ventricular mass (LV) (106.80 vs.84.10 mg). Left ventricular volume during systole (LV Vol; s) was also significantly enhanced in Adipo-TRDN compared with their WT controls (35.25 vs.16.30 μL, p-value: 0.0047). Overexpression of human SIRT1 lead to partial improvement in the pathogenesis of dilated cardiomyopathy in Adipo-TRDN mice. Ejection fraction and fractional shortening were both increased in the Adipo-TRDN/SIRT1 compared with Adipo-TRDN mice (70.70% vs. 49.41%, p-value: 0.0017, 39.60% vs. 27.64% p-value: 0.0151). LV mass and LV Vol;s were reduced in the Adipo-TRDN/SIRT1 compared with Adipo-TRDN mice (75.83 vs. 106.80 mg, p-value: 0.0543) (14.02 vs. 35.25 μL, p-value: 0.0005). LVID (s), LVAW (d) and LVAW (s) were also reduced in Adipo-TRDN/SIRT1 compared with Adipo- TRDN mice (2.1641 vs. 3.0031mm, p-value: 0.0041, 0.8728 vs. 1.1443, p-value: 0.0319, 1.2369 vs. 1.6180mm, p-value: 0.0018).

Conclusion
Development of dilated cardiomyopathy induced by adipocyte specific overexpression of Triadin is partially prevented by adipose SIRT1.
Subclinical abnormalities of systolic and diastolic function in longitudinal echocardiography after mild initial COVID illness
Authors: Shchendrygina A S , Ka M M , Rodriguez Bolanos C , Alsoufi S , Hoffmann J , Kumar P , Carerj M , Vanchin B , Holm N , Karyou A , Mijidsuren M G , Nagel E , Puntmann V 
Published: January 2025

Abstract

Background
Cardiac inflammatory involvement is an increasingly recognized sequelae of COVID-19 disease. The aim of this study was to evaluate the subclinical patterns and evolution of cardiac abnormalities using transthoracic echocardiography (TTE) in patients with mild initial COVID-19 illness.

Methods and results
343 infected individuals (163 males; age 44 (interquartile range, IQR 35-52) years) underwent serial TTE assessments at a median of 109 (interquartile range (IQR), 77–177) and 327 (276-379) days after infection. Compared to non-COVID infected controls (n=94, male n=49), baseline systolic (LVEF, TAPSE) and diastolic function (e’, a’, E/e’) were significantly different in infected participants (p&lt;0.05 for all). Compared to baseline assessments, there was a reduction in global longitudinal strain (GLS), and an increase in E wave, E/A ratio and E/e’ at follow up. At baseline symptomatic participants had lower LVEF and TAPSE, increased IVRT, e’ and E/e’. At follow-up symptomatic patients had lower LV end-diastolic diameter (LVEDd). Symptoms were independently associated with E/e’ at baseline (OR (95%CI) 1.45 (1.12-1.87), p=0.005). At follow up symptoms were associated LVEDd (OR (95%CI): 0.91 (0.86-0.96), p&lt;0.001), followed by the model that also included NTproBNP (OR (95%CI): 1.01 (1.00-1.01), p=0.047). There were significant associations for GLS and troponin, and E/e’ with CRP and NTproBNP at baseline.

Conclusion
In the present cohort of COVID-19 infected individuals with mild initial illness, echocardiographic measurements reveal significant yet subclinical differences in systolic and diastolic function compared to controls, as well as between individuals with cardiac symptoms and those without. All the measured differences were small in magnitude, thus unlikely detectable clinically on an individual level.
Artificial intelligence-enhanced electrocardiogram left ventricular diastolic function assessment for prognostic assessment in mitral annulus calcification
Authors: Tsaban G , Lee E , Wong Y W , Wopperer S B , Abbasi M A , Kane G C , Lopez-Jimenez F , Guerrero M , Eleid M , Nkomo V T , Deshmukh A J , Noseworthy P A , Friedman P A , Attia I , Oh J K 
Published: January 2025

Abstract

Background
Moderate-severe mitral annulus calcification (MAC) and left ventricular (LV) diastolic dysfunction are both linked to increased risks of heart failure and mortality. Assessing LV diastolic function (LVDF) in moderate-severe-MAC by echocardiography is frequently challenging and unreliable. We recently validated an AI-ECG model for LVDF. We aimed to determine if this tool can predict long-term mortality in patients with moderate-severe-MAC and whether it can help establish MAC-specific echocardiographic LVDF parameter cutoffs.

Methods
This retrospective study included all patients from the AI-ECG LVDF study test cohort who underwent comprehensive transthoracic echocardiography confirming moderate-severe-MAC and ECG within fourteen days of each other at Mayo Clinic between 09/2001 and 06/2022. AI-ECG LVDF was determined based on the index ECG. Patients were categorized based on AI-ECG into groups representing normal/grade-1 LVDF, grade-2 LVDF, or grade-3 LVDG (DF-1, DF-2, and DF-3, respectively).

Results
Of 2,506 patients with moderate-severe-MAC [mean age 77, 64.1% females], 709 (28.3%), 1,510 (60.3%), and 287 (11.5%) were classified as DF-1, DF-2, and DF-3, respectively. Worse LVDF grade was associated with older age, male sex, lower LV ejection fraction, and higher rates of noncardiovascular and cardiovascular comorbidities. Over a median follow-up of 2.8 years, 1,059 (42.3%) patients died. In multivariable survival analysis, DF-2 [adjusted hazard ratio (aHR) 1.43, 95% confidence interval (95%CI) 1.21-1.68] and DF-3 (aHR 1.54, 95%CI 1.22-1.93) were independently associated with a higher risk of death (figure). Findings were also consistent after adjusting to mitral inflow gradients. When comparing LVDF echocardiographic parameters in controls without MAC matched by age, sex, left ventricular ejection fraction, and AI-ECG DF grade, significant differences were observed. Patients with moderate to severe MAC generally exhibited lower e' velocities, higher TR velocities, elevated E/e' ratios, and increased LAVi. Interestingly, the E/A ratio between MAC patients and their matched controls across AI-ECG LVDF grades remained consistent.

Conclusion
AI-ECG LVDF predicts mortality risk in patients with moderate-severe-MAC, regardless of mitral inflow gradients. Utilizing AI-ECG LVDF might aid in the risk stratification of patients with significant MAC.
Myocardial work indices and global longitudinal strain: equivalent prognostic value in chronic HFrEF
Authors: Fortuni F , Biagioli P , Sforna S , Mengoni A , Zuchi C , Lauciello R , D'addario S , Bardelli G , Ambrosio G , Carluccio E 
Published: January 2025

Abstract

Background
Non-invasive myocardial work (MW) indices can be estimated from pressure-strain loops obtained by integrating left ventricular global longitudinal strain (LVGLS) with brachial systolic blood pressure (SBP) and cardiac event timings (opening and closure of the aortic and mitral valve). Compared to LV GLS, MW indices offer the possibility to correct myocardial performance for LV afterload and dyssynchrony.

Purpose
To assess whether MW indices could provide additional prognostic value in a contemporary cohort of stable outpatients with chronic heart failure with reduced ejection fraction (HFrEF) on optimal medical and device therapy, with controlled afterload and no dyssynchrony.

Methods
We retrospectively analyzed 307 patients (mean age 65.6±12.7 years, 78% males) with reduced LV ejection fraction (LVEF&lt;50%). Liner regressions were performed to assess the relationships between MW indices and LVGLS, SBP, and parameters of inter- (i.e. inter-ventricular mechanical delay&gt;40 msec) and intra-ventricular (i.e. mechanical dispersion&gt;100 msec) dyssynchrony. The study endpoint was a composite of all-cause death/HF-hospitalization. Multivariable models including each MW indices once at a time [global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE)] were compared with the model including LVGLS by C-statistics.

Results
Mean LVEF was 32±9%, mean LVGLS was -9±3, mean GWI was 800±378 mmHg% and median NT-proBNP was 1.800 pg/ml (IQR: 731–4110). The majority of patients (84%) had SBP&lt; 130 mmHg (mean 117±16 mmHg), and had no inter- (71%) and (68%) intra-ventricular dyssynchrony. Over a median follow-up of 20 months (IQR: 11-34), 82 patients reached the study endpoint. After multivariable adjustment for MAGGIC score, natriuretic peptide levels, LV end-diastolic volume index, left atrial volume index, E/e’ ratio, and TAPSE/PASP ratio, both GWI and GCW were independently associated with adverse outcomes, with identical goodness of fit compared to the model including LVGLS (C-index 0.75 for all). On the contrary, both GWW and GWE were not independently associated with outcomes. While GWI and GCW were strongly correlated with LVGLS (B coefficient&lt;-0.85; Figure), their association with SBP was modest and there was no significant association between them and parameters of intra- and inter-ventricular dyssynchrony.

Conclusions
In a cohort of stable chronic HFrEF patients on optimal medical and device therapy, with controlled afterload and without dyssynchrony, MW indices showed similar prognostic value to LVGLS.
Association between LVGLS and MW indices
Moderate aortic stenosis and preserved ejection fraction are not benign combination
Authors: Petrovic O , Jovanovic I , Paunovic I , Rakocevic I , Vidanovic S , Tesic M , Jankovic N , Vratonjic J , Ostojic M , Boricic-Kostic M , Trifunovic-Zamaklar D , Ivanovic B 
Published: January 2025

Abstract

Background
Degenerative aortic stenosis (AS) is the most common progressive valvular disease and it is followed by adaptive left ventricular (LV) hypertrophy. LV hypertrophy is a compensatory mechanism aimed at reducing wall stress it also alters myocardial perfusion and impairs function and is tightly associated with heart failure with perserved ejection fraction (HFpEF). The outcome in patients with AS depends on the condition of the left ventricle and the presence of symptoms as well as the degree of the stenosis. Current guidelines do not address whether aortic valve replacement should be recommended in patients with moderate aortic valve stenosis regardless of the presence of symptoms and LV dysfunction.

Purpose
This study aimed to evaluate the association between moderate AS, symptoms, and myocardial structure and function after adjustment for comorbidities.

Methods
We conducted a matched cohort analysis. 61 patients with moderate aortic stenosis (MAS), LV ejection fraction &lt;50% and sinus rhytm were matched with 1 comparator by age, gender and presence of arterial hypertension, diabetes, coronary artery disease, chronic obstructive pulmonary disease and renal failure. Echocardiographic parameters and presence of any of three symptoms (dyspnoea, chest pain and syncope) were recorded at and compared between two groups.

Results
No significant difference was found between the two groups concerning the left ventricle (LV) and right ventricle (RV) size, LV ejection fraction RV systolic function, and, pulmonary artery pressure, although patients with MAS tend to have greater end systolic diameter (ESD) but not statistically significant (35.20±8.28mm vs 32.86±6.08; P=0.083), LV global longitudinal strain was less in the MAS patients (-14.29 ±5.37 % vs. -17.95±2.44 %; P = 0.003). The LV mass index (LVMi) was greater, (122.30±31.16g/m2 vs 103.81±27.07; P=0.001), The relative wall thickness (RWT) was greater in MAS patients but not statistically significant (0.43 ± 0.09 vs. 0.41 ± 0.07 cm; P = 0.079). Left atrial volume index (LAVi) was greater in MAS (44±15ml/m2 vs 39±15; P=0.047), E/E′ ratio was greater in MAS (14±6 vs 11±3; P&lt;0.001). Symptoms occurred more frequently in patients with MAS (24.6 %; 15/61 patients) than in the control group (8.2%; 5/61 patients, P=0.013).

Conclusions
LVEF as a means of assessing systolic function is insufficient. Ventricular hypertrophy and dysfunction were more common in patients with MAS than in the matched control group as well as the presence of symptoms. Timing of valve intervention in patients with symptomatic moderate aortic stenosis should be optimized.
Correlation of right heart catheterization with simultaneous echocardiography for the assessment of pulmonary hypertension in patients with severe tricuspid regurgitation
Authors: Kim O , Kim J I H O O N , Choi K H , Yang J H , Park S U N G J , Son J I H E E 
Published: January 2025

Abstract

Background
In severe tricuspid regurgitation (TR), it is important to accurately measure pulmonary artery pressure because pulmonary hypertension is a poor prognostic factor in severe TR. Therefore, we sought to investigate the correlation between PASP using simultaneously measured echocardiography and right heart catheterization (RHC).

Method
In this observational prospective study, a total of 33 patients with severe TR were enrolled between September 2021 and May 2024. Data was obtained by simultaneously measuring echocardiography and RHC. The correlation between the PASP by echocardiography and RHC was analyzed using Pearson correlation and Bland-Altman analysis. To properly evaluate right atrial pressure (RAP), additional parameters, including systolic flow reversal of the hepatic vein and the V wave cut-off sign, were incorporated.

Result
PASP by RHC was strongly correlated with PASP by simultaneous measured echocardiography, with a correlation coefficient (r) of 0.87. The bias was 1.5 mmHg, and the limits of agreement (LoA) ranged from -12.5 to 15.5 mmHg. Recategorizations with systolic flow reversal on hepatic vein Doppler and V wave cut-off sign as well as the size and respiratory collapsibility of inferior vena cava provide a more accurate estimate of RAP (eRAP) by echocardiography (p = 0.004). Using this approach for eRAP, a correlation between PASP by RHC and PASP by echocardiography was more prominent (r = 0.91, LoA -9.9 ~ 13.0 mmHg).

Conclusion
PASP simultaneously measured by echocardiography with systolic flow reversal on hepatic vein Doppler and V wave cut-off sign was highly correlated with PASP by RHC in patients with severe TR.
Reverse remodeling according to the aetiology after mitral TEER
Authors: Marut B , Lee Frost C , Istratoaie S , Leurent G , L'official G , Auffret V , Oger E , Donal E 
Published: January 2025

Abstract

Introduction
Mitral transcatheter edge-to-edge repair (M-TEER) is increasingly used. Reverse remodeling is expected to impact prognosis, yet pre-operative prediction of the beneficial impact of MR treatment remains limited.

Objective
We aimed to describe the impact of M-TEER on heart remodeling according to etiology and to define pre-intervention parameters that might predict this beneficial heart remodeling after M-TEER.

Methods
Consecutive isolated M-TEER patients recruited between 2019 and 2022 were considered. Patients who died or required re-operation within 30 days were excluded (n=9). Preoperative and follow-up echocardiograms were all recorded in the same tertiary center. A core lab analysis was conducted. Patients without follow up at the TEER-center were not included in the final analysis. Transthoracic echocardiography (TTE), including speckle tracking imaging for LV, RV and LA, was analyzed alongside clinical characteristics. Cardiovascular events and other occurrences were recorded up to a 24-month follow-up. The relative variation in left ventricular end-diastolic indexed volume compared to baseline and according to the etiology group was the primary outcome.

Results
Eighty-six (out of 146) patients were included in the final analysis (55% men, 55% functional MR, median LVEF 56%, IQR [45-64]), no major difference in the final analysis population compared to the whole cohort. The decrease in left ventricular end-diastolic volume indexed (LVEDVi) was greater in primary MR (-16.4% vs -7.06%, p-value=0.04). No reverse remodeling was found for LA. Baseline global longitudinal strain (GLS) (p=0.03) but also RV free wall strain (RV FWS) (p=0.02) were independent parameters to predict change in LVEDVi (Fig.1). In secondary MR, NYHA functional class improvement after TEER was also associated with relative change in GLS between baseline and follow-up.

Conclusion
Mitral TEER has a greater impact on LVEDVi in primary MR. LV and RV Speckle tracking parameters are the most reliable parameters to predict the amount of reverse remodeling expected after M-TEER. RV function should be assessed precisely before M-TEER. LA remodeling was non-significant after M-TEER in an elderly population with high prevalence of AF.
Baseline GLS and LV reverse remodeling
Prevalence and significance of late gadolinium enhancement in patients with severe aortic stenosis based on myocardial damage stages in the PARTNER trial
Authors: Hirata K , Kuwabara K , Matsuo Y , Yokoi Y 
Published: January 2025

Abstract

Background
Late Gadolinium Enhancement (LGE) in cardiac MRI marks myocardial fibrosis and irreversible damage. In aortic stenosis (AS), LGE helps assess myocardial damage, crucial for risk stratification and treatment planning. The Placement of Aortic Transcatheter Valves (PARTNER) trial's staging system, based on echocardiographic parameters, stratifies patients from stages 0 to 4. While this staging indicates prognosis, the extent of myocardial fibrosis remains unclear.

Objectives
To clarify the frequency of LGE positivity across different stages of myocardial damage based on echocardiographic assessment in patients with severe aortic stenosis.

Methods
We analyzed MRI data from 58 severe AS patients undergoing transcatheter aortic valve implantation. Patients were categorized into myocardial damage stages using the PARTNER trial's echocardiographic criteria: Stage 0: No cardiac damage, Stage 1: Left ventricular damage, Stage 2: Left atrial or mitral damage, Stage 3: Pulmonary vasculature or tricuspid damage, Stage 4: Right ventricular damage. The frequency of LGE positivity was assessed for each stage. Chi-square tests determined statistical significance across stages.

Results
Among 58 patients, LGE was present in 16 (27.6%). LGE positivity increased with advancing stages: 0% in Stage 0, 20% in Stage 1, 67% in Stage 2, and 100% in both Stage 3 and Stage 4. Chi-square analysis showed significant differences in LGE positivity across stages (χ² = 46.159, df = 4, p &lt; 0.0001).

Conclusions
LGE positivity increases with myocardial damage severity in severe AS patients. This echocardiographic-based staging system reflects the extent of myocardial fibrosis, as even in Stage 1, 20% of patients show fibrosis, and in Stage 2, two-thirds have irreversible damage.