bluuebunny/crossref_metadata_2025_split huggingface dataset:
Natural history of tricuspid regurgitation, a single center cohort analysis
Authors: Michelinakis N , Xamodraka E , Blazakis G , Fragkoulis I , Sfantou D , Kiki I , Pervana A M , Koutsogiannaki E , Siama A , Tsoukas A , Poulimenos L 
Published: January 2025

Abstract

Background-Purpose
High severity of tricuspid valve regurgitation (TR) is associated with poor clinical outcomes. However, the natural history of progression from less severe to more severe TR has not been well characterised.

Methods
A retrospective cohort analysis was performed on patients who underwent TTE from 2008-2024 on a single center. Patients with congenital heart disease or prior tricuspid valve intervention were excluded.

Results
Of initial 28715 patients, 4807 (mean age 71 years) had serial TTE evaluation and were included for analysis. Median follow-up was 917 days (Interquartile range 326-1934 days). Patients were categorised by TR severity on initial TTE: 2051 (42.6%) had none/trace, 2092 (43,5%) were mild, 480 (9,9%) were moderate, and 184 (3,8%) were severe. At median follow up, progression to severe TR was seen in 0.1%, 1.5% and 12.0% of the none/trace, mild, and moderate groups, respectively (Log rank p&lt;0.001). At 3600 days, progression to severe TR was seen in 17.95% of the moderate group. Patients with depressed LV function (LVEF&lt;50%) were associated with greater risk of progression to severe TR compared to preserved LVEF (EF≥50%) (Relative Risk 2.8, 95% CI 2.01-3.7, Log rank p&lt;0.001).

Conclusion
Moderate TR is associated with significant risk of progression to severe TR within 10 years. Patients presenting with moderate TR and LVEF&lt; 50% were associated with increased risk of progression to severe TR. Further studies are required to determine if earlier identification and intervention on patients in this greater risk cohort can result in improved patient outcomes.
Evidence for prognostic yield of dynamic arterial compliance in asymptomatic severe aortic stenosis
Authors: Armenis I , Leontiadis E , Leontiadis E , Tsiapras D , Tsiapras D , Kyrzopoulos S , Kyrzopoulos S , Iakovou I , Iakovou I , Athanassopoulos G D , Athanassopoulos G D 
Published: January 2025

Abstract

Introduction
Degenerative aortic stenosis (AS) is a part of a continuum that may also include a reduction in systemic arterial compliance (Ac). Lower Ac affects cardiovascular prognosis but there are scarce data concerning AS and especially during exercise.

Purpose
Aim of the study was to assess the prognostic role of calculated Ac at rest (R) and during supine ergometry (Ex) in the outcome of asymptomatic severe AS.

Methods
Forty eight AS patients, followed-up on valve clinic in a tertiary center (age 66±12 years), were referred for Ex. AS-related cardiac events (independent decision for surgery, occurrence of AS-related symptoms) during a follow-up of 33±21 months occurred in 19 patients (EV group).
The following parameters were estimated noninvasively both at R/Ex: LV ejection fraction (EF:%), strain (SR:%), transmitral E/e ratio, peak transtricuspid systolic pressure (TRPG: mmHg), AV mean gradient (meanGR: mmHg), valvuloarterial impedance (Za: mm Hg·ml-1m2), peripheral vascular resistance (PVR: Wood units) and arterial compliance (Doppler stoke volume/pulse pressure=Ac: ml/mmHg).

Results
Event (EV) and non-event (nEV) groups had similar % target heart rate at Ex, (96±17 vs 100±12%), age (66±12 vs 66±12 years), women/men ratio (9/19 vs 14/29), EF-R (55±8 vs 56±7%), ST-R (15.0±4.0 vs 14.5±3.5%), TRPG R/Ex (35±14 vs 30±8 and 60±15 vs 54±11mmHg), SR-Ex (16.0±5.0 vs 17.0±4.0%) but lower EF-Ex (59±9 vs 64±6%, p=0.03).
EV group had greater meanGR at R (45±16 vs 37±12mmHg, p=0.03), but similar Za both at R/Ex (2.3±1.0 vs 2.0±0.8 and 2.7±0.8 vs 2.7±1.0mm Hg·ml-1m2 ).
PVR at R/Ex was similar (29.3±12.0 vs 32.0±13.0 and 20.5±6.0 vs 22±9.0 Wood).
Ac was similar between the 2 groups at R but it showed a greater reduction during Ex in EV group (R: 0.85±0.44 vs 0.92±0.60 and Ex: 0.70±0.60 vs 0.84±0.40, p=0.05).
Binary logistic regression analysis for events, including the different parameters between groups (meanGR, Ac-Ex, EF-Ex), selected only EF-Ex [exp(b)=1.15 (1-1.3 p=0.02] as independent predictor.
ROC analysis for event provided a cut off for Ac-Ex of 0.56 (area 0.65, sens=0.72, spec=0.60). ROC classification for events was better for age&gt;70 years (cut off 0.52, area 0.82, sens=0.88, spec=0.77-figure 1).
Kaplan Meier event analysis for a greater Ac-Ex than 0.56 provided an increased hazard ratio (log rank =8, p=0.003 figure 2).

Conclusion
Arterial compliance provides prognostic yield for the outcome of asymptomatic severe AS especially in the aged population. The additive value becomes evident when this parameter is calculated during supine ergometry.
Alfieri mitral valve repair for the zone of apposition in adult patients with significant mitral regurgitation
Authors: Park Y , Lee S H , Kim G Y , Je H G 
Published: January 2025

Abstract

Objectives
Although it is recommended to close the zone of apposition (ZoA) as part of repair of atrioventricular septal defect (AVSD), it had often been left untouched or significant mitral regurgitation (MR) ensued. Adult patients with previously incompletely closed or left open ZoA have more retracted and thickened edges due to long standing MR. Combined with mitral annular dilatation, these factors aggravate MR and consequently complicate surgical repair eventually leading to mitral valve replacement (MVR). In an effort to overcome this problem, we have recently added Alfieri type repair to conventional suture of ZoA.

Methods
We retrospectively reviewed ten adult patients with moderate to severe MR due to ZoA including those with postoperative residual MR after previous repair from 1 January 2009 to 31 December 2021. All patients either had AVSD at presentation or had it closed through prior surgery. We describe the outcome of five patients in whom Alfieri type repair was performed and other five patients who underwent different surgeries.

Results
Mean follow-up was 0.9 years (range 0.1-2 years) in those subjected to Alfieri group. Of these five patients, trivial to mild MR was seen in four patients and one patient who had prior repair showed moderate mitral stenosis (MS) at last follow-up after Alfieri type repair (Figure 1, 2). Of five patients who underwent other surgical corrections, two patients had ZoA repaired previously. Three patients eventually undergone MVR due to severe fibrosis and poor mobility of ZoA and posterior mitral valve. Pericardial leaflet augmentation was performed on one patient and showed mild MR with no MS at one-year follow-up. Another patient had conventional repair but eventually MVR was done due to severe postoperative MS.

Conclusions
For adult patients with significant MR owing to ZoA associated with AVSD, Alfieri type repair in addition to conventional suture of ZoA may be considered to avoid failure of conventional repair or the need for MVR. However, it may cause significant MS when performed long after prior repair.
Figure 1. Result of Afieri stitch
Figure 2. Echocardiography
Progression of truncal valve regurgitation during fetal life: a retrospective multicenter study
Authors: Borzillo I , Masci M , Gosnell K , Peyvandi S , Brook M , Annoni G , Toscano A , Cresalia N 
Published: January 2025

Abstract

Background
Truncus arteriosus is a rare congenital heart defect characterized by a single vessel arising from both ventricles. Truncal valve regurgitation is known to impact the patients’ outcomes; however, it is less known whether the regurgitation progresses during the fetal life. We aim to describe how the truncal valve regurgitation evolves during pregnancy.

Materials and Methods
It is a retrospective multicenter study between January 2003 and April 2024. We compared the two fetal echocardiograms (the first and the second trimester echocardiograms) and the first postnatally echocardiogram. The first endpoint was describing how truncal valve insufficiency progresses during the fetal life and to establishing whether it is related to an abnormal number of cusps, to the Type of Truncus and to the genetic abnormalities.

Results
A total of forty-two fetal echoes were valuated. Compared with the third trimester echocardiograms, twenty echocardiograms were performed, the regurgitation of the TV progressed from absent/mild to moderate in two cases (8%). Comparing with the second trimester echocardiograms, twenty-one echocardiograms were performed and the regurgitation of the TV progressed from absent/mild to moderate in four cases (19%). Bicuspid and quadricuspid valves are more likely to progress to moderate regurgitation (p=0.049) but there is no association with the genetic abnormalities and with the type of truncus.

Conclusion
The truncal valve regurgitation rarely progresses during the fetal life, the insufficiency is more likely related to quadricuspid and bicuspid valve.
External validation of a dual-task deep learning model for the assessment of biventricular systolic function in adults with congenital heart disease
Authors: Constantine A , Tokodi M , Szijarto A , Szeier A , Szavai L , Fabian A , Lakatos B K , Merkely B , Bagyura Z , Alviento M , Austria-Manlapig A , Takeuchi M , Kovacs A , Surkova E 
Published: January 2025

Abstract

Background/Introduction
Accurate assessment of left ventricular (LV) and right ventricular (RV) systolic function is crucial in managing people with congenital heart disease (CHD), but can be challenging given the vast anatomic heterogeneity and varied surgical history in this population. While 3D echocardiography (3DE) is the most reproducible and best-validated echocardiographic technique for assessing biventricular systolic function, it requires special equipment and expertise and is not feasible in patients with poor acoustic windows. EF2Net, a dual-task deep learning model, has shown promise in predicting 3DE-derived LV and RV ejection fraction (EF) from standard 2D echocardiographic (2DE) 4-chamber views (1). The model has been previously tested in patients with acquired heart disease, healthy volunteers, and a low-risk community-based cohort but has not been validated in adults with CHD yet.

Purpose
We sought to validate the performance of the EF2Net model in predicting LV and RV EF in adults with CHD.

Methods
Ninety-six consecutive adults with CHD who had undergone echocardiography as part of their routine clinical follow-up were screened. Patients with univentricular physiology and systemic RV were excluded, as were those with insufficient image quality to obtain 3DE full-volume datasets for both ventricles. The final cohort comprised 90 patients (177 apical 4-chamber views). The EF2Net deep learning model was applied and its predictions of LV and RV EF were compared to the actual 3DE measurements (Figure).

Results
The median age of the cohort was 28.0[IQR 23.0-34.5] years and 48.9% were female. The most common CHD diagnosis was a shunt lesion in 37.8% (of which 64.7% included a post-tricuspid component), followed by LV outflow tract disease in 28.8%, and RV outflow tract disease in 24.4%. Most patients (90%) were in NYHA functional class I. The mean 3DE LV EF was 60.9±6.8% and the mean 3DE RV EF was 51.5±6.8%. EF2Net predicted 3DE-derived LV EF and RV EF with a mean absolute error (MAE) of 5.0 and 6.4 percentage points, respectively.

Conclusions
The EF2Net model accurately predicts biventricular EF in adults with CHD using routine 2DE 4-chamber views. This validation underscores the potential of EF2Net to enhance clinical practice by providing reliable, non-invasive assessments of ventricular function in patients with complex ventricular morphology, particularly in settings where 3DE is not readily available.
Simulator transesophageal echocardiography: the new horizon of training?
Authors: Bianchi L , Costa P , Gil Ad V , Masoero G , Rosa G M , Porto I , Bezante G P 
Published: January 2025

Abstract

Background
trans-esophageal echocardiography (TEE) plays a crucial role in the diagnosis of cardiovascular diseases. In recent years, the importance of theoretical-practical training based on advanced simulation systems in learning specific medical skills has emerged but evidence for the effectiveness for TEE are limited.

Purpose
evaluate the impact of a theoretical-practical course with simulator for TEE in the diagnostic interpretation of morpho-functional images and acquisition of projections according to standard protocol of the American Society of Echocardiography (ASE).

Methods
cardiologist specialists and resident cardiologists who participated in the TEE course at a center of simulation and advanced training center from 2018 to 2023, were retrospectively enrolled in the study.
Before the course, participants underwent a question multiple-choice based test, aimed at assessing theoretical knowledge and clinical interpretation of morpho-functional images and clips recorded during interventional procedures.
During the course, learners where divided into three groups: one utilizing the simulator to conduct exams with clinical cases and acquisition of clips according to ASE protocol, another one participating in interactive discussions of the first group's TEE hands-on activities, and the last one attending lectures with clinical cases. The activities were switched during the two days of the course.
Following the course, the same test was administered to evaluate changes in results.

Results
290 hospital cardiologists and resident cardiologists (95.2% and 4.8%, respectively) participated in the course. Among them, mean age was 45.2 ± 11 years old, 164 were male (57%). Before the course, the learners answered correctly the 77.6% of questions, while after the course this value increase to 89.5% (p value &lt; 0.001).
This improved result was driven by the group above 54 years (p = 0.026) and by the one with an age between 45 and 54 years (p = 0.042), as shown in Figure 1.
205 learners (71.9%) improved their test results after the course, while 41 (14.4%) lowered the score and 39 (13.7%) achieved the same result.
In the learners that improved (205), 79% wronged ≥3 questions at the first evaluation and after the course this number decreased to 15% (p &lt; 0.001); on the other hand, in the ones that not improved (80), 14% wronged ≥ 3 questions and this value grew to 45% after the course (p &lt; 0.001), as shown in Figure 2.
Moreover, at the end of the training, all the learners were able to complete the sequence of 28 projections of the standard protocol of trans-esophageal echocardiographic recommended by international society of echocardiography.

Conclusions
In our cohort of cardiologist specialists and fellows, a two-day theoretical-practical course with a TEE-based simulator improved competencies in interpretation of TEE clips and images.
These findings should therefore encourage greater use of advanced training with simulation TEE training.
Atrial strain analysis predicts atrial arrhythmias recurrence following cavotricuspid isthmus ablation of typical atrial flutter
Authors: Iannaccone G , Scacciavillani R , Graziani F , Tusa F , Piccinni C , Gabrielli F A , Narducci M L , Perna F , Camilli M , Meucci M C , Montone R A , Bencardino G , Lanza G A , Pelargonio G , Lombardo A 
Published: January 2025

Abstract

Background
The evaluation of left atrial (LA) and right atrial (RA) function by two-dimensional speckle-tracking echocardiography has recently appeared as a valuable method to predict atrial arrhythmias (AA) recurrence after electrical cardioversion or transcatheter ablation. However, there are no similar studies performed in patients with typical atrial flutter (AFL).

Aims
The aim of our study is to assess the ability of RA and LA strain reservoir (RASr and LASr) to predict recurrence following cavotricuspid isthmus ablation (CTIA) for typical AFL.

Methods
Consecutive AFL patients who underwent CTIA at our hospital from January 2020 to May 2023 were retrospectively enrolled. Transthoracic echocardiography was performed within one month before CTIA and strain analysis was performed off-line. At follow-up, AA recurrence was recorded reviewing medical records.

Results
A total of 62 patients were analysed (mean age 64.8±13.2 years, 29% females). At a median follow up of 12.1 months (IQR: 7–18.4), AA recurrence occurred in 21 (33.8%).
The study endpoint occurred mainly among females (p=0.021), patients who developed atrial fibrillation (AF) during CTIA and patients with lower RASr and LASr values (both p&lt;0.001). At multivariable Cox regression analysis, only RASr and LASr remained independent predictors of AA recurrence (OR 0.904, 95% CI [0.831–0.984], p=0.02 and OR 0.919, 95% CI [0.852–0.992], p= 0.03, respectively). At ROC curve analysis, RASr and LASr showed similar and satisfactory ability to predict AA recurrence with optimal cut-off values of 16.8% and 17.7%, respectively.
At survival analysis, RASr &gt;16.8% and LASr &gt;17.7% were associated with significantly higher freedom from AA (log rank p=0.001 and p=0.002, respectively).

Conclusion
In our study, lower values of both RASr and LASr resulted to be independent predictors of AA recurrence following CTIA for typical AFL. Therefore, pre-ablation atrial strain analysis may help in the detection of patients at higher risk of recurrence, which could benefit from closer follow up visits and prolonged antiarrhythmic therapy.
Utility of left atrial strain in characterizing patients with reablated atrial fibrillation
Authors: Serrano Lozano D , Margarida De Castro A , Cuesta Cosgaya J M , Llano Cardenal M F , Santiago Setien I , Lerena Saenz P , Fernandez-Valls Gomez M , Zarauza Navarro J , Coroas Pascual C , Carreiro Da Cunha E , Perez Barquin R , Alarcos Blasco H , Arrizabalaga Gil M , Olalla Antolin J J , Ruisanchez Villar C 
Published: January 2025

Abstract

Introduction and Objectives
Atrial fibrillation (AF) is a highly prevalent condition, with projections indicating it will increase in the future. Various ablation techniques exist to try to eliminate the arrhythmia, but the problem of recurrences and the need for reinterventions are not uncommon. We need markers to predict which patients will benefit from these procedures and which will recur despite our efforts. Atrial strain techniques have emerged as a novel tool in assessing the function and degree of atrial fibrosis, which could improve patient selection and increase the success of procedures.

Methods
A retrospective analysis was conducted, including adult patients who had undergone echocardiography at our center during the years 2023-2024. A total of 59 healthy patients with no history of cardiovascular disease, labeled as "normal studies" by the examiner, served as the control group, and another group of 47 patients with recurrent AF with at least two ablation procedures were included. Various left atrial strain values (Reservoir, Conduit, and Pump) of each patient 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 reablated AF showed significantly lower absolute strain values compared to normal patients in all three analyzed varieties (Reservoir, Conduit, and Pump) with p&lt;0.01 for all comparisons. The mean strain in the control group was 41.80 for reservoir strain, -24.01 for conduit strain, and -17.07 for pump strain; while the mean in the AF group was 17.42, -11.72, and -6.33, respectively.

Conclusions
We found significant differences in left atrial strain values between normal patients and patients with reablated AF. These findings suggest that left atrial strain could be useful in selecting patients for AF ablation procedures, as those more prone to recurrence exhibit lower absolute strain values, indicating a higher degree of atrial fibrosis where anomalous circuits may establish and perpetuate the arrhythmia over time.
Normal Vs Atrial fibrillation
Myocardial mechanics and outcomes after transcatheter aortic valve replacement. Does strain rate have added prognostic value?
Authors: Kipourou K , Abdelhafiz H , Barron A , Panoulas V , O'driscoll J , Jimeno M , Meric B , Rahman Haley S , Baltabaeva A 
Published: January 2025

Abstract

Introduction
Transcatheter aortic valve implantation (TAVI) has firmly become treatment option for elderly and/or high-risk patients with severe symptomatic aortic stenosis. Studies have shown that TAVI induces improvement in left ventricular (LV) systolic function, quantified using global longitudinal strain (GLS).

Purpose
To test if improvement in longitudinal deformation post TAVI is associated with changes in strain rate – the only non-invasive echo parameter associated with myocardial contractility. We wanted to assess impact of changes in longitudinal deformation and strain rate (SR) on clinical outcomes.

Methods
We studied retrospectively all consecutive patients who underwent TAVI in our Valve specialist center from 1st April 2023 to 31st March 2024. All participants underwent a transthoracic echocardiogram before and within 3 months following TAVI. We have re-measured mean trans-valvar pressure gradients and performed offline speckle tracking analysis using dedicated software (TomTec and GE EchoPAC) before and after TAVI. Data on all-cause mortality and cardiac hospitalizations were obtained from electronic medical records.

Results
Overall, 305 patients (mean age of 81±7.7 years) with severe aortic stenosis underwent TAVI. 255/305 patients (83%) had a successful and uncomplicated TAVI procedure, 26 (8.5%) developed complete heart block requiring permanent pacemaker insertion during the index admission, 15 (4.9%) experienced vascular access complications (pseudoaneurysm, haematoma), 5 (1.6%) developed haemopericardium requiring drainage and 5 (1.6%) had TAVI-related stroke, all patients were discharged with routine F/U in place.
247 (81%) who had complete echocardiography data were included into analysis, 45% were female. Significant reduction in trans-valvar gradient was accompanied by significant improvement in LV myocardial and endocardial GLS and average LV strain rate post-TAVI. The mean follow-up period was 246±107 days. There were 8 cases contributing to all-cause mortality and 12 cardiac hospitalizations. There was a significant difference in SR between alive and deceased patients (0.94±0.3 vs. 0.70±0.2, P=0.026). Post TAVI strain rate (HR 45.6; 95% CI 1.67 to 124.6, P&lt;0.05) was the only independent predictor of all-cause mortality.

Conclusion
TAVI produces significant early improvement in LV mechanics. LV strain rate is an important independent predictor of all-cause mortality post TAVI. The addition of LV SR during echocardiographic assessment may be of value for the early identification of TAVI patients who are at greatest risk and who may benefit from early intensified risk factor management.

KM CURVE: SR & ALL CAUSE MORTALITY