bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardioembolic events and death predictors in patients with intraventricular thrombus
Authors: Ortiz Lozada R , Ferrera Duran C , Pozo Osinalde E , Fernandez Vega A , Zulet Fraile P , Provencio Regidor A , Mahia Casado P , Noriega Sanz F J , Marcos Alberca P , Fernandez Jimenez R , Gomez De Diego J J , Fernandez Ortiz A , Perez Villacastin J , De Agustin Loeches A , Viana Tejedor A 
Published: November 2023

Abstract

Background
There is poor evidence about the optimal medical treatment and length of anticoagulation for the management of intraventricular thrombus (IVT). Current ESC guidelines recommend continuation of anticoagulation for up to 6 months.

Purpose
The objective of this study was to identify predictors of events during follow-up in patients with IVT in order to infer the best therapy in this clinical scenario.

Methods
All patients with IVT in our tertiary hospital between 2005 and 2021 were retrospectively analyzed. Patients were classified into 2 groups, according to whether they developed (group 1) or not (group 2) the combined event of death, myocardial infarction, stroke or embolism during the first 6 months. A multivariate logistic regression analysis was performed to identify independent risk factors of clinical events.

Results
195 patients were included, of whom 40 (24.1%) presented the combined event at 6 months. There were no differences in age (68.5±15.6 vs 65±13.7 years; p=0.167) or gender distribution (80% men vs 84.9%; p=0.463) between the groups. A history of peripheral vascular disease (22% vs 7.1%; p=0.007), atrial fibrillation (AF) (22% vs 6.3%; p= 0.004) and stroke (34.2% vs 11.8%; p=0.001) were more frequent in group 1. The echocardiogram showed more frequently a mobile thrombus (43.2% vs 23%; p=0.017) with the presence of outgrowths (19.4% vs 5.6%; p=0.012) in the group with events. In addition, these patients had worse ventricular function (LVEF 33.6% vs 40.4%; p=0.002). Regarding treatment, the use of P2Y12 inhibitors was lower in group 1 (36.6% vs. 58.3%, p=0.016). There were no differences in the use of anticoagulants (85.4% vs 87.4%, p=0.737) or in the time until the thrombus clearance (median 119 vs 147 days, p=0.152). The presence of outgrowths in the thrombus, the ejection fraction, and a history of stroke were independently associated with the development of events at 6 months (Table). Considering a cut-off point of one-year follow-up instead, only 7 patients more had events. The presence of outgrowths was the only factor that maintained the independent association with the development of events (OR 9.3 (95%CI 1.6-54.7); p=0.01) during this time frame.

Conclusions
Cardiovascular events after IVT diagnosis are concentrated in the first 6 months. The presence of outgrowths attached to the thrombus, the lower ejection fraction, and a history of stroke were independent predictors of events at 6 months. In addition, the presence of outgrowths maintained its strong association at one year. Therefore, a more aggressive antithrombotic treatment may be considered in the presence of these factors.
Right ventricular-pulmonary artery coupling in the early stages of infarction could optimize patient risk stratification over five years
Authors: Dekleva M , Martinovic M , Stevanovic A , Zivkovic M , Djordjevic A , Djuric T , Stankovic A 
Published: November 2023

Abstract

Background
Right ventricular (RV) dysfunction is recognized as a cardinal prognostic marker in heart failure (HF) patients. Myocardial infarction (MI) is often followed by unrecognized RV dysfunction, which can be associated with worse outcome. It is recently shown that the ratio between TAPSE and PASP (RV/PA) may depict cardiopulmonary hemodynamics better than the two parameters alone.

Aim
To evaluate the interactions between left ventricular (LV) and RV function in early phase of MI and to assess the prognostic significance of RV/PA coupling in patients with first MI during 5 years follow up.

Methods
The prospective study included 144 patients with the first MI treated with the primary percutaneous coronary intervention (p PCI) who underwent Doppler echocardiography within 2±1 days of MI. LV function analysis included: LV ejection fraction (EF), ratio between early diastolic velocity and tissue annular velocity (E/e) and global longitudinal strain (GLS). RV function and RV-PA interaction was expressed as ratio between TAPSE and PASP. During the five-year follow-up, major cardiovascular events and especially hospitalization for HF were analyzed.

Results
Progressive RV/PA uncoupling was associated with higher degree of LV impairment and dysfunction (EF p&lt;0.001, E/e p=0.002, GLS p&lt;0.001) and severity of mitral regurgitation (p=0.013). Lower baseline RV/PA coupling significantly reflects the frequency of hospitalizations for HF in the population of patients with first MI during five-year follow-up (0.62 v.s.0.51, p=0.021). After multivariate adjustment RV/PA remained an independent predictor of all major cardiac events (MACE) after five years (OR 14.0 [1.5–130.8], p=0.019).

Conclusion
A lower baseline RV-PA coupling, reflecting a higher degree of LV-induced pulmonary hypertension and secondary RV-dysfunction, is associated with decline of LV function in early phase of MI, and is independently associated with worse prognosis after five years. The value of RV-PA ratio as an prognstic marker warrants further investigation.
Real world application of left ventricular outflow tract diameter prediction and clinical implications
Authors: Matese C , Calogero Campo G , Venturoli E , Pangallo G , Zuin M , Pavasini R , Tonet E , Calvi S , Cimaglia P 
Published: November 2023

Abstract

Background
The Left Ventricular Outflow Tract diameter (LVOTd) measured with transthoracic echocardiogram is crucial for stroke volume, flow and effective orifice area (EOA) assessment in aortic stenosis (AS), but it’s also a source of error. A formula for its prediction has been proposed (Leye’s formula), based on body surface area (BSA). However, it has never been validated externally.

Purpose
The aim of study is to externally validate the equation by Leye et al. in a retrospective, single-center, large cohort of consecutive non-obese patients with severe symptomatic AS undergoing surgical aortic valve replacement.

Methods
A population of patients with severe symptomatic AS undergoing surgical aortic valve replacement was analyzed; three different LVOTd values were obtained for each patient: measured-LVOTd (m-LVOTd, from echo database), predicted-LVOTd (p-LVOTd, using Leye’s formula) and surgical-LVOTd (s-LVOTd, obtained by surgical reports). p-LVOTd was used to reevaluate stroke volume and EOA.

Results
Data from 735 patients were collected; mean age was 75±8 years and 417 patients (57%) were men, mean BMI was 25.6 kg/m2 and mean BSA was 1.8 m2. m-LVOTd was significantly lower than p-LVOTd (20.2±2.4mm and 22.4±1.0mm, respectively; bias 2.1mm; p &lt; 0,001). Moreover the difference between p-LVOTd and s-LVOTd (23.2±1.7mm; bias 0.8 mm) was lower than the difference between m-LVOTd and s-LVOTd (bias 3.0 mm). When the stroke volume index (SVi) was calculated through p-LVOTd, its value increased significantly compared to SVi calculated with m-LVOTd (50.0±10.9 vs 40.9±10.2 mL/m2, p&lt;0.001), leading to a significant decrease in patients classified as low-flow AS, from 216 (29%) to 73 (10%) (p&lt;0.001). EOA calculated with p-LVOTd was significantly wider than that calculated using m-LVOTd, and correlation was weak (0.86±0.22 vs 0.70±0.16 cm2, p&lt;0.001; r=0.599, p&lt;0.001). Using the p-LVOTd instead of m-LVOTd has lead to the reclassification of 188 (26%) patients from EOA≤1 cm2 to EOA&gt;1cm2.

Conclusion
We found that in non-obese patients with severe AS, LVOTd obtained from the simple formula proposed by Leye et al correlates better with the surgical annulus diameter compared with the echocardiographic measurement of LVOT, and this has relevant consequences on AS assessment.
Patent foramen ovale: high-risk echocardiographic features related to secondary stroke prevention
Authors: Cruz I , Campos I , Braganca B , Lopes R , Santos R , Andrade A 
Published: November 2023

Abstract

Introduction
Patent foramen ovale (PFO) closure has long been a matter of debate concerning the impact of such procedure on preventing ischemic events recurrence. Recent reports support this strategy raising the issue of optimal patient selection based on anatomical high-risk characteristics evaluated by transoesophageal echocardiography (TEE) that may be associated with an increased risk of recurrence.

Purpose
Characterize PFO-related echocardiographic findings and clinical features of a cohort of Embolic Stroke of Undetermined Source (ESUS) patients (pts).

Methods
Unicentric, retrospective analysis of pts with ESUS diagnosis who underwent TEE between 1/2014 and 11/2019. Excluded pts aged older than 70 years. Clinical stroke characteristics and echocardiographic PFO features were analysed.

Results
A total of 124 pts were included in the analysis, presenting a mean age of 50±1.6 [20;68] years and female gender predominance (58.9%). 48.4% of ESUS pts had PFO (53% female). Regarding PFO pts, 38 (62.3%) had significant right-to-left shunt on TEE, which was statistically associated with cortical infarcts (78.9 vs 56.5%,p=0.037). 35pts (58.3%) had shunt occurring at rest and during the Valsalva manoeuvre; when associated to significant shunt there was a correlation with cortical located infarcts (82.1 vs 60.0%, p&lt;0.001). 33 PFOs (54.1%) had tunnel-like morphology. Tunnel-like PFOs were associated with significant right-to-left shunt (78.8 vs 42.9%, p&lt;0.001), atrial septum aneurysm (ASA) presence (68.8 vs 50.0%, p&lt;0.001) and with haemorrhagic transformation of ischemic stroke (15.2 vs 3.6%, p=0.031). 34 PFO pts (60.7%) had ASA. Mean PFO length was 6.42±5.0mm and mean height was 3.2±2.0mm.

Conclusion
In this cohort, there was a similar number of pts with and without PFO. Regarding ESUS pts with PFO, the majority had significant right-to-left shunt that occurred at rest and during Valsalva manoeuvre and were associated with cortical located infarcts. Tunnel-like morphology and ASA were also frequent. Tunnel-like morphology were associated with haemorrhagic transformation of ischemic strokes. These findings support the proposal that PFO characterization should have an additional role in stratifying pts with ESUS and selecting them for device closure.
Implementation of an electronic medical record order set with an opt-out rule increases utilization of ultrasound enhancing agents with transthoracic echocardiography
Authors: Khalil A , Al Badarin F , Manla Y , Bafadel A , Khalil M 
Published: November 2023

Abstract

Background
Use of ultrasound-enhancing agents (UEA) decreases the frequency of non-diagnostic transthoracic echocardiography (TTE) studies and improves accuracy for identification of potentially life-threatening conditions. However, several logistical barriers have led to UEA underutilization, including the need for a separate order for UEA in electronic medical records (EMR). We sought to determine the impact of implementing an EMR order set on utilization of UEA at the echocardiography laboratory of a tertiary care center.

Methods
EMR order for all TTE studies (complete, limited) was modified to include the use of UEA by default with an "opt-out" option for ordering physician when UEA is deemed unnecessary. During study performance, sonographers determined the need for UEA use and utilized existing order to dispense perflutren protein-type A microspheres to complete the examination. Internal policy for UEA use was developed in keeping with Intersocietal Accreditation Commission recommendations. We compared rates of UEA utilization 10 months before and after the implementation date (March 2022) for the new EMR rule.

Results
A total of 10,666 TTE studies were performed prior to, and 11,406 studies after the implementation of the new EMR rule. Of those, 54.3% were performed in outpatient setting, 12% in ICU, and the rest in non-ICU inpatient setting. Prior to the EMR rule implementation, UEA was used in 10% of total studies, 6.0% of outpatient studies, 11.2% of non-ICU inpatient studies, and 24.2% of ICU studies. Following the implementation of the new rule, UEA utilization increased significantly, including 89% increase in total use, 90% increase in outpatient setting, 129% in non-ICU inpatient setting, and 48% increased use in ICU (Figure). No adverse events were reported with UEA during the study period.

Conclusions
The implementation of a standing order in EMR, including default use of UEA with an "opt-out" option facilitates sonographer-driven use and administration of UEA across all patient care settings. While this approach was safe and significantly increased UEA utilization, whether it would translate to improvement in clinical outcomes or hospital length of stay requires further studies.Impact of EMR rule on UEA utilization
Treatment of ischemic heart failure through ultrasound-targeted microbubble destruction and it's mechanism
Authors: Wu J U E F E I , Cai Q Y , Li Q I N , Li S H A S H A , Li H A O Q I , Chen Y U A N Q I , Wang Y G 
Published: November 2023

Abstract

Background
The cavitation effect mediated by ultrasonic-targeted microbubble destruction (UTMD) can regulate the microenvironment and circulation of ischemic myocardium. The UTMD cavitation effect can rapidly enhance blood perfusion and improve cardiac function in patients with ischemic heart failure. However, the internal mechanism of this treatment has yet to be reported.

Objective
The objective of this study was to explore the underlying mechanism of UTMD-mediated cavitation effect to rapidly improve cardiac function in rats with ischemic heart failure.

Methods
In the first part of the study, the ischemic heart failure model was induced by ligation of the left anterior descending branch coronary in Sprague-Dawley rats, the rats were randomly divided into 7 groups: sham group, HF group, HF+MB(microbubble) group, HF+US(ultrasound) group, HF+UTMD group, HF+UTMD+LY294002(PI3K inhibitor) group, and HF+LY294002 group. Serum BNP level and echocardiographic parameters were measured to evaluate cardiac function. Thereafter, SD rats were treated with UTMD by specific ultrasonic parameters and microbubble concentration, cardiac function should be reassessed after treatment. Finally, the myocardial tissues were extracted for Western Blot and immunohistochemical analysis to detect the protein expression of the PI3K/Akt/eNOS signaling pathway, and the contents of serum nitric oxide(NO) and myocardial ATP were detected by Elisa.

Results
The application of UTMD resulted in significant improvements in ejection fraction (EF) and fractional shortening (FS) in rats with ischemic heart failure, as compared to the HF group (EF: 37.16 ± 1.21% vs. HF+UTMD: 46.31 ± 3.00%, P=0.0057; FS: 18.53 ± 0.58% vs. HF+UTMD: 24.05 ± 1.84%, P=0.0089). Additionally, UTMD treatment led to the activation of the PI3K/Akt/eNOS signaling pathway (HF vs. HF+UTMD, P &lt; 0.01), and promoted the production of NO and ATP (HF vs. HF+UTMD, both, P&lt; 0.05). However, when a PI3K inhibitor was used, the cardiac protective effects of UTMD treatment were largely eliminated. EF and FS deteriorated significantly (EF: HF+UTMD+LY294002: 42.84±2.88% vs. HF+LY294002: 32.73±3.05%, P&lt;0.0001; FS: HF+UTMD+LY294002: 21.94±1.69% vs. HF+LY294002: 16.36±1.76%, P&lt;0.0001), and the production of NO and ATP decreased significantly (HF+UTMD+LY294002 vs. HF+LY294002, both, P&lt; 0.05).

Conclusion
The UTMD-mediated cavitation effect can rapidly improve the cardiac function of ischemic heart failure rats by activating PI3K/Akt/eNOS signaling pathway and promoting the release of NO and ATP.
Right atrial strain predicts collagen mRNA levels in human right atrium
Authors: Wester M , Hegner P H , Tafelmeier M T , Lebek S L , Provaznik Z P , Floerchinger B F , Schmid C S , Maier L S M , Arzt M A , Wagner S W 
Published: November 2023

Abstract

Background
Structural remodelling, which includes increased fibrosis and collagen production, is a hallmark of atrial cardiomyopathy. Echocardiographic strain measurements allow detailed assessment of atrial function. We investigated the association between right atrial (RA) strain and collagen mRNA levels in human RA.

Methods
RA biopsies were collected from 21 patients undergoing elective coronary artery bypass grafting in the prospective observational study CONSIDER-AF. Tissue mRNA levels of collagen type I (Col1A) and of collagen type III (Col3A) were quantified using real-time qPCR on ViiA 7 real-time PCR system. Echocardiographic RA strain (reservoir, conduit, and booster function) was measured in the four-chamber view using the designated software Philips QLAB. We performed uni- and multivariable linear regression analysis to elucidate the relationship between RA strain and collagen mRNA levels.

Results
There was a strong correlation between RA reservoir strain and Col1A mRNA levels (p=0.0152, r²=0.2608, Fig A) and Col3A mRNA levels (p=0.0058, r²=0.3374, Fig B) as well as between RA conduit strain and Col1A mRNA levels (p=0.0301, r²=0.2141, Fig C) and Col3A mRNA levels (p=0.0232, r²=0.2430, Fig D). However, there was no correlation between RA booster function and Col1A levels (p=0.5572, Fig E) or Col3A levels (p=0.3426, Fig F). Multivariate regression analysis revealed that RA conduit and RA reservoir function are predictors for Col1A and Col3A mRNA levels independent from clinical covariates (age, sex, body-mass index, systolic blood pressure).

Discussion
Our findings show that RA strain measurements are associated with RA collagen mRNA levels in humans and therefore highlight the potential of strain analysis to identify structural remodelling in atrial cardiomyopathy.FigureTable
Prognostic influence of left atrial strain in heart failure patients with intermediate ECG criteria for cardiac resynchronization therapy
Authors: Sugahara M , Min K D , Mine T , Asakura M , Ishihara M 
Published: November 2023

Abstract

Background
Heart failure (HF) patients with left bundle branch block (LBBB) with QRS width ≥150ms is class I indication for cardiac resynchronization therapy (CRT), whereas it is still controversy to CRT response in HF with QRS width 120-149ms or non-LBBB as intermediate ECG criteria in routine echocardiography. Left atrial (LA) adverse remodeling is a prognostic marker in patients with heart failure. Nevertheless, the prognostic significance of LA strain (LAS) imaging in HF patients with intermediate ECG criteria is not well understood.

Purpose
The objective of this study was to determine the prognostic value of LA deformation analysis in patients undergoing CRT implantation who met the intermediate ECG criteria.

Methods
We studied 94 patients who were defined routine CRT indication by the clinical guidelines. LAS was calculated as the average strain using apical two- and four-chamber views. The predefined endpoint was death, hospitalization due to worsening HF for 5 years after CRT implantation.

Results
Of the 94 patients, LAS is feasible in 76 patients (81%) with aged 69 ± 11 years, 30±8% of LV ejection fraction. 46 patients (61%) fulfilled intermediate ECG criteria. The predefined endpoint occurred in 43 patients (57%). The median LAS was 15%. LAS below 15% were associated with a high probability of unfavorable outcomes over 5 years (Log-rank, p = 0.002). After adjusting for left ventricular ejection fraction, LAS remained significantly associated with poor outcomes (hazard ratio 0.92, 95% confidence interval 0.87-0.97, p&lt;0.001). There is no difference in the probability of poor outcomes between LBBB with QRS width ≥150ms and intermediate ECG criteria. Patients with intermediate ECG criteria and LAS &lt;15% had worse outcome than in those with LBBB with QRS width ≥150ms and in those with intermediate ECG criteria patients with LAS ≥15% (Log-rank: p = 0.046, p = 0.029, respectively).

Conclusion
Baseline LA functional deterioration by deformation analysis was significantly associated with poor outcome after CRT implantation regardless of the ECG criteria for CRT indication and has promise for clinical utility.
The assessment of left atrial and left atrial appendage mechanics in patients with different stages of atrial fibrillation
Authors: Mao Y K , Yang Y , Ma M M , Yu C , Jiang R H , Jiang C Y 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is associated with left atrial (LA) mechanical dysfunction, which predisposes to stasis of blood within the LA and thus increases the risk of stroke. However, limited is known about the mechanical functional alterations of left atrial appendage (LAA) in relation to stages of AF. Here, we sought to analyse LA and LAA mechanics during different stages of AF in detail.

Methods
A total of 92 patients with AF referring for radiofrequency ablation were consecutively enrolled. Patients were categorized according to rhythm and stages of AF:sustained AF(SAF) (n=31), paroxysmal AF with sinus rhythm(PAF-SR)(n=30) andAF rhythm(PAF-AF)(n=31)at the time of echocardiography. Twenty-seven patients without a history of AF were included as controls. Using speckle-tracking echocardiography, LA and LAA global peak positive longitudinal strain (GLS) and mechanical dispersion (MD) were measured in all patients. Mechanical dispersion was defined as the standard deviation of the time to peak of the regional strain corrected by R-R interval.

Results
Patients with PAF-AF and SAF displayed prominently impaired LA and LAA mechanics(all P &lt; 0.01 vs. PAF-SR and no AF). In the presence of SR, only LAA mechanical function were lower in PAF patients than patients without AF(LAA GLS 20.5±5.7%(no AF) vs 15.9±5.4%(PAF-SR); LAA MD 6.9±3.8%(no AF) vs 9.4±3.9(PAF-SR),both P&lt;0.01). AF stages were independent determinants of LA and LAA mechanics after adjusting for age and comobidities.

Conclusions
AF affected mechanical function of LA and LAA on their own, and more so if stage of AF has advanced to more persistent forms. In addition, LAA mechanical dysfunction occurred earlier than that of LA.fig 1fig 2