bluuebunny/crossref_metadata_2025_split huggingface dataset:
The change of mean transmitral pressure gradient and mitral valve area after transcatheter edge-to-edge repair by G4 clips in japanese patients
Authors: Miyoshi T , Soejima N , Yoshida A , Matsuzoe H , Yamada N , Fujita K , Kawamura T , Nakazawa G 
Published: January 2025

Abstract

Background
Transcatheter Edge-to-edge repair (TEER) using the MitraClip is widely used to treat mitral regurgitation (MR). The evaluation of postprocedural mitral stenosis is important in addition to the reduction of MR. Some papers showed the effect of TEER on mitral valve area (MVA) and mean transmitral pressure gradient (tmPG), but those studies were performed in hospitals in Europe or the United States in the G2 clip era. In addition, the data on the relationship between MVA and mean tmPG is limited. Moreover, the study on the changes of those parameters by TEER in patients other than Europe and the United States is scarce. The current study aims to seek the changes in MVA and mean tmPG by TEER using the MitraClip and the relationship between those parameters in Japanese patients.

Methods
The patients with significant MR receiving TEER treatment between June 2023 and May 2024 in our hospital were included. The three-dimensional images of mitral valve and mean tmPG were acquired by transesophageal echocardiography (TEE) during the TEER procedure. The MVA before and after clip implantations (MVApre and MVApost) were retrospectively measured using dedicated software (Qlab, Philips). The reduction rate of MVA (change ratio between MVApre and MVApost) compared between degenerative (DMR) and functional MR (FMR), and also examined the relationship between MVApost and mean tmPG after TEER.

Results
Thirty patients received TEER using the MitraClip in our hospital between June 2023 and May 2024. One patient had two procedures on separate days because of worsening MR and another patient had cardiac surgery during the procedure because of an intraoperative complication. The images during the procedure were inadequate for MVA analysis in one patient. Accordingly, this study included 28 patients who have completed TEER treatment as a first session. Eight and 20 patients were classified as degenerative (DMR) and functional MR (FMR). The MVApre, MVApost, and the reduction rate of MVA were 4.51±1.53cm2, 1.96±0.78cm2, and 55±15%, respectively. The reduction rate of MVApost between DMR and FMR was similar (53±21% and 56±12%, respectively). There was no significant correlation between MVApost and tmPG after TEER even if dividing into two MR groups. However, DMR had a better correlation than FMR.

Conclusions
The reduction rate of MVA was similar between DMR and FMR. MVApost had no significant association with mean tmPG after TEER. Our study included a small number of patients. Further study is needed to deepen the insight into the relationship between MVA and tmPG.
Regional left ventricle strain outperforms global longitudinal strain in predicting late gadolinium enhancement in arrhythmogenic cardiomyopathy
Authors: Martini M , Cozac D A , Amato F , Savo M T , Lassandro E , Mattesi G , Rigato I , Perazzolo Marra M , Bauce B , Pergola V 
Published: January 2025

Abstract

Background
Arrhythmogenic cardiomyopathy (AC) is a genetically determined heart muscle disease characterized by myocyte necrosis and consequent fibro-fatty replacement. The recognition of fibrosis is a relevant finding with important diagnostic and prognostic implications. Speckle tracking echocardiography (STE) may be more accurate than conventional echocardiography in detecting early myocardial alterations that need to be confirmed with the gold standard technique, cardiac magnetic resonance (CMR).

Purpose
The aim of our study is to evaluate if STE-derived strain analysis can predict the presence of fibrosis on CMR in the corresponding segment.

Methods
86 patients with AC (including right/left dominant and biventricular forms) underwent advanced echocardiography with STE-derived strain analysis and CMR. Using a 17-segment Bull's-eye model, the cut-off value that best predicts the presence of gadolinium enhancement on CMR was determined for each wall segment using ROC curve analysis.

Results
The medium age was 45 (32-58) years, male gender was prevalent 71%. Among our patients, 44.1% had a biventricular form, 26.7% had a right-dominant form, 26.7% had a left-dominant form, and 2.3% had a borderline diagnosis. Regarding cardiovascular risk factors, 11.6% of patients had arterial hypertension, 15.1% had dyslipidemia, 2% had diabetes, 1% were smokers and 1% had coronary artery disease with previous percutaneous revascularization. The mean left ventricle (LV) ejection fraction (EF) was preserved 59% (54-64), while the medium LV global longitudinal strain (GLS) was slightly reduced, -18.2% (-20.1 to -15.2). A detailed analysis of regional wall strain was performed, and ROC curve analysis was used to determine a cut-off value for each segment to predict the presence of fibrosis on CMR in the corresponding segment, as shown in Table 1. Lower-than-average values demonstrated good accuracy in predicting the presence of fibrosis on CMR.

Conclusions
STE-strain analysis is a clinically accessible tool that enhances the sensitivity of echocardiography in detecting myocardial tissue alterations in AC, which would otherwise be identifiable only through CMR. Notably, even when GLS is within normal limits, regional strain sub-analysis can additionally reveal myocardial involvement.
Table 1
Prognostic value of noninvasive coronary flow reserve during dobutamine provocation in patients with myocardial bridging in long-term follow-up
Authors: Aleksandric S , Djordjevic-Dikic A , Djordjevic-Dikic A , Giga V , Tesic M , Banovic M , Juricic S , Boskovic N , Vukcevic V , Tomasevic M , Stojkovic S , Orlic D , Nedeljkovic M , Stankovic G , Beleslin B 
Published: January 2025

Abstract

Background
Recent studies showed that noninvasive coronary flow velocity reserve (CFR) measurement during inotropic stimulation with dobutamine (DOB) provides more reliable functional evaluation of myocardial bridging (MB). Additionally, a CFR cut-off value &lt;2.1 during DOB was found to be the most reliable for the identification of MB associated with stress-induced myocardial ischemia. However, studies of clinical outcomes during long-term follow-up associated with the use of noninvasive CFR are lacking. The aim of the study was to evaluate major adverse cardiac events (MACE: unstable angina [UA] that required hospitalization, non-fatal myocardial infarction [MI], and all-cause mortality) associated with established CFR ischemic threshold during long-term follow-up.

Methods
This study included 79 patients (54 males, mean age 55±10 years) with angiographic evidence of isolated MB on the left anterior descending artery and systolic compression ≥50% diameter stenosis assessed by quantitative coronary angiography. CFR at peak DOB (30-40 μg/kg/min) was measured in the distal segment of LAD, and patients were divided into two groups according to previously validated CFR threshold of &lt;2.1. Patients were monitored (ambulatory, hospital, and by telephone) for the occurrence of MACE over a median follow-up 8.2 years (interquartile range: 4.4 to 9.2 years) after enrollment.

Results
A total of 22 events were occurred in 20 patients: UA that required hospitalization in 20 patients (25%), nonfatal-MI in 1 patient (1.2%), and death in 1 patient (1.2%). The group of MB-patients with CFR &lt;2.1 had 3.9 times higher rate of MACE during long-term follow-up in comparison to the group of MB-patients with CFR &gt;2.1 (HR 3.90; 95% CI: 1.673-9.072; p=0.002). This was mainly driven by a 4-fold higher rate of UA that required hospitalization (HR 4.33; 95%CI: 1.773-10.589; p&lt;0.001).

Conclusion
In MB-patients, CFR &lt;2,1 during DOB provocation is associated with a significantly higher rate of UA that required hospitalization, whereas long-term prognosis with respect to death and nonfatal-MI was similar in both groups.
Prognostic value of right ventricular myocardial work in patients with pulmonary arterial hypertension
Authors: Pace N P , Selton-Suty C S , Filippetti L F , Fraix A F , Huttin O H , Mandry D M , Odille F O , Chabot F C , Chaouat A C , Valentin S V 
Published: January 2025

Abstract

Background
Right ventricular function is a key determinant of survival in patients with pulmonary arterial hypertension, with right heart failure being the leading cause of death. ESC/ERS guidelines recommend evaluating RV function at diagnosis and at first reevaluation under treatment to estimate the one-year mortality risk (1). However, few RV function markers address both systolic function and afterload. Noninvasive myocardial work is a promising new tool that incorporates both systolic function and its afterload by creating pressure-strain loops (2). The study aims to evaluate the association of RV myocardial work parameters with the estimated one-year mortality in patients with PAH.

Methods
This retrospective study included patients diagnosed with PAH who had transthoracic echocardiography and right heart catheterization within 48 hours at diagnosis and first reevaluation. Patients with unanalyzable echocardiography data were excluded.

Results
The study included 30 PAH patients and 28 healthy subjects for comparison. Myocardial work parameters (global work index, global constructive work, global wasted work and global work efficiency) were significantly different between PAH patient and healthy subjects. Between diagnosis and first reevaluation, myocardial work parameters showed improvement in most patients. However, patients without global wasted work improvement had a higher risk of estimated one-year mortality and a poorer transplantation-free survival.

Conclusions
Evaluating RV myocardial work at diagnosis and first reevaluation via TTE is feasible and can detect subclinical systolic dysfunction. Myocardial work parameters, and especially global wasted work appear to correlate with the prognosis of PAH patients, justifying larger-scale studies to confirm these findings and determine their prognostic value relative to other markers.
The value of global longitudinal strain and myocardial work indices in the early detection of left ventricular systolic dysfunction in patients with acute myocarditis
Authors: Kalesi A , Kasinos N , Gardikioti V , Karakosta M , Ntiloudi D , Zampelis D , Ntalekou K , Arnas N , Plaitis A , Skantzikas P , Archontikis A , Konstantara A , Destounis A , Patsourakos N , Theodosis - Georgilas A 
Published: January 2025

Abstract

Background/introduction
Conventional transthoracic echocardiography (TTE) is found to have limited sensitivity in detecting myocardial damage in patients with acute myocarditis and preserved left ventricular ejection fraction (LVEF).

Purpose
This study aimed to investigate the role of global longitudinal strain (GLS) and myocardial work (MW) echocardiographic indices in the identification of subclinical left ventricular systolic dysfunction in patients with acute myocarditis.

Methods
The study retrospectively included all patients admitted to the cardiology clinic of a tertiary hospital between December 2019 and May 2024, with suspected myocarditis, preserved ejection fraction, negative findings for coronary artery disease on coronary angiography or coronary computed tomography angiography, and whose diagnosis of myocarditis was confirmed by cardiac magnetic resonance imaging (CMR) using the Lake-Louise criteria. Gender and age-matched healthy individuals were also enrolled. The echocardiographic parameters assessed included global longitudinal strain (GLS) and myocardial work indices, specifically Global Work Efficiency (GWE), Global Work Index (GWI), Global Wasted Work (GWW), and Global Constructive Work (GCW). Statistical analysis was performed using non-parametric tests (Mann-Whitney test) and the predetermined level of statistical significance was set at p&lt;0.05.

Results
A total of 41 patients (34 males – 82.9%) and 32 healthy controls (25 males – 78%) were included in the study. The median age in the patient group was 28 years (range 16-46 years), and in the healthy controls group, it was 29 years (range 17-48 years). In the patient group, the median values were as follows: GLS -18%, GWE 96%, GWI 1636 mmHg%, GWW 66 mmHg%, and GCW 1842 mmHg%. In the healthy controls group, the median values were GLS -19.6%, GWE 96%, GWI 1856 mmHg%, GWW 76 mmHg%, and GCW 2095 mmHg%. Patients showed significantly lower absolute values of GLS (p=0.014), GWI (p=0.023), and GCW (p=0.005) compared to healthy individuals. There were no statistically significant differences found for GWE and GWW values between the two groups.

Conclusion
Our study suggests that GLS, GWI, and GCW indices may be valuable in the early detection of left ventricular dysfunction in patients with myocarditis and preserved ejection fraction. Larger epidemiological studies are needed to further validate these findings.
Left atrial stiffness difference between beta thalassemia major and sickle cell disease patients
Authors: Gialeli F , Patsourakos D , Dimitroglou Y , Delicou S , Xydaki K , Aggeli C 
Published: January 2025

Abstract

Introduction
Diastolic dysfunction emerges as the earliest cardiac abnormality in individuals with hemoglobinopathies including sickle cell disease (SCD) and β-thalassemia major (β-ΤΜ). In symptomatic patients with hemoglobinopathies, Heart Failure with preserved Ejection Fraction (HFpEF) stands out as the predominant cardiac phenotype. Left Atrial Stiffness Index (LASI) has been established as a prognostic indicator in HFpEF patients.

Purpose
To investigate potential LASI differences between SCD and β-ΤΜ patients.

Methods
In this cross-sectional study, thirty-four SCD patients (mean age 46.6 ± 15.6 years, 44.2% males), sixty, age- and sex-matched, patients with β -ΤΜ, and twenty-nine, age- and sex-matched, controls were enrolled. Various echocardiographic parameters, including left ventricular ejection fraction (LVEF), early mitral inflow velocity to basal septal early diastolic velocity ratio (E/e’), left atrial volume index (LAVI), tricuspid valve regurgitation velocity (TVR), and left atrial deformation at reservoir phase (LASr), were calculated. LASI was derived as the [E/e’]/[LASr] ratio. Patients with LVEF &lt;50% were systematically excluded. Diastolic dysfunction was established based on 2016 ASE/EACVI Guidelines and Standards.

Results
LASI was greater in β-ΤΜ patients compared to both SCD patients (0.30 ± 0.22 vs 0.22 ± 0.11, p = 0.006) and controls (0.30 ± 0.22 vs 0.18 ± 0.06, p = 0.002). No statistically significant difference was observed between SCD patients and controls. Among SCD patients, those with diastolic dysfunction (n = 12) demonstrated elevated LASI (0.31 ± 0.10 vs 0.16 ± 0.04, p = 0.001) and reduced LASr (24.50 ± 3.20 vs 51.50 ± 11.20, p = 0.001) compared to those without diastolic dysfunction. Moreover, SCD patients with diastolic dysfunction had a higher LASI value (0.31 ± 0.10 vs 0.16 ± 0.06, p = 0.001) compared to controls.

Conclusions
There is significant difference in terms of left atrial stiffness between β-ΤΜ and SCD. A possible explanation could be the regular blood transfusions in β-ΤΜ patient group that could contribute to the increased left atrial stiffness in these patients.
Evaluation and comparison of strain and myocardial work parameters in patients undergoing percutaneous edge-to-edge mitral valve repair with mitraclip system
Authors: Guarino L , Mega S , Annunziata M V , Carpenito M , Cocchia F , Mule' M T , Cammalleri V , Coletti F , Ussia G P , Grigioni F 
Published: January 2025

Abstract

Introduction
Myocardial Work (MW) is an advanced echocardiographic technique that assesses left ventricular performance, considering the hemodynamic load on the ventricle. Unlike traditional measures such as ejection fraction (EF) and global longitudinal strain (GLS), MW provides a comprehensive evaluation throughout the cardiac cycle.

Purpose
This study evaluates and compares echocardiographic parameters, specifically GLS and MW, before and after percutaneous edge-to-edge repair with the Mitraclip system, to highlight post-procedural improvements in ventricular performance.

Methods
A total of 59 patients with severe symptomatic mitral regurgitation, candidates for Mitraclip, were enrolled from March 2023 to April 2024. Parameters included GLS, Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), and Global Work Efficiency (GWE). Pre- and post-procedure measurements were analyzed using paired t-tests, considering patient comorbidities. The chi-square test and logistic regression were used to evaluate associations and predictive capacities.

Results
Significant improvements were observed in post-procedural GLS (-9.17±5.95 to -13.41±5.22, p=0.0001), GWI (p &lt; 0.005), and GWE (p &lt; 0.005), with a reduction in GWW (p = 0.0001). In hypertensive and non-hypertensive patients there was a significant increases in GWI and GWE, and reduction in GWW. In diabetic and dyslipidemic patients there was a significant improvements in GWI, GWE, GLS and reduction in GWW. In patients with atrial fibrillation there was a significant improvements in GWI, GWE, GLS and reduction in GWW. In patients with coronary artery disease patients there was a significant increases in GWI and GWE. No significant changes in GCW were observed in any group. For degenerative mitral regurgitation (DMR), leaflet fibrosis was associated with residual mitral regurgitation post-procedure (more than mild). In functional mitral regurgitation (FMR), ischemic etiology was not significantly associated with residual regurgitation (more than mild). Logistic regression indicated that reduced GWI and increased GLS were linked to adverse outcomes, though not statistically significant.

Conclusions
GLS and MW are highly sensitive and useful non-invasive diagnostic parameters compared to ejection fraction, demonstrating improvements in myocardial work efficiency and ventricular performance post-Mitraclip. Long-term follow-up studies are needed to confirm the durability and clinical outcomes of these benefits.
Left and right atrial strain in patients with heart failure with preserved ejection fraction
Authors: Tatsis E , Papadopoulos C , Oikonomidis D , Tasoulis A , Kouloulias I , Floropoulou C , Tsiafoutis I , Michalis L , Naka K 
Published: January 2025

Abstract

Background/Introduction
Left Atrial (LA) End Systolic Diameter (ESD) and Left atrial Volume index (LAVi) are used for the evaluation of dystolic dysfunction and the diagnosis of patients with Heart Failure with preserved Ejection Fraction (HFpEF). Recent studies imply that left atrial strain rate is an index of atrial myopathy . Also other studies imply a relationship between right atrial function and clinical status in HFpEF patients.

Purpose
The aim of our study is the evaluation of these echocardiography indexes in HFpEF patients.

Methods
We enrolled 50 subjects in our study (25 patients with HFpEF and 25 control subjects). All patients undergone in clinical evaluation, electrocardiography (All subjects were in sinus rhythm) and transthoracic echocardiography, applying Speckle Tracking Imaging techniques.

Results
Statistical analysis revealed a significant difference within patients with HFpEF and control group concerning LA ESD (median ESD LA (mm) 42.5 vs. 36, Wilcoxon rank-sum p-value=&lt;0.001 ) , LAVi (cm2 ) (median 34.5 vs. 26, Wilcoxon rank-sum p-value = &lt;0.001 ), LA median Strain (%) (23 vs. 32, Wilcoxon rank-sum p-value= &lt;0.001) and RA median Strain (26 vs 32, Wilcoxon rank-sum p-value = &lt;0.001)

Conclusion(s)
The current study demonstrates that patients with HFpEF have a significantly impaired left and right atrial strain, indexes that can be of important value in the further evaluation of these patients.
Table 1. Echocardiography Parameters
Myocardial work and left ventricular function in patients with heart failure with preserved ejection fraction
Authors: Tatsis E , Papadopoulos C , Oikonomidis D , Tasoulis A , Kouloulias I , Floropoulou C , Tsiafoutis I , Michalis L , Naka K 
Published: January 2025

Abstract

Background/Introduction
Patients with Heart Failure with preserved Ejection Fraction (HFpEF) have impaired diastolic function that plays a major role in the syndrome΄s pathophysiology . Several studies imply that these patients also suffer from left ventricular systolic dysfunction as assessed by Global Longitudinal Strain (GLS) estimation . Other studies show that the estimation of General Myocardial Work (GMW) is associated with left ventricular systolic function.

Purpose
The aim of our study is the evaluation of these echocardiography indexes in HFpEF patients.

Methods
We enrolled 50 subjects in our study (25 patients with HFpEF and 25 control subjects). All patients undergone in clinical evaluation, electrocardiography (All subjects were in sinus rhythm) and transthoracic echocardiography, applying modern techniques (GLS , Global Work Index – GWI and Global Work Efficiency – GWE).

Results
Statistical analysis revealed a significant difference within patients with HFpEF and control group concerning GLS (median GLS LV (%) - 18.0 vs – 19.7, Wilcoxon rank-sum p-value = 0.001). In addition , HFpEF group had significant lower GWE (median GWE (%) 91 vs 95, Wilcoxon rank-sum p-value = 0.001) . There was no significant difference in GWI (median GWI (mmHg) 1806.0 vs 2006.0 , Wilcoxon rank-sum p-value = 0.16) within groups. (Table 1)

Conclusion(s)
The current study shows that patients with HFpEF have a significant impaired GLS and GWE, revealing primary underlying myocardial damage in these patients.
Table1. Echocardiographic parameters
Insights into left ventricular deformation characteristics in sarcoidosis using multilayer strain imaging
Authors: Bal E , Okcun B , Barman H A , Cetinkaya E , Boyuk F , Yavuz Y E 
Published: January 2025

Abstract

Background
Sarcoidosis is a systemic inflammatory disease that can affect different layers of the myocardium. However, there is limited knowledge about layer-specific contraction in this clinical setting.

Purpose
To investigate multi-layer longitudinal strain in patients with sarcoidosis, in comparison to a control group of healthy individuals.

Methods
30 patients diagnosed with stage I-II pulmonary sarcoidosis (confirmed through non-cardiac biopsy , asymptomatic and routinely followed) and 30 healthy volunteers without known cardiac or systemic diseases were included in this case-control study. Conventional echocardiographic parameters were assessed, including Left Ventricular Ejection Fraction (LVEF), Endocardial Global Longitudinal Strain (Endo.GLS), Midmyocardial Global Longitudinal Strain (Mid.GLS), Epicardial Global Longitudinal Strain (Epi.GLS), Right Ventricular (RV) deformation (RV free-wall longitudinal strain (RVFWSL) and four-chamber longitudinal strain (RV4CSL)), and left atrial reservoir phase deformation (LASr).

Results
Sarcoidosis patients had similar age, blood pressure, heart rate, ejection fraction, left ventricular diameters, and diastolic parameters compared to healthy controls. Strain analysis using the speckle tracking method showed significantly lower Endo.GLS(-17.8(±1.6)vs-19(±2.3), p:0.018) Mid.GLS(-15.6(±1.7)vs-17.6(±2), p&lt;0.001) and Epi.GLS(-14.2(±1.7)vs-16.2(±1.9) p&lt;0.001) values in the sarcoidosis group compared to the control group.No statistically significant difference was found in right ventricul strain values between the groups (RVFWSL-24.3(±5.3)vs-26.9(±5.9), p: 0.077 and RV4CSL -19.98-+3,6vs-21.48-+5.3 p: 0.204) LASr was significantly lower in the sarcoidosis group compared to the control group (39.9(±11.8) vs47.8(±11.3) p value of 0.011).
Discussion: The strain values of the left ventricle and left atrial reservoir phase deformation were found to be lower in sarcoidosis patients compared to the healthy control group. These results suggest that layer-specific speckle tracking strain analysis may enable early detection of myocardial dysfunction in sarcoidosis, even in asymptomatic patients.