bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right atrial strain in Anderson-Fabry disease
Authors: Lillo R , Cianci A , Meucci M C , Iannaccone G , Tusa F , Di Brango C , Marsilia M , Lanza G A , Lombardo A , Burzotta F , Graziani F 
Published: January 2025

Abstract

Background
Nowadays limited data are available on right atrium (RA) morpho-functional remodelling and mechanics in Fabry disease (FD).

Purpose
To investigate RA structural and functional remodelling in FD using 2D speckle tracking echocardiography (STE) and to explore if differences exist in FD patients with and without left ventricular hypertrophy (LVH) compared to controls.

Methods
In this prospective study we enrolled FD patients and controls matched for age, sex and cardiovascular risk factors. FD patients were divided in two groups, according to the presence/absence of LVH (LVH+: left ventricular wall thickness &gt; 12 mm). All patients underwent standard echocardiography and STE analysis investigating the mechanics of all cardiac chambers, including RA reservoir, contractile and conduit strain.

Results
A total of 64 patients with FD (50% males; mean age 50 ± 17 years; 51.5 % LVH+) and 64 controls were included. Focusing on right chambers, RA and RV dimensions were similar between FD and controls; 25 FD patients (39%) had RV hypertrophy and RV TDI systolic velocity was lower in FD vs controls (p=0.041) while TAPSE and RVFAC did not significantly differ between the 2 groups. STE revealed impaired values of all cardiac chambers strains in FD vs controls: LV-GLS (p&lt;0.001), LA reservoir (p=0.001), conduit (p=0.012) and contractile strains (p&lt;0.001), RV-GLS and RV free wall strain (p&lt;0.001). All RA strains were significantly reduced in FD vs controls (RA reservoir 27.4 ± 11.1 vs 41.9 ± 8.3%, p&lt;0.001; RA contractile 9.9 ± 5.1 vs 18.0 ± 4.9%, p&lt;0.001; RA conduit 19.1 ± 8.1 vs 24.1 ± 8.1%, p=0.001) and in 27 FD patients (42.1%) RA reservoir strain was &lt;25%. When comparing FD LVH- vs controls, RA reservoir and contractile strains were significantly reduced in the formers (p&lt;0.001). In multivariable linear regression analyses, LA reservoir (p=0.010) and LV-GLS (p=0.044) emerged as independent correlates of RA mechanics, after adjustment for RA dimensions, RV systolic function parameters and hypertrophy, maximal LV wall thickness.

Conclusions
In FD impaired RA strain is a common finding. RA reservoir and contractile strains are reduced in FD patients before LVH as compared to controls. LA reservoir strain and LV-GLS showed an independent correlation with RA reservoir strain.
Characteristic of adult patients with cyanosis due to congenital heart disease: special focus on endothelial damage.
Authors: Nartowicz A , Marcin G , Janus M , Cieslewicz A , Malesza K , Bartczak-Rutkowska A , Lesiak M , Trojnarska O 
Published: January 2025

Abstract

Background
Patients with cyanosis secondary to congenital heart disease (CHD) are characterized by erythrocytosis and increased blood viscosity, which contributes to endothelial dysfunction that is associated with an increased risk of atherosclerosis. Flow-mediated dilatation (FMD) is a phenomenon associated with NO release that indirectly assesses endothelium function. The intima-media complex measured in the carotid artery indicates the severity of atherosclerosis.

Aim
The aim of this study is to evaluate the intima-media complex and flow mediated dilation and demonstrate their potential relationship with the clinical presentation in cyanotic population.

Methods
A cross-sectional study including 36 adult CHD cyanotic patients [(12 males)(39 median, 19-73 years)] with arterial blood oxygen saturation less than 92% and 30 healthy controls [(11 males)(38.5 median, 26-59 years)] was performed. All patients underwent clinical examination, blood testing, and echocardiography. Endothelial function was assessed using intima-media thickness and flow-mediated dilatation during ultrasonography. Lipid profile, erythrocytosis indicators, as well as inflammatory and vascular markers, including sphingosine-1-phosphate, were measured.

Results
We did not demonstrate any difference between CHD patients and the control group in the intima-media complex, flow-mediated dilatation, and the size of the brachial artery after ischemia. Among the laboratory indicators of erythrocytosis, atherosclerosis, and inflammation, the size of the brachial artery after ischemia correlated positively with the level of erythrocytes (p=0.008), hemoglobin (p=0.02), hematocrit (p=0.03), LDL cholesterol (p=0.01), and negatively with d-dimer (p=0.003). Flow-mediated dilation correlated positively only with HDL cholesterol (p=0.02) concentration. The intima-media complex correlates positively only with body mass index (p=0.04).

Conclusions
Endothelial function assessed by FMD and the severity of atherosclerosis assessed by IMT do not appear to be abnormal in patients with cyanosis secondary to CHD.
Endothelial dysfunction
Logistic regression for FMD&lt;7%
Increased myocardial stiffness as assessed by echocardiographic shear wave imaging is associated with Fontan circulatory failure
Authors: Youssef A , Van Belle H , Dhooge J , Voigt J U , Van De Bruaene A 
Published: January 2025

Abstract

Background
Diastolic dysfunction with elevated end-diastolic pressures is a key component of Fontan circulatory failure. However, conventional echocardiographic parameters of diastolic function do not correlate with invasive pressures in Fontan patients. Natural shear waves (SW) are emerging as a novel echocardiographic parameter of myocardial stiffness, a key determinant of diastolic function.

Purpose
We investigated the relationship between natural SW velocities and Fontan circulatory failure.

Methods
Fontan patients were prospectively recruited from a single center. They underwent a blood sampling for NT-proBNP and cardiopulmonary exercise testing on a supine bicycle combined with echocardiography and with peripheral venous pressure (PVP) measurement. PVP correlates with mean pulmonary arterial pressure in Fontan patients, and a PVP/cardiac output (CO) slope &gt; 3 is associated with worse clinical status. In addition, high frame rate SW imaging was performed at rest in the parasternal long axis view. An anatomic M-mode was drawn along the ventricular septum, or if absent, in the corresponding anterior wall. In the color-coded M-mode maps for tissue acceleration, SW appear as tilted green bands after atrio-ventricular valve closure (AVVC), the slope of which represents their propagation velocity. A clinical diagnosis of Fontan circulatory failure was defined as one the following: dyspnea on exertion with NT-proBNP &gt;300 ng/l, need for diuretics, a peak oxygen consumption (VO2) inferior to the lowest quartile according to age- and sex-adjusted Fontan norms, Fontan associated liver disease complicated by ascites or hepatocellular carcinoma, or protein losing enteropathy.

Results
Twenty-nine Fontan patients were included, of which 48.3% were female and 82.76% had a dominant left ventricle. The mean age was 33.7 ±8.6 years, the mean peak VO2 19.9 ± 5.9 ml/min/kg and the median NT-proBNP 225 ng/l (IQR 52-473.5). SW velocities increased with age (r = 0.63, p &lt; 0.001) and time since Fontan palliation (r = 0.53, p = 0.005, Figure 1A). In addition, SW velocities significantly correlated with unfavorable clinical parameters: lower peak VO2 (r = -0.76, p &lt; 0.001), elevated NT-proBNP (r = 0.53, p = 0.003) and an increased PVP/CO slope (r = 0.66, p &lt; 0.001) (Figure 1 B-D). Of interest, SW velocities were significantly higher in patients with a clinical diagnosis of Fontan circulatory failure (mean 5.3 vs 7.4 m/sec, p = 0.003, Figure 2A). A cut-off value of 6.3 m/sec had a 90% sensitivity and 84% specificity to predict Fontan circulatory failure (AUC = 0.89; 95% CI [0.77 – 0.99], p = 0.001, Figure 2B).

Conclusion
Natural SW velocities after AVVC strongly correlated with parameters of Fontan circulatory failure. The preliminary results of this ongoing study highlight the potential of SW elastography in the assessment of patients with a Fontan circulation.
Figure 1
Figure 2
The effect of a dietary supplement containing glycosaminoglycans and fucoidanon endothelial glycocalyx integrity and vascular function in patients after COVID-19 infection
Authors: Ikonomidis I , Pavlidis G , Kountouri A , Katogiannis K , Kostelli G , Pliouta L , Thymis J , Korakas E , Michalopoulou E , Prentza V , Katsanaki E , Vlachomitros D , Parissis J , Lambadiari V 
Published: January 2025

Abstract

Background/Introduction
Coronavirus disease 2019 (COVID-19) has been associated with impaired subclinical markers of endothelial and vascularfunction.

Purpose
We investigated whether intervention with Endocalyx (Microvascular Health Solutions),a dietary supplement containing glycosaminoglycans and fucoidan, can improve endothelial glycocalyx integrity,arterial stiffness, and coronary microcirculationin patients after COVID-19 infection.

Methods
Fiftypatients within 15 days after a confirmed mild-to-moderate COVID-19infection were randomized to receive Endocalyx(n=25) or placebo (n=25) for 4 months. We measured at baselineand at 4 months of treatment: a) perfused boundary region(PBR) of the sublingual microvessels with a lumen diameter ranging from 4 to 25 μm, as a marker of endothelial glycocalyx integrity, b)carotid-femoral pulse wave velocity (PWV - Complior SP ALAM) and c)coronary flow reserve (CFR) using Doppler echocardiography.

Results
Four months after treatment, patients under Endocalyx showed an important reduction of PBR 4-25μm (2.24±0.2 vs. 2.37±0.23μm), PBR 10-19 μm (2.52±0.24 vs. 2.65±0.21μm), PBR 20-25 μm (2.75±0.4 vs. 3.04±0.48μm) and PWV (9.8±2.1 vs. 10.6±2.3m/s) and an improvement of CFR (2.68±0.53 vs. 2.47±0.64) (p&lt;0.05 for all comparisons).No significant changes in the aforementioned markers were observed in placebo group (p&gt;0.05; Table). In patients who were treated with Endocalyx, the percentage reduction of PBR 4-25μm was associated with thecorresponding decrease of PWV (r=0.31, p=0.047) and with the improvement of CFR (r=-0.59, p=0.008) at 4 months.

Conclusions
Four-month treatment with Endocalyx may improve endothelial glycocalyx integrity, coronary and vascular function in patients after COVID-19 infection.
Pulmonary artery acceleration time: a valid alternative when tricuspid regurgitation is missing
Authors: Cano Carrizal R , Casanova Rodriguez C , Velez Salas A , Rodriguez Alcudia D , Martin-Penato Molina A , Cadenas Chamorro R , Iglesias Del Valle D , De La Cruz Berlanga E , Paredes Gonzalez M B , Martinez Dosantos V , Aguilera Martinez M C , Lareo Vicente A , Garcia Garcia A 
Published: January 2025

Abstract

Background
the latest guidelines from the European Society of Cardiology (ESC) on the diagnosis of pulmonary hypertension recommend the use of peak tricuspid regurgitation velocity (TRV) as an initial measure. However, in a significant proportion of patients this measurement is not feasible due to the absence of regurgitation or inadequate quality of the Doppler signal curve. Pulmonary artery acceleration time (PAAT), on the other hand, is a measurement that can be easily obtained in nearly all patients.

Purpose
the aim of our study is to analyse the relationship between PAAT and TRV and to evaluate its diagnostic accuracy for the TRV values established in the latest ESC guidelines (2.8m/s and 3.4m/s), determining appropriate cut-off points for this purpose.

Methods
a retrospective analysis was conducted on 1,255 consecutive transthoracic echocardiograms in which both TRV and PAAT were measured. Patients with pulmonary stenosis (peak velocity ≥ 2m/s) were excluded. The relationship between both variables was analyzed using different linear and non-linear models, choosing the one with the lowest degree of residuals. Diagnostic accuracy was assessed using the area under the curve (AUC) and sensitivity (Se) and specificity (Sp) values. Optimal cut-off points (OCP) were derived from ROC curve analysis.

Results
the mean age of the sample was 72.5±13.8 years, with 54% (683) being women and 63% (795) in sinus rhythm. Eighty six patients (7%) exhibited severe, massive or torrential tricuspid regurgitation. The mean TRV was 2.77±0.47m/s and the mean PAAT was 100.50±29.40ms. The mean TAPSE was 21.34±4.70mm, with 196 patients (16%) having systolic dysfunction (defined as TAPSE &lt; 17mm). The relationship between TRV and PAAT fits a quadratic model (p for the quadratic term &lt;0.001). The diagnostic accuracy of PAAT for both TRV cut-off points was good: TRV &gt; 2.8m/s: AUC 0.78 [95% CI 0.76-0.80], OCP 93ms [Se 72.4%, Sp 71.8%]; TRV &gt; 3.4m/s: AUC 0.80 [95% CI 0.78-0.82], OCP 85ms [Se 77.5%, Sp 70.6%].

Conclusions
the relationship between TRV and PAAT follows a non-linear model. Cut-off points of 93ms and 85ms demonstrate good discriminatory power for identifying patients with TRV superior to 2.8m/s and 3.4m/s, respectively. Therefore, PAAT constitutes a reliable alternative for the initial echocardiographic assessment of the pulmonary hypertension probability in patients in whom TRV cannot be determined.
Relationship PAAT/TRV
Use of music as an adjunct for sedation in transoesophageal echocardiography
Authors: Rodrigues A C , Eng A V , Martins J A A , Lira E B , Oliveira F R C , Valelongo P O , Roveri P , Monaco C G , Daminello E , Silva M F I , Fischer C H , Oliveira W , Costa R C P L , Morhy S S , Vieira M L C 
Published: January 2025

Abstract

Background
Transoesophageal Echocardiography (TOE) is semi-invasive examination used for cardiac evaluation, frequently associated to a certain degree of anxiety, and often requiring sedation for patient comfort; alternatively, sedation can result side effects such as hemodynamic changes (hypotension) or hypoventilation and hypoxemia. Music has been used as a non-pharmacological strategy to reduce stress and anxiety levels during medical procedures; accordingly, we hypothesized that music could be used to decrease anxiety and/or sedation dose in patients referred for TOE.

Methods
63 patients over 18 years old undergoing TOE were randomized either to intervention (music group, 31 patients) or no intervention (control group, 32 patients); music was started before transthoracic echocardiography (TTE) and continued up to the end of TOE; an anxiety mini query consisting in 4 degrees of anxiety levels (no, mild, moderate and high) was answered before transthoracic echocardiography (TTE) and again just before sedation; data regarding hemodynamic status (blood pressure, heart rate, oximetry and respiratory incursions ) were examined before and after the intervention; additionally, groups were compared regarding administered total midazolam dose (initial dose plus additional doses).

Results
There was no difference between the groups regarding age (55.1 ±13.7 years vs 49.8± 15.5 p = NS), sex, ethnics, body mass index or the presence of comorbidities . Both groups presented a decrease in anxiety levels before TOE (p = 0.04), however the decrease was more substantial with music compared to control (p&lt; 0.008). Hemodynamic variables were unchanged, except for diastolic blood pressure (p=0.03), showing a slight but significant decrease after music (Table). No difference was seen in the total midazolam dose between the groups (median 5.0 mg with range [4.5 - 7.0 mg] vs 5.0 mg [4.0 - 8.0 mg], p = 0.4; additionally, a negative correlation was found for midazolam dose and age, whereas no correlation was found for other hemodynamic parameters.

Conclusion
Despite no reduction in sedation dose in patients assigned for TOE, listening to music decreases the degree of anxiety, with a small decrease in blood pressure; therefore, music could be useful as an adjunct to sedation in this scenario.
Tricuspid leaflet identification on 2D multiplane transesophageal echocardiography: derivation and validation of a simple two-step approach
Authors: Vella A , Zannoni J , Tusa M , Donal E 
Published: January 2025

Abstract

Background
Tricuspid valve (TV) leaflet identification by two-dimensional (2D) transesophageal echocardiography (TOE) is complex due to the considerable variability in the visualized leaflets. While three-dimensional (3D) imaging can easily overcome this problem by acquiring the whole valve anatomy, the overall image quality is often suboptimal and the technique somewhat unsuitable for real-time monitoring during interventional procedures like TriClip implantation. Using information derived from both 2D and multiplanar reconstruction of 3D datasets, we elaborated a step-wise approach to identify TV leaflets during multiplane 2D TOE and tested it on a validation cohort.

Methods
TOE data from 83 patients was retrospectively collected. The 3D data of each patient was appropriately sliced to simulate and accurately match what would be seen by "sweeping" the cursor across the TV during real-time multiplane imaging (Fig. 1). Following data analysis, a "two-step" reference table was created and subsequently evaluated for accuracy on a validation cohort of 41 patients from a distinct hospital and country. To evaluate the usability of the approach, 11 echocardiographers were presented with a random selection of 5 multiplane images. They were then instructed to identify the visualized leaflets initially without using the reference table, and subsequently with its assistance.

Results
After removal of redundant information, 231 unique multiplane sets were obtained. Combining anatomical features (number of leaflets visualized and presence of the interventricular septum) from the 2D views allowed easy and consistent identification of TV leaflets (Fig. 2), as confirmed by correlation with the 3D dataset. The same "two-step" approach was subsequently tested on an independent validation cohort of 41 patients (96 unique multiplane sets). Accurate leaflet identification was possible in 35 patients (85%), while in 6 cases (15%) the image sector was too narrow to confidently assess the presence of the interventricular septum. The accuracy in exact leaflet recognition without the aid of the reference table was rather modest (mean score of 1 out of 5) among echocardiographers with different experience in TV TOE, but significantly increased (mean score of 3.2 out of 5) with the adoption of the proposed approach, accounting for a 44% improvement in accuracy (p&lt; 0.001).

Conclusion
Simple anatomical features allow precise TV leaflet identification during multiplane 2D TOE. A streamlined "two-step" approach, validated on an independent cohort of patients, significantly improves accuracy in leaflet recognition among both beginner and advanced echocardiographers.
Prognostic role of left ventricular mechanical dispersion and global longitudinal strain for adverse cardiac remodeling in patients after ST-segment elevation myocardial infarction
Authors: Kobets A V , Petyunina O V , Kopytsya M P 
Published: January 2025

Abstract

ST elevation myocardial infarction (STEMI) remains to have high risk of mortality even in patients with percutaneous coronary intervention (PCI), that is considered to be the result of adverse cardiac remodeling (ACR) due to suboptimal reperfusion, microvascular obstruction and inflammation.
The aim of the study was to assess left ventricular (LV) mechanical dispersion (MD) and global longitudinal strain (GLS) as early predictors for ACR in patients after STEMI with successful PCI after 1 year.

Materials and Methods
Using the inclusion (acute STEMI, age &gt;18 years old, PCI) and exclusion criteria (poor acoustic window, previous myocardial infarction, irregular heart rhythm, severe comorbidities), we finally enrolled 119 STEMI patients. Clinical, ECG, 2-dimensional echocardiography with Doppler and speckle-tracking parameters were measured at the baseline and after 1 year to estimate ACR. Circulating biomarkers levels were measured at the baseline. ACR was determined as an increase in LV end diastolic and/or end systolic volume&gt;10% at 12 months (with the time window±14 days) follow-up period after PCI.

Results
A total of 119 post-PCI patients with STEMI with TIMI III were included in the study. They were mainly male (88.2%) with a mean age of 59 years. They were divided into 4 groups according to increased LVMD. The univariate log regression analysis revealed that GRACE score, N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) level, peak Troponin I level, LV ejection fraction, LVGLS and LVMD were found to be predictors for ACR. Multivariate log regression analysis displayed that LV GLS&gt;–8%, high quartile of LVMD and NT-proBNP&gt;953 pg/mL remained independent predictors for ACR.
ROC analysis showed that all 3 predictive models based on LVMD (AUC=0.84. p&lt;0.001, sensitivity (sen) 80.8%, specificity (spe) 87.5%, cutoff point (CP)=68 msc), LV GLS (AUC=0.62; p&lt;0.001, sen 82.0% and spe66.7%, CP=–8%) and NT-proBNP (AUC=0.60. p&lt;0.001, sen78.2%, spe73.5%, CP=953 pg/mL) significantly distinguished from the basal model and allowed to identify patients with STEMI at baseline with high risk of ACR.
The addition of LVMD to the based predictive model (NT-proBNP&gt;953 pg/mL) significantly improved the discriminative potency of the whole prognostic model (AUC 0.84(0.72-0.90), p=0.001), whereas LVGLS did not yield it neither alone (AUC 0.62(0.58-0.69), p=0.49), nor when in combination with LVMD (AUC 0.83(0.73-0.91), p=0.001). Thus only LVMD became an independent predictor of ACR that enabled to improve the discriminative potency of NT-proBNP.

Conclusion
Our study demonstrated that measurement of LVMD and LVGLS in acute period might be useful in prognosis of ACR in patients with STEMI after 1-year follow-up period. But only LVMD became an independent predictor of ACR in prognostic model.