bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atrial strain assessment in elite athletes: unveiling physiologic adaptation
Authors: Baptista Carvalho A , Mendes L 
Published: January 2025

Abstract

Background
Left atrial (LA) strain, measured by speckle-tracking echocardiography, provides insights into cardiac function beyond traditional volumetric assessments. In athletes, the effects of chronic exercise on LA strain are unclear, with conflicting findings on whether it reflects physiological adaptation or potential dysfunction.

Aims
This study aimed to comprehensively assess LA remodeling and function in professional soccer players compared to controls. We hypothesized that while athletes would exhibit LA enlargement, their atrial function would remain preserved due to the physiological nature of cardiac remodeling in this population.

Methods
A retrospective analysis of echocardiographic parameters, namely left atrial strain, was carried out in a group of professional male athletes compared to a control group of healthy male individuals. A GE Vivid E95 echocardiographic ultrasound system and EchoPAC V.206 software (GE Vingmed Ultrasound AS, Horten, Norway) were used. Shapiro-Wilk test was used to test data distribution, ANOVA and t-test were used as a parametric tests, and Man-Whitney as a non-parametric Test (SPSS v.27).

Results
The study analyzed 111 athletes with a median age of 24 (21-31) years and 70 healthy male individuals from the control group with a median age of 27 (23-32) years.
Athletes had a significantly higher indexed left atrial end-systolic volume compared to the control group (41 ± 9 ml/m² vs. 31 ± 7 ml/m², p&lt;0.001). Despite the difference in volume, the early and late diastolic tissue velocities were similar in both groups and E/E’ was lower (4.4 ± 0.9 vs. 5.0 (4.5-5.8), p&lt;0.001). There were no significant differences between athletes and the control group in Left Atrial Reservoir Strain (LASr) and Left Atrial Conduit Strain (LAScd). The active contraction of the left atrium during atrial systole is reduced in athletes, which had a significantly lower left atrial contraction strain compared to the control group (-9 (-11 – -8)% vs. -12 ± 4%, p&lt;0.001).

Conclusion
The data suggests that athletes' hearts have undergone specific adaptations, particularly in terms of increased left atrial size and altered contraction patterns. Maintaining atrial reservoir strain (the most validated parameter for normality) and atrial conduit strain within normal ranges may indicate that morphological changes are merely normal adaptations to the high cardiac output demands during exercise.
Descriptive analysis
LA strain example
Long COVID echocardiography, cardiac MRIi, and endomyocardial biopsy findings in previously healthy individuals
Authors: Gomez Monterrosas O G M , Martinez Juarez D M , Loyola G L , Jimenez Cisneros G J , Miro J M 
Published: January 2025

Abstract

Aims
There are many possible causes of myocardial injury in long COVID patients. The aim of the study was to search by endomyocardial biopsy EMB in patients with not previous comorbidities histopathological causes.

Material and Methods
This is part of a single center registry, 209 patients with chest pain due to long COVID without previous known comorbidities, all patients have had positive COVID polymerase chain reaction (PCR) or rapid antigen test. The median of 32.56 weeks following diagnosis, due to lack of improvement of symptoms with medical treatment, according with clinical, laboratory results, echocardiography, and cardiac magnetic resonance (CMR), the endomyocardial biopsy (EMB) was performed, a total of 16 patients from January 2021 to January 2024 were included.

Results
Of the 16 patients included,7 (43%) had persistent high-sensitive I troponin (HS-TnT) and 8 (50%) HS-CRP, all patients have low vitamin D level. 5 of them 31% evidenced myocardial injury in CMR, elevated T1 or T2 mappings, anormal extracellular Volume (ECV), or late gadolinium enhancement (LGE).
The main findings in histopathology, immunohistochemistry staining, and PCR proof of viral genome. 12 (75%) patients had had diffuse ischemic necrosis with loss of general myocardial architecture, and interstitial edema, early cellular degeneration in the presence of intracytoplasmic lipofuscin 2 patients have lymphocytic myocarditis criteria, from this 2, 1 had immunoperoxidase for SARS-Cov2 (Bio&Sb), where nuclei with uptake evidenced with diaminobenzidine favors virus infection (Sars-Cov2), 1 patient thrombotic microangiopathy and 1 AA amyloidosis.

Conclusion
Most of patients have diffuse ischemic necrosis instead, inflammatory changes, also it is possible to find AA amyloidosis and thrombotic microangiopathy
table 1 and 2
Left atrial stiffness index in patients with cryptogenic ischemic stroke: a clue of atrial fibrillation?
Authors: Gabrielli F A , Bencardino G , Abruzzese S , Di Renzo A , Colo' F , Lanza G A , Lombardo A , Pelargonio G , Burzotta F , Broccolini A 
Published: January 2025

Abstract

Introduction
About 25% of cryptogenic ischemic stroke are due to undiagnosed atrial fibrillation. New echocardiographic markers derived from left atrial strain analysis could be useful to early identify patients candidates to oral anticoagulation.

Purpose
Aim of our study was to investigate the relationship between left atrial strain parameters assessed by speckle tracking echocardiography (STE) and the new documentation of atrial fibrillation at follow-up in patients admitted for acute cryptogenic ischemic stroke.

Methods
From 2020 to 2023 consecutive patients admitted to Stroke Unit of our Hospital for cryptogenic ischemic stroke undergoing loop-recorder implantation were retrospectively enrolled in our study. Main exclusion criteria were previous diagnosis of atrial fibrillation and poor image quality. All patients underwent full echocardiographic examination, including left atrial strain analysis with STE by dedicated software.

Results
Sixty-nine patients were finally selected, divided in patients with and without atrial fibrillation at follow-up (26 and 43 pts, respectively). No clinically significant differences were found between the two groups at baseline. Analysing echocardiographic parameters, significant differences were found in patients with and without diagnosis of atrial fibrillation at follow-up, respectively, with regard to left atrial volume index (LAVi, 44.26 ± 10.58 vs 34.54 ± 11.03 ml/m2, p 0.005), peak atrial longitudinal strain of reservoir phase (PALSr 19.50 ± 8.48 vs 26.22 ± 9.11%, p 0.01) and contraction phase (PALSct 5.70 (0; 20.92) vs 11.23 (5.98; 16), p 0.017). Left atrial stiffness index was defined as the ratio between E/E’ (expression of left ventricular filling pressures) and PALSr. Using a cut-point of 0.55, identified with ROC analysis, a significant difference was found between the two groups (10/26 (38.4%) vs 4/43 (9.3%), p 0.002). Among all these parameters, at the multivariate logistic regression analysis only left atrial stiffness index showed a trend to the significance (p 0.06).

Conclusions
Left atrial strain analysis can be useful to better select patients with cryptogenic stroke who need loop-recorder implantation and a closer follow-up to prompt recognize atrial fibrillation. In particular, Left atrial stiffness index seems to be the most useful parameter to stratify patients at higher risk of atrial fibrillation.
Acute alterations in blood lactate in the setting of transient stress induced myocardial ischaemia
Authors: O'driscoll J , Smith E , Bibat M , Edwards J , Compton C L A I R E , Kipourou K , Coleman D , Wiles J , Cunliffe E , Marciniak A , Sharma R 
Published: January 2025

Abstract

Background
An elevation in resting venous blood lactate levels ([La-]b) in conditions of myocardial hypoperfusion is associated with adverse prognosis and survival. This investigation aimed to assess changes in venous [La-]b levels induced by dobutamine stress in the presence and absence of myocardial ischaemia and adverse outcomes at 1-year.

Methods
404 consecutive patients (mean age 70±10 years, 243 male) reporting chest pain underwent dobutamine stress echocardiography and were categorised as ischaemic (IS) or non-ischaemic (NI) responders. Conventional and global longitudinal strain (GLS) echocardiographic measures were recorded at rest. Venous [La-]b samples were acquired at rest, peak stress and 1, 3, 5 and 10-minutes into recovery using a commercially available Lactate Pro 2 device.

Results
There were no significant differences in [La-]b concentrations between IS (1.75±0.76 mmol×L-1) and NI (1.73±0.60 mmol×L-1) responders at baseline (p=0.592). However, [La-]b concentrations were significantly greater at peak stress (1.83±0.57 vs. 1.68±0.60 mmol×L-1), 1 (1.90±0.56 vs. 1.73±0.71 mmol×L-1), 3 (1.97±0.56 vs. 1.73±0.71 mmol×L-1), 5 (1.98±0.60 vs. 1.74±0.70 mmol×L-1), and 10-minutes (2.01±0.63 vs. 1.76±0.71 mmol×L-1) into recovery between IS and NI responders (all p&lt;0.001), respectfully. GLS was significantly lower in IS compared to NI responders (-15.5±2.9 vs -16.2±2.7%, p=0.02) at baseline. In patients who experienced an adverse cardiac event during 1-year of follow-up, GLS (-14.4±2.7 vs -16.1±2.8%, p&lt;0.001) and [La-]b concentrations were significantly lower at baseline (1.54±0.55 mmol×L-1 vs. 1.78±0.70 mmol×L-1, p=0.02), as were [La-]b concentrations at 5 (1.68±0.55 mmol×L-1 vs. 1.88±0.68 mmol×L-1, p=0.04) and 10-minutes (1.70±0.56 mmol×L-1 vs. 1.93±0.71 mmol×L-1, p=0.02) into recovery compared to patients who did not experience an adverse event, respectively. GLS (HR 1.21; 95% CI 1.11 to 1.33, p&lt;0.001) and [La-]b concentrations at 10-minutes into recovery (HR 0.54; 95% CI 0.33 to 0.85, p=0.01) were significant independent predictors of an adverse event.

Conclusions
Transient myocardial ischaemia is associated with a significant elevation in [La-]b concentrations, which extends into the recovery period, compared to NI responders. A blunted metabolic response to dobutamine stress and attenuated longitudinal myocardial mechanics are independently associated with short-term adverse events.
Mean pulmonary arterial pressure over cardiac output slope for risk stratification in patients with unexplained dyspnea: does the math matter?
Authors: Bekhuis Y G , Falter M , Milani M , Hoedemakers S , Moura-Ferreira S , Verbrugge F , Gevaert A B , Debonnaire P , Dhont S , Van De Bruaene A , Stassen J , Herbots L , Jasaityte R , Claessen G , Verwerft J 
Published: January 2025

Abstract

Background
Pulmonary artery pressure corrected for cardiac output (mPAP/CO) assessed by exercise echocardiography and calculated as the mPAP/CO slope improves risk stratification in various populations. However, it is unclear whether simplified alternatives have a similar predictive ability for outcomes.

Purpose
To evaluate whether the methodology employed to calculate the mPAP/CO slope affects prognostic assessment.

Methods
This is a secondary analysis of a multicenter cohort study that included patients with unexplained dyspnea who underwent exercise echocardiography. The primary analysis evaluated the additional prognostic value of the mPAP/CO slope. The mPAP was derived from the colloid-enhanced peak tricuspid regurgitation velocity using the Chemla formula. Cardiac output was calculated by multiplying heart rate by stroke volume, determined by the velocity time integral of the left ventricular outflow tract. The mPAP and CO were measured at rest, intermediate, and peak effort. The mPAP/CO relationship was calculated in six different ways: (1) linear regression based on three points, (2) delta from rest to peak, (3) delta from rest to intermediate, (4) delta from intermediate to peak effort, (5) mPAP/CO at intermediate effort and (6) mPAP/CO at peak effort. The primary outcome was the composite endpoint of all-cause mortality or non-elective cardiovascular hospitalizations. Receiver Operating Characteristic (ROC) curve analysis was used to assess the diagnostic performance of the different calculation methods, and the DeLong approach was used to compare differences in the area under the curve (AUC).

Results
Out of 2538 exercise echocardiography exams performed between January 2016 and March 2023, 2022 exams were included (age 62±15 years, 53% women) The patients' characteristics are shown in Figure 1. After 19 (11-36) months of follow-up, the overall event rate was 11.23%. Five of the six methods performed equally (Figure 2; AUC between 0.603 and 0.615, p&gt; 0.05 for comparisons). The delta from intermediate to peak effort method was significantly less accurate than the other methods (Figure 2; AUC: 0.543; 95% CI: 0.521, 0.565; p-values ranging from 0.03 to &lt; 0.001).

Conclusion
For risk stratification of patients with unexplained dyspnea, the 3-point linear regression method is not superior to more straightforward methods such as a 2-point slope (rest to peak; rest to intermediate effort) or a single-point mPAP/CO ratio during intermediate or peak effort. These findings can enhance the implementation of the mPAP/CO relationship in clinical practice.
Figure 1. Patient characteristics
Figure 2. ROC curves for each calculatio
Quantifying right ventricular function in tetralogy of fallot: 3D echo into longitudinal, radial, and anteroposterior directions
Authors: Schneijdenberg J W , Zwaan R R , Chen Y , Bowen D J , Van Burken G , Bosch J G , Van Den Bosch A E 
Published: January 2025

Abstract

Introduction
Tetralogy of Fallot (ToF) is a congenital heart disease requiring surgical correction in early childhood. Despite high surgical success rates, patients cope with severe morbidity during adulthood predominantly originating from the right ventricle (RV). Pathophysiological processes underlying these conditions remain largely unknown, but are mostly attributed to RV remodelling. Improved understanding of remodelling patterns is essential for advancements in clinical decision making and treatment planning.

Purpose
To gain better insight in RV remodelling in patients with ToF, a method for detailed quantification of directional components of RV function was developed using three-dimensional echocardiography (3DE).

Methods
From RV-focused 3DE studies of 50 ToF patients and 50 healthy controls, three-dimensional dynamic RV meshes were obtained using commercially available software (TomTec 4D RV-Function). Within an in-house developed software application (RV-Dynamics), a technique was realized to decompose RV contraction in longitudinal (LT), radial (RD), and anteroposterior (AP) motion directions (Figure 1). Their relative contributions to RV ejection fraction (RVEF) were calculated as measure for RV function, analysed, and statistically compared within and between ToF patients and healthy controls.

Results
Decomposed RVEF in the AP motion direction was identified as the largest relative contributor to RVEF in both ToF patients (38% [31 – 42]) and healthy controls (40% [37 – 44]). Moreover, the AP component was significantly reduced in ToF patients compared to healthy controls (p=0.004). Deterioration in AP direction was complemented by a significant increase of the LT RVEF component (p=0.009), with 28% [26 – 33] in ToF patients compared to 26% [23 – 31] in healthy controls. Relative contribution of RD motion remained the same between both groups (p=0.649) (Figure 2).

Conclusion
RV-Dynamics allowed for effective directional decomposition of RVEF, enabling detailed quantification of RV function in patients with ToF. The AP component proved to be the largest relative contributor to RVEF in both ToF patients and healthy controls, disputing currently applied parameters focussing on LT wall motion for RV function assessment. Deterioration of RV function in ToF patients was mostly assigned to decreased contribution of AP wall motion to RVEF. We hypothesised this relates to the crucial involvement of left ventricular function in RV function, as RV motion in AP direction is largely attributed to left ventricular systolic function. A compensatory increase in LT contraction was observed, suggesting RV remodelling in LT direction in ToF patients.
3D echocardiographic assessment of permanent pacemaker ventricular lead position according to the type of ventricular pacing
Authors: Fusini L , Maranzano G , Marongiu A , Arcudi A , Provenzano E , Rondinara G , Dell'era G , Tundo F , Erbetta R , Garlasche A , Pepi M , Muratori M , Pontone G , Patti G 
Published: January 2025

Abstract

Introduction
In recent years, there has been a significant increase in the use of permanent pacemakers (PPM). Endocardial leads can induce or worsen tricuspid regurgitation (TR) when they interfere with tricuspid valve (TV) leaflets motion. Additionally, right ventricular pacing can also worsen TR and mitral regurgitation (MR).

Purpose
We aimed to assess: 1) the feasibility of utilizing 3D transthoracic echocardiography (TTE) to visualize PPM lead position, 2) the prevalence of different lead positions relative to the TV leaflets, and 3) the short-term echocardiographic outcomes based on the type of ventricular pacing (right ventricular apical pacing, RVAP, and left bundle branch area pacing, LBBAP).

Methods
We prospectively enrolled 48 consecutive patients who underwent PPM implantation with RVAP and LBBAP. Both 2D and 3D TTE were obtained from all patients at baseline and at a 3-month follow-up.

Results
3D TTE was feasible in 94% of patients. The most common lead location was the posteroseptal commissure, regardless of the ventricular pacing types (65% RVAP vs 60% LBBAP, p = 0.761). TV diameters were similar in both groups (TV maximum diameter: RVAP 37±3 mm vs LBBAP 38±4 mm, p=0.248; TV minimum diameter: RVAP: 27±5 mm vs LBBAP 29±5 mm, p=0.143). However, a greater distance between the TV plane and lead tip insertion was found in RVAP compared to LBBAP. No differences were detected in the biventricular size/function and the severity of MR and TR based on the type of ventricular pacing at the 3-month follow-up (Table). High agreement was observed between two operators in identifying the lead localization by 3DTTE (Cohen K = 0.63, p &lt; 0.001).

Conclusions
3D TTE enables precise localization of PPM leads at the tricuspid valve level. Therefore, 3D TTE should be routinely employed, in particular to facilitate the detection of TV interference and the progression of TR after PPM implantation.
Table. Echocardiographic characteristics
Associations between systolic left ventricular rotational mechanics and peak left atrial reservoir strains - a three-dimensional speckle-tracking echocardiographic study
Authors: Nemes A , Kormanyos A , Ambrus N , Lengyel C 
Published: January 2025

Abstract

Introduction
In systole, during left ventricular (LV) twist, the left atrium (LA) acts as a reservoir, its volume is the largest. In this phase of LA function, the direction of its wall movement is opposite to that of the LV wall, and can be quantitatively characterized using strains.

Purpose
The objective of the present study was to investigate the relationship between LV twist and LA strains as assessed simultaneously by three-dimensional speckle-tracking echocardiography (3DSTE) under healthy conditions by examining what happens when the above parameters are smaller or greater than the average.

Methods
In the present study, 157 healthy adults (mean age: 33.2 ± 12.7 years, 73 men) were involved. Complete two-dimensional Doppler echocardiography with 3DSTE-derived data acquisition were performed in all cases. 3DSTE-derived LA strains and LV rotational parameters were determined at a later date.

Results
Increased basal LV rotation was associated with a decreasing tendency of apical LV rotation and increased LV twist. Increased apical LV rotation was associated with a decreasing tendency of basal LV rotation and increased LV twist. Peak LA global circumferential (GCS) and area (GAS) strains proved to be reduced in case of the highest basal LV rotation, other peak LA strains did not show association with increasing basal LV rotation. Peak LA global radial strain (GRS) was highest in case of the lowest apical LV rotation. Peak LA global 3D strain (G3DS) was lowest in case of the highest apical LV rotation. All peak LA strains showed an increasing tendency of other strains but to different extent. With increasing peak LA-GRS, increasing peak LA global longitudinal strain (GLS), LA-GCS and LA-GAS could be detected, but only up to a point, beyond which further increase cannot be detected (except peak LA-G3DS). Increasing peak LA-GCS was associated with increase of all other strain values except for peak LA-G3DS. Increase of all peak LA strains could be seen with increasing peak LA-GLS, except for peak LA-GRS. From complex strains, with increasing peak LA-G3DS, increasing peak LA-GLS, LA-GCS and LA-GAS could be detected, but only up to a point, beyond which further increase cannot be detected (except peak LA-GRS). Increase of all peak LA strains could be detected with increasing peak LA-GAS, but only up to a point, beyond which further increase in peak LA strains cannot be detected. Only apical LV rotation proved to be significantly reduced in case of the highest peak LA-G3DS. Other peak global LA strains did not show any associations with basal and apical LV rotations.

Conclusions
In LV systole, LV rotational mechanics are associated with LA deformation represented by peak reservoir LA strains even in healthy circumstances.
Three-dimensional speckle-tracking echocardiography-derived deformation analysis of the morphologic left ventricle in adults with corrected dextro-transposition of the great arteries
Authors: Kormanyos A , Gyenes N , Ambrus N , Lengyel C , Havasi K , Nemes A 
Published: January 2025

Abstract

Introduction
Dextro-transposition of the great arteries (dTGA) stands out as a prevalent cyanotic congenital heart defect, characterized by an intricate reversal in the arrangement of the major arteries. In the past, surgical interventions, including atrial redirection (switch), were embraced, with survivors from those pioneering procedures still living today. Recent advancements in cardiovascular imaging have led to the emergence of several novel echocardiographic techniques, notably three-dimensional (3D) and/or speckle-tracking echocardiography (STE).

Purpose
The present study aimed to employ 3DSTE to determine morphologic left ventricle (mLV) strain parameters in adults with dTGA who underwent Senning’s and Mustard’s procedures at infancy. Furthermore, it was also aimed to assess whether the type of correction procedure had any impact on mLV deformation parameters.

Methods
Eleven dTGA patients, with a mean age of 28.8 ± 8.5 years (6 males, 6 Senning- and 5 Mustard-operated patients) were enrolled. They were compared to 34 healthy controls matched for age and gender (age: 35.7 ± 12.8 years, 21 males). All subjects underwent complete 2D Doppler echocardiography with 3DSTE data acquisition as per recent guidelines.

Results
Comparing all dTGA patients to the control group no mean segmental or global mLV strains showed significant differences, however out of the regional strains, midventricular longitudinal strain was significantly higher in dTGA compared to the healthy group (-6.8±7.4 % vs. -13.3±2.5 %, p&lt;0.05). The Mustard-operated patients showed significantly lower global LV-CS compared to that of controls (-22.1±12.4 % vs. -28.9±4.7 %, p&lt;0.05). Out of the regional strains the Mustard’s group had a significantly lower apical V-CS (-24.8±11.9 % vs. -28.9±4.7 %, p&lt;0.05), higher midventricular LV-LS (-20.1±9.2 % vs. -13.3±2.5 %, p&lt;0.05) and a lower apical LV-AS (-36.3±17.0 % vs. -48.8±9.7 %, p&lt;0.05).

Conclusions
Significant mLV strain abnormalities are present in dTGA late after atrial switch procedures. These differences are more pronounced in the Mustard operated subgroup.