bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial strain to predict post-operative atrial fibrillation in patients undergoing coronary artery bypass grafting
Authors: Pastore M C , Degiovanni A , Sozzani M , Giordano A , Grisafi L , Salvatici C , Lorenz V , Cameli M , Patti G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Post-operative atrial fibrillation (POAF) is a common complication occurring after cardiac surgery. POAF is associated with higher risk of stroke, cardiac arrest and congestive heart failure, as well as prolonged in-hospital stay. Revealing left atrial (LA) subtle structural/functional abnormalities before the operation may help identifying patients most prone to develop POAF in order to apply appropriate preventive strategies and implement approaches of post-operative diagnosis and treatment.

Purpose
Our study was aimed at assessing the potential usefulness of LA strain parameter by speckle tracking echocardiography (STE) as independent predictor of POAF in patients undergoing coronary artery bypass graft (CABG).

Methods
Patients referred to isolated CABG were prospectively enrolled in two Italian centers. Patients with age &lt;18 years, history of AF, previous cardiac surgery, hypo-/hyper-thyroidism or unfeasible STE were excluded. All patients underwent transthoracic echocardiography &lt;7 days before the operation. Baseline clinical features, intra-operative parameters and post-surgery clinical data were also collected. Primary study endpoint was the relationship between pre-surgery LA strain data and occurrence of POAF before discharge.

Results
Overall, 260 patients were enrolled (age 67.5 ± 8.6 years, 82% males). POAF occurred in 98 patients (38%) at a mean of 2.3 ±1.5 days after the operation. A global PALS &lt;26.2% prior surgery represented the optimal threshold to predict POAF with an AUC of 0.66 (p&lt;0.0001). At multivariate analysis, global PALS and age were independent predictors of POAF (Table 1). A model including PALS &lt;26.2% and age &gt;70 years was associated with a &gt;4.5-fold increased risk of POAF at discharge (HR 4.87, 95% CI 2.43–9.76, p&lt;0.0001). At ROC analysis this model identified those patients developing POAF with a specificity of 85%, Kaplan Meier curves confirmed its significant prediction for lower POAF-free survival (Figure 1).

Conclusions
The combined use of age and pre-surgery global PALS may help clinicians to identify patients at higher risk of POAF after isolated CABG. This approach can be useful in selecting patients who may be candidate to preventive anti-arrhythmic strategies, as well as to stricter and longer monitoring to early detect and treat POAF.
Myocardial work and left heart strain variation according to different grades of mitral regurgitation severity and symptoms
Authors: Pastore M C , Mandoli G E , Vannuccini F , Lisi M , Iuliano M A , Santoro A , Niglio F P , Barilli M , Lorenz V , Focardi M , Cavigli L , D'ascenzi F , Valente S , Cameli M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Myocardial work (MW) estimation by pressure-strain loops using an implemented speckle tracking software has showed to estimate LV contractile properties overcoming the load-dependency limit of left ventricular (LV) global longitudinal strain (GLS). This has proved useful particularly in clinical setting characterized by frequent hemodynamic variations, such as heart failure and valvular heart disease. However, the variation of MW parameters across different stages of mitral regurgitation (MR) and its impact on symptoms has never been investigated.

Objective
The aim of this observational study was to assess the variations of MW and deformation parameters of left heart chambers in mild, moderate and severe MR.

Methods
Consecutive patients with mild, moderate and severe MR were prospectively enrolled. Exclusion criteria were: chronic atrial fibrillation, valvular heart prosthesis, previous cardiac surgery.
Clinical evaluation, blood sample tests, ECG and echocardiography were performed. Speckle tracking analysis completed by myocardial work were performed offline. Patients were then divided into groups first according to MR severity. Differences among the groups were analyzed by student T test (or non-parametric tests for non-normally distributed variables) and predictors of symptoms (as NYHA class ≥ 2) were explored by logistic regression analysis.

Results
Overall, 120 patients were enrolled (40 mild, 40 moderate, 40 severe MR). LV GLS improved according to severity, while Global PALS reduced according to MR severity. Global constructive work (GCW) and global wasted work (GWW) significantly improved in patients with moderate and severe MR, while global work efficiency (GWE) showed a trend towards reduction in patients with higher grades of MR. Global work index did not change significantly in the three groups (Fig.1). Among strain parameters, global PALS emerged as a predictor of NYHA class (R2=0.2, p&lt;0.001) These results are explained by the pathophysiology of MR, characterized by a mechanism of attempted LV compensation to volume overload with increased contractility parallel to the disease progress, although with low efficacy on increasing LV stroke volume and increased wasted work; while LA and diastolic function have an early reduction which is associated with the occurrence of symptoms.

Conclusions
Myocardial deformation parameters of the left heart chambers accurately reflect the pathophysiologic mechanisms of MR stages and are associate with the burden of symptoms.
Novel handheld ultrasound with spectral Doppler modality allows for reliable valvular blood flow velocity assessment
Authors: Filipiak D , Kasprzak J D , Lipiec P 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Handheld Ultrasonographs (HUD) have soldified their position as a entry-level echocardiographic tool tailored for introducing non-invasive imaging diagnostics to everyday clinical practice. Current approach to valve assessment with the use of HUD could only involve qualitative method based on the visual detection of morphologic abnormalities and color Doppler assessment. It was not until recently that, Quantitative analysis was enabled with the implementation of spectral doppler to the HUD.

Purpose
To assess if HUD featured with spectral Doppler modality enables for reliable evaluation of the valvular flow velocity.

Methods
102 consecutive patients reporting to the cardiological emergency room underwent HUD examination involving both the measurement of mitral valvular flow velocity with the pulsed wave Doppler and aortic valvular flow with continuous wave Doppler. Subsequently, the same parameters were measured with the high end stationary workstation, and acquired results were treated as reference. Mitral valvular blood velocity &gt; 1,3 m/s and atrial valvular blood flow velocity &gt;2,0 m/s. were considered as abnormal values.

Results
The correlation between the measurements of maximum velocity through mitral valve obtained with the HUD and standard echocardiography was high (r=0,85; p&lt;0,0001; 95% CI 0,78–0,89). The Bland-Altman plot showed no clinically relevant bias (mean difference 0,06 m/sec, upper limits of agreement 0,2 m/sec lower limit of agreement 0,32 m/s). Accelerated valvular blood flow (present in 4 pts) was detected with HUD with sensitivity of 75 % (95% CI: 19%-99%), specificity of % (95% CI: 96%-100%), positive predictive value of 100% (95% CI: 29%-100%), negative predictive value of 99% (95% CI: 95%-100%). Corresponding assessment of aortic valve showed the following correlation: r=0,87; p&lt;0,0001; 95% CI 0,81–0,91). The Bland-Altman plot analysis indicated small underestimation bias of −0,17 m/sec (P &lt; .001), upper limits of agreement of 0,47 m/sec, lower limit of agreement −0,81. Accelerated valvular blood flow (found in 7pts): sensitivity of 57% (95% CI: 19%-90%), specificity of 100% (95% CI: 96%-100%), positive predictive value of 100% (95% CI: 40%- 100%), negative predictive value of 97% (95% CI: 91%-99%).

Conclusion
Correlations calculated between the results of valvular blood flow measured with HUD and conventional workstation proved to be very strong. HUD examination enables for detection of accelerated blood flow through mitral and aortic valves with high positive and negative predictive value.
Characterization of right-sided strain parameters in atrial and ventricular functional tricuspid regurgitation
Authors: Galloo X , Dietz M F , Fortuni F , Prihadi E A , Cosyns B , Bax J J , Ajmone Marsan N 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Atrial functional tricuspid regurgitation (A-FTR), defined as TR due to prominent right atrial (RA) dilatation without significant right ventricular (RV) remodelling, has recently emerged as a distinct subtype of FTR, and can be distinguished from ventricular FTR (V-FTR), defined by significant RV remodelling leading to annular dilatation and leaflet tethering. However, so far no data has been reported on the values of RV and RA strain in these patients.

Purpose
To evaluate potential differences in right-sided strain parameters in patients diagnosed with severe atrial and ventricular FTR.

Methods
Patients with severe FTR, without a cardiac implantable electronic device, were categorized as V-FTR when in sinus rhythm and either having left-sided cardiac disease, pulmonary hypertension, or moderate/severe RV dysfunction. Patients, in sinus rhythm or atrial fibrillation, with no other cause of annular dilatation and impaired leaflet coaptation than RA dilatation were classified as A-FTR. Extensive echocardiographic assessment was performed, including 2D-speckle-tracking strain analysis.

Results
A total of 525 patients with severe FTR (mean age 66 ± 15 years, 42% male) were included, of which 401 patients (76%) were classified as V-FTR and 124 patients (24%) as A-FTR. Baseline clinical and echocardiographic characteristics are shown in Figure 1. Patients presented with mild RV dilatation (RV end-diastolic area 12.9 ± 4.0cm2/m2) and RV dysfunction (RV free wall longitudinal strain [FWLS] 18.3 ± 6.8%), and with moderate-to-severe RA dilatation (RA max volume 36.8 [26.9 – 52.2] ml/m2) and moderate-to-severe RA dysfunction (RA reservoir strain 17.0 [11.0 – 27.0] %). Corresponding to the phenotype, patients with A-FTR presented with significantly smaller RV size and better RV function (Figure 1). However, despite overall normal values of RV function by RV fractional area change, tricuspid annular plane systolic excursion (TAPSE) and RV FWLS, 27% of A-FTR patients showed reduced RV FWLS based on cut-off value of −20%. In addition, patients with A-FTR showed more dilated RA, as compared to patients with V-FTR, but with better RA function assessed by 2D-strain values (Figure 1). Notwithstanding, still 73% of the A-FTR-patients showed reduced RA strain values, when using the cut-off reported for normality of 34%.

Conclusion
Approximately 25% of patients diagnosed with severe FTR presented with A-FTR. These patients presented with significantly better right-sided strain parameters as compared to patients with V-FTR, despite more pronounced RA dilatation.
Changes in coronary plaque component volumes comparing different virtual monoenergetic images using photon-counting computed tomography
Authors: Vattay B , Szilveszter B , Boussoussou M , Vecsey-Nagy M , Lin A , Konkoly G , Kubovje A , Schwarz F , Merkely B , Maurovich-Horvat P , Williams M C , Dey D , Kolossvary M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): BV was supported by the ÚNKP-22-3-II-SE New National Excellence Program of the Ministry for Culture and Innovation from the source of the National Research, Development and Innovation Fund.

Introduction
Photon-counting CT (PCCT) allows virtual monoenergetic images (VMIs) which may aid more precise assessment of coronary plaques. We aimed to analyze how plaque component volumes change on different VMIs.

Methods
Coronary CT angiography images were acquired using a dual-source PCCT and VMIs were reconstructed between 40–180 keV in 10 keV increments. Polychromatic images at 120 kVp (T3D) were also reconstructed and used as reference. Quantitative image quality analysis was performed on all reconstructed images. Quantitative plaque assessment was performed on T3D images and segmentation masks were copied to all VMI images. Calcified plaque (CP; &gt;350 Hounsfield units, HU), non-calcified plaque (NCP; 30–350HU) and low-attenuation NCP (LAP; −100-30HU) volumes were calculated.

Results
We analyzed 51 plaques from 51 patients (67% male, mean age 65±12 years). Average attenuation and contrast-to-noise ratio (CNR) decreased significantly with increasing keV levels, with similar values observed between T3D and 70 keV images (299±209 vs 303±225 HU, p = 0.15 for mean HU; 15.5±3.7 vs. 15.8±3.5, p = 0.32 for CNR). Mean NCP volume was comparable between T3D and 100–180 keV reconstructions. There was a graded decrease in mean CP volume, with a significant difference between all VMI images and T3D (p&lt;0.05). LAP volume increased with increasing VMI energy levels and all VMI images showed a significant difference compared to T3D, except for 50 keV (28.0±30.8 mm3 and 28.6±30.1 mm3, respectively, p = 0.63).

Conclusion
Fixed threshold settings result in significantly different plaque volumes when using VMIs as compared to T3D images. Normalization protocols are needed to have comparable results between future studies.
Echocardiography identifies geometric and functional cardiac alterations in patients with Familial Partial Lipodystrophy
Authors: Romano M , Sapalo A T , Guidorizzi N R , Moreira H T , Ines P A C , Kalil L C , Paula F J A , Foss M C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
Lipodystrophy (LPD) is a rare condition characterized by levels of loss of adipose tissue in a generalized or partial form. Cardiovascular disease is a significant cause of morbidity in this population,n but cardiomyopathy associated with LPD is still not well described. We sought to characterize cardiac morphology and left ventricle function in patients with partial LPD with no cardiac symptoms.

Methods
This is a cross-sectional case-control study. Adult patients with clinical diagnosis of familial partial LPD and Controls were invited to collect echocardiographic images prospectively. Transthoracic echocardiography was performed with conventional bidimensional and Doppler techniques and LV Speckle-tracking technique. Left atrium (LA) dimension and volumes, LV dimension, thickness, mass, and diastolic and systolic function were measured. Data between groups compared with appropriate tests according to variable distribution. Relation between echocardiographic variables and LPD diagnosis were tested with simple and multiple regression models, considering the effect of systolic arterial blood pressure (SBP) as an independent variable. The significance level was set as p &lt;0.05.

Results
twenty-nine patients with LPD were compared to 17 control. LPD patients and control group did not differ in age (44.58±11.77 vs. 43.84±13.32, p = 0.94), gender, BMI (26.73±4.30 vs. 24.52±5.04 Kg/ml, p = 0.05) or BSA (1.70±0.23 vs. 1.67±0.16, p = 0.9). Patients with LPD had statistically higher SBP (122.7±14.85 vs. 110.9±11.08, p = 0.02). LPD had LA higher dimension (37.27±4.44 vs. 32.12±4.25 mm, p = 0.001) and volume (LAVi)(30.17±7.24 vs. 24.94±9.04 ml/m2, p = 0.02), LV mass_i (79.29±17.38 vs. 67.10±19.36, p = 0.02), and also reduced diastolic LV parameters as mitral tissue Doppler E' lateral (11.07±3.48 vs. 14.94±2.35 cm/s, p = 0.001) and E' septal ( 8.0±2.73 vs. 11.38±2.02 cm/s, p = 0.001, and also E/E' ratio (7.89±2.22 vs. 6.35±1.29, p = 0.02). Parameters of LV systolic function as LVEF (64.70±4.56 vs. 62.15±4.35 %, p = 0.08) or GLS were not statistically different between groups (−17.06±2.70vs. −18.02±1.98%, p = 0.25). There was a positive relation of LA dimension ( β 5.6, p&lt;0.001), wall thickness (β 1.3, p 0.011), tissue Doppler E' lateral (β −3.5, p = 0.002) and E' septal (β −3.2, p&lt;0.001) to LPD diagnosis, even after adjusted for SBP.

Conclusion
patients with familial partial LPD present early cardiomyopathy with LV hypertrophy, LA enlargement, and LV diastolic dysfunction before LV systolic dysfunction. Echocardiographic parameters are related to LPD diagnosis independent of SBP.
Association between diastolic dysfunction with coronary artery calcium score in stable coronary artery disease patients
Authors: Lubis H I L F A N , Ardini T E N G K U , Andra C U T , Lubis A N G G I A , Zebua J U A N G , Putri C U T , Rialdy I S F A N , Brahmana A N D R E W 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objectives
Diastolic dysfunction is a common problem in patients with obesity, hypertension, diabetes, or coronary artery disease (CAD) including stable CAD. The coronary artery calcium score (CACS) is used to non-invasively evaluate cardiovascular risk in asymptomatic patients with a low to intermediate pre-test probability for CAD. The purpose of this study was to evaluate the association of diastolic dysfunction with an abnormal CAC score.

Materials and Methods
This study considered a cohort of patients &gt; 18 years of age with normal ejection fraction who were admitted to the hospital with chest pain but low risk presentation for acute myocardial infarction. Patients then underwent cardiac CT for measurement of CAC score. Patients were excluded if they had prior history of CAD, ECG findings diagnostic of an acute coronary syndrome, an elevated troponin level, or hemodynamic instability.

Results
A total of 200 patients were included and 96 (48%) patients had echocardiographic evidence of diastolic dysfunction. Patients with diastolic dysfunction were more likely to have a higher mean calcium score (12,154.68 ± 17,588.30 vs 2,666.38 ± 9,725.82; p&lt;0.001). Receiver operating characteristics (ROC) analysis showed the area under the curve was 86.3% and cut off was 129.5 with sensitivity 85% and specificity 74%.

Conclusions
Our study demonstrates that left ventricular diastolic dysfunction is associated with an abnormal CAC score. Patients without known CAD that present with chest pain with evidence of abnormal diastolic function on echocardiogram may warrant more thorough evaluation for coronary atherosclerotic disease with CAC score assessment.
Severe pulmonary regurgitation does not influence exercise capacity in patients with repaired Tetralogy of Fallot
Authors: Alborikan S A , Pandya B P , Vonklemperer K V , Bhattacharyya S B , Encarnacion D E , Althunyyan A T , Prista Monteiro R M , Lloyd G L 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Identifying exercise determinants in patients with repaired Tetralogy of Fallot (rTOF) is complex. We sought to investigate exercise performance and to identify the best exercise predictors.

Methods
We prospectively recruited 100 patients with rTOF, 60 patients with severe PR (SPR), and 40 patients with no PR (control). All patients underwent cardiopulmonary exercise testing with echocardiography. Right ventricle (RV) contractile reserve (CR) was defined by the change in peak systolic velocity (ΔRVS’), and change in fractional area change (ΔFAC). Left ventricle (LV) CR was defined by the change in systolic function (ΔLVS’), and change in global longitudinal strain (ΔLVGLS).

Results
There was no significant difference in the reduced exercise performance between the SPR and control groups by peak absolute oxygen consumption VO2(1695±627 vs 1744±521, ml/min, p&gt;0.05). During exercise, lower RV CR was observed in the SPR group by ΔRVS’ (41±28 vs 48±20%, p&lt;0.05); and ΔFAC (20±15 vs 23±16, %, p&lt;0.05), while it was greater for LV CR by ΔLVS’ (67±34 vs 61±28%, p&lt;0.05). Change in ΔLVGLS was the same (15±17 vs 16±15, %, p&gt;0.05). There were no associations between exercise measures with the degree of PR and RV volume at rest and during exercise. Augmentation of LVGLS and FAC demonstrated independent associations with peak VO2(r=.55, r=.45, p&lt;0.05).

Conclusions
There was an overall marked reduction in exercise capacity, but no difference between those with and without PR. The degree of exercise limitation is more dependent upon the ability of RV and LV to augment longitudinal function rather than severity of PR.
Effects of sacubitril/valsartan on atrial function and structure as treatment response indicators in patients with heart failure with reduced ejection fraction: an observational prospective study
Authors: Camilli M , Iannaccone G , Chiorazzo G , Felici T , Maggio L , Lombardo A , Crea F 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sacubitril/valsartan (Sac/Val) has been shown to improve mortality and reduce hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF), also through reverse cardiac remodeling. However, temporal changes of functional and structural left atrial parameters, including speckle tracking (ST) analysis, have not been comprehensively characterized yet.

Purpose
This prospective study sought to: (1) evaluate the impact of Sac/Val on echo parameters, focusing on left atrial function and structure metrics, at two timepoints, 6 and 12 months, after treatment initiation; (2) assess the predictive role of these factors on Sac/Val response at 12 months, including LVEF and biomarker outcomes.

Methods
From January 2020 to September 2021, HFrEF patients from Policlinico Universitario Agostino Gemelli IRCSS outpatient HF service with indication to Sac/Val treatment were prospectively enrolled; subjects with history of atrial fibrillation and more than moderate mitral regurgitation were excluded. Echocardiographic evaluation was performed before Sac/Val, at 6 and 12 months after treatment initiation. Patients with improvement in left ventricular ejection fraction (LVEF) ≥ 35% and with N-terminal pro-b-type natriuretic peptide (NT pro-BNP) reduction below 1000 pg/mL were considered responders.

Results
Sixty-six patients (50 males, 16 females) with an age of 64 ± 12 years were finally enrolled, of which 41% were affected by chronic ischemic heart disease. At enrollment, 19 subjects were in New York Heart Association class III-IV, median NT-proBNP was 3063.00 pg/mL and mean LVEF was 30.3±7.7%. LA-EF was 27.8±12.8%, while Left Atrio-ventricular coupling index (LACi) was 0,30±0,12. At ST echocardiography, LV GLS was -8,2±3,0% and LA reservoir strain (LARS) 11,60%. All structural and functional LA parameters significantly improved at T1 and T2: at T2, LARS was 22,51%, LA-EF 37,4±15,8% and LACi 0,28±0,12 (respectively p &lt;0,001, p = 0,05, p = 0,018 compared to baseline). No differences were detected according to dysfunction etiology. Improvements were larger among patients who achieved the pre-specified outcome. LA reservoir strain was the best predictor of positive changes in LVEF and NT-proBNP.

Conclusions
Precise characterization of LA structural and functional parameters, including ST analysis, may help identifying patients experiencing the highest benefit from Sac/Val, therefore guiding treatment in the HFrEF population.