bluuebunny/crossref_metadata_2025_split huggingface dataset:
Natural shear waves show sequential changes in myocardial stiffness In paediatric multi-inflammatory systemic syndrome post COVID
Authors: Youssef A , Salaets T , Bezy S , Wouters L , Orlowska M , Caenen A , Duchenne J , Puvrez A , Cools B , Gewillig M , Dhooge J , Voigt J W 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Egyptian ministry of research and higher education

Background
Multi-inflammatory systemic syndrome post COVID infection (MIS-C) in children causes myocarditis and affects myocardial diastolic function. Recent high frame rate echocardiography allows to assess myocardial shear waves (SW). SW are mechanical waves generated by mitral and aortic valve closure (MVC & AVC). Their propagation velocities are related to myocardial stiffness (MS), a determinant of diastolic function. Nevertheless, this has not yet been tested in paediatric cardiology and in this pathology.

Purpose
This study aimed at exploring the changes in natural SW propagation velocity as measure of myocardial diastolic properties in paediatric patients with MIS-C.

Methods
Seven MIS-C children (mean age 6.7 ±3.6 years) were prospectively followed over 6 months (group A). As a control group; one hundred-four healthy volunteers (HV) (mean age 10.2 ±4.4 years) were recruited (group B). High-frame rate echocardiography was used to obtain parasternal long axis views of all subjects at a frame rate of 1580 ±113 Hz. An anatomical M-mode was drawn along the interventricular septum and Tissue Doppler acceleration maps were extracted to measure SW propagation speed after MVC and AVC (Figure 1). Independent sample t-test was used to compare between both groups. Repeated measures analysis of variance (ANOVA) was used to show sequential changes during follow-up.

Results
SW propagation velocities were significantly higher among MIS-C patients than in HV group after both MVC (4.3 ±0.6 m/s vs 2.8 ±0.3 m/s respectively, p&lt;0.001) and AVC (5.2 ±0.6 m/s vs 3.0 ±0.3 m/s respectively; p&lt;0.001). Interestingly, SW propagation speeds in MIS-C patients declined significantly with myocardial recovery during course of disease (figure 2) and normalised 6 months post discharge (MVC: 2.9 ±0.3 m/s; P&lt;0.001, AVC: 3.2 ±0.4 m/s; P&lt;0.001) compared to admission.

Conclusions
SW speed found to be 1.5 to 1.7 fold higher with myocardial inflammation in MIS-C patients compared to HV. Values normalised within 6 months. These findings indicate that SW velocities can show sequential changes in the course of a disease and suggest that SW imaging has potential to serve as a new non-invasive diagnostic tool in paediatric cardiac diseases.
Cardiovascular magnetic resonance in neuromuscular disorders: looking ahead
Authors: Amador A , Martins Da Costa C , Calvao J , Marques C , Cabrita A , Pinho A , Santos L , Oliveira C , Madureira A , Martins E , Pinho T , Macedo F 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Neuromuscular disorders (NMD) have a wide range of different cardiac presentations. Cardiac magnetic resonance (CMR) has an established role in diagnosis and risk stratification. We sought to access how CMR performs in predicting events in a real cohort of NMD patients (pts).

Methods
We included consecutive pts followed in a tertiary clinical center with NMD from January 2012 to December 2018. Clinical and CMR data were collected. During follow-up (FUP), we considered major adverse cardiovascular events (MACE) as a composite of device implantation, ventricular tachycardia/appropriate shock therapy and death.

Results
A total of 65 patients (pts) were included, 33 (51%) women, with mean age of 32 ± 16 years. Most patients had myotonic dystrophy (34, 52%), followed by limb–girdle muscular dystrophy (22; 34%); the remained 9 (13%) had other NMD. About half had inferior limbs predominantly affected and 74% had none, mild or moderate functional impairment. Regarding cardiac manifestations, 18% had cardiac symptoms, 97% were in sinus rhythm, median PR and QRS duration were 169 (IQR 47) ms and 101 (IQR 11) ms, respectively; median BNP was 26 (IQR 25) mg/dl. Regarding CMR, 43,3% of pts had ≥ one abnormality. Six pts had left ventricle dilation and 7 had left ventricle ejection fraction (LVEF) 55%. Three pts had significant hypertrophy (&gt;12 mm) and there were isolated cases of hypertrabeculation, segmental alterations or right ventricle dilation. Regarding tissue characterization, 2 pts had T2 hyperintensity, 8 had early gadolinium enhancement (EGE) and 22 had late gadolinium enhancement (LGE). LGE was located mainly intramyocardium (45%) or subepicardial (36%) and the most affected segments were basal and medium inferolateral (40%). During a median FUP of 77 (IQR 33) months there were 7 deaths, 8 implanted devices (4 pacemakers and 4 CRT-D, 3 in primary prevention) and one sustained ventricular tachycardia in holter; there were no shock therapies. Table 1 describes some CMR parameters according to the occurrence of events. Using Kaplan Meier curves, there were associations between LVEF&lt;55% and presence of LGE with occurrence of allevents (log rank test, p = 0,002 and p = 0,045, respectively), but no association were found with age, LGE pattern nor number/distribution of affected segments. Using Cox Regression, we found that the LVEF&lt;55% was associated with 6 fold higher risk of events (HR crude 6,15; 95% CI 1,65–22,93), that remained significant after adjusting for LGE (HR adjusted 4,81, 95% CI 1,07–15,9).

Conclusion
In our cohort, CMR LVEF&lt;55% and the presence of LGE were significantly associated with events during FUP, reinforcing the role of this technique on risk stratification of NMD populations
Prognostic impact of disproportionate secondary tricuspid regurgitation
Authors: Cascella A , Gavazzoni M , Muraru D , Perelli F , Tomaselli M , Radu N , Parati G , Badano L P 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Current quantitative parameters used to assess the severity of secondary tricuspid regurgitation (STR) do not account for the size of the right ventricle (RV). To address this issue, the concept of proportionality of the severity of the STR to the size of the RV has been recently mutuated from the mitral regurgitation field to improve the prognostic stratification of patients with STR.

Purpose
We sought to compare the prognostic value of a classification of STR based on the proportionality of the regurgitant volume (Reg Vol) to the RV stroke volume with the guideline-recommended grading scheme of STR severity.

Methods
Patients with at least mild STR were prospectively enrolled and underwent complete 2D, Doppler and 3D echocardiography with the measurement of RV volumes. To determine STR proportionality status, we evaluated the difference between the measured and the theoretical RegVol of severe STR (the latter was defined as the RV stroke volume needed to have a regurgitant fraction [RF] ≥ 50% according to the actual RV stroke volume). This classification took into account a bias of 8 ml in the computation of Reg Vol, derived from Bland-Altman analysis (picture 1). Accordingly, patients were classified as non severe (NS_STR, measured RegVol&lt; theoretical RegVol), severe proportionate (SP_STR, measured RegVol ≈ theoretical RegVol), and severe disproportionate (SD_STR, measured RegVol &gt; theoretical RegVol) STR (picture 1). The incidence of the combined endpoint of heart failure (HF) hospitalization and death for any cause was used as the primary endpoint.

Results
We enrolled 333 consecutive patients (mean age 71±14 years, 53.3 % women). After a median follow up of 20 months (10–32), 134 patients (40.2%) reached the combined end point. Patients with SD_STR showed a significantly higher incidence of events (67.9%) in comparison to patients with SP_STR (40.6%, p = 0.005 for difference) and NS_STR (31.3%, p&lt;0.001 for difference) (picture 2). At Cox multivariate analysis, the proportionality of STR (adjusted for age, atrial fibrillation, right atrial volume, RV free-wall longitudinal strain, and RV ejection fraction) independently correlated with the combined endpoint (adjusted hazard ratio: 1.785; 95% confidence interval [CI]: 1.249–2.550; p = 0.002). When tested with the same variables, the conventional STR severity grade lost its independent correlation with combined end point (p = 0.258).

Conclusions
Disproportionate STR is independently associated with all-cause mortality or heart failure hospitalization, and it improves the risk stratification of patients compared to the guideline-recommended grading scheme of STR severity.
Non-invasive in vivo thrombus imaging in patients with ischaemic stroke or transient ischaemic attack
Authors: Whittington B , Tzolos E , Bing R , Andrews J , Lucatelli C , Macaskill M , Clark T , Koglin N , Stephens A , Van Beek E , Dweck M , Williams M C , Whiteley W , Wardlaw J M , Newby D E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation Life Molecular Imaging provide reagents for GP1 production free of charge.

Background and Purpose
18F-GP1 is a novel positron-emitting radiotracer that has high and specific binding affinity for the activated glycoprotein IIb/IIIa receptor, a key receptor in platelet activation and thrombus formation. Preliminary studies 18F-GP1 demonstrated excellent in vivo binding properties which enabled detection of intravascular thrombosis in a range of conditions including coronary thrombosis, left ventricular thrombus, pulmonary thromboembolism, and deep vein thrombosis. In a pilot proof-of-concept study, we aimed to determine its potential clinical application in establishing the role and origin of thrombus in stroke .

Methods
Autoradiography of 18F-GP1 uptake was performed on post-mortem samples of infarcted brain tissue following an acute ischaemic stroke and from control brain tissue without stroke. Eleven patients with recent ischaemic stroke (n=9) or transient ischaemic attack (n=2) underwent 18F-GP1 positron emission tomography and computed tomography angiography at median of 11 (absolute range 2–21) days from symptom onset. 18F-GP1 uptake (quantified by maximum target-to-background ratio, TBRmax) was assessed in the carotid arteries and brain.

Results
Ex vivo autoradiography of post-mortem infarcted brain tissue showed focal uptake corresponding to intraluminal thrombus within the culprit vessel and downstream microvasculature. There was also evidence of lower diffuse uptake within some of the infarcted brain tissue reflecting microthrombi within regions of reperfusion haemorrhage. In vivo 18F-GP1 uptake was identified in 9 of 11 patients: 3 in the carotid arteries only, 3 in the brain only and 3 in both the brain and carotid arteries. In those with carotid uptake, 3 participants had &gt;50% stenosis and 3 had non-stenotic disease. One case had bilateral stenotic disease (&gt;70%) but only the culprit carotid artery demonstrated 18F-GP1 uptake. The average uptake was higher in the culprit (median TBRmax 1.55 [interquartile range 1.26–1.82]) compared with the contralateral non-culprit carotid artery (TBRmax 1.22 [1.19–1.6]). In those with brain 18F-GP1 uptake (TBRmax 6.45 [4.89–7.65]), areas of acute infarction on computed tomography correlated with brain 18F-GP1 uptake in 6 cases. There was no brain 18F-GP1 uptake in the 7 cases without CT-defined acute cerebral infarction.

Conclusions
18F-GP1 positron emission tomography and computed tomography angiography is a novel non-invasive method of identifying in vivo cerebrovascular thrombosis which holds major promise in understanding the role and origin of thrombosis in stroke.
Lower left ventricular cardiac strain in patients who recovered from COVID-19
Authors: Mojica Pisciotti M , Panovsky R , Holecek T , Opatril L , Feitova V 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Health of the Czech Republic.

Introduction
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes the highly contagious coronavirus disease 2019 (COVID-19). This disease has been linked to several cardiac problems. Studying heart deformation with cardiovascular magnetic resonance feature-tracking (CMR-FT) might help detect subtle systolic or diastolic dysfunction in patients who recovered from COVID-19.

Purpose
We aimed to characterize the left ventricular strain in patients who recovered from COVID-19 by using cardiovascular magnetic resonance feature tracking (CMR-FT).

Methods
In this study, we compared a cohort of 55 patients who recovered from COVID-19 (age 48 ± 16 years, time between diagnosis and CMR 46 (34 to 166) days) to 44 sex- and age-matched control subjects (age 47 ± 16 years) with a CMR examination before March 1st, 2020. All the participants were examined in our hospital. By using CMR-FT, we determined the left ventricle (LV) global circumferential strain (GCS), global longitudinal strain (GLS), and global radial strain (GRS). LV clinical parameters were indexed to the body surface area. The student's t-test and Wilcoxon rank-sum test were used to compare normally and non-normally distributed variables. The adjusted P-value was obtained by using a false discovery rate correction.

Results
Although the left ventricular ejection fraction was significantly lower in patients who recovered from COVID-19 than in controls (64 (60 to 70) % vs. 68 (64 to 73) %, P-value = 0.022), the former had normal systolic LV function. At the same time, they had higher LV end-systolic indexed volume (23.0 (15.4 to 30.4) ml/m2 vs. 19.4 (15.2 to 24.4) ml/m2, P-value = 0.048). Regarding the global LV strain, all parameters were significantly lower in the patients who recovered from COVID-19 than in controls (GCS −17.1 (−18.4 to −15.4) % vs. −18.1 (−19.7 to −17.0) %, P-value = 0.004; GLS −17.3 (−18.7 to −15.6) % vs. −18.2 (−19.3 to −16.9) %, P-value = 0.011; GRS 28.1 (23.8 to 31.8) % vs. 31.6 (28.4 to 34.3) %, P-value = 0.004).

Conclusion
Compared to controls, patients who recovered from COVID-19 exhibit lower global left ventricular strain values assessed by CMR-FT.
Right atrial strain: what does it tell us about cardiac function and prognosis?
Authors: Curtis E , Lemarchand L , L'official G , Leurent G , Auffret V , Oger E , Donal E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): New Zealand National Heart Foundation

Background
The role of speckle tracking echocardiography has been expanding thanks to its utility in detecting subtle changes in cardiac function, and has prognostic value(1). Right atrial (RA) strain has shown promise in prognostication amongst patients with pulmonary hypertension and heart failure. It is associated with RA size, RV function and IVC size. However, its clinical utility and application remain under investigation (2–5).
We sought to evaluate the associations of right atrial strain with both invasive and non-invasive measure of RV function and the association of RA strain with heart failure hospitalisations and death across a heterogeneous cohort.

Methods
A single-centre retrospective analysis of data from 225 consecutive patients (age 72 ±11.6 years old; male 56%) with both right heart catheterization (RHC) and TTE. Data regarding unplanned heart failure hospitalisations and date of death were recorded. Statistical analysis was performed using SAS 15.1 to assess the association between right atrial strain and prespecified echo and haemodynamic measures of right and left heart function and prognosis defined by heart failure hospitalisations and death.

Results
Over a median follow up of 28±16 months, there were 59 events. RA strain was associated with the following non-invasive and invasive measures of right heart function and left heart systolic function : TAPSE; RA size, RA pressure, RV strain, PAPi, RVSWI, RV FAC, LAVi, RV PA coupling (TAPSE/systolic PAP), LVEF, cardiac index, diastolic function (E/e’) with a p value of &lt;0.05. Increasing atrial size was associated with lower values of R strain. Despite the association of impaired RV strain with prognosis, HR 2.94 (1.14 – 7.60), RA strain did not appear to be associated independently with prognosis HR 0.98 (0.95–1.0) P value = 0.0676.

Conclusions
Right atrial strain is independently associated with both invasive and non-invasive measures of RV function and may be a useful tool to help us assess right heart function. It did not appear to be associated with prognosis despite being independently linked with RV strain, which was strongly associated with prognosis in our cohort.
Cardiac magnetic resonance phenotypes and cardiovascular prognosis in classical vs cardiac variant of Fabry disease
Authors: Guida G , Attanasio A , Disabato G , Tondi L , Lombardi M , Camporeale A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Fabry disease (FD) is an X-linked lysosomal storage disorder due to a deficiency/absence of alfa-galattosidase A enzyme activity. More than 1000 GLA gene mutations have been identified to be causative of classical or late-onset clinical phenotype. Cardiac variants (p.N215S, p.F113L and IVS4+919G&gt;A) cause a predominant late-onset cardiac involvement with minimal systemic manifestations compared to classical phenotype.1 Cardiac magnetic resonance (CMR) is widely used to assess FD cardiac involvement, thanks to its accuracy in quantification of left ventricular mass and to the possibility to perform a non-invasive tissue characterization.2 Since cardiac involvement is the main cause of FD morbidity and mortality,3 CMR findings play a prognostic role in FD.

Purpose
the aims of this study were: 1) to compare CMR phenotypes of FD patients with classical and cardiac variant of the disease; 2) to compare the prognostic role of CMR parameters in these two groups of FD patients.

Methods
study population included 128 FD patients (classical variant: 69%, cardiac variant 31%). Clinical characteristics and CMR findings were compared between classical and cardiac variant. CV events during follow-up were abstracted from the patients’ records and only first event after CMR was used for survival analysis. The composite endpoint was defined as the development of one of the following events: a) sustained or non-sustained ventricular tachycardia, b) bradyarrhythmias requiring pacing, c) heart failure hospitalization, d) atrial fibrillation, e) myocardial infarction and f) all-cause mortality.

Results
compared to patients with cardiac variant, FD patients with classical mutations were younger (39 [26–53] vs 46 [37–57], p = 0,050), with a more severe systemic involvement according to Mainz Severity Score index (MSSI: 20,50 [9,25–27,00] vs 9,00 [2,00–23,00], p = 0,003). Overall, 37% (48/130) of patients assumed FD specific treatment, most of them exhibiting a classical mutation (43/48 patients, p&lt;0,001).No significant differences in CMR parameters were observed comparing the two groups of patients. The percentage of patients with LVH, LGE and low T1 values were similar in classical and cardiac variants. During a median follow-up of 36 [17–57] months, Kaplan Meier curves shows a similar event-free survival probability (Log-rank p = 0,362) between the two phenotypes (Fig. 1). In addition, presence of LVH and LGE were both associated with composite CV endpoint in these two groups of patients.

Conclusion
patients with cardiac variants of FD showed similar CMR phenotype and CV prognosis compare to patients with classical mutations. The presence of LVH and LGE play the same prognostic impact in both the clinical phenotypes. CMR assessment of cardiac involvement represents a pivotal step in the evaluation of FD patients irrespective of patients’ genotype.
Left atrial function as a determinant of symptoms in patients with severe degenerative mitral regurgitation
Authors: Paci G , Ingallina G , Margonato D , Italia L , Barki M , Slavich M , Ancona F , Stella S , Biondi F , Tavernese A , Belli M , De Bonis M , Castiglioni A , Maisano F , Agricola E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Understanding the pathophisiology of symptoms onset in degenerative mitral regurgitation may be helpful in the management of asymptomatic patients.
Left atrium (LA) is far from simply being a passive connection chamber between mitral valve and pulmonary circulation, and the role of left atrial function as a predictor of symptoms onset has not yet been evaluated.
The increase in atrial pressure that causes elevation of pulmonary capillary pressures and the onset of dyspnoea may be driven by the reduction of left atrial compliance, which can be assessed by peak atrial longitudinal strain (PALS) derived from speckle tracking echocardiography.

Aim
To assess the role of left atrial function as a determinant of symptoms in patients with severe degenerative MR.

Methods
We analysed retrospectively all patients affected by severe degenerative MR evaluated for cardiac surgery between May 2019 and July 2022 at IRCCS San Raffaele Hospital. The cohort was divided in symptomatic (NYHA &gt;I) and asymptomatic (NYHA =I) patients. A comprehensive assessment of LA function was performed including pulmonary venous blood flow, LA ejection fraction, LA fractional atrial change, and PALS. Patients with atrial fibrillation during echocardiographic evaluation, left ventricular disfunction and more than mild left heart valvulopathy associated with MR were excluded.

Results
The final study population consisted of 408 patients. The grade of MR, assessed by multiparametric approach, was not different between the two groups. Age, history of coronary artery disease, dyslipidaemia, hypertension and history of atrial fibrillation were found to be predictive on symptomatology. Fractional area change (OR: 0.89; CI:0.87–0.91, p &lt;0.001), atrial ejection fraction (OR: 0.92, CI= 0.90–0.94, p &lt;0.001), atrial volume(OR: 1.04, CI: 1.02–1.05, p&lt;0.001), pulmonary artery systolic pressure(OR:1.09, CI:1.06–1.13, p&lt;0.001) and longitudinal atrial strain (OR:0.88, CI:0.85–0.90, p&lt;0.001) but not EROA ( OR:1.06, CI: 0.63–2.30, p = 0.8) were found to be predictive. On multivariate logistic regression, only indexed biplane LA volume (OR: 1.02, CI 1.00–1.07, p = 0.035) and PALS (OR: 1.02, CI: 0.87–0.94, p&lt;0.001) were found to be predictive. The best PALS threshold to identify symptomatic patients was 22% (OR: 3.3, SE 67%, SP 87%).

Conclusions
LA function is a determinant of symptoms in severe degenerative MR. The reduction of PALS appears to be a predictor of symptoms and a value of PALS &lt; 22% identified symptomatic patients with 85% specificity and 67% sensitivity.