bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic classification of anatomical diversity of the tricuspid valve: insights from the bright trial
Authors: Donal E , Schmitz T , Bekeredjian R , Nickenig G , Mollmann H , Von Bardeleben S R , Schmeisser A , Atmowihardjo I , Estevez R , Heitkemper M , Goebel B , Lurz P 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Trial funded by Abbott

Background
As the treatment of tricuspid regurgitation with tricuspid transcatheter edge-to-edge repair (TEER) becomes more widespread, a better understanding of tricuspid anatomy is increasingly important to properly select patients for this therapy. The diversity of tricuspid anatomies in the real-world population is not well known, and strategies for characterization of some anatomic features are not well defined.

Purpose
To propose a method to accurately and consistently characterize the tricuspid valve anatomy with transthoracic and transesophageal echo in patients receiving tricuspid TEER and investigate the diversity of tricuspid valve anatomies reflected in a real-world population.

Methods
The bRIGHT trial is a prospective, single-arm, multi-center registry initiated to evaluate the safety and effectiveness of the TriClip transcatheter edge-to-edge repair (TEER) System in patients with severe tricuspid regurgitation (TR) in a real-world post-market setting. Detailed echocardiographic analysis was performed on subjects from 25 sites with available baseline echo. Subjects were evaluated for three key anatomical factors that are anticipated to be critical in determining the feasibility of TEER: number of tricuspid valve leaflets, degree of leaflet restriction, and coaptation gap size. Herein, we present a proposed method for characterizing these factors through echo analysis.

Results
Between August 2020 and July 2022, 312 patients subjects (age, 78.4±7.6 years, 54% women) at 25 sites were enrolled into the bRIGHT trial and 283 subjects had available baseline echo. Coaptation gap size was measured at the largest clippable location (Figure 1) and was found to range from 2.3 mm to 20.8mm (avg. 8.6 ± 3.3 mm). According to the analysis method proposed by Hahn et. Al, the majority of subjects were found to have 3 leaflets (80%), however 4 and 5 leaflet anatomies were also present (20% and 1% respectively). Severity of leaflet restriction was categorized according to a 4-grade scale. In the subjects studied, restriction severity ranged from none to severe, with 21% of subjects having no restriction, 65% displaying mild restriction, 12% displaying moderate restriction, and 2% severe restriction.

Conclusions
In this analysis of 283 subjects treated as part of the bRIGHT trial, a proposed method to accurately and consistently characterize the tricuspid valve anatomy from baseline echo was developed. The method reaved the broad range of tricuspid valve anatomies realized in this real-world population.
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Left atrial dynamics and the pulmonary circulatory-right ventricular uncoupling in patients with severe degenerative mitral regurgitation
Authors: Barki M , Paci G , Margonato D , Ingallina G , Morosato M , Stella S , Biondi F , Ancona F , Fanti D , De Bonis M , Castiglioni A , Maisano F , Slavich M , Agricola E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The uncoupling of right ventricular (RV) function to pulmonary circulation (Pc) represents a prognostic index in patients affected by degenerative mitral regurgitation (DMR) undergoing surgical or percutaneous repair. In this context, the deterioration of Left Atrial (LA) dynamics favors the development of pulmonary venous congestion and vascular remodeling, triggering pulmonary hypertension (PH) and right ventricular (RV) dysfunction. However, the relationship between LA function and RV-to-Pc coupling is not well defined in this population.

Purpose
The aim of the study was to investigate the association between RV-to-Pc uncoupling, assessed by the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PAPS), and LA dynamics, evaluated with Speckle Tracking Echocardiography (STE), in patients with DMR.

Methods
351 consecutive patients with hemodynamically-significant DMR who were evaluated for cardiac surgery at San Raffaele Hospital and underwent a complete transthoracic and transesophageal echocardiography were retrospectively enrolled (mean age 59±14 years, 65% males). Patients were then stratified in two groups according to TAPSE/PAPS ratio (group I: TAPSE/PAPS &gt;0.4 mm/mmHg; group II: TAPSE/PAPS ≤0.4 mm/mmHg). LA function was evaluated analyzing LA strain at peak relaxation (Global peak atrial longitudinal strain) and STE analysis was performed offline. All the patients enrolled were in sinus rhythm.

Results
At baseline, patients exhibited normal LV dimensions and function (EDVi 70±20 ml/m2, LVEF 63±6%), increased LA size (48±20 ml/m2) and a mean GPALS of 26±13%. Additionally, a preserved RV function and coupling with PC was found in the population in study (average TAPSE/PASP at admission: 0.84±0.2 mm/mmHg), with only 10% of the cohort exhibiting a reduced TAPSE/PAPS ratio. When stratified according to RV-to-PC coupling, patients with higher TAPSE/PAPS (&gt;0.4 mm/mmHg) exhibited significantly higher values of LA reservoir strain (group I: GPALS 27.8±12.7% vs group II GPALS 22.7±11.3%; p = 0.04) (Figure 1, 2). Additionally, a direct correlation between LA-Strain values and TAPSE/PAPS ratio was noticed (r=0.3, CI 95% 0.21–0.5; p&lt;0.001).

Conclusions
In DMR, there is a strong association between echo-derived measures of LA mechanics and RV to Pc uncoupling, with higher values of LA strain correlating with a better RV functioning and coupling. These results, although preliminary, suggest the importance of a multiparametric approach in the risk-stratification of these patients, potentially improving the long-term outcome.
Assessment of right atrial strain parameters in half marathon amateur runners
Authors: Szalek-Goralewska A , Dankowski R , Sacharczuk W , Ozegowski S , Walla W , Szyszka A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Endurance training may cause atrial remodeling and atrial arrhythmias in professional athletes. However, there is a lack of data on the right atrial (RA) adaptation to training and half marathon run in amateur runners. Recently introduced atrial deformation strain analysis allows to assess the RA function more precisely.

Purpose
The study aims to assess the influence of ten-weeks training and half marathon run on the RA strain parameters in non-elite athletes. It also investigates whether these changes affect the runner’s competitive performance. We hypothesized that the training and 21.0975 kilometers run itself cause functional atrial changes in recreational runners.

Methods
The study group consisted of 45 recreational runners with a mean age of 32.96 ± 5.12 years, 27 men. Two-dimensional, Doppler and speckle tracking echocardiography was performed before the ten-weeks training period (stage 1), 48 hours before (stage 2) and within 48 hours after (stage 3) the half marathon run. We measured RA volumes, ejection fraction and strain during reservoir, conduit and contraction phases at all stages (Figure). Training intensity was expressed in declared kilometers run per week.

Results
There were no significant changes in RA volumes and RA ejection fraction between stages. We did not notice significant differences in RA strains during reservoir, conduit and contraction phases between stages. Athletes who trained more intensively had significantly higher maximum RA volume at stage 1 (r = 0.32; p = 0.033) and at stage 3 (r = 0.44; p = 0.003). They had also larger RA area at stage 1 (r = 0.32; p = 0.030). Runners whose RA area was larger, achieved significantly better finishing race time (r = -0.49; p = 0.001). Higher RA volume correlated with better half marathon performance (r = -0.32; p = 0.039).

Conclusions
Ten-weeks training period and participation in half marathon run were not associated with RA dilatation or functional changes based on strain deformation analysis in amateur runners. However, we observed the influence of intensity of physical training on the enlargement of volume and surface area of the right atrium, which resulted in better half marathon finishing time.
Diagnostic performance of somatostatin receptor imaging by PET/CT in patients with cardiac sarcoidosis: a systematic review and meta-analysis
Authors: Ballo H , Doghman F , Knuuti J , Saraste A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Backgrounds
Somatostatin receptor (SSTR) based positron emission tomography/computed tomography (PET/CT) is a novel approach for detecting myocardial inflammation and, consequently, cardiac sarcoidosis (CS). However, the diagnostic performance of SSTR PET/CT was only evaluated in small studies.

Purpose
To evaluate the clinical performance of SSTR PET/CT in diagnosing CS.

Methods
PubMed, Embase, and Cochrane Library were searched from the earliest available date of indexing to December 2022 for studies evaluating the SSTR PET/CT for the evaluation of possible CS defined by the Japanese Ministry of Health, Labour and Welfare (JMHW) criteria. Studies were eligible if they were performed on patient level. The case reports and reviews were excluded. To calculate the overall performance of the diagnostic accuracy of SSTR PET/CT, a summary receiver operating curve (SROC) was done. The sensitivities and specificities of eligible studies were pooled. Heterogeneity was evaluated with the I² test. Sensitivity analysis excluding outliers was conducted.

Results
Six studies used SSTR PET/CT involving 104 patients (mean age 50 years, 45% male) fulfilled the inclusion criteria. All included studies used 68Ga-DOTATOC analogue. The pooled sensitivity of SSTR PET/CT for diagnosis of CS was 75.6% (95% CI 36.5–94.4%; I² = 34%), and the pooled specificity was 97.6% (95% CI 84.9–99.7%; I² = 0%) (Figure 1). SROC analysis demonstrated good overall accuracy for SSTR PET/CT (Figure 2). Moreover, the sensitivity analysis of SSTR PET/CT (5 studies) showed a pooled sensitivity of 80% (95% CI 58.9–92.5%; I² = 0%) and a pooled specificity of 97.1% (95% CI 82.3–99.6%; I² = 0%).

Conclusions
SSTR PET/CT is a useful adjunctive diagnostic tool in evaluating CS. Further large multi-center studies are warranted to validate the diagnostic accuracy of SSTR PET/CT for the diagnosis of CS.
Olive extract enriched with hydroxytyrosol improves cardiac and vascular function in patients with stable coronary artery disease: a double-blind, placebo-controlled trial
Authors: Katogiannis K , Chania C , Tsoumani M , Brinia E , Pavlidis G , Thymis J , Tsilivarakis D , Kountouri A , Korakas E , Lambadiari V , Skaltsounis L , Tseti I , Iliodromitis E K , Andreadou I , Ikonomidis I 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Olive Heart Operational Programme Competitiveness, Entrepreneurship and Innovation 2014–2020 (EPAnEK)

Aims
We investigated the effect of olive extract enriched with hydroxytyrosol, on vascular and myocardial function markers in patients with stable coronary artery disease (SCAD).

Methods
In a prospective, cross-over, double-blind, placebo-controlled, clinical trial, 30 patients with stable CAD were randomly assigned to an oral supplement containing olive oil extract enriched with hydroxytyrosol (OOHT) or placebo for one month and then were crossed over to the alternate treatment (placebo or OOHT for one more month). We measured a) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), b) flow-mediated dilation (FMD), c) Coronary Flow Reserve (CFR) and markers of LV diastolic function by Doppler echocardiography d) Pulse Wave Velocity (PWV) e) oxidative/nitrosative stress and inflammatory biomarkers and blood lipids at baseline and after one month treatment.

Results
Treatment with OOHT improved PBR, FMD, CFR and PWV compared to baseline (1.81±0.35 vs 1.77±0.40 μm p = 0.04 3.71±2.12 vs 6.51±2.31%, p&lt;0.001;2.37±0.40 vs 2.45±0.41, p = 0.030 and 11.03±1.81 vs 11.78±2.34 m/sec, p = 0.002), while there was no effect after placebo (p&gt;0.05). Compared to baseline, treatment with OOHT reduced malondialdehyde (MDA) a marker of lipid peroxidation (2.10±1.37 vs 1.69±0.83 mmol/lt, p = 0.045), oxidized LDL, triglycerides, PCSK9 and CRP blood levels (p&lt;0.05) in contrast to placebo. There was a parallel improvement of E’ of the mitral annulus and deceleration time of the E wave of mitral inflow after OOHT (p&lt;0.05) but not after placebo.

Conclusions
Olive extract enriched with hydroxytyrosol improves endothelial and arterial function likely by reducing oxidative and inflammatory burden leading to improved LV diastolic function after one month of treatment in patients with stable CAD.
Effect of glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors and their combination on left atrial strain and arterial function
Authors: Katogiannis K , Thymis J , Kousathana F , Pavlidis G , Korakas E , Kountouri A , Prentza V , Tsilivarakis D , Lambadiari V , Ikonomidis I 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
We investigated the effects of insulin, glucagon-like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on left atrial function of patients with type 2 diabetes mellitus and we searched for a relation with arterial function.

Patients and methods
A total of 201 patients (59,5±9,1 year old, 161 male) with type 2 diabetes mellitus treated with metformin were randomized to insulin (n= 50 served as controls), liraglutide (n=51), empagliflozin (n=50) or their combination (GLP-1RA+SGLT- 2i) (n= 50) as add-on. We measured at baseline and 6 months posttreatment: (a) perfused boundary region of the sublingual arterial microvessels (marker of endothelial glycocalyx thickness), (b) pulse wave velocity (PWV) and central systolic blood pressure, (c) global left ventricular Longitudinal strain, (d) left atrial strain.

Results
Six months after intervention, all patients improved left atrial reservoir strain (GLP1RA 30,7±9,3 vs 33,9±9,7%, p = 0,011/SGLT2i 30±8,3 vs 32,3±7,3%, p = 0,04/ GLP1&SGLT2i 29,1±8,7 vs 31,3±8,2, p = 0,007) in comparison with controls (33±8,3% vs 32,8±7,4, p = 0,829). Also, patients treated with GLP1RA and their combination improved left atrial conduction strain (p&lt;0.05). GLP-1RA or GLP-1RA+SGLT-2i provided a greater improvement in GLS compared with insulin or SGLT-2i (controls –18,5±3,9% vs − 19,1±3%, p = 0,202/GLP1RA –18,2±4,1% vs –19,1±3,5%, p = 0,03/SGLT2i –19±4,1% vs − 19,1±3,8%, p = 0,764/GLP1&SGLT2i –16,7±3,9% vs –17,5±4,3%, p = 0,026). SGLT-2i or GLP-1RA and SGLT-2i showed a greater decrease of PWV (Controls 12,06±3,02 vs 11,62±2,79 m/sec, p = 0,142/ GLP1 11,54±2,91 vs 11,45±2,52 m/sec, p = 0,822/ SGLT2 11,86±2,51 vs 11,33±2,28 m/sec, p = 0,047/ GLP1&SGLT2 12,01±2,46 vs 10,85±1,79 m/sec, p = 0,021) and central and brachial systolic blood pressure than insulin or GLP-1RA. At baseline, there was a correlation of LA reservoir strain with PWV (r =−0,209, p = 0,008), central SBP (r =−0,151, p = 0,030), EF (r=0,214, p = 0,004), GLS (r =−0,279, p = 0,009). At 6 months follow up, there was a correlation of LA reservoir strain with PWV (r=0,217, p = 0,003), central SBP (r =0,214, p = 0,004), EF (r=–0,221, p = 0,049), GLS (r =0,275, p = 0,014).

Conclusions
Treatment with GLP-1RA, SGLT-2i, and their combination for 6 months showed a greater improvement of left atrial function compared to insulin treatment in parallel with improvement arterial and myocardial function.
Effect of Sacubitril/Valsartan and enalapril on left ventricular function in patients with hematologic malignancies after bone marrow transplantation
Authors: Katogiannis K , Ikonomidis I , Stamouli M , Makavos G , Tsilivarakis D , Koliou G A , Vythoulkas D , Tsirigotis P 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background and Aims
Chemotherapy is known for its potential adverse effects on myocardium. Optimal medical treatment for heart failure may reverse myocardial dysfunction in the early stages of toxicity development. We hypothesized that early initiation of treatment with sacubitril/valsartan (s/v) or enalapril (ena) might prevent cardiotoxicity.

Patients and methods
90 patients (mean age 45.7 ± 14,1 years old, 52 male) with preserved ejection fraction, who suffered from hematologic malignancies (lymphoma, leukemia) and underwent bone marrow transplantation, were randomized to receive sacubitril/valsartan 24/26 mg bid daily or enalapril 5 mg bid daily or placebo. We measured at baseline, before transplantation and after six months: i) Global Longitudinal Strain (GLS) of left ventricle (LV) by speckle tracking imaging, ii) myocardial global work index (GWI), global constructive work (GCW), global wasted work (GWW) and myocardial global work efficiency (GWE), by longitudinal strain-peripheral blood pressure loops, and iii) Left Ventricular Ejection Fraction (LVEF Simpson’s Method).

Results
The two treatment groups had similar age, sex atherosclerotic risk factors and cardiotoxic medication before and after bone marrow transplantation.
Compared to baseline, patients treated with sacubitril/valsartan or enalapril for six months did not show a deterioration of LV GLS (−19.8±2.8 vs −19.3±4.1%, p = 0.403 for s/v, −20.3±2.8 vs −20.0±3.6%, p = 0.634 for ena). Conversely, patients treated with placebo for six months, presented a significant impairment of LV GLS (−20.9±2.1% vs −18.5±2.2, p = 0,001).
No significant changes were found in LVEF after treatment with sacubitril/valsartan or enalapril for six months (57.5±4.9 vs 57.9±6.8%, p = 0.826 for s/v, 58.8±5.4 vs 60.7±7.1%, p = 0.419, for ena), while a borderline deterioration was noticed after treatment with placebo for six months (60.6±5.4 vs 57.7±6.7%, p = 0,045).
We did not notice any alteration in GWi, GCW, GWW, GWE in patients treated with enalapril. On the other hand, in patients treated with sacubitril/valsartan GWE was improved (94.2±3.1 vs 95.8±1.8 %, p = 0.030) and GWW was diminished (111.5±75.7 vs 86.4±43.1 mmHg%, p = 0.045), while GWI and GCW did not show any significant alteration. Conversely, in the placebo group, GWI was reduced (1909.9±336.4 vs 1727.9±340.9 mmHg%, p = 0.027), GWW was increased (80.7±60.6 vs 110.6±65.1 mmHg%, p = 0.045), GWE was diminished (95.9±2.1 vs 94.1±3.9 %, p = 0.039) and GCW did not change.

Conclusions
Treatment with sacubitril/valsartan or enalapril prevented deterioration of myocardial function six months after bone marrow transplantation in patients with hematologic malignancies and preserved ejection fraction. Moreover, sacubitril/valsartan showed a more favorable effect on myocardial work.
Impact of Covid-19 and pandemic restrictions on post infarction myocardial scar evaluated on cardiac magnetic resonance
Authors: Enrico Tadiello M D , Anna Piccoli M D , Giovanni Benfari P H D , Eleonora Bonvicini M D , Giovanni Puppini M D , Flavio Ribichini P R O F 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Italy was one of the first nations in the world to face the threat of COVID-19. Data suggest that mortality from cardiovascular causes increased during the pandemic period, compared with a reduction of the number of hospitalizations for the same cause1–2.

Purpose
Extension of myocardial damage after a cardiac ischemic event is strongly related to patient's short- and long-term prognosis. Aim of this retrospective study is to evaluate the impact of COVID-19 and pandemic restrictions on the extension of the post-infarct myocardial scar, assessed by cardiac magnetic resonance imaging.

Methods
Fifty consecutive patients hospitalized for acute myocardial infarction who underwent CMR were retrospectively enrolled: 30 patients in the pre-COVID period (from January 2015 to February 2020) and 20 in the pandemic period (from March 2020 to June 2021). We selected only patients with no previous history of ischemic heart disease. Clinical, anamnestic and imaging data (echocardiography and cardiac magnetic resonance) were collected.

Results
Patients of the two groups did not differ in clinical characteristics, except for the absence of women in the pandemic group (23% vs 0%, p = 0.02). Drugs and treatments used, severity of coronary artery disease and echocardiographic parameters were similar in both groups. The number of segments with transmural fibrosis was larger in COVID group (5.9 vs 4.2, p = 0.05, considering 17 myocardial segments on a bull eyes map). Furthermore in COVID group end diastolic volume was larger (101.3 vs 86.9 ml/mq, p = 0.08) and left ejection fraction was lower (36.0 vs 41.4%, p = 0.18), although not statistically significative. Right ventricle ejection fraction was significatively lower (59.0 vs 63.2%, p = 0.04).

Conclusion
Patients admitted during pandemic waves had a larger myocardial scar, bigger left ventricular volume and lower ejection fraction. According to literature, this have mainly been caused by the long presentation time from symptoms to hospital admission3. Considering that the extension of the post-infarct myocardial scar visible on cardiac magnetic resonance imaging strongly correlates with the short- and long-term prognosis4-5, these data suggest that COVID 19 had and will have in the coming years a significant impact on mortality from myocardial infarction.