bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial strain is associated with the burden of symptoms in cardiac amyloidosis: a speckle tracking study
Authors: Pastore M C , Giacomin E , Marrese F , Ragazzoni G L , Mandoli G E , Susini F , Focardi M , Gozzetti A , Cavigli L , Lisi M , D'ascenzi F , Valente S , Cameli M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
cardiac amyloidosis (CA) is characterized by an impairment of cardiac diastolic and, in the severe state of the disease, systolic function, with increasing worsening of functional capacity and quality of life (QoL). Six minute walking test (6MWT) and Kansas City Cardiomyopathy Questionnaire (KCCQ) are two well-known and validated methods to assess the impact of heart failure (HF) symptoms and functional capacity. Left atrial strain by speckle tracking echocardiography has emerged as an index of left ventricular (LV) diastolic function and filing pressure, and is also associated with symptoms in HF. However, its possible association with functional capacity and QoL in CA has not yet been investigated.

Objectives
in this observational pilot study, our aim was to evaluate the relationship of left atrial strain with 6MWT and KCCQ in patients with CA (both AL and ATTR).

Methods
we enrolled consecutive patients with CA during routine follow up visits. Patients underwent clinical and echocardiographic evaluation. On the same day, 6MWT was performed and KCCQ was administered. Speckle tracking analysis was performed offline by an experienced operator blinded to the other data. Correlation analysis was conducted using Pearsons’ coefficient and linear regression analysis

Results
overall, 43 patients with CA (25 ATTR, 18 AL) were enrolled. Mean age was 74 ±11, 16% (n=7) were female. Most patients showed normal left ventricular (LV) ejection fraction (55±9) and reduced LV global longitudinal strain (GLS =−12 ± 7%), 32 of them with apical sparing pattern (Table 1). Mean global peak atrial longitudinal strain (PALS) was 14 (median[IQR]=6.5;23.5), mean 6MWT score = 382 ± 104 and mean KCCQ score= 67 ± 24.
Global PALS showed a strong direct correlation with 6MWT (Fig 1, P= 0.4, R2=0.2, p-value=0.032) and a trend towards correlation with KCCQ (R2=0.3, p-value=0.06), although not reaching statistical significance, probably due to the low sample size. The correlation between PALS and 6MWT was even stronger in patients with ATTR (p = 0.7, R2 0.4; p-value&lt;0.0001).

Conclusions
our preliminary results show that, global PALS is associated with functional capacity and the burden of HF symptoms in ATTR and AL, suggesting its role as a more objective marker of disease severity in CA.
Abnormal origin of the coronary arteries by echocardiography. And then what?
Authors: Constantin I , Carrero M C , Denes J , Ventura A , Oestereicher C , Pessio C , De Stefano L , Mezzadra M , Jaimovich G , Masson Juarez G , Stutzbach G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The anomalous origin of the coronary arteries from the opposite sinus (AOCA) is increasingly recognized. The most frequent diagnosed by echocardiography is the circumflex artery arising from the right sinus of Valsalva with a retroaortic course. Classically is believed to be a low-risk malformation, nevertheless, whether this anomaly is associated with other high risk features (coexistence with other high-risk AOACA, acute take off angle, intramural course, etc) not easily identify by echocardiography is unknown.

Objectives
The objectives of this study are to know the prevalence of anomalies of the origin of the coronary arteries diagnosed by echocardiography, to determine the use of additional diagnostic tests and to evaluate the coexistence of the anomalous origin of the circumflex artery with other anomalies and / or risk characteristics.

Materials and methods
A retrospective search of AOCA diagnosis was performed among echocardiography reports of outpatients in a high complexity cardiology center between March 2018 and December 2021. The clinical history was investigated to identify if the AOCA diagnosis led to further testing (coronary Angio CT or Ischemia diagnosis test) and if these studies provided clinically relevant information.

Results
Of a total of 26260 echocardiogram reports investigated, 50 presented suspected AOCA (0. 2%), 49 circumflex arteries with anomalous arising from the right sinus with retroaortic course and 1 left coronary artery arising from the right sinus with a subpulmonary course. 18 coronary CT angiography (36%) and 13 stress tests (26%) were requested. In 17 of 18 patients (98%) coronary CT angiography confirmed the diagnosis of anomalous origin of circumflex artery arising from the right sinus with retroaortic course (true positive). In 4 of the 17 OAAC confirmed by CT angiography, the study provided additional important information (2 associated anomalies of the origin of the anterior descending, 1 interarterial course and 1 circumflex artery arising from the right sinus with a retroaortic course and an angle take-off from the aortic wall ‹45°).

Conclusion
The diagnosis of AOCA by echocardiography is an uncommon finding and most of them are low risk. The most frequent variant is the circumflex artery arising from the right sinus with a retroaortic course. CT angiography adds additional information by identifying associated abnormalities of other coronary arteries and evaluating the angulation of the origin of abnormal coronary arteries.
Automated measurements based on artificial intelligence software in pediatric echocardiography: a feasibility study
Authors: Vasile C M , Avesani M , Velly C , Chan C , Iriart X 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Transthoracic echocardiography is the first-line non-invasive investigation for assessing pediatric patients' cardiac anatomy, physiology, and hemodynamics, based on its accessibility and portability, but complete anatomic and hemodynamic assessment is time-consuming. The study aimed to determine the accuracy and reliability of a new automated artificial intelligence software initially developed for adults for analyzing the main echocardiographic parameters in pediatric patients.

Materials and Methods
The study was performed at the University Hospital of Bordeaux between August and September 2022 and included 45 patients who underwent a 2D transthoracic echocardiographic examination, mainly for murmur (n=8), post ASD closure evaluation(N=5), chest pain, or arrhythmia as we aimed to have a homogeneous group of patients with normal or near normal heart architecture. We compared AI automatic measurements with manual measurements performed by a senior and junior pediatric cardiologist. Pearson correlation and Bland and Altman analysis were used. As the AI software has been developed for adults, we decided to subclassify our patients into two subgroups: the first group (patients aged between 0–8 years) and the second group (patients over 8 years). The decision was made because pediatric anatomy differs from adults and to see if the dedicated artificial intelligence soft for adults has better reproducibility for pediatric patients older than 8 years.

Results
The median age was 8.9 years. Comparison between senior and junior pediatric cardiologists for all subgroups was significant (Pearson correlation &gt;0,7 for most measurements performed). For younger patients (&lt;8 years old), we found excellent correlations (Pearson correlation &gt;0.8) for heart chambers measurements measured from A4CH and A2CH views (LV end-diastolic volume, LV end-systolic volume, RV end-diastolic area, and RV area) between AI software and both junior and senior pediatric cardiologist, but poor correlation for the measurements performed from parasternal long axis view (r=0.06 for STJ measurement). We achieved stronger correlations for the measurements evaluation of patients over 8 years old ( r&gt;0.8 for aortic annulus, STJ, E, A, S waves, LV end-diastolic volume in A4CH, LV end-systolic volume in A4CH) for both junior and senior cardiologist in relation to AI measurements.

Conclusion
In this preliminary study, we found that automated artificial intelligence software provided promising results for measuring mainly volumes (LV end-diastolic volume, LV end-systolic volume) in A4CH and A2CH. The software requires improvements for automated measurements within the parasternal long-axis section to achieve better accuracy. Results obtained with the AI software for patients over 8 years old were significantly improved compared to those obtained for those under 8 years of age.
Predictive value of myocardial performance indices for the detection of significant coronary artery disease in patients with a positive ischemia test
Authors: Fraichot V , Pace N , Filippetti L , Fraix A , Metzdorf P A , Varlot J , Hennequin J , Lamiral Z , Selton-Suty C , Popovic B , Huttin O 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Echocardiography using conventional global or segmental function evaluation has low diagnostic value in detecting subclinical coronary artery disease (CAD). Deformation parameters are more informative but load-dependent. Myocardial Work (MW) based on non-invasive LV pressure-strain loops has been suggested as a new alternative tool for the early detection of CAD.

Purpose
This study aimed to determine MW diagnostic performance in patients with a positive ischemia test.

Methods
Fifty-four patients referred for a coronary angiography secondary to a positive ischemia test were included (43 men (79.6%), mean age: 64.3 ± 9.7 years). Patients were divided into two groups according to the presence (SCAD) or absence (NCAD) of significant CAD requiring revascularization. Global and segmental MW parameters were measured on top of conventional echo parameters. Territorial myocardial work index (TWI) and constructive work (TCW) were analyzed according to coronary angiogram results.

Results
All patients had normal wall motion and left ventricular ejection fraction. There were no significant differences between the two groups regarding conventional echocardiographic parameters and global myocardial deformation. Patients with SCAD had a significantly reduced Global Constructive Work (GCW) compared to NCAD group (2316 mmHg% vs. 2565 mmHg%; p = 0.012). Territorial analysis confirmed a significant decrease in TCW in myocardial segments related to SCAD. GCW is the parameter with the largest AUC to predict a SCAD (AUC = 0.706; CI 95% (0.56 – 0.84)) with a high positive predictive value (73.9%).

Conclusion
Patients with SCAD had significantly impaired global and territorial MW parameters. MW quantification allows better discrimination of patients with confirmed SCAD. The routine addition of those parameters should improve the predictive value of ischemic tests.
Normal right ventricular augmentation during stress echocardiography- A comparative study
Authors: Alborikan S 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The assessment of right ventricular (RV) contractile reserve (CR) during exercise echocardiography in healthy subjects is not well described. We aimed to describe normal RV CR in healthy cases and to compare CR to patients with defined RV compromise because of previous repair of Tetralogy of Fallot.

Methods
40 healthy individuals with satisfactory RV windows were randomly selected and retrospectively analysed from previously published study (marathon study). These cases were compared to 100 adult patients with repaired TOF. We defined RV CR by the change in tricuspid lateral annular systolic velocity (ΔRVS’), change in tricuspid annular plane systolic excursion (ΔTAPSE), and change in fractional area change (ΔFAC). All parameters were evaluated at baseline and at peak stress.

Results
During exercise, RVS’ was increased by 60±20%, followed by TAPSE 48±15%, and the lowest with FAC by 32±10%. These ranges were significantly higher than in TOF population. RV CR was greater in males than females for all RV functional measures (34±10 vs 28±10, %, p&lt;0.05); (50±10 vs 44±11, %, p&lt;0.05); (61±12 vs 52±11, %, p&lt;0.05), for ΔFAC, ΔTAPSE, and ΔRVS’, respectively. There was no association between RV CR and functional capacity parameters in healthy individuals, whereas in patients with repaired TOF there was a significant association with peak absolute VO2 (ml/min) (r=.36, p&lt;0.001, with ΔFAC).

Conclusions
We have presented normal values for RV CR parameters in healthy cases during stress echocardiography. RV CR is an important determinant of exercise capacity in patients with abnormal RV function but not in normal subjects.
Echocardiographic assessment of right ventricular function and right ventriculoarterial coupling in tricuspid regurgitation
Authors: Trousselle L T , Eggenspieler F E , Nazeyrollas P N , Faroux L F , Huttin O H , Pace N P , Filippetti L F , Fraix A F , Carquin B C , Selton-Suty C S S , Metz D M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Echocardiographic evaluation of the cardiopulmonary unit may be difficult in the presence of tricuspid regurgitation (TR) and combined echocardiographic parameters could therefore be useful in such patients.

Purpose
To assess the variation of simple and combined echocardiographic parameters analysing the cardiopulmonary unit according to the severity of TR.

Methods
Echocardiographic images were reviewed in 179 patients to assess TR grade according to Hahn’s 5 grades classification. Classical morphological (right ventricle (RV) end diastolic (ED) length and area), function (tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), S’ wave, RV free wall longitudinal strain (RVFWS)) and load (TR Time-velocity integral (TR TVI), pulmonary artery systolic pressure (PASP)) parameters analysing RV were assessed. Combined parameters of function and load (TAPSE/PASP, TR TVI x RVFWS), morphology and load (load adaptation index (LAI) = TR TVI x RVED length/area) and morphology, load, and function (myomechanical index (MMI = RV-RA mean pressure gradient x RVFWS/indexed RAED area x 10–2 ) and morphology-load-function index (MLF = RVED length/area x TR TVI x RVFWS)) were calculated. We used receiver operating characteristic (ROC) curve analysis to analyze the diagnostic value of echocardiographic parameters to predict potential high (&gt;3) or low (&lt;6) surgical risk of mortality according to TRISCORE.

Results
Simple parameters were significatively different among groups with a nonlinear progression between the 5 levels of severity of TR. Combined parameters were also significatively different among groups. Among them, MMI and MLF had a linear progression between the 5 groups (MMI: grade 1: 0.20±0.09; grade 2: 0.15±0.08; grade 3: 0.10±0.05, grade 4: 0.09±0.08; grade 5: 0.05±0.04 p = 0.000; MLF: grade 1: 7.56±2.06; grade 2: 6.57±2.14; grade 3: 4.85±2.29, grade 4: 4.79±3.17; grade 5: 3.06±1.82 p = 0.000) and had the best predictive value for TRISCORE high and low risk (MMI: AUC =0.889 p = 0.000 for low risk, 0.855 p = 0.000 for high risk; MLF: AUC =0.873 p = 0.000 for low risk, 0.822 p = 0.000 for high risk).

Conclusion
Combined parameters are relevant to evaluate cardiopulmonary unit in a population presenting with TR, especially when combining morphology, function and load parameters. Their good predictive value for TRISCORE risk suggests a potential role of such parameters in the prognostic assessment of TR patients and in the selection for new percutaneous repair techniques.
Acute modification of hemodynamic forces in patients with severe aortic stenosis after transcatheter aortic valve replacement
Authors: Zaccaro L , Vairo A , Alunni G , D'ascenzo F , De Ferrari G M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Transcatheter-Aortic-Valve-Implantation (TAVI) is the established first-line treatment for patient with severe aortic stenosis not suitable for surgery. Echocardiographic evaluation of hemodynamic forces (HDFs) is a growing field, holding the potential to early predict improvement in LV function.

Methods
A prospective observational study was conducted. Transthoracic echocardiography was performed before and after TAVI. HDFs were analyzed along with traditional left ventricular (LV) function parameters.

Results
25 consecutive patients undergoing TAVI were enrolled: mean age 83±5 years, 74.5% male, mean LV Ejection Fraction (LVEF) at baseline 57±8%. Post-TAVI echocardiographic evaluation was performed 2.4±1.06 days after the procedure. HDFs amplitude parameters improved significantly after the procedure: LV Longitudinal Forces (LF) apex-base [mean difference (MD) 1.79%; 95%CI 1.07–2.5; P-value &lt;0.001]; LV systolic LF apex-base (MD 2.6%; 95%CI 1.57–3.7; P-value &lt;0.001); LV impulse (LVim) apex-base (MD 2.9%; 95%CI 1.48–4.3; P-value &lt;0.001). Similarly, HDFs orientation parameters improved: LVLF angle (MD 1.5°; 95%CI 0.07–2.9; P-value 0.041); LVim angle (MD 2.16°; 95%CI 0.76–3.56; P-value 0.004). Conversely, Global Longitudinal Strain and LVEF did not show any significant difference before and after the procedure. Conclusion: Echocardiographic analysis of HDFs could help differentiate patients with LV function recovery after TAVI from patients with persistent hemodynamic dysfunction.
Increased risk of coronary plaque vulnerabilization following COVID-19 infection, identified by elevated FAI index of pericoronary inflammation at coronary CT
Authors: Matyas B , Benedek I , Opincariu D , Blindu E , Rosca A , Bordi L , Benedek B , Benedek T 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This research has been funded by the research grant Intel-FAT, proposal registration code PN-III-P4-ID-PCE-2020-2861, contract number PCE 206/2021, Project funded by the European Union and the Government of Romania through the Ministry of European Funds, and the Doctoral School of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania.

Background
Inflammation plays an essential role in all stages of atherosclerosis, with stable plaques characterized by chronic inflammation and vulnerable or ruptured plaques exhibiting "active" inflammation. COVID infection may significantly increase systemic inflammation, but the role of SARS COV-2 infection on local plaque vulnerability is still not elucidated. Mapping the PCAT - FAI on routine CCTA can detect coronary artery inflammation non-invasively by measuring changes in the composition of pericoronary fat.

Purpose
The aim of this study was to assess the impact of COVID-19 infection on CAD in patients who underwent CCTA examinations for chest pain in the early stages after infection, using the new AI - powered CaRi-Heart® solution.

Methods
In our study, we included 158 patients (mean age was 61.63 ± 10.14 years) with chest pain and low to intermediate clinical likelihood of CAD, who underwent 128-slice CCTA for assessment of coronary anatomy, atherosclerosis, and determination of FAI – Score. The study population was divided into two main groups: Group 1 (n = 75) – patients who had a COVID-19 infection a few months prior to their CCTA examination, and Group 2 (n = 83) – patients adjusted for age and gender, who did not have a COVID-19 infection.

Results
The FAI - Score was consistently higher in the non COVID-19 group: LAD (11.61 ± 7.60 vs. 9.32 ± 6.00, p = 0.05), LCX (12.43 ± 6.65 vs. 10.48 ± 6.24, p = 0.05), RCA (15.40 ± 11.36 vs. 14.54 ± 12.17, p = ns), the average FAI - Score (12.81 ± 8.28 vs. 10.47 ± 7.19, p = 0.001). For the FAI-Score Centile, the overall pattern shifts significantly, as the values for all three coronary arteries are higher for the subjects in the COVID-19 positive group, as follows: LAD (0.66 ± 0.29 vs. 0.58 ± 0.28, p = 0.05), LCX (0.79 ± 0.16 vs. 0.68 ± 0.26, p = 0.03), RCA (0.83 ± 0.20 vs. 0.68 ± 0.29, p = 0.05). In both cases, the CaRi Heart® Risk (p &lt; 0.0001) and the Duke Score (p &lt; 0.0001) had significantly higher values for the patients in the COVID-negative group.

Conclusion
Lesions with higher pericoronary FAI - Score Centile values were more commonly found in patients who had previously been infected with COVID-19. The higher levels of inflammation in the pericoronary adipose tissue suggests that COVID-19 infection is linked to an increased risk of coronary plaque destabilization.
Evaluation of the impact of transmitral mean gradient elevation after transcatheter mitral valve implantation
Authors: Chong-Nguyen C , Duvillier P , Brochet E , Cailliau A , Delhomme C , El Beze N , Himbert D , Iung B , Ou P , Urena-Alcazar M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Transcatheter mitral valve implantation (TMVI) has emerged as an alternative to surgery in high risk patients with failing mitral bioprosthesis (valve-in-valve) or annuloplasties (valve-in-ring). The presence of an elevated mean gradient &gt; 5mmHg after the procedure has been defined as an unsuccessful procedure but the impact and outcomes of an elevated mean gradient after TMVI have not been studied.

Materials and methods
103 patients undergoing TMVI from 2010 to 2020 were included. Patients were classified in three groups according to mean gradient after the procedure: Group 1&lt; 5mmHg, Group 2 between 5 and 10mmHg and Group 3 &gt; 10mmHg.

Results
The median age was 71 (52.5–81.5) years. Indications for TMVI were bioprosthesis failure in 67 patients (65%) and ring annuloplasty failure in 36 patients (35%). 84 (81.6%) patients were in NYHA class III or IV. 42 patients were in group 1, 51 in group 2 and 10 in group 3, without any difference in baseline characteristics or procedural findings. At 30 days, the rates of all-cause mortality (respectively 2,6%, 0% and 0%, p = 0,66), rehospitalization for heart failure (respectively 8,4%, 7,7% and 8,4%, p = 0,89), paravalvular leak (10,3%, 27,7%, 22,2%, p = 0,33), LVOT obstruction (respectively 6,3%, 8,2% and 10%, p = 0,99) or valve thrombosis (respectively 7,7%, 4,3% and 0%) were similar in the three groups. At a median follow up of 2 years, 27 patients have died with a cumulative rate of all-cause mortality at 1 and 2 years of 21.5% and 38.1% respectively. The presence of an elevated mean gradient was not associated with increased risk of mortality (HR=1,11, (95% CI [0,93, 1,31]), p = 0,25) An improvement of NYHA class was observed in the three groups without any difference between the groups. Median systolic pulmonary arterial pressure significantly improved in group 1 (from 53mmHg (30–90) in baseline to 45mmHg (25–60), p = 0.005) and 2 (from 55mmHg (30–112) in baseline to 40mmHg (30–75), p = 0.004)) but not in group 3.

Conclusion
An elevated mean gradient post-TMVI had no impact on cardiovascular outcomes up to 2 years. Further studies with longer follow up are necessary.