bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation between novel echocardiographic indices and biomarkers of myocardial injury in patients with NSTEMI
Authors: Karakosta M , Kalesi A E , Ntiloudi D , Kapsokoli C , Boukis D , Barmpagiannis D , Arnas N , Konstantara A , Grigoraki E , Zachos P , Destounis A , Kasinos N , Pisimisis E , Theodosis-Georgilas A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction / Purpose
The extent of myocardial injury is a prognostic factor in patients with myocardial infarction presenting without persistent ST elevation (NSTEMI). The purpose of this study was the assessment of possible correlation between novel echocardiographic indices and biomarkers of myocardial injury in patients with NSTEMI and normal left ventricular ejection fraction (LVEF).

Methods
Patients with NSTEMI (18 to 80 years old) who were examined at the echocardiography laboratory of our general hospital, from May 2021 until August 2022, were enrolled in this study. All patients had no former history of cardiac disease or other significant comorbidities, and they all had LVEF ≥55% and normal wall motion score index. After coronography all of them were diagnosed with significant coronary artery disease. Among the novel echocardiographic indices, global longitudinal strain (GLS), and the parameters of myocardial work, global work index (GWI), global constructive work (GCW), global wasted work (GWW) και global work efficiency (GWE) were examined. The biomarkers were maximum high sensitive troponin I (hsTNI) during hospitalization, creatine phosphokinase (CPK) and its myocardial isoenzyme (CK-MB). Correlation between the variables was examined with Spearman method, and a p value &lt;0.05 was considered statistically significant.

Results
In this study 34 patients with NSTEMI (26 males), of mean age 60.1 years (SD 10.5 years) participated. Median |GLS| was 17.9%, GWI 1957.7mmHg%, GCW 2231.0mmHg%, GWW 141.7mmHg% and GWE 92.2% (Table 1). As for the biomarkers, median maximum hsTNI value was 1718.0ng/l, CPK 172.0U/l and CK-MB 31.0U/l. A negative correlation was shown between hsTNI and GWE (Spearman’s rs =−0.515, p = 0.002), and a positive between hsTNI and GWW (Spearman’s rs =−0.426, p = 0.013). Also, CK-MB values had a negative correlation with |GLS| (Spearman’s rs =−0.411, p = 0.017) and GWE (Spearman’s rs =−0.425, p = 0.014). No correlation was found between CPK and the echocardiographic indices.

Conclusion
Novel echocardiographic indices were correlated with biomarkers of myocardial injury in patients presenting with NSTEMI and normal LVEF.
Determinants of left atrial reservoir strain in a large healthy population
Authors: Nyberg J , Jakobsen E O , Ostvik A , Holte E , Stolen S , Lovstakken L , Grenne B , Dalen H 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Centre for Innovative Ultrasound Solutions Nord-Trøndelag Hospital Trust.

Background
Echocardiographic evaluation of the left atrium (LA) has until recently been done by assessment of LA end-systolic volume (LAESV) or Doppler measurements. While these measurements provide prognostic information, they indirectly measure LA function. LA reservoir strain, however, is a direct measurement of LA function and provides additional prognostic information but is affected by the left ventricle (LV) through movement of the atrioventricular plane.

Purpose
By evaluation of echocardiograms from a large healthy population we aimed to study the associations of LA reservoir strain with age, LA-, and LV volumes, and LV global longitudinal strain (LV GLS).

Methods
Echocardiographic acquisitions and analyses were performed according to current recommendations. All study personnel were experienced and affiliated with a European Association of Cardiovascular Imaging accredited echocardiographic laboratory. The associations of LA reservoir strain as outcome variable with age, LAESV, LV end-diastolic volume (LVEDV) and LV GLS were assessed by multiple linear regression analyses.

Results
In total 1412 subjects (56% females) with mean (SD) age 57 (12) years were included. Mean LVEF was 60.4% in females and 59.6% in males. Totally, 39% of the variance in LA reservoir strain between subjects was explained by age, LAESV, LVEDV and LV GLS (Table 1). All four characteristics were significantly associated with LA reservoir strain (all p&lt;0.001). Age and LV GLS were the two most important characteristics for determining LA reservoir strain, indicating lower LA reservoir strain with higher age and lower absolute LV GLS. Six years of higher age had a similar effect as one percent lower absolute LV GLS. Similarly, 28 mL larger LAESV and 35mL smaller LVEDV corresponded to one percent lower absolute LV GLS.

Conclusion
In this large healthy population, almost 40% of the variance in LA reservoir strain between subjects was explained by age, LV GLS, and the volumes of LA and LV. The most important determinants were age and GLS, contributing equally to a reduction of LA reservoir strain with higher age and lower absolute LV GLS. Correspondingly, the size of LA and LV contributed less to the variability of LA reservoir strain. In conclusion, both age and LV function should be considered when interpreting LA reservoir strain.
Determinants of disproportionate functional mitral regurgitation
Authors: Arao Y , Izumi Y , Kagiyama N , Maekawara S , Kaneko T , Terada M , Higuchi R , Saji M , Takamisawa I , Nanasato M , Isobe M , Morishima I 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Recent studies have suggested that "disproportionate" functional mitral regurgitation (FMR) defined by greater MR than expected from the degree of left ventricular (LV) dilatation may be a good candidate for transcatheter edge-to-edge repair (TEER). Determinants of disproportionate FMR (d-FMR) is unknown. We hypothesized that additional factors such as asymmetric tethering, extreme mitral annular dilatation, and deep indentation, might worsen the severity of FMR regardless of LV volumes and lead to d-FMR.

Purpose
To investigate the impact of the additional factors on the proportionality of FMR.

Methods
We reviewed consecutive FMR patients who underwent TEER and 3D transesophageal echocardiography (3DTEE) in our institute between 2018 and 2022. d-FMR and proportionate FMR (p-FMR) were defined by the effective regurgitant orifice area (EROA)/LV end-diastolic volume (LVEDV) &gt;0.2 and ≤0.2 mm2/mL, respectively.

Results
A total of 110 FMR patients (63 d-FMR and 47 p-FMR, 75±12 years old, 46.3% female) were included. Patients with d-FMR had significantly larger EROA than p-FMR (41 ± 12 vs 33 ± 11 mm2, P&lt;0.001) despite smaller LVEDV index (100 ± 28 vs 138 ± 49 mL/m2, P&lt;0.001), better LV ejection fraction (37 ± 10% vs 27 ± 8%, P&lt;0.001), and lower tenting height (7.6 ±2.9 vs 9.4 ± 2.7 mm, P=0.009). The 3DTEE analysis revealed that patients with d-FMR were more likely to have asymmetric tethering (29% vs 21%), extreme mitral annular dilatation (&gt;700 mm2/m2; 54% vs 30%), and deep indentation (22% vs 4.3%) The presence of such additional factors was independently associated with d-FMR (odds ratio 3.83, P=0.0081) after adjustment by body surface area and LVEDV index. Furthermore, EROA/LVEDV increased as the number of additional factors increased. (Jonckheere-Terpstra test, P&lt;0.001). TEER successfully reduced FMR regardless of the presence of such additional factor (success rate 95% vs. 96%, P&gt;0.99).

Conclusions
The presence of additional factors exacerbates MR independently of LV size and is an important mechanism of d-FMR. TEER is an effective therapy to reduce FMR regardless of these factors.
Predicting revascularization using 15O-H2O PET myocardial perfusion imaging - impact of atrial fibrillation
Authors: Madsen S , Kjaerulff M L G , Ejlersen J A , Nielsen B R R , Jakobsen L , Sorensen J , Tolbod L P , Gormsen L C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Myocardial perfusion imaging (MPI) by 15O-H2O positron emission tomography (PET) has excellent diagnostic accuracy for detecting significant coronary stenoses and consequently revascularization in patients with angina and no previous coronary artery disease (CAD). However, arrhythmias such as atrial fibrillation (AF) are thought to reduce myocardial perfusion globally and thresholds indicating ischemic CAD are therefore likely lower in patients with AF.

Purpose
To determine the ability of 15O-H2O PET MPI to predict subsequent revascularization in patients with known AF and angina.

Methods
We prospectively included 330 patients with angina and persistent or paroxysmal AF referred for rest/stress 15O-H2O MPI prior to possible angiography and revascularization. 55% of patients had previously documented CAD (181 patients with CAD and 149 with no CAD), and 41% had AF at the time of the MPI (136 patients with AF and 194 with sinus rhythm (SR)). Thus, patients were divided into four groups (SR-noCAD, AF-noCAD, SR-CAD, AF-CAD) to determine the independent impact of AF on myocardial blood flow (MBF). Primary outcome parameters were hyperemic MBF and revascularization within 3 months of the MPI.

Results
As expected, MBF was significantly affected by the presence of both AF and CAD [MBF (ml/g/min): 2.77 +/- 0.93 (SR-noCAD) vs. 2.10 +/- 0.93 (AF-noCAD) vs. 2.22 +/- 0.93 (SR-CAD) vs. 1.80 +/- 0.74 (AF-CAD), ANOVA p&lt;0.001]. In total, 37 patients (50 coronary vessels) were subsequently revascularized. ROC-analysis of vessel specific hyperemic MBF yielded the following optimal MBF cut-offs (ml/g/min) to predict early revascularization: SR-noCAD: 2.03 (AUC 0.95, p&lt;0.001); AF-noCAD: 1.16 (AUC 0.79, p&lt;0.001); SR-CAD: 1.45 (AUC 0.77, p&lt;0.001); AF-CAD: 1.28 (AUC 0.88, p&lt;0.001).

Conclusion
Hyperemic MBF was approximately 20 % lower for patients with AF regardless of known CAD status. Despite this, the overall ability of 15O-H2O MPI to predict subsequent revascularization was high in this single centre setup, although the presence of AF and/or documented CAD at the time of the PET decreases the diagnostic accuracy moderately.
Ebstein valve rotation angle: a novel quantitative index of anatomical severity and higher clinical risk in Ebstein's anomaly
Authors: Cavazza B , Pasqualin G , Bevilacqua F , Caldaroni F , Chessa M , Giamberti A , Saracino A , Lombardi M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The study aimed to identify cardiovascular magnetic resonance (CMR) imaging parameters representative of Ebstein's Anomaly (EA) anatomical and clinical severity.

Materials and Methods
Consecutive CMR of patients with EA referred to our Center, were evaluated retrospectively. Displacement index (DI) was defined as the distance between the septal leaflet hinge point and the atrio-ventricular groove over the body surface area. The Ebstein’s valve rotation angle (EVRA) was quantified by connecting the inferior atrio-ventricular groove and the systolic leaflet closure plane. The Celermajer index was calculated using area (Cel-a) and volumes (Cel-v) as the ratio between the atrialized RV (aRV) plus the right atrium over the sum of the functional RV (fRV) and left chambers. The occurrence of unfavorable outcome was defined as the presence of sustained brady-tachyarrhythmia or New York Heart Association (NYHA) class ≥ II for unoperated patients and the presence of an at least moderate tricuspid regurgitation or a sustained brady-tachyarrhythmia during the post-operative hospital stay for patients undergone surgical correction.

Results
The study included 45 patients (age 28 +/- 15 years, 64% males). DI, Cel-a, Cel-v and EVRA tend to increase with worsening Carpentier classification (p = 0.002, p =0.02, p = 0.01, p &lt; 0.0001 respectively). EVRA was the only parameter that showed to discriminate patients with unfavorable outcome both in the group of operated (68 ± 13.9° vs 43.5 ± 26.8° p = 0.03) and unoperated patients (58 ± 27° vs 30 ± 27°, p = 0.02). Among the other analyzed parameters, aRV indexed end-diastolic volume (68 ± 45 ml/m2 vs 31 ± 22 ml/m2 , p = 0.03) and anatomical RV (192 ± 81 ml/m2 vs 128 ± 32 ml/m2, p = 0.03) were significantly higher in unoperated patients with unfavorable follow-up, while both fRV/ARV axis (0.52 ± 0.14 vs 0.66 ± 0.2, p = 0.04) and volumes (0.67 ± 0.11 vs p 0.87 ± 0.29, p = 0.03) were significantly lower. fRV indexed-end diastolic volume was significantly lower (110 ± 32 ml/m2 vs 145 ± 31 ml/m2 , p = 0.03) in patients with an unfavorable post-operative stay. The EVRA value that showed to best discriminate patients who had an unfavorable follow-up event was 44.5 °, with a sensitivity of 0.57 (0.37–0.76, 95% CI) and a specificity of 0.88 (0.69–0.96, 95% CI).

Conclusions
EVRA is an emerging parameter that may help to provide a quantitative assessment of EA anatomical severity and may be integrated in the risk stratification for clinical follow-up and surgical planning.
Total regurgitant fraction to predict aortic valve surgery in patients with concomitant aortic and mitral regurgitation
Authors: Montes A , Cecconi A , Teis A , Lacalzada-Almeida J , Lopez Melgar B , Caballero P , Hernandez Muniz S , Benavides C , Viliani D , Di Silvestre M , Izquierdo-Gomez M M , Baeza Garzon F , Escabia C , Jimenez Borreguero L J , Alfonso F 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Both aortic regurgitation (AR) and mitral regurgitation (MR) produce left ventricular (LV) volume overload (1). Current prognostic assessment of AR does not include the presence and magnitude of MR. Therefore, in patients with concomitant AR and MR we might be underestimating the future need of valve replacement surgery. Cardiac magnetic resonance (CMR) is a very precise tool to quantify LV volumes together with aortic and mitral regurgitant volumes. Combining data from cine and phase contrast sequences it is possible to obtain a set parameter: total regurgitant fraction (TRF).

Purpose
To describe the prognostic value of TRF in patients with concomitant AR and MR.

Methods
Patients with concomitant AR and MR with CMR studies were retrospectively recruited in three tertiary hospitals. Cases of at least moderate AR and any grade of MR were included in the analysis. Patients with indication of aortic valve surgery (symptoms, severe LV dilatation or reduced LV eyection fraction) in the moment of the CMR were excluded. Aortic regurgitant fraction (ARF) was calculated from the phase constrast data as the ratio of AR volume and LV forward volume. Mitral regurgitant Fraction (MRF) was calculated from the cine sequences as the ratio of the MR volume and the LV stroke volume (LVSV) . TRF was calculated as the ratio of mitral plus aortic regurgitant volumes and the LVSV (MRV+ARV/LVSV)

Results
35 cases were analyzed, with a mean follow up period of 40 months. 9 patients developed indications of aortic valve surgery. TRF had an area under curve (AUC) to predict aortic valve surgery of 0.82, in opposite to aortic regurgitant fraction (ARF) which had an AUC of 0.75 (Figure 1) The optimum cutoff value of TRF and ARF to predict the need of surgery in our series were 38% and 27%, respectively. After 3 years of follow up 53% of patients with TRF &gt; 38% had to be intervened (Figure 2A). In contrast, 32% of patients with ARF &gt;27% had to be intervened (Figure 2B)

Conclusion
MR presence increases volume overload in patients with moderate or severe AR. TRF is a promising parameter to predict the need of aortic valve surgery in this patients
Subclinical dysfunction in left atrial compliance after successful cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation
Authors: Pilichowska E , Sikorska A , Kowalik I , Baran J , Piotrowski R , Krynski T , Kulakowski P , Zaborska B 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): The Medical Centre of Postgraduate Education.

Purpose
It has been suggested that cryoballoon ablation (CB) for paroxysmal atrial fibrillation (PAF) may lead to more extensive left atrial (LA) injury than radiofrequency ablation (RF), however, results are conflicting. The aim of our study was to estimate the LA function after successful CB and RF for PAF using transthoracic echocardiography (TTE).

Methods
90 pts (66% males, mean age 57±10 years) successfully treated (no AF recurrences confirmed in serial 4–7 day ECG Holter monitoring) with RF (51%) or CB (49%) for PAF were prospectively studied. TTE with speckle tracking (STE) and tissue doppler was performed before and 12 months after the procedure in sinus rhythm. The peak longitudinal LA strain (LAS) during the reservoir (r), conduit (cd) and contraction (ct) phases were measured. The global LAS for each LA phase was calculated by averaging the values observed in all LA segments in the 4- and 2-Chamber views. We set the zero strain point as the time from the beginning of the QRS wave. The velocities of the early (e') and late (a') diastolic phases at the mitral annular septal and lateral corners were measured.
Analysis of covariance was applied to compare changes over time with the baseline measurement as covariance and the type of ablation as the factor. The parallelism of the slopes of the covariance was tested.

Results
Parameters of LA function regarding the mode of ablation at 12 months after the procedure are shown in the table.
Significant decrease in LAScd and e’ was observed in the CB subgroup with better preserved baseline values (≥16% and ≥12cm/s respectively).

Conclusion
Worsening of parameters reflecting LA compliance was observed 12 months after successful CB vs RF ablation for PAF. This might suggest subclinical dysfunction of LA after CB procedure. Clinical significance of this finding warrant further long-term observation.
Role of reduced left atrial mechanical function reserve in exercise intolerance progression in hypertensive heart disease
Authors: Przewlocka-Kosmala M , Serafin A , Jasic-Szpak E , Ponikowski P , Kosmala W 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The identification of mechanisms in hypertensive heart disease (HHD) that favor the development of symptomatic heart failure (HF) is essential. Little is known about the role of left atrial (LA) mechanical response to exertion in this context.

Objectives
We sought to investigate the association of LA strain parameters response to exercise with functional capacity and symptomatic HF in a representative group with HHD.

Methods
Echocardiography (including LA strain and strain-derived LA stiffness index assessment) was performed at rest and immediately post exercise test in 61 patients with stage A, 67 patients with stage B and 73 patients with stage C HF.

Results
There was a progressive worsening of exercise capacity from stage A through stage B to stage C, which was accompanied by a gradual impairment of changes from rest to exercise in LA reservoir and contractile strain, whereas LA stiffness reserve remained unchanged until the HF stage C (Table). In multivariable analysis including LA and left ventricular reserve and clinical variables, changes from rest to exercise in LA reservoir strain and mitral annular e’ (both beta 0.16, SE 0.07, p = 0.02) were the only cardiac function parameters independently correlating with exercise capacity. However, LA stiffness reserve and E/e’ were the strongest associations of symptomatic HF stage C (Akaike information criterion 111.6 and 101.1, respectively).

Conclusions
LA reservoir strain and LA stiffness exercise reserves are among the mediators of reduced functional capacity in HHD, however the trajectories of changes of these parameters are not parallel. While LA strain reserve progressively deteriorates across HF stages, a marked impairment in LA stiffness reserve can only be seen in patients with HF symptoms. This suggests a potential role for these parameters in stratifying the risk of progression to overt HF in HHD.
Comparing of Peak Longitudinal strain and Post Systolic Shortening in detecting ischemia at rest in stable coronary artery disease: an angiography verified study
Authors: Arslan M , Ozden O , Ohtaroglu Tokdil K , Barutcu A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Coronary artery disease is a major public health problem. Early diagnosis and treatment of coronary artery disease is crucial. There is a need for a practical, reliable and cost-effective non-invasive imaging tool. We aimed to evaluate the rest ischemia with speckle tracking echocardiography (STE) compare to the two methods in patients who were scheduled coronary angiography according to the stress tests.

Methods
We included fifty patients with stable angina pectoris who were scheduled for conventional coronary angiography after the stress tests in our study. Speckle tracking echocardiography was performed just before coronary angiography. The association of 2 parameters with coronary artery disease was investigated and compared.

Results
Among 50 patients recruited for the study, 38 of them had severe CAD (&gt;50%), whereas 12 patients had non-significant CAD. Post systolic shortening (PSS) was significantly related with CAD (p&lt;0.0001). The relationship of PLS with the area at risk was found to be statistically insignificant but global longitudinal strain (GLS) was significantly lower in patients with severe CAD (p = 0.011).

Conclusion
PSS may detect coronary ischemia in patients with stable coronary artery disease and it is more sensitive and specific in patients with stable CAD. PSS is a very useful, practical and easy applicable non invasive tool for the detection of severe coronary artery disease at rest.