bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myocardial contraction fraction: an underused imaging biomarker
Authors: Kurdi H , Thornton G , Shiwani H , Artico J , Abiodun A , Patel K , Schelbert E , Treibel T , Manisty C , Moon J , Davies R 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The Myocardial contraction fraction (MCF% – stroke volume over myocardial volume) is an alternative/complementary measure of cardiac function to the ejection fraction (EF% – stroke volume over end diastolic volume), (1–2). It is dimensionless, does not need allometric scaling, is easy to compute and intuitive: the stroke volume produced per unit of myocardium, with some data for its utility in different forms of hypertrophy, (3–5). EF limitations (eg HFpEF) are well known. We explored the potential utility of MCF in a variety of cardiac diseases.

Purpose
To define reference ranges for MCF in normal and disease using a large dataset, exploring sex and age-related differences. To evaluate and compare the potential use of MCF as a prognostic biomarker compared to the more commonly used LVEF.

Methods
3 cohorts were used:
1. Health: 3,541 subjects from UK biobank, supplemented by 72 local healthy volunteers (UKB lower age limit is 45) to define normality and age/sex differences.
2. Disease: n=380 with a range of diseases : 125 HCM, 157 Fabry disease (FD) and 26 Transthyretin (TTR) Amyloid.
3. Prognostic cohort: n=1500 patients from a single centre with outcomes (26% death or hospitalisation with heart failure over a median 5.5years follow-up)
All CMR images were analysed using a clinically validated artificial intelligence (AI) algorithm for convenience of large-scale analysis (6) to determine MCF and LVEF.

Results
Health: There was no significant changes in MCF with age but there was a significant sex difference (male 0.94, range 0.68–1.2; female 1.10, range 0.82–1.37 p&lt;0.05)—see figure 1. Disease: MCF values for each disease cohort is shown in figure 2, all with a significant reduction compared to the healthy controls. Values ranged from 0.47 with Amyloid to 0.94 with Fabrys. Outcome: MCF strongly predicted patient outcomes – and was a more powerful predictor than LVEF (LVEF chi-squared=84 vs MCF chi-squared=160).

Conclusion
MCF is a complementary measure of cardiac performance to LVEF and equally as logical, intuitive and easy to calculate. It is frequently reduced even when LVEF is normal, and is a much stronger predictor of outcome than LVEF.
The impact of BMI on myocardial work and left atrial strain in young overweight patients with preserved left ventricular ejection fraction
Authors: Trimarchi G , Lofrumento F , Taverna G , Mancinelli A , Cusma Piccione M , Manganaro R , Trio O , Di Bella G , Zito C , Carerj S 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Overweight and obesity are a health problem of growing significance all over the world with increasing prevalence in both developed and developing countries. Numerous studies have demonstrated a relationship between obesity and cardiovascular diseases, underscoring the need to early treat this pathological condition. Overweight and obesity cause structural and functional changes on left ventricular (LV) and left atrial (LA) performance, which lead to heart failure.

Purpose
to evaluate the impact of BMI on myocardial work parameters and left atrial strain and to early detect LV and LA performance changes in overweight patients.

Methods
80 young individuals were prospectively enrolled, distinguishing between overweight patients with BMI greater than or equal to 25 to 29.9 kg/m^2 (n= 36; 45 ±11 years) and normal weight patients with BMI greater than or equal to 18.5 to 24.9 kg/m^2 (n=44; 43±9 years). All patients underwent transthoracic echocardiogram to calculate global longitudinal strain (GLS), global work index (GWI), global work efficiency (GWE), global wasted work (GWW), global constructive work (GCW) and left atrial strain.

Results
Overweight patients have higher BSA (1,9±0,16 vs 1,6±0,17 mq; p&lt;0,0001), Diastolic Blood pressure (81±12 vs 74±10 mmHg; p = 0,01) mean arterial pressure (98±15 vs 91±11 mmHg; p = 0,01), Heart Rate (71±13 vs 70±12 bpm; p = 0,02) and Global Longitudinal Strain (−19,3% ±1,7 vs −20,3% ±1,8; p = 0,02). With respect to myocardial work parameters, in overweight patients GWE (93% vs 95%; p = 0,01) is significantly reduced, whereas GWW (132 vs 102 mmHg%; p = 0,03) is significantly increased. Left atrial reservoir (LAres) (36% vs 40%; p = 0,04) and conduit (19% vs 24%; p = 0,005) function are significantly reduced in overweight patients. BMI inversely correlates with GWE (r=-0,36; p = 0,005) and LAres (r=-0,33; p = 0,007), whereas it directly correlates with GWW (r=0,31; p = 0,006).

Conclusions
Overweight induces early LV and LA performance changes that can be precociously detected by myocardial work and left atrial strain, in order to better characterize individual cardiovascular risk profile.
Intracavitary blood flow dynamics in the systemic right ventricle: a 4D-Flow MRI study
Authors: Pasqualin G , Riva A , Sturla F , Bevilacqua F , Giese D , Chessa M , Redaelli A , Votta E , Lombardi M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Failure of the systemic right ventricle (SRV) is based on morphological differences between right and left ventricles (RVs and LVs). RV adaptation to systemic afterload includes increased circumferential (GCS) over longitudinal global myocardial strain (GLS) with an unknown impact on intracavitary blood flow distribution. This study aimed to explore the SRV pattern of hemodynamic forces (HFs).

Methods
4D-Flow cardiovascular magnetic resonance data were acquired using a prototype sequence on a 1.5-T MAGNETOM Aera. The ratio between transverse (inferior-anterior, HFIA and septal-lateral, HFSL) and longitudinal (basal-apical, HFBA) HFs (RRMS) was calculated as in Figure 1, for systole and diastole.

Results
We enrolled 12 adults with SRV (6 D-transposition of great arteries after atrial switch operation and 6 L-transpositions) and 12 age-matched healthy subjects (41±12 vs 42±13,p = 0.89).
SRVs reported comparable end-diastolic volumes (83±18 ml/m2), ejection fraction (60±8%) and GLS (−20.2±3.8%) to control RVs (75±13 ml/m2,p = 0.18; 64±5%,p = 0.25; −23±5.6%,p = 0.21). Differently, SRV mass (55±24 g/m2) and GCS (−18.9±7.8%) were greater than RVs (20±3 g/m2,p&lt;0.001 and −12.4±4,p = 0.016) and comparable to control LVs (57±11 g/m2,p = 0.7 and −20.2±3.8%,p = 0.3). The 4D-Flow analysis showed that SRV systolic RRMS (0.98±0.31) was similar to LVs (0.94±0.27,p = 0.78) but lower than RVs (1.32±0.45,p = 0.04). This reflected a significantly increased HFBA with respect to RVs (0.338±0.150 vs. 0.162±0.097, p = 0.0025) and similar to LVs (0.462 ± 0.186, p = 0.087). Concomitantly, a moderate correlation was demonstrated between SRV systolic HFBA magnitude and GCS (r2=0.47,p = 0.013). During diastole, SRVs showed lower HFBA (0.173±0.086) than LVs (0.304±0.104,p = 0.0028), revealing a diastolic RRMS (0.74 ± 0.14) comparable to RVs (0.73 ± 0.17,p = 0.95) and significantly different from LVs (0.50 ± 0.19,p = 0.003).

Conclusions
In SRVs, RRMS is similar to LVs during systole, possibly as a result of increased GCS. Inversely, the SRV filling appears to be closely related to ventricular morphology as suggested by RRMS comparable to RVs during diastole.
Right ventricular to pulmonary artery coupling change after catheter ablation of atrial fibrillation
Authors: Bonelli A , Degiovanni A , Cersosimo A , Spinoni E G , Bosco M , Dell'era G , Patti G , Adamo M , Curnis A , Moreo A , De Chiara B C , Gigli L , Giannattasio C , Metra M , Inciardi R M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Right ventricular (RV) to pulmonary artery (PA) coupling can be assessed using the ratio between tricuspid annular plane systolic excursion (TAPSE) and pulmonary arterial systolic pressure (PASP). Although its use has been widely adopted in clinical practice, less is known about its role in patients with atrial fibrillation (AF) and its change after catheter ablation.

Purpose
The aim of this study is to assess the changes and the clinical impact of RV-PA coupling in patients with AF who underwent catheter ablation.

Methods
This is a prospective study that enrolled patients undergoing catheter ablation for AF between March 2021 and September 2022 in three tertiary centers in Italy. We evaluated the changes in RV structure and function and TAPSE/PASP between baseline and the 3-month follow-up and their relation with AF relapse after procedure.

Results
A total of 135 patients were included (mean age 65.2 ± 9.1 years; 68% males, mean left ventricular ejection fraction [LVEF] 56.9 ± 7.9%). Patients in the lowest tertile (TAPSE/PASP &lt; 0.67 mm/mmHg) were older, with and LVEF and LV global longitudinal strain (LVGLS). They also showed lower TAPSE, S’ wave at Tissue Doppler and RV global strain and higher PASP.
In the overall population, after 3 months from the ablation procedure, we observed a significant increase of TAPSE (from 22.4 ± 4.1 to 24.0 ± 3.8, p &lt; 0.001), a reduction of PASP (from 29.5 ± 6.6 to 27.9 ± 7.7, p = 0.030) and an increase in TAPSE/PASP from 0.81 ± 0.27 to 0.93 ± 0.29 (p &lt; 0.001). The latter improved both in the patients who were in sinus rhythm (p = 0.031) and with AF (p = 0.003) at baseline.
Compared to patients in the highest TAPSE/PASP tertile, those in the lowest one (TAPSE/PASP &lt; 0.67 mm/mmHg) showed an increased risk of AF relapse after catheter ablation (OR 4.33, 95% confidence interval 1.25 – 14.96, p = 0.020). Moreover, the increase of TAPSE/PASP ratio during the follow-up period was associated with a reduced probability of AF relapse, after adjustment for covariates (OR 0.70, 95% confidence interval 0.49 – 0.99, p = 0.046).

Conclusion
In a multicenter cohort of patients with AF undergoing catheter ablation, a significant improvement of RV-PA coupling, assessed by the TAPSE/PASP ratio, has been observed, regardless of rhythm at admission. Moreover, TAPSE/PASP at baseline, and its change, may represent a useful parameter to predict AF relapse after the procedure.
Should we use a semi-quantitative assessment of apical rocking to predict outcome in CRT patients?
Authors: Puvrez A , Mirea O , Wouters L , Bezy S , Beela A , Duchenne J , Donal E , Voigt J U 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Apical rocking (AR) is a systolic septal-to-lateral motion of the apex observed on echocardiography in the apical 4-chamber view in some patients with a ventricular conduction delay. It is a strong predictor for outcome after cardiac resynchronization therapy (CRT) and has been suggested as selection criterion for CRT. Critics argue that simple visual assessment of AR may be too subjective for clinical use. Speckle-tracking based myocardial motion analysis may allow to objectify AR and may reduce a potential observer dependence.

Purpose
To compare the visual assessment of AR (VAR) to the semi-quantitative assessment of AR (QAR) in patients for the prediction of (i) volume response and (ii) all-cause death after CRT. To assess interobserver agreement for VAR and QAR.

Methods
We retrospectively analyzed data from 166 patients with a first CRT implantation. All patients had an echo before CRT implantation and approximately 1 year after implantation. VAR and QAR analysis were performed by three experienced observers on echocardiographic apical 4-chamber views before CRT implantation. QAR was obtained by performing speckle-tracking in the apical segments of the lateral and septal wall. A negative lateral displacement with a positive septal displacement during systole was considered as AR (Figure). Areas under the ROC-curves (AUC) for prediction of volume response were determined and compared using the DeLong method. Volume response was defined as a ≥15% decrease in left ventricular end-systolic volume (LVESV) within 1 year. Patients were followed for a mean duration of 5.2 years. Hazard ratios (HR) for all-time all-cause death after CRT were calculated using an univariate Cox proportional-hazards regression model. Interobserver agreement was analysed using the intraclass correlation coefficient (ICC) based on an average measurement, absolute agreement, two-way mixed effects model.

Results
77% (n = 122) of patients were volume responders. Seven patients died before follow-up echocardiography. 31% (n = 52) of patients died during follow-up. AUC for volume response were similar for VAR and QAR (0.73 vs 0.72, p = 0.782). HR for all-time all-cause death were similar for VAR (0.39, 0.25–0.61; p&lt;0.001) and QAR (0.37, 0.23–0.59; p&lt;0.001). ICC was good for VAR (0.78; 0.55–0.90) and QAR (0.84; 0.67–0.93).

Conclusion
Semi-quantification of AR (QAR) using speckle-tracking technology achieves comparable results as the simple visual assessment of AR (VAR) when performed by an experienced reader for prediction of volume response and prediction of all-cause death in patients eligible for CRT. Interobserver agreement for VAR and QAR was similarly good. QAR could be used as confirmation of the visual assessment and may support clinicians less familiar with the visual assessment.
Is relevant to add stress echocardiography with semi-supine bicycle at the screening of pulmonary hypertension in systemic sclerosis patients?
Authors: Ayala- Leon M I G U E L , Ramirez-Sanchez P , Rodriguez-Reyna T , Mercado-Velazquez P , Orihuela-Sandoval C , Hernandez-Oropeza J L 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pulmonary hypertension (PH) is the leading cause of death in systemic sclerosis, with a 50% mortality rate within three years of PH diagnosis. The 3-year survival of patients with SSc and PH is estimated to be 56% compared with 94% for those without PH.(1,2). Patients with SSc are at risk of developing group 1 to 3 PH. Detection of PH with echocardiography at rest remains the essential clinical tool; several studies suggested that in patients with SSc, an even earlier change would be the abnormal increase in pulmonary pressures with exercise. (3–6)

Purpose
Exercise-induced pulmonary hypertension may represent an early but clinically relevant phase in the spectrum of pulmonary vascular disease. On the other hand, increases in mean pulmonary artery pressure on exercise echocardiography can be followed over time, indicating the progression of the pulmonary vascular disease before PH.

Methods
Observational, prospective, cross-sectional, and analytical study.
A basal transthoracic echocardiogram (TTE) and physical stress echocardiogram test were performed, and a TTE follow-up at four years.

Results
40 patients. A follow-up was 48 months ED 6 months. Women (93%). Mean age of 49.8 ED 11.4 years. 9.8% of the patients had systemic arterial hypertension; no patient had diabetes mellitus or other chronic-degenerative diseases.
28 (68.3%) patients had the limited cutaneous variety, and 13 (31.7%) patients had the diffuse type.
In the basal TTE at the first visit, all had a low probability of presenting pulmonary hypertension; in the follow-up echocardiogram, 11 (26.8%) patients showed a high likelihood of pulmonary hypertension.
TTE with a cycle ergometer at first visit: 19 (46.3%) patients presented PSAP &gt;50 mmHg, 16 (39%) patients gave DeltaPSAP &gt;24 mmHg, 19 (46.3%) patients showed a relationship mPAP &gt;30 mmHg + PVR &gt; 3 mmHg/L/min
The correlation between stress test variables and the high probability of pulmonary hypertension at follow-up was PSAP&gt;50 mmHg exercise (r 0.58, p&lt;0.001). Delta PSAP &gt;24 mmHg exercise(r 0.40, p 0.011). mPAP&gt;30 mmHg + PVR&gt;3 mmHg/L/min exercises (r 0.45, p 0.003). PVR and &gt;3 mmHg/L/min (r 0.15, p 0.310).

Conclusion(s)
Exercise-induced pulmonary hypertension is a promising tool in screening patients with systemic sclerosis for the detection of pulmonary hypertension at earlier preclinical stages.
Identifying patients with closer follow-up for TTE at rest every 3 to 6 months and not every year as suggested in this disease.
Troponin and NT-proBNP in the prediction of impaired myocardial deformation after STEMI
Authors: Tomoaia R , Beyer RȘ , Zdrenghea D , Dadarlat-Pop A , Hada N C , Moldovan O , Chetan I M , Fringu F I , Cismaru G L , Minciuna I A , Pop D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): University of Medicine and Pharmacy “Iuliu Hațieganu” Cluj- Napoca.

Introduction
One adverse consequence that may follow an ST-elevation myocardial infarction (STEMI) is left ventricular (LV) remodeling. The majority of evidence indicates speckle-tracking echocardiography and global longitudinal strain may identify early changes in deformation after MI, while circumferential strain (GCS) is less extensively studied. However, since strain is thought to be afterload-dependent, the global work index (GWI), a novel afterload-incorporating parameter recently evolved.

Objective
The aim of this study was to determine whether the levels of high-sensitive troponin and NT-proBNP, two variables known to be of prognostic significance in STEMI, might indicate whether GCS and GWI are more impaired after STEMI.

Material and methods
60 patients with STEMI and preserved LVEF who underwent PCI were included in the study. Using a Vivid E95 scanner, early echocardiography (2–4 days) was performed, and the EchoPac BT13 software (GE Vingmed ultrasound) was used for analysis. Both conventional and deformation parameters were assessed. GWI was determined by using pressure-strain loops (strain and estimated LV pressure from the peak arterial brahial cuff pressure). ROC curves were used to determine the optimal cut-off values of Troponin and NT-proBNP to predict the values below the median for each of the studied parameters (GCS and GWI).

Results
The mean age of the patients was of 68±13 years and 55% were male. The majority of the patients presented with anterior MI (n=29, 48.3%), followed by inferior MI (n=25, 42%). Patients frequently reported hypertension (n=45,75%), while others had dyslipidemia (n=15, 25%), diabetes (n=8, 13.3%), and smoking (n=23, 38.3%) as cardiovascular risk factors. The median values of NT-proBNP were 600 [280–1930] pg/mL and 0.52 mg/dL [0.16–1.6] for troponin, respectively. Mean values of GCS were −11.6 ± 5.1% and of GWI were 927 ± 403 mmHg%.
We analysed the ROC curves of troponin and NT-proBNP to predict values below the median of −10% for GCS and of 937mmHg% for GWI (Fig.1). We found that troponin values &gt; 0.612 mg/dL (AUC 0.674, 95% CI 0.541 to 0.790, p = 0.014, Se 66%, Sp 71%) and NT-proBNP values &gt; 715 pg/mL (AUC 0.678, 95 %CI 0.545 to 0.793, p = 0.0117, Se 59%, Sp 74%) were able to predict more impaired GWI. Interestingly, only troponin values &gt; 0.315 mg/dL, a threshold that was lower than in the case of GWI, were able to predict more impaired GCS (AUC 0.755, 95% CI 0.627 to 0.857, p&lt;0.0001, Se 91%, Sp 58%).

Conclusion
High sensitive troponin and NT-proBNP may indicate more impaired myocardial mechanics after STEMI. Both GCS and GWI, a parameter integrating strain and afterload, may provide additional information In the early stages of remodeling following MI.
Discordance between conventional functional parameters and 3D echocardiography-derived ejection fraction in the detection of right ventricular systolic dysfunction
Authors: Tolvaj M , Radu N , Cascella A , Muraru D , Lakatos B , Fabian A , Tokodi M , Tomaselli M , Gavazzoni M , Perelli F , Merkely B , Badano L P , Kovacs A , Surkova E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EFOP-3.6.3-VEKOP-16-2017-00009 project.

Background
The conventional echocardiographic parameters of the right ventricular (RV) systolic function (e.g., tricuspid annular plane systolic excursion - TAPSE, fractional area change - FAC) only partially portray the complex functional characteristics of the RV; therefore, they may fail to capture the full spectrum of RV dysfunction and associated adverse clinical outcomes. 3D echocardiography-derived RV ejection fraction (RVEF) is a well-validated and reproducible parameter that overcomes these limitations.

Purpose
We aimed to investigate the discordance between TAPSE, FAC and RVEF in RV systolic function grading and associated outcomes.

Methods
Two retrospective databases from different centers including consecutive patients with various cardiac diseases who underwent clinically indicated 2D and 3D echocardiography (n=750) were analysed. Patients were followed up for the occurrence of all-cause mortality. RVEF was measured by a single, commercially available 3D software package. Guideline-recommended cut-off values were used to indicate RV systolic dysfunction (TAPSE&lt;17 mm, FAC&lt;35%). RVEF &lt;45% served as the "ground truth" of RV dysfunction.

Results
Among patients with normal RVEF (n=511), 109 (21%) had reduced TAPSE, 168 (33%) had reduced FAC, and 49 (10%) had both reduced TAPSE and FAC. Among patients with reduced RVEF (n=239), 108 (45%) had normal TAPSE, 57 (24%) had normal FAC, and 38 (16%) had both normal TAPSE and FAC. Correspondingly, sensitivity and specificity for discrimination of RV systolic dysfunction (RVEF&lt;45%) were 66% and 70% for TAPSE, and 71% and 76% for FAC on ROC analysis, respectively (Figure 1).
During the median follow-up time of 3.7 years, 112 patients (15%) died. Using univariable Cox regression, TAPSE (HR [95% CI]: 0.911 [0.881–0.942]), FAC (0.940 [0.924–0.957]), and RVEF (0.928 [0.913–0.944]) were all significant predictors of mortality (p&lt;0.001). Interestingly, combination of the functional assessments based on either TAPSE or FAC with RVEF separates four risk groups that differ significantly in terms of all-cause mortality (Kaplan-Meier curves, Figure 2, log-rank p&lt;0.05).

Conclusion
Guideline-recommended cut-off values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. This phenomenon may hinder the proper risk stratification of patients with RV systolic dysfunction.