bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contemporary early left ventricular thrombus resolution by echocardiography: insight from a longitudinal multicenter registry
Authors: Mantovani F , Bursi F , Pedone C , Celeste F , Passarini G , Concilio C , Formigaro L , Turina M C , Malagoli A , Pistelli L , Zito C , Benfari G , Bartolacelli Y , Barbieri A , Pepi M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Multicenter longitudinal data are lacking regarding the incidence and the time needed for total left ventricular thrombus (LVT) regression obtained with contemporary antithrombotic regimens diagnosed with modern echocardiographic technology.

Purpose
To quantify the effect of antithrombotic therapy on LVT evolution using sequential up-to-date echocardiography in a large cohort of patients with LVT.

Methods
Ten centers were involved in this observational prospective multicenter study. LVT was defined as an echo-dense mass adjacent to a hypokinetic or akinetic myocardial segment. To be distinguishable from the underlying myocardium, a clear thrombus–blood interface was required and the LVT had to be visible on at least 2 views during the cardiac cycle. Initial follow-up echocardiograph was scheduled at 14±7 days (T0) and 42±7 days (T1). The early resolution was defined when LVT was no longer detected at T1. The use of different anticoagulant regimens and ultrasound contrast was left at the discretion of attending physicians, according to good clinical practice.

Results
From October 2020 to November 2022, 99 patients with LVT (mean age 66 ± 11 years, 80% men) were identified with echocardiography, in 53% ultrasound contrast was used. Early resolution of LVT was observed in 42%. Echocardiographic characteristics by early resolution of LVT are shown in Table. The independent correlates of early LVT regression were smaller baseline LVT area, higher LVEF, and mobile LVT (p&lt;0.05).

Conclusions
In this large and well-characterized present-day cohort of patients with LVT, early regression by echocardiography was achieved in less than half of the patients and was mostly related to the size of the LVT and heart function rather than treatment despite a high proportion of antithrombotic therapy. The next step will be to assess the impact of LVT persistence on subsequent clinical outcomes.
The impact of real-time guiding by deep learning on test-retest variability of automated left ventricular systolic function measurements
Authors: Pettersen H , Saeboe S , Pasdeloup D , Olaisen S , Oestvik A , Boen G C , Langoey P K , Jakobsen P O , Smistad E , Stoelen S , Grenne B , Loevstakken L , Dalen H , Holte E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian University of Science and Technology, St. Olavs University Hospital, Central-Norway Health Authority.

Background
Left ventricular (LV) ejection fraction (EF) and left ventricular volumes are key parameters for characterisation of cardiac function. Test-retest variability of EF and LV end-diastolic volume (EDV) are dependent on image quality and analyses. Foreshortened LV recordings cause inaccuracies in estimation of EF and EDV. Real-time guiding of LV length using deep learning (DL) could improve standardization of image acquisition and reduce variability of automated analyses of EF (auto-EF) and EDV (auto-EDV).

Purpose
To study the impact of real-time feedback of LV length using a robust deep-learning (DL) software during echocardiography on variability of automated analyses of EF (auto-EF) and EDV (auto-EDV).

Methods
Patients with mixed cardiac pathology were consecutively included if they were in sinus rhythm without need for contrast. Three consecutive echocardiograms were performed; the first and second by two of three experienced sonographers (Sonographer 1 and 2) and the third (reference) by one of four cardiologists in random order, all affiliated to an EACVI accredited echocardiographic laboratory. All exams included the standard apical views, and the reference exams also included tri-plane recordings of the LV. All measurements were done retrospectively using automated algorithm for measuring. LV volumes were measured in four- and two-chamber views and averaged by the method of discs’ formula. LV EF was calculated as biplane measurements. The coefficients of variation (CV) between sonographers and cardiologists were compared for both LV EF and end-diastolic LV volume from biplane measurements. One-way ANOVA was used to estimate within-patient variation for automated and manual measurements.

Results
A total of 47 patients (47% women) were included with mean (SD) age 64 (15) years. There was no significant difference in CV for neither auto-EF nor auto-EDV using the DL tool (Table) compared to standard care. Manual and automated measurements of LV volumes and EF correlated well with R 0.91 and R 0.74, respectively (only data for EF shown in the figure).

Conclusion
Real-time guiding did not significantly reduce variation of automated analyses of LV volumes and EF when used by experienced sonographers. Further studies are needed to evaluate the effect of real-time guiding to optimize LV acquisition in inexperienced users.
Photon-counting detector CT enables more precise assessment of coronary artery stenosis
Authors: Balogh H , Vertes M , Nagy N , Kerkovits N , Vecsey-Nagy M , Boussoussou M , Vattay B , Szilveszter B , Merkely B , Maurovich-Horvat P , Simon J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Hungarian Academy of Sciences.

Introduction
In contrast to conventional energy-integrating detectors, photon-counting detector (PCD) CT translates the photon energy directly to electric signal, which allows image acquisition with lower noise and improved spatial resolution.

Objective
The aim of our study was to assess coronary stenosis by comparing conventional CT and PCD-CT.

Method
In our retrospective study, we included patients who underwent coronary CT angiography (CCTA) performed by PCD-CT between January and December 2022. The control population consisted of consecutive patients who underwent coronary CCTA with a 280-slice CT. In our study, heart transplanted patients, patients with stent, pacemaker or valve implantation, or non-diagnostic image quality were excluded. The degree of coronary stenosis was evaluated according to the following classification: normal coronary artery (0%), minimal (1–24%), mild (25–49%), moderate (50–69%), severe stenosis (70–99%) or occluded coronary artery (100%).

Results
A total of 812 consecutive patients were included in our study (n=401 control, n=412 PCD-CT). There was no difference between the two groups in mean age (58.1±11.9 vs. 58.7±12.8 years) and sex (48.4% vs. 42.6% female). We found a significant difference in the degree of CAD between conventional CT and PCD-CT as follows: normal coronary arteries 29 vs 26%; minimum 23 vs 31%; mild 20 vs 23%; moderate 15 vs 10%; severe 12 vs 9%; occluded 3 vs 2%, respectively (all p&lt;0.001).

Conclusions
According to our preliminary results, PCD-CT is less likely to overestimate the degree of stenosis and can detect smaller plaques more precisely.
Left atrial pump strain predicts mortality in patients undergoing transcatheter aortic valve implantation
Authors: Winkler N , Anwer S , Reeve K A , Rumpf M , Tsiourantani G , Tanner F C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Swiss Heart Foundation, Novartis Foundation.

Introduction
Speckle-tracking echocardiography is an increasingly important tool for the assessment of degenerative aortic stenosis (AS), the most common valvular heart disease in the Western world with growing prevalence in the aging population. Left atrial reservoir (LARS) and pump strain (LAPS) were studied for their association with all-cause mortality in AS patients undergoing transcatheter aortic valve implantation (TAVI).

Purpose
To investigate left atrial function assessed by LARS and LAPS and its association with all-cause mortality during long-term follow-up after TAVI.

Methods
From our prospective AS registry, 198 patients with severe AS were identified who underwent TAVI and had a comprehensive echocardiographic examination prior to the procedure, allowing full target analysis with TomTec Image Arena. All-cause mortality was defined as the endpoint.

Results
Left atrial volume index (LAVI) was increased (mean (SD): 46.9 ml/m2 (16.5)) and left atrial deformation (LARS (21.7 % (6.9); LAPS (−9.5 % (4.5)) impaired in the study population, while left ventricular ejection fraction (LVEF) (56.7 % (11.5)) was preserved. During a median follow-up time of 1835 [IQR 1371 – 2337] days, 70 patients (35.4 %) died. There was no significant difference between women and men. LARS and LAPS were lower in non-survivors (20.3 % (6.7) and −8.4 % (4.1), respectively; Figure 1) than survivors (22.5 % (6.9); P = 0.034 and −10.1 % (4.6); P = 0.012; Figure 1), while LAVI did not differ (P = 0.175). In univariable Cox regression models, LAPS was associated with all-cause mortality (HR 1.06 [95% CI 1.01 – 1.12]; P = 0.029; ꭓ2 5.03; ꭓ2 P = 0.025), while LARS was not (HR 0.97 [0.94 – 1.01]; P = 0.120; ꭓ2 2.50; ꭓ2 P = 0.114). In bivariable models, association of LAPS with mortality was independent of gender (data not shown), STS-Score, LVEF and LAVI (Figure 2). Likelihood ratios revealed that inclusion of LAPS to STS-Score, LVEF or LAVI improved the fitness of predictive models (Figure 2), while that of LARS did not (data not shown).

Conclusions
LAPS was associated with mortality after TAVI, while LARS and LAVI were not. The association of LAPS was independent of STS-Score, LVEF, and LAVI and showed potential incremental value for assessment of outcome association. Hence, left atrial dysfunction as reflected by LAPS was a predictor of mortality and may be a useful follow-up parameter after TAVI.
CCTA characteristics of vulnerable plaques preceding acute coronary syndromes-a comparative analysis between STE- and NSTE-ACS
Authors: Opincariu D , Rat N , Gorea Stanescu A , Blindu E , Matyas B , Kovacs I , Benedek I , Benedek T 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the University of Medicine, Pharmacy, Science and Technology „George Emil Palade“ of Târgu Mureș Research Grant number 510/13/17.01.2022.

Background
CCTA adverse plaque features, that illustrate increased vulnerability, have been established as significant predictors for adverse events in patients with coronary artery disease. Decades of research have benchmarked the implication of vulnerable plaques (VP) in the occurrence of acute coronary syndromes (ACS). Still, there is little information concerning the interrelation between VP features and the subsequent type of ACS.

Aim
We sought to identify specific characteristics of future culprit vulnerable plaques, in a comparative analysis between the type of ACS they trigger, in patients undergoing CCTA and plaque analysis for stable chest pain.

Material and Methods
We conducted a prospective analysis, with a 3 year follow-up, on 50 subjects who underwent CCTA evaluation for stable chest pain. Coronary plaques were analyzed at baseline, for lesions that presented moderate stenosis, with at least one vulnerability marker (LAP, PR, NRS, SCs), which became culprit lesions during follow-up. Patients were initially divided into 2 groups (gr.1 – with STE-ACS, n=13) gr.2 – patients with NSTE-ACS, n=37). The secondary analysis divided the population in 3 groups gr.1-patients with UA (n=28); gr.2- with STEMI (n=13); gr.2 –with NSTEMI (n=9).

Results
The time to the occurrence of an ACS was higher for STE-ACS compared to NSTE-ACS (169.9±177.4, p&lt;0.001), which was similar when comparing NSTEMI vs. UA vs. STEMI (p = 0.0001). The lowest degree of stenosis was present for VP that had triggered NSTEMI (p = 0.03). Evaluation of plaque composition revealed that the STE-ACS group presented higher non-calcified (171.6±63 vs. 130.6±80.1 mm3 p = 0.04) and lipid rich (19.9±16.7 vs. 11.42±10.5 mm3, p = 0.04) volumes, with no other differences regarding plaque composition and morphology. Plaques that had triggered STEMI during follow-up, presented highest non-calcified (p = 0.01) and lipid rich (p = 0.01) volumes. The greatest number of plaques with over 2 vulnerability markers per lesions were found in NSTEMI precursor lesions compared to UA and STEMI (77.8% vs. 53.8% ±25%, p = 0.01).

Conclusions
Compared to NSTE-ACS triggering lesions, vulnerable plaques that precede STEMI-ACS present a more lipid rich, non-calcified phenotype. NSTEMI precursor lesions are heterogeneous, with a low calcium volume and increased number of vulnerability markers, while VPs triggering unstable angina are calcified, with a low lipid rich volume and spotty calcifications.
Implications of methods for calculating the left ventricular outflow tract area in aortic stenosis severity grading
Authors: Lozano Edo S , Calvo-Asensio M , Sanz-Ros J , Rodriguez-Serrano M , Buendia-Fuentes F , Navarrete J , Sorolla J A , Osa-Saez A , Martinez-Dolz L , Aguero J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): - Spanish Ministry of Economy and Competitiveness through the Carlos III Institute of Health-Fondo de Investigación Sanitaria.
- Post-residency research contract. Medical Research Institute Hospital La Fe (IIS La Fe), Valencia, Spain.

Introduction
Aortic valve area (AVA) calculation by continuity equation is a fundamental aspect to estimate aortic stenosis (AS) severity. The estimation of the left ventricular outflow tract (LVOT) area is a source of technical variability in the calculation of AVA that can lead to errors in severity grading. Formulas for calculating LVOT diameter (LVOTd) based on body surface area (BSA) and patient height have been proposed, but their impact on reclassifying patients based on severity has not been described.

Purpose
To evaluate the differences in AS grading according to the LVOT area used in the calculation of the AVA.

Methods
We retrospectively analyzed (2019–2022) 1722 echocardiograms with a diagnosis of AS and with the following variables reported: AVA calculated using the continuity equation, height and weight of the patient. Predicted LVOTd by BSA was calculated by the formula: (5.7*BSA + 12). Predicted LVOTd by height was calculated as: (5.78 * height + 12.1).

Results
LVOT area and AVA from predicted LVOTd based on BSA and height showed slightly higher values. The AVA based on the LVOTd predicted by BSA was associated with a lower prevalence of severe AS, as well as a lower prevalence of discordant cases (mean gradient &lt;40 mmHg and AVA &lt;1 cm2) (Table). The AVA based on both methods of predicted LVOTd led to a reclassification from severe (by the standard method) to non-severe in a significant percentage of patients (13.6% for the BSA-predicted method, and 8.7% for the height-predicted method). For the AVA predicted by BSA, the "downgrade" of AS severity was more frequent (23.3%) in patients in the quartile with the highest BMI (&gt;30 kg/m2), while the degree of obesity did not affect the method predicted by height.

Conclusion
Despite suppressing the potential errors derived from the LVOTd measurement, the AVA based on predicted LVOTd methods using BSA or height lead to a significant percentage of reclassification in terms of severity and prevalence of discordant severe AS due to low gradient. In obese patients, the method predicted by BSA is highly discordant and the method predicted by the patient's height is preferable.
Aortic stenosis progression by different echocardiographic parameters: which one should we use?
Authors: Lozano Edo S , Sanz Ros J , Calvo Asensio M , Navarrete J , Sorolla J A , Buendia Fuentes F , Rodriguez Serrano M , Martinez Dolz L , Osa Saez A , Aguero J 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): - Spanish Ministry of Economy and Competitiveness through the Carlos III Institute of Health (Fondo de Investigación Sanitaria).
- Post-residency research contract. Medical Research Institute Hospital La Fe (IIS La Fe), Valencia, Spain.

Introduction
Aortic stenosis (AS) is a significant health problem, particularly in older individuals, and is the most common valve disease necessitating surgical or percutaneous intervention. Echocardiography is central in the diagnosis, management and assessment of disease progression of AS patients. AS severity grading is based on 3 parameters: aortic valve area by continuity equation (AVA), mean gradient (MG), and peak aortic valve velocity (Vmax). Although the AVA is relevant in low gradient situations, its calculation is more complex and therefore may show greater technical variability. Knowing the differences between the 3 parameters to assess progression may be useful in clinical practice.

Purpose
Assess the differences between the 3 main quantitative parameters to detect the progression of disease in patients with AS.

Methods
We retrospectively analyzed a cohort of 130 patients with a diagnosis of isolated AS (without other valve disease) and 2 echocardiograms performed at an interval of more than 1 year, in which the AVA calculated using the continuity equation was measured. The annual rate of change of AVA, MG, and Vmax, and the proportion of patients with progression based on predefined criteria (AVA decrease &gt;0.2 cm2, MG increase &gt; 10 mmHg, and Vmax &gt; 30 cm/s) were analyzed.

Results
The mean interval between the 2 echocardiograms was 26 (9) months. Globally, the annual rate of change was small for the 3 parameters, with a higher proportion of relevant progression considering Vmax (49.2%), and lower for MG (28.5%), being intermediate for AVA (36.1%) (Table). Of the 47 patients with AS progression by AVA criteria, progression by Vmax criteria was observed in 32 patients (68%), and only in 19 patients (40%) by MG criteria.

Conclusions
Although the criterion for progression of AS based on Vmax is considered in the clinical practice guidelines, in many patients it is not associated with relevant changes in AVA or MG. Discrepancies on AS progression across different parameters is frequent and may lead to inconsistent decision making.
Right ventricular strain by speckle tracking echocardiography in patients with systemic scleroderma and absence of pulmonary hypertension
Authors: Karapedi E , Tsagaropoulos A , Kalavri E , Giannakopoulou I , Antoniades K , Hamodraka E , Tsoukas A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In patients with scleroderma the morphological remodeling and alteration of right ventricular (RV) function begins even before the setting of pulmonary artery hypertension (PAH). These alterations are associated with worse outcomes and high mortality rate as 30% of deaths are attributed to cardiovascular causes followed by respiratory causes (17%).

Purpose
Early detection of RV dysfunction is possible using advanced imaging techniques and can lead to specific therapeutic management before installation of PAH and clinical signs and symptoms of heart failure . Purpose of this study is to evaluate new indices, based on speckle tracking echocardiography, for identification of subclinical RV systolic failure.

Methods
Thirty (30) scleroderma patients without any signs or symptoms of PAH and forty (40) healthy subjects were included in the present study. Two-dimensional echocardiography (2DE) and two-dimensional speckle-tracking echocardiography (2DSTE) were performed. All the usual 2DE, Doppler and tissue Doppler imaging measurements were obtained for the evaluation of RV function. Moreover, TAPSE, maximum systolic myocardial velocity from TDI of lateral tricuspid valve annulus (SRV), auto RV global longitudinal strain (aRVGLS) and auto RV free wall longitudinal strain (aRVFWLS) by 2DSTE were measured. aRVGLS and aRVFWLS are new indices, with appropriate RV function echo logistics in new technology echo systems, independent from known manual measurements.

Results
In scleroderma patients significantly higher systolic pulmonary artery pressure was recorded, although it remained within normal limits in both groups (24.6+-5.4mmHg vs 19.2+-5.9 mmHg) . Scleroderma patients had significant decreased RV systolic function with significantly lower TAPSE and SRV. Both aRVGLS and aRVFWLS were also lower in scleroderma patients compared to the control group (−18.6+-2.7 vs −23.1+-2.3 % and −25.4+-3.1 vs −26.4+-2.2 % respectively). aRVGLS was the best significant predictor of early RV systolic impairment in patients with scleroderma.The difference in aRVFWLS was not significant.

Conclusions
Scleroderma is a severe systematic disease associated with high mortality rates. RV remodeling, dysfunction, and progressive pulmonary artery hypertension are among the most important internal organ manifestations of this disease. Early detection of RV dysfunction before installation of pulmonary hypertension is possible by 2DSTE, and may be helpful to guide further therapy in these patients.
Impact of plasma volume redistribution on outcomes in patients with heart failure with reduced ejection fraction
Authors: Skidan V I , Goda A Y , Challa A B , Pislaru C , Nkomo V T , Miller W L , Pislaru S V 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The impact of capacitance and blood volume redistribution on outcomes of patients with chronic heart failure is incompletely understood. Quantitative plasma volume (PV) measurements together with echocardiographic evaluation allow a comprehensive assessment of the interplay between volumetric overload, cardiac chamber remodelling and myocardial function.

Purpose
We hypothesize that PV expansion is associated with myocardial and renal dysfunction, right ventricular-pulmonary arterial uncoupling and unfavorable outcomes in HF patients with reduced ejection fraction (HFrEF).

Methods
Patients hospitalized at Mayo Clinic with decompensated HF and who had PV by the indicator-dilution nuclear methodology (Daxor BVA100) were included. Patients were considered hypervolemic if BV was ≥25% over expected. The primary endpoint was the composite of all-cause mortality or heart transplantation. The closest TTE to the time of PV was used to measure various indexes of myocardial performance (standard echo parameters and global chamber-specific strain parameters). Event-free survival was estimated using the Kaplan-Meier method. The relationship between PV and various parameters was evaluated with correlation coefficient (r²).

Results
A total of 65 patients were enrolled in the study. Reduced LVEF was present in 53 (81.6%) patients. There were 44 events (32 deaths, 12 heart transplants) after a median follow-up of 43 months (IQR 14–65). Results in patients with HFrEF are presented in the Table. Our main findings were: 1) PV expansion was associated with an increased risk of adverse events (Figure 1); 2) Volume redistribution correlated with various indexes of cardiac chamber function, suggesting that volume overload and associated cardiac remodeling may be responsible for altered myocardial mechanics in patients with HFrEF (Figure 2); 3) right ventricular-pulmonary arterial uncoupling was triggered by the plasma volume expansion, that causes postcapillary pulmonary hypertension; 4) PV redistribution was also associated with renal dysfunction and increasing the level of the protein catabolism (Table 1).

Conclusion
Expansion of plasma volume in HFrEF patients is associated with left atrium dilatation, abnormal filling of both atria and right ventricular dilatation / dysfunction. Plasma volume redistributions apparently became a trigger of right ventricular-pulmonary arterial uncoupling and stimulated postcapillary pulmonary hypertension, renal dysfunction with increasing the level of protein catabolism and unfavorable outcomes.