bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic significance of calibrated integrated backscatter in patients submitted to transcatheter aortic valve implantation
Authors: Ferreira A , Teixeira R , Rio P , Timoteo A T , Branco L , Leal A , Varela F , Cacela D , Galrinho A , Ferreira R C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
There is a reported association between calibrated integrated backscatter (cIB) and myocardial fibrosis, mostly noted in cardiomyopathies and aortic stenosis cases. But whether this measure of myocardial ultrasound reflectivity could help predict outcomes in patients submitted to transcatheter aortic valve implantation has not been previously tested.

Purpose
To demonstrate whether cIB may help differentiate patients undergoing transcatheter aortic valve implantation (TAVI) at risk of major cardiovascular events.

Methods
Consecutive patients submitted to transfemoral TAVI between October 2020 and December 2021 were routinely imaged by echocardiography in the five days peri-procedure. Calibrated integrated backscatter was obtained from the parasternal long-axis view (PLAX) by subtracting pericardial cIB intensity from myocardial septal and posterior wall average cIB. Patients with poor PLAX views were excluded from the study. All measurements of cIB were performed at end-diastole. The primary endpoint was the occurrence of major cardiovascular events at one year of follow-up.

Results
A total of 184 patients underwent a TAVI procedure during the study period. Of these, 159 had a reasonable acoustic window for cIB measurement and were included in the study. Patient mean age was 81.1±6.1 years, and 58% were female. At baseline, 81% of patients had preserved left ventricle function, the mean aortic mean gradient was 44.8±15.1 mmHg, and the mean Euroscore II was 5.55±3.75. No significant association was found between cIB and TAVI-related major acute complications (21.02±10.4 vs 19.8±7.1 dB, p = 0.544). There was also no significant correlation of cIB with major cardiovascular events (19.71±7.25 vs 20.39±10.47 dB, p = 0.478) or with valve safety (19.59±7.07 vs 18.84±10.32 dB, p = 0.709), defined accordingly to the Valve Academic Research Consortium-2 consensus, at one-year follow-up. There was, however, a positive association between cIB and all-cause mortality (19.24±7.06 vs 22.92±9.36, p = 0.021) at one-year follow-up, with deaths occurring due to multiple causes, mainly cardiovascular, infectious, and neoplastic. Measured cIB was also significantly higher in patients with a pre-TAVI estimated glomerular filtration rate of less than 30 mL/min/1.73m2 (22.42±7.17 vs 19.56±6.88 dB, p = 0.043).

Conclusion
Higher cIB was not associated with a higher risk of major cardiovascular events or with valve safety in patients submitted to TAVI, but it can potentially have prognostic value in differentiating patients at increased risk of all-cause mortality.
Right ventricular-pulmonary artery coupling ratio derived from 3D echocardiography - better predictor of outcome in patients with precapillary pulmonary hypertension
Authors: Radu D N , Enache R , Calin A , Beladan C C , Rosca M , Platon P , Predescu L , Coman I M , Popescu B A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In patients with pulmonary hypertension (PH), right ventricular (RV) function has a well-known prognostic value. Recent data suggest that right ventricular-pulmonary artery (RV-PA) coupling is an independent predictor of outcome in this setting. RV-PA coupling can be assessed invasively as the endsystolic/arterial elastance ratio or noninvasively using surrogates such as CMR-derived RV stroke-volume (SV) to endsystolic volume (ESV) ratio or 2D echocardiography-derived TAPSE/PASP ratio. Data regarding the 3D echocardiography-derived RV SV/ESV as parameter of RV-PA coupling in PH patients are scarce.

Purpose
To assess the RV-PA coupling as 3DE-RV SV/ESV ratio and its impact on clinical outcome in patients with precapillary PH compared with the validated 2DE-TAPSE/PASP.

Methods
Thirty-two patients (40±13 years, 27 women) with precapillary PH receiving vasodilator therapy and 25 controls of similar age and gender (37±9 years, 18 women) were studied. Clinical data, BNP levels and RV function parameters (TAPSE, free-RV wall S- and e’-wave, RV FAC, Tei index, RV-IVA, RVEF by 3DE) were assessed. RV global longitudinal strain (RV-GLS) was measured as the average of 6 segments and RV free wall strain as the average of 3 segments by speckle-tracking 2DE. RV-PA coupling was assessed as TAPSE/PASP and 3DE-RV SV/ESV ratios. PH patients were followed for 41 months (2–77). Cardiac death was the endpoint.

Results
PH patients had impaired 2DE and 3DE RV function parameters and RV-PA coupling compared to controls (p&lt;0.001). At baseline, 3DE-RV SV/ESV and TAPSE/PAPS correlated with each other (r=0.51, p = 0.003) and both correlated with RV function parameters, but only SV/ESV correlated with BNP levels (Table) and WHO functional class (0.71±0.16 in class II, 0.66±0.21 in class III, 0.34±0.14 in class IV, p = 0.01). During follow-up, 5 patients died and these patients had at baseline higher BNP levels (LnBNP 5.91±1.62 vs 4.32±1.29, p = 0.02) and lower values of TAPSE (15±4 vs 18±3 mm, p = 0.03), S-RV (9.2±2.3 vs 11.1±1.8 cm/s, p = 0.04), RV free wall strain (−11.6±6.6 vs −18.1±5.3%, p = 0.02), RVEF (32±11 vs 40±7%, p = 0.04), and SV/ESV (0.49±0.22 vs 0.68±0.19, p = 0.05), but similar values for TAPSE/PASP (0.18±0.10 vs 0.20±0.05 mm/mmHg, p = 0.75).

Conclusion
In PH patients, 3DE-RV SV/ESV ratio as parameter of RV-PA coupling is altered and correlates with clinical status and RV function parameters. Besides parameters of RV function and BNP levels, 3DE-RV SV/ESV ratio seems a better predictor than TAPSE/PASP in this setting.
Cardiac magnetic resonance features associated with the risk of cardiac arrest in patients with acute myocardial infarction
Authors: Szabo E , Benedek T , Kovacs I , Rat N , Bordi L , Parajko Z S , Rosca A , Mihaila T , Ion B , Benedek I 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by the George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Research Grant number NR. 164 / 26 / 10.01.2023.

Background
Cardiac arrest (CA) is the most severe complication of acute myocardial infarction (AMI). The role of different factors related to the site and severity of coronary occlusion in the pathogenesis of AMI-related cardiac arrest is still under investigation.
The aim of the study was to investigate the association between (1) different cardiac magnetic resonance (CMR) features associated with the location and severity of the myocardial injury, and (2) the risk of CA accompanying an AMI.

Methods
In total, 54 patients AMI undergoing post-AMI CMR imaging with delayed gadolinium enhancement were enrolled in the study. The study lot was divided into 2 groups: group 1–8 patients who survived a CA in the acute phase of AMI and group 2–46 patients, matched for age and gender, with AMI but without CA. In all patients, infarct mass, the proportion of high transmural extent, and scar mass at different myocardial segments were calculated using the QMap software (Medis BV).

Results
Compared to patients without CA, those with CA had a significantly higher infarct mass (47.9 +/- 38 g versus 23.3 g, p = 0.03), infarct mass % (26.9 +/ 17.3% vs 15.1 +/- 8.6 %, p = 0.02), and a higher degree of transmurality (29.28 +/- 20.2 % vs 14.1 +/- 9.2 %, p = 0.01). Location of myocardial injury at the level of latero-apical, anterolateral, and bazal anterior segments seemed to be more frequently associated with the risk of CA in the acute phase of AMI: infarct mass 33.9 +/- 30.6 g in group 1 vs 13.6 +/- 17.3 g in group 2, p = 0.02 for the latero-apical segment, 26.5 +/- 29.0 g in group 1 vs 8.9 +/- 12.8 g in group 2, p = 0.02 for the anterolateral segment, and 20.1 +/- 21.5 g in group 1 vs 7.8 +/- 14.7 g in group 2, p = 0.02 for anterobazal segment.

Conclusions
Myocardial mas, high transmural extent at CMR imaging, and a large myocardial injury identified by CMR at the level of the anterior and lateral ventricular segments seems to be associated with an increased risk of CA in the acute phase of AMI.
Automated analysis of echocardiograms at diagnosis is able to predict prognosis in ATTR cardiomyopathy
Authors: Ioannou A , Patel R K , Razvi Y , Hanger M , Martinez-Naharro A , Venneri L , Chi Lim S , Yoran H , Frost M , Lam C , Gillmore J D , Fontana M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Transthyretin amyloidosis cardiomyopathy (ATTR-CM) is progressive and ultimately fatal cause of heart failure. ATTR-CM often displays characteristic echocardiographic features, and manual measurements of both stroke volume and longitudinal strain are independent predictors of mortality. We sought to investigate whether automated analysis of echocardiographic parameters at the time of diagnosis were able to predict prognosis in this population.

Methods
We analysed all consecutive patients between 2006–2021 who underwent an echocardiogram at the time of diagnosis, and analysed their echocardiograms using artificial intelligence software that has been developed and validated by Us2.ai.

Results
We identified 1972 patients with ATTR-CM (age: 75.6±8.7 years, male: 86.9%), comprising of 1329 wild-type ATTR-CM and 643 hereditary ATTR-CM (V142I = 376, T80A = 171, other = 96). Patients with V142I had an increased relative wall thickness (P&lt;0.001) lower stroke volume indexed (P&lt;0.001), and worse longitudinal strain (P&lt;0.001) than patients with wild-type and T80A ATTR-CM. In a multi-variable analysis of echocardiographic parameters selected a priori (interventricular septal diameter, relative wall thickness, left and right atrial area indexed, biplane stroke volume indexed, full thickness longitudinal strain, and E/e’ lateral), left atrial area indexed (HR=1.08, 95%CI[1.02–1.14], P=0.005), biplane stroke volume indexed (HR=0.96, 95%CI[0.94–0.98], P&lt;0.001) and full thickness longitudinal strain (HR=1.04, 95%CI[1.01–1.08], P=0.009) all remained independent predictors of mortality.

Conclusions
Automated of analysis echocardiograms using artificial intelligence demonstrated that patients with V142I had more advanced cardiac disease at diagnosis. Automated measurements produced by artificial intelligence software are able to predict prognosis and identify the same parameters as those identified using manual analysis as powerful independent predictors of mortality.
A strain-based LBBB classification predicts the degree of reverse remodeling and outcome in patients with cardiac resynchronization therapy
Authors: Duchenne J , Calle S , Aalen J , Galli E , Larsen C K , Mirea O , Puvrez A , De Buyzere M , Kongsgard E , Voros G , Penicka M , Donal E , Smiseth O A , Timmermans F , Voigt J U 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Research Foundation Flanders (FWO).

Introduction
Septal strain patterns measured by echocardiography reflect the gradual process of left bundle branch block (LBBB)-induced left ventricular (LV) remodeling. We investigated whether these strain stages also predict progressive volumetric response and outcome in cardiac resynchronization therapy (CRT) patients.

Methods
This prospective study enrolled consecutive CRT patients from 5 European centers who underwent echocardiographic examination with speckle-tracking strain analysis before CRT implantation. Dyssynchrony was assessed using septal strain curves, which were classified into 5 patterns (stage LBBB-0 to LBBB-4). The magnitude of reverse remodeling was determined at 1 year. The pre-defined outcome was death from any cause or heart transplantation.

Results
The study involved 267 patients (age 66±11 years; 69% men; 90% LBBB) with a mean LV ejection fraction (EF) of 30±7%. Across the stages, CRT resulted in a gradual volumetric response, ranging from almost no response in LBBB-0 patients (ΔLV end-systolic volume −9 ±21ml; ΔLVEF +4±8%) to super-response in LBBB-4 patients (ΔLV end-systolic volume −85 ±54ml; ΔLVEF +20±9%) (p&lt;0.001 for both). Median follow-up was 49 months. LBBB-0 patients had worst outcome (log rank p = 0.002, Figure), with subsequent LBBB stages gradually showing more favorable outcome (log rank p = 0.045, Figure). There was a stepwise decrease in adverse events according to the staged LBBB classification. LBBB stages 1 to 4 predicted long-term survival without heart transplantation with respective hazard ratios of 0.61 (95% CI 0.25–1.50), 0.26 (95% CI 0.10–0.68), 0.29 (95% CI 0.11–0.77) and 0.13 (95% CI 0.04–0.51) compared to LBBB-0. After multivariable adjustment for baseline LVEF, ischemic heart disease and presence of an implantable cardioverter defibrillator, LBBB staging remained significantly associated with a decreased risk for adverse outcome (hazard ratio 0.69 (95% CI 0.51–0.92) per 1-stage increase).

Conclusions
Septal strain patterns are associated with the extent of reverse remodeling and outcome in CRT patients. The proposed LBBB classification provides pathophysiological insights in LBBB-induced LV dysfunction and may be helpful to identify patients who may benefit most from CRT implantation.
Can echocardiographic parameters effectively predict elevated pcwp in heart transplant patients?
Authors: Santos A R , Albuquerque F , Goncalves A , Moreira R I , Silva T P , Viegas J , Castelo A , Ferreira V , Bras P , Reis J , Mano T , Mendonca T , Sousa L , Soares R , Ferreira R C 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.
PCWP measurement remains the gold standard for the diagnosis of Heart Failure with preserved ejection fraction. Nevertheless, right heart catheterization (RHC) is a last step procedure nowadays, with most of the patients diagnosed solely by transthoracic echocardiography (TTE) parameters, as it is widely available and not associated with the risks of the invasive procedures. Heart transplant (HT) patients, on the other hand, routinely perform RHC as follow-up for rejection surveillance, allowing frequent invasive hemodynamic assessment.

Purpose
Evaluate the association between TTE parameters and the invasively measured pulmonary capillary wedge pressure (PCWP) by RHC in HT patients.

Methods
A retrospective analysis of consecutive HT patients submitted to RHC between February 2016 and November 2021, who previously performed TTE, was made. The area under the curve (AUC) was performed to evaluate the association between several TTE parameters (left ventricular (LV) end-diastolic diameter (LV EDD), LV end-systolic diameter (LV ESD), LV ejection fraction (LV EF), interventricular septum wall thickness (ST), LV global longitudinal strain (GLS), left atrium volume index (LAVi), transmitral E/A ratio (E/A), LV E/e’ ratio (E/e’), E velocity deceleration time (DT), isovolumetric relaxation time (IV RT), tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP)) and elevated PCWP (defined as &gt;15mmHg). Statistical differences with a p-value &lt;0.05 were considered significant.

Results
A total of 127 RHC were performed during the study period. Mean age was 50 years, 79% (n=100) were male, mean LV EF 58 ± 10% and mean BNP 808 ± 984 pg/mL. Mean PCWP was 12 ± 6 mmHg, with 28% (n=35) with a value higher than 15mmHg. AUC results of several TTE parameters for the prediction of elevated PCWP are depicted in Table 1. LV EF (AUC 0.702, p = 0.001) and GLS (AUC 0.768, p = 0.07) were significantly correlated with elevated PCWP, while the remaining parameters failed to do so.

Conclusion
In this HT group, several TTE indices commonly employed for non-invasive estimation of increased intraventricular pressures, including E/e', E/A ratio, LAVi, and sPAP, showed a poor correlation with elevated PCWP. GLS, a TTE parameter widely used to assess subclinical dysfunction were the parameter with the most robust association with elevated PCWP in this population, demonstrating that it has the potential to be used in routine clinical practice.
Prognostic value of lung ultrasound in patients who underwent open heart surgery due to aortic stenosis and mitral regurgitation
Authors: Jdid Mahmoud S , Morvai-Illes B , Csadi R , Monoki M , Varga A , Agoston G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Severe, native valvular heart diseases are frequently associated with heart failure (HF). The most frequent valvular lesions are aortic stenosis (AS) and mitral regurgitation (MR). Pulmonary congestion (PC) is a universal finding in patients with HF and is associated with poor prognosis. B-lines assessment with lung ultrasound (LUS) is a reliable, fast, and simple quantitative method to assess pulmonary congestion.
This study aimed to assess the short-term prognostic value of B-lines in patients with severe mitral regurgitation or aortic stenosis who underwent open heart surgery.

Methods
A single-centre prospective cohort of 70 patients (66.4±10.6 years, 53.9% male) with severe AS (73%) and MR (27%) were consecutively enrolled. Comprehensive transthoracic echocardiography and LUS evaluation (8-sector assessment) were performed 48 hours before open heart surgery (aortic and mitral valve replacement). The relationship between PC and echocardiographic parameters was determined, and patients were followed up for 7.1±3.4 months to assess the composite endpoint of death and readmission due to HF.

Results
The number of B-lines correlated with left ventricular ejection fraction (r-0.549, p&lt;0.0001), left atrial volume (r 0.566, p&lt;0.0001), and right ventricular function indices such as TAPSE (TAPSE r −0.448, p&lt;0.0001) and right ventricular coupling defined as TAPSE/PASP (r −0.596, p &lt;0.0001). During the follow-up, 10 events were detected. The performance of the number of B-lines in the prediction of events showed 72.7% sensitivity and 84.5% specificity, with the best cut-off value at 21 B-lines. Having ≥ 21 B-lines was associated with a significantly worse event-free survival (Log-rank: 7.304, p &lt; 0.05) Figure 1.

Conclusion
Pulmonary congestion detected by LUS reflects structural and functional damage related to severe valvular heart disease. Lung ultrasound is a promising tool to assess high-risk patients before open heart surgery.
Right ventricle involvement in cardiac transthyretin amyloidosis in SPECT/CT with [99mTc]Tc-DPD
Authors: Holcman K , Rubis P , Szot W , Dziewiecka E , Karabinowska A , Stepien A , Graczyk K , Mroz K , Sachajko Z , Podolec P , Kostkiewicz M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Pfizer Research Grant (ID#57165999).

Background
Transthyretin amyloid (ATTR) cardiomyopathy continues to be considered a rare disease; however, it is now more frequently diagnosed, partly due to advances in imaging techniques. Application of hybrid technique single-photon emission computed tomography and computed tomography (SPECT/CT) provides greater anatomic resolution, enabling the assessment of regional cardiac involvement.

Purpose
The aim of this prospective study was assessment of right ventricle involvement in patients with ATTR in SPECT/CT with [99mTc]Tc 3,3-disphono-1,2-propanodicarboxylic acid (DPD).

Methods
We present data based on evaluation of 100 patients, including 28 (group 1) index patients with ATTR and 72 (group 2) first-degree relatives who were studied between June 2020 and January 2023. Study protocol included clinical data, free light chain blood immunoglobulins and urine immunofixation, transthoracic echocardiography (TTE) with global longitudinal strain (GLS) analysis, SPECT/CT with [99mTc]Tc-DPD, genetic testing by an amplicon-based next-generation TTR sequencing approach, and in selected cases cardiac or soft tissue biopsy.

Results
In group 1 there were 39% patients diagnosed with hereditary ATTR (ATTRm) and 61% with ATTR wild type (ATTRwt). There were detected following types of TTR variants - Phe53Leu, Ala101Val, Glu112Lys, Glu109Lys, Glu122Lys, Glu82Lys. Overall, 26% first-degree relatives were diagnosed with pathogenic TTR variant and 7% had positive SPECT/CT with [99mTc]Tc-DPD. In group 2 there was a significant predominance of Phe53Leu variant among carriers. Importantly, among patients with positive SPECT/CT with [99mTc]Tc-DPD 78% presented also right ventricle uptake. Overall, right ventricle involvement was present in 80% of patients with ATTRm and 76% of patients with ATTRwt who presented left ventricle uptake (p&gt;0.05).

Conclusions
Right ventricle involvement in cardiac transthyretin amyloidosis can be assessed in SPECT/CT with [99mTc]Tc-DPD. In presented group 78% of patients who had cardiac tracer uptake presented as well right ventricle involvement. There were no statistically significant differences in rates between the ATTRwt and ATTRm groups (p&gt;0.05). Assessment of right ventricle involvement in cardiac transthyretin amyloidosis in SPECT/CT may in future translate into further enhancement of disease evaluation and improving prognosis in the group of patients.