bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extrapolation of CT aortic annulus derived diameter/CT aortic annulus area from 2D echocardiography aortic annulus diameter in TAVR: not a reliable tool
Authors: Medilek K , Bis J , Polansky P , Dusek J , Brtko M , Tuna M , Praus R , Ballon M , Stasek J , Parizek P 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Computed tomography (CT) aortic annulus area, CT area derived diameter and two-dimensional echocardiography (2D ECHO) diameters are used for valvular sizing in transcutaneous aortic valve replacement (TAVR). According to our previous study, 2D ECHO annulus diameter was smaller in comparison to CT derived diameter (22.6±2.9 vs 25.0±5.5mm, p = 0.013), but both CT aortic annulus area derived diameter/CT aortic annulus and 2D ECHO diameter predicted correct valve size selection with the same accuracy of 79–80%. However, CT requires radiation and iodine contrast administration, which might be the limitation in patients with chronic kidney disease or history of iodine allergy.

Purpose
To determine if 2D ECHO diameter can be used for reliable estimation of CT area derived diameter/CT aortic annulus area.

Methods
139 consecutive patients with favourable outcome of Sapien XT/Sapien S3 TAVR (no more than mild aortic regurgitation, only one valve implanted) were included in the study. 2D ECHO diameter was measured from mid oesophageal three-chamber view (110–135°) just below the anatomical aortic valve annulus. CT aortic annulus was obtained as double oblique plane by manual multiplanar reconstruction of CT dataset, defined by three lowest attachment points of valvular leaflets. Aortic annulus area was measured by manual tracking of lumen contours, area derived diameter as 2*√(area/π). Linear regression analysis between pre-implant CT area derived diameter and 2D ECHO diameter was performed; extrapolated CT annulus area diameter and CT aortic annulus area [π*(d/2)2] were calculated from 2D ECHO diameter. Concordance of valve size selection based on extrapolated CT area derived diameter vs original CT area derived diameter and extrapolated CT aortic annulus area vs original CT aortic annulus area was determined on patients where CT aortic annulus area/annulus derived diameter were falling outside the overlap of the manufacturer recommended ranges for neighbouring valve sizes.

Results
Significant relationship between CT aera derived diameter and 2D ECHO diameter was found (r=0.720, p&lt;0.001, Fig 1,2). Extrapolated CT area derived diameter would have led to inappropriate size selection in 33/100 more cases (undersizing in 16%, oversizing in 17%), similar to extrapolated aortic annulus area, where both undersizing and oversizing was observed in 18/106 (17%) more cases in comparison to original CT based parameters.

Conclusion
Extrapolation of CT aortic annulus area/area derived diameter from 2D ECHO diameter is not a reliable tool in valvular sizing for balloon expandable Sapien valve. In patients with chronic kidney disease or history of iodine allergy, three-dimensional (3D) ECHO aortic annulus assessment remains the only viable alternative tool.
Mitral annulus excursion depression as the expression of left ventricle strain parameters damage in patients with dilated cardiomyopathy
Authors: Toader D M , Neagoe O , Scorbura T , Craciun-Mirescu A , Mirea O , Oprita O , Carstea I , Istratoaie O , Militaru C , Florescu D , Munteanu I , Iordache S , Ispas I , Aniculesei A , Vaduvescu A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
4D echocardiography is a useful tool to identify both decreasing of mitral annular excursion (MAE) and left ventricle (LV) strain damage in patients with dilated cardiomyopathy (DCM). Our study aimed to identify a correlation between MAE decreasing and LV strain parameters in patients with DCM.

Methods
We enrolled 75 patients with DCM and 30 healthy volunteers. The evaluation consisted of clinical examination, laboratory tests, 12 leads electrocardiography. All participants underwent a complete transthoracic echocardiogram to determine cardiac structure and function according to the current guidelines. The study evaluated MAE by 4D Auto Mitral Valve Quantification (4D - MVQ). 4D LV Quantification (4D-LVQ) measured global longitudinal strain (GLS), global circumferential strain (GCS), global area strain (GAS), and global radial strain (GRS).

Results
1. We divided the patients into two groups: 27 with DCM and atrial fibrillation (AF) and 48 with DCM and sinus rhythm (SR). 2. Mean values of MAE were 3.89 (SD=2.2, CV=0.56) in patients with DCM and 11.1 (SD 1.08, CV 0.09) in the healthy volunteers’ group. (P&lt;0.0001). In patients with DCM and RS MAE mean value was 4.24 (SD=2.34, CV=0.54), and in the AF group was 2.98 (SD=1.38, CV=0.45) (p = 0.0125). 3. Mean values of strain in patients with DCM and RS compared with those in AF were: GLS −6,63 vs. −4,1 (P = 0.0005), GCS −6.08 vs. −5,2 (P = 0.1931), GAS −11.22 vs. −8.47 (P = 0.0181), GRS = 14.5 vs. 10.89 (P = 0.0493). 4. The correlations obtained between MAE and LV strain in patients with DCM were: GLS (r=-0.67), GAS (r=-0.61), GRS (r=0.5), and GCS (r=-0.39).

Conclusions
1. MAE was significantly reduced in patients with DCM compared with healthy volunteers. 2. The patients with DCM and AF presented the lowest values of MAE and LV global strain parameters. 3. MAE correlated better with GLS and GAS, moderate with GRS, and weak with GAS in patients with dilated cardiomyopathy phenotype.
TAPSE/PAPS ratio as a predictor of hospital staying in patients affected by severe degenerative mitral regurgitation undergoing mitral valve surgery
Authors: Barki M , Ingallina G , Paci G , Margonato D , Stella S , Biondi F , Ancona F , Morosato M , Fanti D , Castiglioni A , De Bonis M , Maisano F , Slavich M , Agricola E 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Chronic severe degenerative mitral regurgitation (DMR) is a progressive disease with a negative impact on prognosis and surgical repair or replacement represents the standard of care. Recently, the coupling between right ventricular (RV) function and the pulmonary circulation (Pc) emerged as a prognostic index in patients undergoing transcatheter edge-to-edge mitral repair. However, the relationship between pulmonary circulatory right ventricular uncoupling and clinical outcomes in patients undergoing surgery for DMR has poorly been investigated.

Purpose
In a cohort of patients affected by DMR undergoing mitral valve surgery (repair or replacement), we investigated the association between the degree of RV-to-Pc uncoupling, assessed by the ratio between tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PAPS), and the time of hospitalization.

Methods
389 consecutive patients affected by DMR who underwent mitral surgery (repair or replacement) were retrospectively enrolled. In the pre-operatory phase, all patients underwent a transthoracic echocardiography. The degree of RV-to-PC uncoupling was defined by TAPSE/PASP ratio with a cut-off of 0.4 mm/mmHg and was correlated with the time of hospitalization expressed in days.

Results
A total of 389 eligible patients (mean age 52±14 y, 65% male, 85% in sinus rhythm) who were admitted for mitral valve surgery at San Raffaele hospital (85% repair, 15% replacement) for hemodynamically significant DMR were retrospectively enrolled from January 2019 to June 2022. Mean hospital stay was 11±8 days. At baseline, only 28% of the cohort exhibited normal left ventricular (LV) and left atrial (LA) size and function, with the majority of the cohort exhibiting increased LA dimension (mean LAVi 49±10 ml/m2). RV to PC coupling was measured before surgery (mean TAPSE/PAPS: 0.8±0.2 mm/mmHg) and only 15% of the cohort had a TAPSE/PAPS≤0.4 mm/mmHg. Interestingly, patients with lower TAPSE/PAPS ratio had longer hospitalization (TAPSE/PAPS≤0.4 mm/mmHg: 15±8.2 days vs TAPSE/PAPS &gt;0.4 mm/mmHg: 11±7.5 days; p = 0.04) and an inverse relationship was found between TAPSE/PAPS values at admission and the length of hospitalization (r=0.4, CI 95% 0.21–0.57; p&lt;0.001; Figure 1).

Conclusions
In DMR, a strong association was noted between TAPSE/PAPS ratio and length of hospitalization in patients undergoing mitral valve surgery. These data, although preliminary, underline the impact of RV dysfunction and PC uncoupling on clinical outcomes also in the short-term evolution after surgery.
Myocardial deformation as a stratification tool in HCM
Authors: Stolpe G , Martel H , Lucas C , Morel V , N'guyen K , Donal E , Reant P , Habib G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Sudden cardiac death (SCD) is a major issue in hypertrophic cardiomyopathy (HCM) management, and its risk prediction stays challenging for clinicians.
Ventricular arrythmias (VAs) have to be treated rapidly, indeed VAs lower prognosis in HCM patients.
Current ESC guidelines for cardioverter-defibrillator implantation include left atrial (LA) whereas left ventricle (LV) ejection function (LVEF) is incorporated in AHA latest guidelines. We explore the potential role of LA and LV strain as more sensible parameters in HCM rhythmic prognostication.

Purpose
To assess LA and LV strain in risk stratification in HCM patients as accurate markers of SCD.

Methods
Patients with newly diagnosed HCM were enrolled in three French University Hospital (Marseille, Bordeaux and Rennes) between 2007 and 2018. At the inclusion we realized a comprehensive clinical exam, biological analysis, an echocardiography including LA strain in two and four apical-chambers, and a MRI.
Composite primary endpoint (PE) analysis was occurrence of rhythmic related adverse cardiac events: ventricular tachycardia (VT), ICD therapy for ventricular arrhythmia, or all-cause death.
Occurrence and dates of endpoints were retrieved by patient’s medical records and phone calls to all patients and family members.

Results
At a mean follow-up of 57 (34–82) months, patients with adverse cardiac events (n = 52) presented with more impaired LA and LV deformation function. After multivariate analysis, we found a significant association between impaired LA strain and our composite primary endpoint P 0,023 HR 0,95.
LV strain revealed to be correlated with our PE P 0,012 HR 2,48.

Conclusions
Myocardial deformation appears to be a relevant marker which could be linked to sudden cardiac death in HCM.
These parameters might be relevant in new risk calculators.
Cardiac troponin T, NT-proBNP and GDF-15 associate with future focal myocardial scar types, but not diffuse fibrosis assessed by cardiac magnetic resonance
Authors: Wimalanathan T , Paus M F , Skranes J B , Berge T , Tveit A , Roesjoe H , Omland T , Lyngbakken M N , Heck S L 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Akershus University Hospital Trust, Vestre Viken Hospital Trust, South-Eastern Norway Regional Health Authority, Roche Diagnostics provided reagents for hs-cTnT analyses

Background
In cardiovascular risk prediction, there is growing evidence that imaging and circulating cardiac biomarkers provide incremental prognostic value compared to single biomarkers or traditional risk factors. In patients with suspected or established cardiovascular disease (CVD), cardiac troponin T (cTnT) and N-terminal pro B-type natriuretic peptide (NT-proBNP) associate with focal and diffuse fibrosis assessed by cardiac magnetic resonance (CMR) imaging. There is limited data on the associations between established and emerging circulating cardiac biomarkers with subsequent myocardial fibrosis in subjects without CVD recruited from the general population.

Purpose
Assess the associations between biomarkers of cardiac injury (cTnT), stress (NT-proBNP) and fibrosis and inflammation (growth differentiation factor-15, GDF-15), and subsequent focal and diffuse myocardial fibrosis assessed by CMR imaging.

Methods
We recruited 200 study participants born in 1950 from the general population. All participants were without known coronary artery disease or renal dysfunction. cTnT, NT-proBNP, and GDF-15 were measured in samples collected at baseline in 2012–2015, and CMR was performed 4–7 years later. Presence and type (ischemic/non-ischemic) of focal myocardial fibrosis were assessed by late gadolinium enhancement (LGE) imaging. Diffuse fibrosis was assessed by the extracellular volume (ECV) in the midventricular septum. Logistic regression analysis was used to examine relationships between log transformed concentrations of cardiac biomarkers and CMR parameters.

Results
The median age was 63.9 (63.4–64.5) and 52% were male (Table 1). cTnT was associated with presence of any LGE scar adjusted for common cardiovascular risk factors (OR 1.85, 95% CI 1.25–2.72), but this association was attenuated when left ventricular mass was added to the model (Table 2). NT-proBNP (OR 1.66, 95% CI 1.10–2.72) and GDF-15 (OR 4.45, 95% CI 1.29–15.27) were associated with presence of any LGE scar in the fully adjusted models (Table 2). cTnT (OR 1.90, 95% CI 1.06–3.39) and NT-proBNP (OR 2.72, 95% CI 1.29–5.76) were associated with ischemic scars. Only GDF-15 (OR 4.52, 95% CI 1.09–18.72) associated with non-ischemic scars in adjusted models. None of the biomarkers were significantly associated with ECV.

Conclusion(s)
In a general population cohort, biomarkers of myocardial injury and stress associate with ischemic type scars, but not diffuse fibrosis. GDF-15, an emerging circulating biomarker of fibrosis and inflammation, associates with non-ischemic type scars.
Determinants of post-operative left ventricular dysfunction in degenerative mitral regurgitation
Authors: Althunayyan A , Alborikan S , Badiani S , Wong K , Uppal R , Patel N , Petersen P , Lloyd G , Bhattacharyya S 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Saudi Arabian Cultural Bureau.

Background
Chronic degenerative mitral regurgitation leads to volume overload causing left ventricular (LV) enlargement and eventually LV impairment. Current guidelines determining thresholds for intervention are based on LV diameters and ejection fraction. There is sparse data examining the value of LV volumes and newer markers of LV performance on outcomes of surgery in mitral valve prolapse.

Purpose
Identify the best markers of LV impairment after mitral valve surgery.

Methods
Prospective, observational study of patients with mitral valve prolapse undergoing mitral valve surgery. Pre-operative LV diameters, volumes, ejection fraction (LVEF), global longitudinal strain (GLS) and myocardial work measured. Post-operative LV impairment defined as LVEF &lt; 50% at 1 year post-surgery.

Results
Eighty-seven patients included. 13% developed post-operative LV impairment. Patients with post-operative LV dysfunction showed significantly larger indexed LV end-systolic diameters (LVESD), volumes (LVESV), lower LVEF and more abnormal GLS than patients without post-operative LV dysfunction. In multivariate analysis, indexed LVESV (Odds ratio 1.11 (95% CI 1.01 – 1.23), p = 0.039) and GLS (odds ratio 1.46 (95% CI 1 – 2.14), p = 0.054) were the only independent predictors of post-operative LV dysfunction. The optimal cut-off of 36.3 ml/m2 for indexed LVESV had a sensitivity of 82% and specificity of 78% for detection of post-operative LV impairment.

Conclusion
Post-operative LV impairment is common. Indexed LV volumes (36.3ml/m2) provided the best marker of post-operative LV impairment.
Prognostic value of left atrial strain by speckle-tracking echocardiography in patients admited for heart failure
Authors: Garcia Duran A B , Rodriguez C , Covas X , Garcia-Alonso A , Moreno J M , Vicente M , Mojon D , Gonzalez Guardia A , Mas-Stachurska A , Llagostera M , Molina L , Cladellas M , Ble Gimeno M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Clinical practice guidelines support the diagnostic value of left atrial volume in preserved heart failure (HF), but there is little evidence in left atrial (LA) function prognostic usefulness. Some recent studies have proved the diagnostic and prognostic value of atrial strain independently of ejection fraction (EF) in patients with HF.

Objectives
We aim to assess the usefulness of measuring the LA reservoir function by echocardiogram with speckle-tracking in patients admitted for HF, both in sinus rhythm (SR) or atrial fibrillation (AF). First re-admission due to HF or cardiovascular mortality were evaluated as a combined primary endpoint during follow-up.

Methods
We conducted a prospective study of all patients admitted for HF during 12 months. The study of the LA reservoir function was analysed by peak atrial longitudinal strain (PALS) measurement, divided into tertiles, and biplane auricular EF.

Results
122 patients were included (39% with reduced EF). Age 72±11 years, men 83(68%), AF 57(47%), previous HF 41(34%), with median follow-up 3.7 years. During follow-up, 65 cases (53%) were readmitted for HF and 14 (18%) died of cardiac causes. The univariate analysis showed significant differences in rhythm and atrial volume, but not with NT-proBNP nor left ventricular EF. The multivariate analysis adjusted for age, sex, rhythm, atrial volume, previous HF and LA EF showed a significant association between the minor tertile of PALS and admission for cardiac decompensation or death (HR 2.05; CI 95% 1.08–3.90; p = 0.028).

Conclusions
The study of atrial strain in HF is a prognostic marker of readmission for HF or cardiac death, assessable both in SR or AF. The minor tertile of PALS was associated significantly with the combined endpoint of re-admission due to HF and/or cardiovascular mortality.
Pectoralis muscle measures on preoperative computed tomography are strong predictors of early rehospitalization after left ventricular assist device implantation
Authors: Tanabe J , Akazawa Y , Nakamura D , Nakamoto K , Sera F , Oka T , Mizote I , Ohtani T , Hikoso S , Kawamura T , Yoshioka D , Miyagawa S , Sakata Y 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Skeletal muscle mass is reduced in severe heart failure and has a significantly impacts on subsequent outcomes and quality of life. The assessment of pectoralis muscle measures by computed tomography (CT) scan may be predictive of outcomes after left ventricular assist device (LVAD) implantation.

Purpose
This study aims to assess preoperative pectoralis muscle measures before LVAD implantation to predict early rehospitalization of the patient.

Methods
We measured the cross-sectional area and mean CT values of the unilateral pectoralis muscle (PHUm: mean Hounsfield unit of pectoralis muscle) by CT scans within 3 months before surgery in patients who underwent HeartMate 3 implantation for the bridge to transplant (BTT) or destination therapy (DT) at our hospital, by August 2022. The cross-sectional area of the unilateral pectoralis muscle was corrected for body surface area (PMI: pectoralis muscle index). The pectoralis muscle was measured by SYNAPSE VINCENT image analysis (Fuji Film) using an axial section of the superior margin of the aortic arch (Figure A). The area under the curve (AUC), sensitivity, and specificity of each index was calculated by receiver operating characteristic (ROC) analysis for the prediction accuracy of PHUm, PMI, and the product of PHUm and PMI in rehospitalization 30, 60, 90 and 180 days from discharge.

Results
Of reviewed 39 patients who underwent HeartMate 3 implantation, 32 (82%) were male, and 32 (82%) underwent BTT. The median age at LVAD implantation was 52 years (interquartile range [IQR], 42–57). During the follow-up period after discharge (median: 520 days, IQR: 116–707), 19 patients (53%) had unscheduled hospitalizations due to 8 LVAD-related infections, 1 heart failure, 1 cardiac arrhythmia, and 9 other reasons. The median time between discharge and rehospitalization was 70 days (IQR, 31–139).
ROC analysis showed that the AUC was particularly high for early rehospitalization within 30 days, with the optimal cutoff of 21.8 Hounsfield unit (HU) for PHUm (sensitivity 0.903, specificity 0.800, AUC 0.884), 6.37 cm2/m2 for PMI (sensitivity 0.806, specificity 0.800, AUC 0.735), and 142.8 for the product of PHUm and PMI (sensitivity 0.903, specificity 1.000, AUC 0.948) (Figure B).

Conclusion
The product of PHUm and PMI may be a strong predictor of early rehospitalization within 30 days of discharge after LVAD implantation.
Spectrum of ascending aortic aneurysms at a peri urban tertiary hospital: an echocardiography-based study
Authors: Meel R , Hasenkam M , Goncalves R , Blair K , Mogaladi S 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Thoracic ascending aortic (TAA) aneurysms are an important cause of clinical disability that require early detection by imaging methods for rapid and effective management. There is a paucity of data from Africa pertaining to TAA aneurysms.

Purpose
To describe the spectrum of TAA aneurysms at a Tertiary hospital in Africa.

Methods
A descriptive retrospective study was conducted based on clinical and echocardiographic imaging data of patients with clinical diagnosis of TAA, from October 2017-October 2022. Advanced strain imaging using speckle tracking echocardiography was performed to determine the circumferential strain (CS) of ascending aorta as a surrogate of compliance. Left ventricular global longitudinal, and basal and apical circumferential strain were also determined.

Results
The study comprised 139 cases of TAA aneurysms (52.5% females) with a mean age of 50±14.8 years, and 45 age and gender matched normal controls. Majority were of African ethnicity (95%). Main etiologies were hypertension (41.7%), human immunodeficiency virus (HIV) (36.6%), connective tissue disease (10.7%), congenital (2.2%) and mixed pathologies in 8.6% of patients. Two thirds of patients (69.7%) presented in heart failure and 10% of patients presented with aortic dissection. Thirty percent of the patients were in New York Heart Association (NYHA) class I, 59.7% were in NYHA II, 8.6 % in NYHA III and 1.4% of patients in NYHA class IV. Echocardiography revealed enlarged aortic dimensions compared to controls (P=0.00000). TAA aneurysms were complicated by severe aortic regurgitation (AR) in half (50.3%) of the patients, 25.8% had moderate AR and 14.3% of patients had mild AR. The left ventricular ejection fraction was reduced at 46.9±12.7% compared to controls (P=0.0000). Aortic CS was markedly reduced compared to controls (4.5±4.0% vs 10.3±4.37%, P=0.000). Left ventricular longitudinal strain (−13.9±3.9% vs −18.1±6.7%,P=0.000001), basal CS (−13.9±5.6% vs −17.9±5.8%, P=0.00008) and apical CS (−18.7±8.5% vs −30.6±3.8%,p = 0.0016) were all significantly reduced compared to controls. Majority (&gt;50%) of the patients were on diuretic and anti-remodeling therapy for heart failure. Surgery was performed in 29.4% of patients. The overall estimated mortality was 7.9 %.

Conclusion
TAA aneurysms associated with hypertension and HIV are common in this population, and are associated with considerable morbidity and mortality. CS of the aneurysmal aorta was significantly reduced translating into stiffer aortas, possibly at risk for further dilation and dissection.