bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tricuspid annulus remodelling after transcatheter edge-to-edge repair for reduction of tricuspid regurgitation
Authors: Widmann M , Nerla R , Castriota F , Squeri A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
Clinically relevant tricuspid regurgitation is a prevalent valvular disease that has a significant impact on survival. The remarkable progress made in cardiac imaging and in interventional cardiology in the last decades, permits today a better understanding of tricuspid valve and right ventricle morphology and pathophysiology. This allowed to develop multiple transcatheter devices for tricuspid valve interventions. Structural valve interventions are considered nowadays valuable treatment options in anatomically eligible patient at high surgical risk. Transcatheter tricuspid valve interventions are directed to increasing leaflet coaptation either directly by bringing the leaflets together (leaflet approximation devices) or indirectly by reducing the dilated annulus (annuloplasty devices). Efficacy and clinical outcome are promising, but the effect on right ventricle and tricuspid annular reverse remodelling is still under evaluation.

Purpose
Aim of the study is to evaluate the acute tricuspid annulus remodelling after percutaneous leaflet repair, using a leaflet approximation device for reduction of tricuspid regurgitation.

Methods
This is a retrospective dual-center cohort study that includes 22 consecutive patients, treated with TriClip in our Hospital. Tricuspid annulus geometry was evaluated using three-dimensional transoesophageal echocardiography examinations conducted during the procedure before and after Triclip implantation. The 3D data sets were analysed using the multiplanar reformatting method.

Results
The mean age of the study cohort was 80 years, and 90,9% were female. Tricuspid regurgitation was graded severe or greater at pre-operative examination in all patients, mostly due to annular dilation. Procedure was successfully in all patients, with at least 1-grade reduction of tricuspid regurgitation before hospital dismissal. A significative reduction of mean septal-lateral diameter (4,09 ± 0,45 cm vs 3,55 ± 0,57 cm, p = &lt; 0,0001), mean major diameter (4,60 ± 0,56 cm vs 4,24 ± 0,58 cm, p = 0,0011), planimetric area (13,70 ± 2,68 cm2 vs 11,00 ± 2,49 cm2, p = &lt;0,0001) and perimeter (13,50 ± 1,36 cm vs 12,40 ± 1,49 cm, p = 0,0001) of the tricuspid annulus was observed. The eccentricity index (obtained dividing septal-lateral by antero-posterior diameter) was 0,99±0,17 before TriClip implantation and 0,91± 0,19 after (p = 0,0336).

Conclusions
In this small real-world population, edge-to-edge repair using TriClip was found to be effective and safe. Tricuspid transcatheter repair with a leaflet approximation device lead also to a reduction in the tricuspidal annular dimensions. This is to date the first study that shows positive changes in tricuspid annular geometry, that could have potentially relevant therapeutic implications.
Difference in left ventricular reverse remodelling after mitral valve surgery between mitral valve prolapse subtypes: barlows disease versus fibroelastic deficiency
Authors: Pype L , Paelinck B P , De Bock D , Van Craenenbroeck E M , Van De Heyning C M 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Surgical correction of severe mitral regurgitation (MR) can reverse left ventricular (LV) remodelling in patients with mitral valve prolapse (MVP), however it is currently unknown whether this process is similar in Barlow’s Disease (BD) and Fibroelastic Deficiency (FED). Particularly the recently suggested concomitant cardiomyopathy in BD could affect LV (reverse) remodelling beyond volume overload.

Purpose
Evaluate LV reverse remodelling after mitral valve surgery in patients with BD versus FED.

Methods
Retrospective analysis of all MVP patients with severe MR who underwent mitral valve surgery at a single tertiary center. We assessed MR severity, LV volumes and systolic/diastolic function by transthoracic echocardiography before surgery and 6 months post-operative.

Results
A total of 55 MVP patients with BD (n=24) or FED (n=31) were enrolled between January 2013 and July 2022. Both BD and FED showed a male predominance (58.3% and 80.6% respectively, p = 0.071) and patients with BD were generally younger (52 ± 13 vs. 63 ± 12 years old; p = 0.005). Baseline LV end-diastolic (LVEDV), end-systolic volumes (LVESV) and LVEF were similar between BD and FED. In addition, pre-operative MR severity (evaluated by a multi-integrative approach) was not significantly different between both groups. However, patients with BD presented with a larger prolapse volume (12.2 ± 8.2 ml versus 5.8 ± 4.7 ml; p = 0.004) and larger mitral annulus diameter (37 ± 6 mm versus 33 ± 5 mm; p = 0.016) compared to FED.
Overall, mitral valve repair with annuloplasty, neochord and/or triangular/quadrangular resection were the most frequent surgical interventions. Mitral valve replacement was performed in selected patients when valve repair was not feasible, mainly in BD (45.8% vs. 19.4%; p = 0.035).
After a median follow-up period of 281 days, residual MR (≥grade 2) was present in 16.1% of patients with FED versus 8.3% with BD (p = 0.390). LV reverse remodelling was present in both groups, with a similar decrease in LVEDV (19.2 ± 18.8 ml/m2 in BD versus 24.4 ± 20.0 ml/m2 in FED; p = 0.337). Interestingly, the less load-dependent LVESV showed a trend towards less reverse remodelling in BD (3.4 ± 11.0 ml/m2 versus 7.5 ± 9.0 ml/m2; p = 0.138), which resulted in a significantly lower LVEF in BD versus FED (51.7 ± 7.6% versus 56.3 ± 6.1%; p = 0.016). Of note, LVEF at follow-up was independent of sex, comorbidities, baseline LV volumes and type of surgical intervention.

Conclusions
While patients with BD and FED showed similar MR severity, LV volumes and LVEF at baseline, post-operative LVEF was significantly lower in patients with BD. These findings suggest that LV (reverse) remodelling in BD could be affected by other mechanisms beyond volume overload, like a concomitant cardiomyopathy.
Correlations between CT-assessed vascular inflammation at different levels of the coronary circulation and the risk of atrial fibrillation
Authors: Gerculy R , Benedek I , Kovacs I , Rat N , Halatiu B , Rodean I , Bordi L , Blindu E , Rosca A , Matyas B , Szabo E , Parajko Z S , Benedek T 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. 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 510/5/17.01.2022
This research has been funded by the research grant Intel-FAT, proposal registration code PN-III-P4-ID-PCE-2020-2861, contract number PCE 206/2021, Project funded by the European Union and the Government of Romania through the Ministry of European Funds, and the Doctoral School of the “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, Romania.

Background
Atrial fibrillation (AF) may occur any time in the evolution of various cardiovascular diseases, most of them having an inflammatory substrate. Perivascular inflammation may be assessed nowadays using coronary computed tomography angiography (CCTA) imaging. The new pericoronary fat attenuation index (FAI HU) and the FAI Score (an individualized quantification of coronary artery inflammation adjusted for age and gender) have prognostic value for predicting future cardiovascular events.

Purpose
The aim of our study was to investigate the correlation between pericoronary fat inflammation and the presence of atrial fibrillation among patients with coronary artery disease. We also compared the CA-Ri Heart Risk derived from the FAI Score values, the plaque burden and other clinical risk factors in patients with AF versus those in sinus rhythm.

Methods
In total, 81 patients (mean age 64.75 ± 7.84 years) who performed 128- slice CCTA were included in the study and divided them in two groups: group 1: 36 patients with documented AF, and group 2: 45 patients without known history of atrial fibrillation. For each patient demographyc characteristics, comorbidities and cardiovascular risk factors, echocardiography findings and lab tests were recorded and the FAI and FAI score were calculated.

Results
The CaRI Heart Risk was not significantly different between the two groups (18.14±14.09 vs. 18.09±13.59, p = ns). There were no significant differences in the absolute value of fat attenuation between the study groups (p&gt;0.05). However, mean FAI Score was significantly higher in patients with AF (15.53 ± 10,29 vs. 11.09±6,70, p&lt;0.05). Regional analysis of coronary inflammation indicated higher levels of inflammation especially at the level of the left anterior descending artery (13.17 ± 7,91 in group 1 vs 8.80 ± 4,75 in group 2, p = 0.008).

Conclusions
Patients with AF present a higher level of inflammation in the epicardial fat surrounding coronary arteries especially at the level of the left coronary circulation. A high inflammation at this level seems to be associated with a higher risk of atrial fibrillation development.
Left atrial hyper-strain in dyssynchronous hearts: potential driver for adverse left atrial remodelling
Authors: Hammersboen L E R , Stugaard M , Puvrez A , Larsen C K , Remme E W , Kongsgaard E , Duchenne J , Galli E , Khan F H , Sletten O J , Penicka M , Donal E , Voigt J U , Aalen J M , Smiseth O A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Institute for Surgical Research, Oslo University Hospital.

Introduction
It was recently shown that left bundle branch block (LBBB) is associated with risk of developing atrial fibrillation. A potential mechanism is abnormal left atrial (LA) loading caused by LA dyssynchrony.

Purpose
To investigate if LBBB is associated with abnormal LA loading as reflected in non-uniform segmental strains.

Methods
In a prospective study of 143 heart failure patients with LBBB, myocardial strain was measured by speckle-tracking echocardiography prior to and after 7±2 months on cardiac resynchronization therapy (CRT). As indicated by brackets in the lower panels in the Figure, LA strain amplitudes were calculated as the difference between minimum and peak strain during the reservoir phase.

Results
In the Figure, the upper panel shows segmental and average LA strain traces in a representative LBBB patient. This patient illustrates marked spatial non-uniformity in strain amplitude between the interatrial septum and the LA lateral wall during the reservoir phase. For the entire study population, strain amplitudes were 19±9% (mean±SD) for the interatrial septum and 24±11% for the LA lateral wall (p&lt;0.0001). In the quartile of patients with largest differences, strain amplitudes were 16±9 and 32±12%, respectively (p&lt;0.0001). CRT abolished these differences (p = NS).

Conclusions
Patients with LBBB showed marked spatial non-uniformity of LA strains. Potentially, the excessive LA lateral wall strain amplitudes may stimulate atrial adverse remodelling. Future studies should investigate if abnormal LA strains may be a trigger mechanism for atrial fibrillation in patients with LBBB.
Diagnostic performance of the non-invasive myocardial work indices in predicting subclinical myocardial work impairment in Fontan patients
Authors: Pozza A , Sabatino J , Cuppini E , Biffanti R , Cerutti A , Reffo E , Fumanelli J , Di Candia A , Avesani M , Castaldi B , Sirico D , Di Salvo G 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): public hospital sources.

Background
The Fontan procedure is an operation that has allowed many paediatric patients suffering from severe congenital heart disease to reach adulthood. More and more frequently we come to interface with the consequences of Fontan's circulation, such as cardiac function and exercise capacity deterioration. Recently the new non-invasive method for calculating myocardial work (MW) based on spackle tracking analysis with the estimation of left ventricular pressure and the measurement of non-invasive blood pressure has been introduced.

Purpose
Aim of this study was to evaluate the diagnostic performance of the non-invasive myocardial work indices in predicting subclinical myocardial work impairment in patients with Fontan circulation.

Methods
A total of 69 patients were included and compared with healthy age- and sex- matched controls (CTRL). Ventricular systolic function and global longitudinal strain (GLS) were assessed. Cardiopulmonary exercise test was performed. Global myocardial work index (MWI) was calculated as the area of the LV pressure strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated.

Results
The two groups were comparable for blood pressure, weight end height. Mean age of Fontan patients was 21.0±9.2 years. MWI (1162 ± 364 mmHg% vs 1777 ± 240 mmHg%, p &lt; 0.001), MCW (1554 ± 450 mmHg% vs 2102 ± 221 mmHg%, p = 0.001) and MWE (90 ± 6% vs 96 ± 2% p = 0.001) were significantly reduced in Fontan patients compared with healthy CTRL. Moreover, GLS (−13,9± 3,1 % vs −21,2 ± 1.5%, p &lt; 0.001) and the ejection fraction (EF) (58,9 ± 4.5% vs 63.3 ± 3.9%, p &lt; 0.002) were significantly lower in Fontan patients. Fontan patients with normal EF showed, however, significantly reduced values of MWI compared with CTRL (p&lt;0.05). Fontan patients with functional right ventricle showed significantly reduced MWE compared with patients with functional left ventricle (p = 0.030).In univariate analysis, peak VO2 was significantly associated with age, SatO2, MWI. In multivariate regression, lower peak VO2 was associated with older age (p = 0.003) and lower MWI (p = 0.026).

Conclusions
Fontan's physiology is associated with impaired ventricular work. Estimation of myocardial work indices may be a more sensitive indicator of impaired myocardial work compared with ejection fraction and is able to predict exercise capacity.
Accuracy of non-invasive assessment of pulmonary pressures by Doppler echocardiography versus right heart catheterisation
Authors: Lwin M T , Phetcharat S , Mano T , Arvanitaki A , Dimopoulos K , Constantine A , Seitler S , Li W 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pulmonary hypertension (PH) is haemodynamically defined according to the latest ESC/ERS guidelines as a mean pulmonary arterial pressure (mPAP) &gt; 20 mmHg at rest. Transthoracic echocardiography (TTE) is a non-invasive and widely available initial screening test for PH, though studies of the correlation between echo-derived estimates of systolic pulmonary artery pressure (sPAP) and right heart catheterization (RHC) measurements have provided mixed results and few studies have used estimates of mPAP utilising pulmonary regurgitation (PR), especially since the recent redefinition of PH.

Aim
1) To investigate the correlation between TTE-derived mPAP and sPAP estimates and RHC in a large contemporary cohort of patients, using the new PH definition 2) To assess the impact of potential confounding factors, such as heart rhythm, the quality of continuous wave Doppler envelopes, chronologic proximity of TTE to RHC and the severity of tricuspid and pulmonary valve regurgitation (TR and PR).

Method
A single centre database of newly diagnosed PH patients by RHC between January 2010 and December 2020 was retrospectively reviewed and analysed. Patients who had medication changes between TTE and RHC were excluded. Investigators analysed individual TR and PR Doppler tracings off-line in all eligible patients. Spearman correlation (r) was used to explore the correlation between TTE and RHC parameters.

Results
Overall, 503 patients had RHC during the study period (Table 1). All TTEs were performed within a 5-month interval from RHC. Median age was 63.2 (16.0 – 91.1) years. There was moderate-strong correlation between RHC and TTE-assessed right atrial pressure ( r=0.47, p &lt; 0.001), mPAP ( r=0.45, p &lt;0.001) and sPAP ( r=0.61, p &lt;0.001), with an improved correlation when all confounding factors (rhythm, quality of Doppler envelope, valve regurgitation severity) were considered and re-analysed ( r=0.63, p &lt;0.001 for sPAP, r=0.58, p&lt; 0.001 for mPAP, Table 2). When only patients who had TTE within 24 hours of RHC were assessed, correlation improved significantly for sPAP (r = 0.71, p &lt;0.001), however this could not be assessed for mPAP due to an insufficient number of patients.

Conclusion
These findings are in agreement with previously published data, suggesting that there is at least moderate correlation between TTE-derived PAP estimates and RHC, which is stronger when confounding factors were considered and the time between the two investigation was short. While RHC is the gold standard for diagnosing and assessing the severity of PH, TTE remains a very useful PH screening tool, but only if measurements are standardised and meticulous, in order to improve accuracy.
Dynamic left atrial strain by dobutamine: Evidence for relationship with both left ventricular strain and atrioventricular volumetrics
Authors: Armenis I , Christodoulou M , Tsiapras D , Kyrzopoulos S , Athanassopoulos G D 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial strain (LASR) by speckle-tracking echocardiography allows the assessment of LA function in each phase of the cardiac cycle. However, its determinants and its relation with left ventricular (LV) function have not yet been fully described. Moreover, a potential effect of the LV cavities volumes has been recently proposed.

Purpose
Purpose of the study was to assess the effect of LV functional indices to LASR in combination with LA and LV volumes both at rest (R) and during dobutamine stress echo (D).

Methods
We studied 58 consecutive patients (age 59/12, male/female 37/19) who underwent D without evidence of ischemia. Using 2-D speckle tracking in apical views, both LA and LV strain analysis was performed at R and D. The following parameters were estimated: LA volumes (max/min), LA emptying function (max-min/max), LA strain (SR: overall, reservoir, conduit, active), LV volumes (systole: LVSvol, diastole: LVDvol) stroke volume (SV), LV ejection fraction (LVEF), LV longitudinal strain (LVSR) and LA/LV max volume ratio (LA/LVvol).

Results
At R, among LA indices, LAtotalSR only was related to LVSR (r=0.31, p = 0.02). However, at D, LAcondSR, LAactive SR, LAtotalSR were related to LVSR (r=-0.25/0.36/0.3 respectively, all p&lt;0.001).
At R, LAEF, LAactiveSR and LAtotalSR were related with La/LVvol (r=-0.40/-0.40/0.45 respectively, all p&lt;0.002). At D, LAEF, LAreservoirSR, LAactiveSR and LAtotalSR were related with La/LVvol (r=-0.39/-0.31/-0.31/-0.42 respectively, all p&lt;0.001).
For the determination of LAactiveSR at R, using stepwise multiple regression analysis including LVEF LVSR LVsv, LVDvol, La/LVvol, the greater contribution was provided by La/LVvol (initial R=0.41), with small improvement by LVSR (final R=0.50, p&lt;0.001). In contrast, at D, the greater contribution for LAactiveSR was provided by LVSR (initial R=0.36) with some improvement by La/LVvol (final R=0.47 p&lt;0.001).
For the determination of LAtotalSR at R, the greatest contribution was provided by LA/LVvol (initial R=0.45) with improvement by LVSR (R=0.57) and finally by LVDvol (final R=0.64, p&lt;0.001). For LAtotalSR at D, the greatest contribution was provided also by LA/LVvol (initial R=0.43) with further improvement by LVSR (final R=0.54, p&lt;0.001).

Conclusions
LA strain indices are determined partially by LV strain both at rest and mainly during inotropic stimulation. However, they are further and beyond LV strain modulated by the ratio of LV and LA volumes, which play a key role for the overall LA strain both at R and during D. The LA active component is less dependent on volumes, and it is coherent to LV strain during inotropic modulation. Nonetheless, dynamic LA strain is of interest since it integrates LV/LA function, thus providing new insights for clinical application.
Mitral valve thickness: A promising echocardiographic parameter for distinguishing between cardiac amyloidosis and Fabry disease
Authors: Mattig I , Steudel T , Barzen G , Frumkin D , Spethmann S , Romero Dorta E , Stangl K , Heidecker B , Landmesser U , Knebel F , Canaan-Kuehl S , Hahn K , Brand A 
Published: June 2023

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): The study was financially supported by Alnylam Pharmaceuticals (Cambridge, MA, USA).

Background
Left ventricular (LV) "hypertrophy" is present in various cardiomyopathies, such as cardiac amyloidosis (CA) and Fabry disease (FD). To differentiate both, multiple echocardiographic characteristics have been evaluated, but diagnosis and treatment are still often delayed.

Purpose
We evaluated new diagnostic indices, including the thickness of the mitral valve leaflets (ML) and the ratio of PM to LV area (PM/LV ratio), to distinguish between CA and FD.

Methods
We retrospectively enrolled patients with diagnosed CA and genetically confirmed FD and measured (i) the thickness of the ML in mid-diastole in the parasternal long axis view and (ii) the PM/LV ratio at end-diastole in the parasternal short axis view, as described by Nieman et al. in an offline analysis (EchoPAC PC, GE Vingmed, Horton, Norway; Vivid E9 or E95, GE Vingmed, Horton, Norway, M5S[c] 1.5–4.5MHz transducer). Receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic accuracy of the measurements. The reproducibility of leaflet measurement was calculated using the intra-class correlation coefficient for intra-observer agreement and inter-observer agreement.

Results
A total of 129 patients with FD (n=49) and CA (n=80) were analyzed. The ML were significantly thicker, and the area of PM and LV were significantly larger in CA compared to FD patients (ML: 4±1 mm in CA vs. 3±1 mm in FD, p&lt;0.001). This resulted in a comparable PM/LV ratio between the two groups (0.23 [0.20–0.26] in CA vs. 0.21 [0.14–0.28] in FD, p = 0.223). Specifically, the posteromedial PM and the LV area were significantly larger in CA patients, while the increase in anterolateral PM area did not reach statistical significance. The thickness of the ML showed the best diagnostic accuracy (area under the curve [AUC]: 0.75, 95% confidence interval [CI]: 0.65–0.85) for discriminating between CA and FD. The reproducibility of leaflet measurement had a good to excellent agreement (intra-class correlation coefficient for intra-observer agreement: 0.92 [95% CI 0.79–0.97] and inter-observer agreement:0.85 [95% CI 0.64–0.94]).

Conclusion
In contrast to previous studies, the PM/LV ratio did not differ between FD and CA. Nevertheless, the measurement of ML may be useful in routine clinical practice to differentiate between the two cardiomyopathies.