bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of regurgitant orifice ellipticity on quantitation of tricuspid regurgitation using the proximal isovelocity surface area method
Authors: Tat E , Hamid N , Khalique O , Lehenbauer K , Sitticharoenchai P , Nazif T , Vahl T , Ng V , George I , Cahill T , Blusztein D , Mihatov N , Leon M , Kodali SK , Hahn RT 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The proximal isovelocity surface area (PISA) method to quantify tricuspid regurgitation (TR) severity relies on the geometric assumption of a circular, planar regurgitant orifice. However, the TR orifice is often non-circular resulting in underestimation of TR severity when calculating the effective regurgitant orifice area (EROA) and regurgitant volume (RegVol).

Purpose
To evaluate the effect of ellipticity of the tricuspid annulus on EROA-PISA correlation with quantitative Doppler (EROA-Dopp), and three-dimensional vena contracta area (VCA-3D).

Methods
Patients undergoing both transthoracic (TTE) and transesophageal (TEE) echo evaluation of TR severity were included in this study. Regurgitant orifice ellipticity was calculated as the ratio of the vena contracta maximum and minimum widths (VC-Ratio). Quantification of EROA and RegVol were performed on TTE for EROA-PISA and EROA-Dopp. Vena contract area was measured on TEE (VCA-3D).

Results
Of 44 total pts, the median age was 80 ± 9, 61% were female, 89% had atrial fibrillation, (86%) had functional TR, 32% were graded as severe, and 71% had a EROA-PISA ≥ 0.4 cm2. Median VC-Ratio was 1.3 (IQR 1.1-1.8) and was used to differentiate more circular orifices (VC-Ratio &lt;1.3) from more elliptical orifices (VC-Ratio ≥1.3) (Table). EROA-PISA was significantly smaller compared to EROA-Dopp and VCA-3D in the whole group as well as elliptical subgroups (p &lt; 0.0001 for all). There was no significant difference between EROA-Dopp and 3D-VCA for the whole group, or in circular or elliptical orifice subgroups (p &gt; 0.5 for all). EROA-PISA correlated better with both EROA-Dopp and VCA-3D in circular compared to elliptical orifices (Table). EROA-Dopp and VCA-3D demonstrated high correlation for both circular and elliptical orifices (r = 0.76, p &lt; 0.0001 and r = 0.77, p &lt; 0.0001 respectively).

Conclusion
Our study demonstrated that there is a significant difference in quantitative measurements of tricuspid regurgitant orifice area, with EROA-PISA significantly underestimating both EROA-Dopp and VCA-3D. In more circular orifices, the EROA-PISA correlation was higher, however EROA-Dopp and VCA-3D were still significantly larger. Whether EROA-Dopp and VCA-3D are more predictive of outcomes requires further study. Abstract Table 1 Abstract Figure 1
The relationship of epicardial adipose tissue with hemodynamics and cardiopulmonary fitness in heart failure with preserved and reduced ejection fraction
Authors: Pugliese NR , De Biase N , Mazzola M , Paneni F , Del Punta L , Gargani L , Mengozzi A , Virdis A , Nesti L , Taddei S , Flammer A , Borlaug BA , Ruschitzka F , Masi S 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Recent evidence shows epicardial adipose tissue (EAT) acts as a paracrine organ and may directly alter myocardial function by exerting mechanical compression.
Purpose. We evaluated EAT thickness through transthoracic echocardiography and investigated its relationship with cardiopulmonary fitness and cardiovascular haemodynamics at rest and during exercise in a population of heart failure (HF) patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction.
Methods. We prospectively enrolled 393 consecutive HF outpatients (205 HFrEF, 188 HFpEF) who had been referred to our hospital due to dyspnoea and/or effort intolerance, together with 44 healthy controls. We performed a resting state-of-the-art echocardiographic evaluation, followed by combined cardiopulmonary-echocardiography exercise stress.
Results. EAT thickness was higher in HFpEF (median 8 mm, interquartile range [IQR] 4–12 mm) and progressively reduced in controls (median 5 mm, IQR 3–7 mm; p &lt; 0.0001) and HFrEF (median 3 mm, IQR 2–6 mm).  In HFpEF, EAT thickness was inversely correlated with peak oxygen consumption (VO2) and peripheral oxygen extraction (AVO2diff), while a direct association was observed for the same parameters in HFrEF (Figure 1). Furthermore, EAT independently predicted peak VO2 and AVO2diff in HFrEF and HFpEF regardless of body mass index and waist circumference. These relationships were direct in HFrEF (standard regression coefficient [SRC] for peak VO2: 0.18, p = 0.02; SRC for peak AVO2diff: 0.17, p = 0.03) and indirect in HFpEF (SRC for peak VO2: -0.33, p &lt; 0.0001; SRC for peak AVO2diff: -0.25, p &lt; 0.0001).
As there are no definite cut-off values to define increased EAT, patients were divided based on the median EAT value (5 mm) of the overall population. Thinner EAT (≤5 mm) was associated with worse LV systolic dysfunction (peak average S’) and remodeling (3D LV mass index) in HFrEF. In HFpEF, on the other hand, increased EAT (&gt;5 mm) was related to worse right ventricular systolic dysfunction (3D right ventricular ejection fraction) and more severe left atrio-ventricular (left atrium reservoir strain/left ventricle global longitudinal strain) and right ventriculo-arterial (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) coupling (Figure 2).
Conclusion. In HFpEF, increased EAT thickness is associated with a worse hemodynamic profile and functional capacity. Conversely, in HFrEF, EAT thinning portends more advanced LV dysfunction and impaired cardiopulmonary fitness. Abstract Figure 1 Abstract Figure 2
Right ventricle function improvement after six month of therapy with Sacubitril/Valsartan in a real-life population of patients with chronic heart failure with reduced ejection fraction
Authors: Mazzeo P , Correale M , Magnesa M , Fortunato M , Mallardi A , Leopizzi A , Tricarico L , Mennella R , Iacoviello M , Brunetti ND 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Observational studies have demonstrated that treatment with sacubitril/valsartan may improve left ventricular (LV) systolic and diastolic function in subjects with reduced LV ejection fraction (LVEF) in real-world studies. Subjects with heart failure and reduced EF (HFrEF), however, are also characterized by an impaired right ventricular (RV) function. We therefore aimed to evaluate whether also RV function may improve after S/V therapy and possible predictors of RV improvement could be identified at echocardiography and tissue Doppler imaging.

Methods
Fifty consecutive patients (67 ± 8 years, LVEF 28 ± 6%, male 86%) with chronic HFrEF and NYHA class II-III were followed up for 6 months after therapy with S/V. L&RV function was assessed at baseline and after 6 months of therapy.

Results
After 6-month therapy with S/V a significant improvement was shown in the following echocardiography parameters assessing RV function: PAsP(31 ± 11vs 35 ± 10mmHg,p &lt; 0.001),
TAPSE(19 ± 3vs18 ± 3mm,p &lt; 0.001),RVFAC(38 ± 7 vs 34 ± 6 mm,p &lt; 0.001), RVS’(12 ± 2vs10 ± 2cm/sec,p &lt; 0.001), RVFWGLS(-20 ± 5vs-18 ± 5%,p &lt; 0.001), RV4ChGLS (-16 ± 5vs-14 ± 5%,p &lt; 0.001). At multivariable analysis improvement in RVFWGLS was associated to baseline levels of RV S’ (r 0.75, p &lt; 0.01) and RAV (r–0.32,p &lt; 0.05).

Conclusions
In a real-world scenario, 6-month therapy with S/V was associated with an improved RV function in HFrEF. RV function improvement may be predicted by assessing baseline RV S’ and right atrial volume values.
Association between early changes in left atrial strain and global left ventricular function in patients with heart failure with preserved EF ( HFpEF)
Authors: Hristova K , Tselov N , Tsonev SV , Slavchev B , Velikov T , Zlatancheva G , Marinov R 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial (LA) maximal volume and index (LAVI) had a prognostic value in patients with heart failure and incidence of atrial fibrilation(AF) . Recently, LA mechanical function and LA strain have been introduced as alternative methods to assess LA performance more accuratly.

Aim
To evaluate the relation between early changes in LA function and strain ( PALS) and correlate the association with global left ventricular (LV) function and longitudinal strain (GLS) in patients with HFpEF.

Methods
We evaluated 132 subjects in sinus rhythm: 22 normals (31y ± 5), and 70 pts with HFpEF (65y ± 12), 60 pts HFrEF ( 64 y ± 10). Echocardiography was performed in all patients and follow up after 12 monts and analyzed offline in order to extract the global and segmental strain values of the LV and LA and LA volume and LAVI.

Results
The two groups of patients were comparable for most of clinical variables. LV volumes, ejection fraction, stroke volume, and mitral valve effective regurgitant orifice were similar between the two groups. The LA diameter and maximal volume were higher in HFrEF group. The GLS is significantly reduced in HFrEF group. LV GLS is the main parameter for myocardial dysfunction, which changed significantly in the HFrEF (p &lt; 0,001) at 12mFU. Reduced PALS in HFrEF was associated with impairment of all measures of LV systolic and diastolic function and events of atrial fibrilation / 33 % in HFrEF and 12 % in HFpEF/ and the correlation between global longitudinal strain and PALS was highly significant (p &lt; 0.001; r=-0.71). At 12mFU, PALS was significantly associated with lower global longitudinal strain in group with HFrEF (p &lt; 0.001, r = 0.61 ), LAVI &gt; 28 ml/m2 (p &lt; 0.01,r = 0.57) and slightly decreased in HFpEF /p &lt;0.5, r =0.34/. ROC analysis shows the cut –of value of 29 % for PALS which correlated with AF events. Conclusions: PALS and GLS are significantly reduced in HFpEF patients and decreased in HFpEF. PALS provides additional ,prognostic value beyond LA volume and LAVI. Severe LV myocardial dysfunction and reduced GLS and decreased PALS, even still normal LAVI is a prognostic index for AF.
Right ventricular longitudinal systolic strain can predict new onset heart failure with preserved ejection fraction in hypertensive patients
Authors: Marketou M , Danelatos C , Maragkoudakis S , Patrianakos A , Zervakis S , Plevritaki A , Savva E , Fragkiadakis K , Kladou E , Kampanieris E , Kochiadakis G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
Accurate assessment of right ventricular (RV) systolic function is important, as it is an established prognostic marker in cardiac diseases. Speckle-tracking echocardiography is a sensitive tool for detection of subclinical left ventricular impairment in essential hypertension. We associated RV function using longitudinal peak systolic strain (GLS) in patients with essential hypertension with the risk of future development of heart failure with preserved ejection fraction (HFpEF).

Methods
We performed a retrospective observational study that included 458 patients with essential hypertension (266 males, aged 63 ± 18 years) and 179 normotensives (100 males, aged 66 ± 15 years). Standard echocardiography was performed at the initial visit. 2D speckle tracking echocardiography with evaluation of longitudinal strain in each segment of the RV (basal: RVLS-B; mid: RVLS-M, apical: RVLS-A) and global RV free-wall strain (RVLS-G) were also performed. We studied the cases of new onset HFpEF in hypertensive patients.

Results
The median follow up was 85 months (22–122). RVLS-G, RVLS-B and RVLS-M were significantly impaired in hypertensives compared to controls (RVLS-G: -16.1 ± 9.7 vs -20.0 ± 5.1, RVLS-B: -11.7 ± 3.7 vs -20.6 ± 3.3, RVLS-M:-16.3 ± 5.4 vs -20.7 ± 4.9, p &lt; 0.05 for all). No significant difference was detected for the RVLS-A (-20.1 ± 3.8 for hypertensives vs -21.31 ± 6.5 for controls, p = NS). Thirty two hypertensive patients developed HFpEF (7 %). A cut-off RVLS-G worse than -17 % was significantly associated with new onset HFpEF (p&lt; 0.001) in those patients. A multivariate Cox regression analysis showed that RVLS-G had independent significant prognostic value for the risk of HFpEF (HR: 10.5, 95% confidence interval (CI): 7.3-25.4).

Conclusions
Essential hypertension leads to a decrease of RVLS which is strong predictor of a new onset HFpEF. Future studies are needed to assess the significance of these findings and the effects of treatment.
Evaluation of RV-arterial coupling in advanced heart failure
Authors: Dias Ferreira Reis JP , Bras P , Ferreira V , Goncalves A , Pereira Da Silva T , Soares R , Timoteo AT , Galrinho A , Branco L , Ferreira R 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The ratio of echocardiography-derived tricuspid annular plane systolic excursion (TAPSE) and pulmonary arterial systolic pressure (PASP) - TAPSE/PASP ratio - is a noninvasive measure of RV-arterial coupling. TAPSE/PASP ratio is a potent independent predictor of prognosis in heart failure and pulmonary arterial hypertension, with a prognostic cutoff value of 0.36 mm/mmHg.

Objective
To assess the prognostic impact of TAPSE/PASP ratio in a population of advanced HF patients.

Methods
Prospective evaluation of adult patients with advanced HFrEF referred to our Institution for evaluation with HF team and possible indication for urgent heart transplantation (HT) or MCS. Patients were followed up for 2 years for the primary endpoint of cardiac death and HT. Echocardiographically determined TAPSE/PASP ratio was used to assess RV-arterial coupling and a survival analysis was performed to evaluate the prognostic impact of the suggested cutoff of 0.36 mm/mmHg.

Results
A total of 450 Heart Failure with Reduced Ejection Fraction (HFrEF) patients with a mean age of 56 ± 12 years, of which 80% are male, and with a mean LVEF of 29 ± 4%, mean TAPSE of 19 ± 3 mm and PASP of 38 ± 11mmHg. The mean TAPSE/PASP was 0.80 ± 0.28. Fifty-four patients (12%) met the primary endpoint. Patients with RV-arterial uncoupling (TAPSE/PASP &lt; 0.36 mm/mmHg) were more likely to have a non-ischaemic etiology for HF (66.7% vs 40%, p = 0.047), had a lower prevalence of diabetes (53.3% vs 77.9%, p = 0.041), a higher prevalence of moderate-to-severe mitral regurgitation (33.3% vs 13.0%, p = 0.035), a lower LVEF (26.2 ± 6.1 vs 29.9 ± 5.9, p = 0.038), a higher prevalence of RV dysfunction (73.3% vs 26.7%, p &lt; 0.001) and worse cardiopulmonary fitness (pVO2: 12.7 ± 5.1 vs 15.8 ± 6.0 ml/kg/min, p = 0.047; VE/VCO2 slope: 49.5 ± 17.2 vs 37.6 ± 9.7, p &lt; 0.001; cardiorespiratory optimal point: 36.9 ± 11.3 vs 29.0 ± 6.4, p &lt; 0.001). More patients in the group of TAPSE/PASP &lt; 0.36 mm/mmHg met the primary endpoint (33.3% vs 9.6%, p = 0.034) and more patients underwent urgent HT (13.3% vs 1.4%, p = 0.44). RV-arterial coupling was associated with a lower survival free of events during follow-up (log-rank p = 0.010).

Conclusion
RV-arterial coupling predicts a worse prognosis in advanced HF patients, with those below a cutoff of 0.36 mm/mmHg having lower survival. This variable may improve risk stratification in this setting. Abstract Figure.
Echocardiographic assessment of mechanical dyssynchrony: are the new parameters better?
Authors: Puvrez A , Mirea O , Duchenne J , Bezy S , Wouters L , Beela AS , Donal E , Voigt J-U 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction - The high cost and important non-response rate are preventing optimal use of cardiac resynchronization therapy (CRT). Assessing mechanical dyssynchrony on echocardiography in candidates for CRT could remove these barriers by improving patient selection. In 2008 the PROSPECT study compared several old parameters of dyssynchrony in search of a reproducible parameter capable of better predicting response to CRT. Unfortunately, the results were disappointing and the assessment of dyssynchrony became discredited. Promising new parameters have been developed but a comparison with the old parameters is currently missing.
Purpose - To compare the old and new parameters of mechanical dyssynchrony for (1) their effect on response to CRT as additional selection criteria, (2) predicting favourable long-term outcome after CRT and (3) their reproducibility.
Methods - 146 CRT patients were analysed retrospectively in a multicentre setting. Mechanical dyssynchrony was assessed using three old parameters: septal-to-posterior wall motion delay (SPWMD), left ventricular filling time/cardiac cycle ratio (LVFT/RR), and intraventricular mechanical delay (IVMD); and three new parameters: systolic stretch index (SSI), myocardial work index (MWI), and visual presence of septal flash or apical rocking (SFoAR). Response to CRT was defined as a ≥15% decrease in LV end-systolic volume 1 year after CRT. For each parameter patients were categorized using previously published cut-offs as ‘eligible’ or ‘non-eligible’. The ‘non-eligible’ were considered untreated. Results were compared to the guidelines (Fig. 1). The hazard ratio (HR) for cardiac death within 5 years after implantation was computed for all patients (Fig. 2), and intra- and interrater agreement was determined.
Results - 73% (n= 107) of patients showed response to CRT. The old parameters maintained less than 75% of the original responders. SFoAR preserved the highest proportion of responders (93%), while reducing the number of non-responders by 39% (Fig. 1). The prediction of cardiac death was significant for SFoAR (HR = 0.29; 95% CI: 0.12-0.74; P = 0.009) and IVMD (HR = 0.32; 95% CI: 0.13-0.79; P = 0.014) (Fig. 2). Intra- and interrater agreement was best for SFoAR (κ = 0.89; 95% CI: 0.67-1.0 and κ = 0.78; 95% CI: 0.50-1.0 respectively). Interrater agreement was poor for all old parameters (κ &lt; 0.6).
Conclusion - The new parameters for dyssynchrony are performing better. The visual presence of apical rocking or septal flash provided the most responders to CRT, predicted favourable long-term outcome and was highly reproducible. Our results show that future research should focus on the new parameters. Abstract Figure. Abstract Figure.
Incremental prognostic value of vasodilator stress cardiovascular magnetic resonance over coronary computed tomography angiography in symptomatic patients
Authors: Pezel T , Hovasse T , Lefevre T , Sanguineti F , Unterseeh T , Champagne S , Benamer H , Neylon A , Toupin S , Garot P , Chevalier B , Garot J 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
Current guidelines recommend to perform noninvasive functional imaging in patients with obstructive coronary artery disease (CAD) on coronary computed tomography angiography (CCTA). However, the prognostic value of stress cardiovascular magnetic resonance (CMR) over traditional risk factors and CCTA is not known.

PURPOSE
To assess the incremental prognostic value of stress CMR beyond traditional risk factors and CCTA in patients with obstructive CAD on CCTA.

METHODS
Between 2008 and 2020, consecutive symptomatic patients without known CAD referred for CCTA were screened. Among those, patients with obstructive CAD (at least 1 ≥50% stenosis on CCTA) and referred for functional stress CMR were included and followed for the occurrence of major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction. Univariable and multivariable Cox regressions were performed to determine the prognostic value of CCTA and CMR findings.

RESULTS
Of 2,210 patients who completed the CMR protocol, 2,038 patients (46.5% male, mean age 69.8 ± 12.2 years) completed the follow-up (median 6.8 [IQR 5.9-9.2] years); 281 experienced a MACE (13.8%). Stress CMR was well tolerated without severe adverse events. Using Kaplan-Meier analysis, inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of MACE (hazard ratio, HR: 4.51, [95%CI: 3.55-5.74]; and HR: 3.32, [95%CI: 2.55-4.32], respectively; both p &lt; 0.001). In multivariable Cox regression, the presence of inducible ischemia and LGE were independent predictors of a higher incidence of MACE (HR: 3.97, [95%CI: 3.43-5.13]; HR: 2.30, [95%CI: 1.52-3.33]; respectively, both p &lt; 0.001). After adjustment, stress CMR findings showed the best improvement in model discrimination and reclassification above traditional risk factors and CCTA findings (C statistic improvement: 0.08; NRI = 0.421; IDI = 0.047).

CONCLUSIONS
In symptomatic patients with obstructive CAD of unknown significance on CCTA, stress CMR has an incremental prognostic value to predict MACE over traditional risk factors and CCTA findings. Abstract Figure. Kaplan-Meier curves for MACE Abstract Figure. Competitive risk analysis
Epicardial fat volume improves prediction of adverse clinical events
Authors: Viegas JM , Mano TB , Reis JP , Ramos R , Fiarresga A , Cacela D , Marques H , Figueiredo L , Ferreira RC 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Recent studies have demonstrated the potential of epicardial fat volume (EFV) to predict obstructive coronary artery disease (CAD), however its impact in clinical outcomes remains elusive.

Objectives
To assess the association between EFV and demo­graphic and morphometric data, coronary atherosclerotic burden and adverse events in a population of patients (pts) referred for coronary computed tomography angiography (CTA).
­Methods: Retrospective analysis of pts without known CAD referred for coronary CTA in a single tertiary care centre. A standardized protocol for quantification of EFV, thoracic fat volume (TFV), coronary artery calcification (CAC) and coronary angiography was performed. Endpoint was composite of cardiovascular death, nonfatal myocardial infarction and urgent hospitalization leading to revascularization at 12 months.

Results
72 pts were included, 58% male, mean age 67 ± 9 years. The prevalence of hypertension, dyslipidemia and diabetes was 75%, 82% and 24%, respectively. Median EFV was 101 (68) ml and total TFV 1504 (694) ml. EFV was directly related with age (rs= 0.42, p &lt;0.001), male sex (135 ± 50 vs 78 ± 30, p &lt;0.001), body mass index (rs= 0.32, p= 0.008) and TFV (rs= 0.27, p= 0.025). A positive correlation with CAC (rs= 0.47, p &lt;0.001) and a significant association with CAD (116 ± 50 vs 90 ± 37, p= 0.029) and obstructive CAD (141 ± 60 vs 97 ± 39, p= 0.031) were demonstrated. Composite endpoint was observed in 13 pts (18%). After adjusting for all considered confounders, EFV remained an independent predictor of adverse events (OR: 1.015, 95%CI: 1.003-1.027, p= 0.041). ROC analysis of EFV (AUC 0.751, p = 0.005) allowed to estimate that EFV &gt;124 ml had a sensibility and specificity to predict clinical outcomes of 69% and 71%, respectively.

Conclusion
EFV positively relates to coronary atherosclerotic burden. This study also advocates that EFV may improve risk stratification for clinical outcomes. Larger studies are required to evaluate these results. Abstract Figure 1