bluuebunny/crossref_metadata_2025_split huggingface dataset:
Could premature ventricular contractions lead to atrial remodeling?
Authors: Keles N , Kahraman E , Parsova E , Bastopcu M , Karatas M , Yelgec N S 
Published: October 2022

Abstract

Background
Premature ventricular contraction (PVC) is a frequent kind of arrhythmia that affects around 1% of the general population. While PVC most frequently impairs ventricular function in structurally normal hearts, retrograde ventriculo-atrial conduction can occur in people with PVC. These retrograde atrial activations may mimic pulmonary vein-derived atrial ectopies. As a result, PVC may raise the risk of AF by retrograde ventriculo-atrial conduction.
The Four-Dimensional Automated Left Atrial Quantification (4D Auto LAQ) tool is a left atrial analytical approach that utilizes three-dimensional volume data to quantify the volume, as well as LA longitudinal and circumferential strain. The purpose of this study was to determine if clinical diagnosis of PVC is connected with abnormal LA functions as determined by LA strain evaluation utilizing a 4D Auto LAQ compared to the normal population.

Methods
58 patients with frequent PVCs were enrolled in the research, along with 53 healthy volunteers as a control group. Imaging was performed using the GEvivid E95 ultrasonic diagnostic instrument (GE Healthcare; Vingmed Ultrasound, Horten, Norway) equipped with an M5S probe (frequency range: 1.5–4.6 MHz) and a 4V probe (frequency range: 1.5–4.0 MHz). Images were imported into and selected for analysis using the EchoPAC203 software (GE Healthcare). The analysis mode was selected, followed by the volume and 4D Auto LAQ submodes. Following that, the sample point was positioned in the center of the mitral orifice in each of the three planes. The'review' function was used to acquire the LA parameters measured by 4D Auto LAQ, including volume and strain parameters.

Results
The maximum left atrial volume (LAVmax) and minimal left atrial volume (LAVmin) were signifcantly higher in patient group (38.91±9.72 vs. 46.31±10.22, 17.75±4.52 vs. 23.10±7.13 respectively, all p values &lt;0.001).On the other hand left atrial reservoir longitudinal strain (LASr), conduit longitudinal strain (LAScd), contraction longitudinal strain (LASct), reservoir circumferential strain (LASr-c), conduit circumferential strain (LAScd-c), and contraction circumferential strain (LASct-c) were signifcantly lower in patient group (26.64±5.64 vs. 19.16±4.58, −19.53±3.72 vs. −11.28±3.47, −10.34±1.56 vs. −4.59±1.49, 30.72±4.04 vs. 19.31±2.60, −19.91±1.78 vs. −13.38±2.85, −15.89±6.37 vs. −9.24±1.63, respectively all p values &lt;0.001).

Conclusion
The present study found that premature ventricular contractions can lead to atrial remodeling as well as ventricular remodeling in patients with PVC and 4D LAQ technology can quantitatively evaluate atrial myocardial function and detect these changes early.

Funding Acknowledgement
Type of funding sources: None.
Right ventricular mechanics among beta-thalassemia major patients
Authors: Patsourakos D , Aggeli C , Gatzoulis K , Delicou S , Xydaki A , Koukos M , Gialleli F , Dimitroglou Y , Tsioufis K 
Published: October 2022

Abstract

Introduction
Right ventricular function among β-thalassemia (β-TM) patients is affected by both pulmonary circulation pressure and primary iron deposition on right ventricular myocardium.

Purpose
In our study we aimed to detect the presence of impaired right ventricular function and right ventricle to pulmonary circulation (RV-PC) coupling by applying novel echocardiographic techniques among these patients.

Methods
47 β-TM patients (mean age 39.02±8.76 years, 48.9% male sex) and 24, age and sex matched, healthy controls were examined by transthoracic echocardiography. Conventional echocardiographic parameters were estimated (LVEF, E/e' ratio, left atrial volume index (LAVI), right ventricular systolic pressure (RVSP), S' wave of tricuspid annulus), alongside with deformation indices (left atrial strain at reservoir phase (LASr), right ventricular free wall (RVfw) and 4 chamber (RV4c) strain), as well as RV-PC coupling expressed as S'/RVSP, RVfw/RVSP and RV4c/RVSP. T2* was calculated by cardiac magnetic resonance imaging in β-TM patient group.

Results
E/e' ratio, LVEF, LAVI, RVSP, LASr, RVfw, RV4c, S'/RVSP, RVfw/RVSP and RV4c/RVSP differed significantly between patients and controls (Table 1). T2* did not correlate with either right ventricular deformation indices or RV-PC coupling indices. A correlation was found regarding LASr with both S'/RVSP (r=0.383, p=0.008) and RV4c/RVSP (r=−0.388, p=0.007) but not with RVfw/PVSP (Table 2).

Conclusions
Right ventricular deformation indices were found to be impaired in β-TM patients compared to controls, but they do not seem to be associated with myocardial iron load (T2* index). RV-PC coupling was also found to be impaired among patients and a correlation was found between RV-PC indices and left atrial strain. The latter suggests that the presence of atrial cardiomyopathy in β-TM patients could be associated with the impaired RV-PC coupling.

Funding Acknowledgement
Type of funding sources: None.
The impact of left atrial mechanics on adverse events and clinical outcome after cardiac surgery
Authors: Dalos D , Haaser S S , Hofer F , Kazem N , Koller L , Hammer A , Steinlechner B , Laufer G , Hengstenberg C , Niessner A , Sulzgruber P 
Published: October 2022

Abstract

Objectives
Post-operative atrial fibrillation (POAF) represents a common complication after cardiac surgery that is associated with unfavorable clinical outcome. Identifying patients at risk for POAF is crucial but challenging.

Purpose
This study aimed to investigate the prognostic potential of speckle tracking echocardiography (STE) on POAF and fatal adverse events from a long-term perspective.

Methods
A total of 124 patients undergoing elective cardiac surgery were prospectively enrolled and underwent pre-operative STE. Patients were followed prospectively for the occurrence of POAF within the entire hospitalization and reaching the secondary endpoints cardiovascular (CV) and all-cause mortality.

Results
Within the study population 43.5% (n=53) of enrolled individuals developed POAF. After a median follow-up of 3.9 years, 25 (20.2%) patients died. We observed that patients presenting with POAF had lower global peak atrial longitudinal strain (PALS) values compared to the non-POAF arm (POAF: 14.8% [95% CI: 10.9–17.8] vs. non-POAF: 19.4% [95% CI: 14.8–23.5], p&lt;0.001). Moreover, global PALS was a strong and independent predictor for POAF (adjusted Odds Ratio per 1-SD: 0.37 [95% CI: 0.22–0.65], p&lt;0.001), and independently associated with mortality (adjusted Hazard Ratio per 1-SD: 0.63 [95% CI: 0.40–0.99], p=0.048). CART analysis revealed a cut-off value of &lt;17% global PALS as high-risk for both POAF and mortality.

Conclusion
Global PALS is associated with the development of POAF following surgery in an unselected patient population undergoing CABG and/or valve surgery. Since patients with global PALS &lt;17% face a poor long-term prognosis, routine assessment of global PALS needs to be considered in terms of proper secondary prevention in the era of personalized medicine.

Funding Acknowledgement
Type of funding sources: None.
Incremental value of global longitudinal strain in long-term risk prediction after acute coronary syndrome. A SWEDEHEART registry based echo study
Authors: Lenell J , Lindahl B , Erlinge D , Spaak J , Jernberg T , Baron T 
Published: October 2022

Abstract

Background
Global longitudinal strain (GLS) by 2D speckle tracking echocardiography has emerged as a new method for assessing left ventricular (LV) function, however its added value in long-term risk prediction after Acute Coronary Syndrome (ACS) has not been clearly established. This study aimed to investigate GLS as a predictor of death and heart failure re-hospitalization after ACS in relation to more established echocardiographic measures.

Method
1385 consecutive patients with acute coronary syndrome (47% STEMI, 45% NSTEMI, unstable angina 3.6% and unspecified ACS 4.5%), admitted between 2008 and 2014 to the three participating Swedish university hospitals were reported to the SWEDEHEART registry and underwent routine echocardiography during their hospital stay. The echo data was retrospectively collected from each study site and reviewed at a Core Lab. The prognostic value of systolic left ventricular function parameters (LVEF and GLS) regarding all-cause mortality and heart failure (HF) hospitalizations (median follow-up 6.8 years) was studied using the Cox proportional Hazards model. A nested model comparison was performed with C-statistics.

Results
In the 942 patients remaining after exclusion (median age 65 years, 77% men) median LVEF was 55% (inter quartile range (IQR) 47–60) and median GLS −14.8% (IQR −17.8–11.8). The combined endpoint of HF hospitalization and all-cause death was reached in 17.7% of the patients, 12.1% of the patients died and 8.7% were re-admitted due to HF. After adjustment for baseline characteristics, both LVEF and GLS were individual independent predictors of the combined endpoint, HR 0.964 (95% CI 0.949–0.980, p&lt;0.001) and HR 1.042 (95% CI 1.002–1.084, p=0.042) respectively. The C-statistics increased from 0.752 (95% CI 0.712–0.792) to 0.755 (95% CI 0.706–0.785) when GLS entered the model with clinical data and LVEF.

Conclusion
In a large cohort of patients with ACS and normal or near-normal ejection fraction, GLS emerged as an independent long-term risk predictor of all-cause mortality and heart failure hospitalizations. The incremental predictive value of GLS on top of clinical background and LVEF was statistically significant, but of limited clinical significance.

Funding Acknowledgement
Type of funding sources: None.
Echocardiographic assessment of left ventricular radial strain to differentiate cardiac amyloidosis from Fabry disease
Authors: Steudel T , Mattig I , Romero Dorta E , Barzen G , Frumkin D , Laule N , Al Daas M , Spethmann S , Knebel F , Canaan-Kuhl S , Stangl K , Hahn K , Brand A 
Published: October 2022

Abstract

Background
Left ventricular (LV) wall thickening is a typical echocardiographic finding in infiltrative cardiomyopathies like cardiac amyloidosis (CA) and Fabry disease (FD). The discrimination of both infiltrative diseases remains challenging by standard as well as 2D speckle tracking echocardiography (2DSTE)-based analysis of longitudinal LV strain patterns. Over the recent years, a constant development in image quality and data processing provided better possibilities to analyse layer specific myocardial deformation indices. With regards to FD, specific layer LV strain patterns may be useful to rule-in FD in patients with suspected infiltrative cardiomyopathy.

Purpose
The aim of the present study was to investigate differences and the diagnostic value of layer specific 2D STE-based radial LV strain indices in CA and FD.

Methods
Next to standard parameters of a comprehensive echocardiographic assessment (Vivid E9 or E95, GE Vingmed, Horton, Norway, with an M5S 1.5–4.5MHz transducer), we retrospectively analysed the transmural radial LV strain (GSradial), the subendocardial radial LV strain (GSendo), the subepicardial radial LV strain (GSepi), and the strain gradient (GSendo − GSepi) (EchoPAC software, GE) in FD patients and CA patient from the amyloidosis registry at our study site. A Receiver operating curve (ROC) analysis was used to assess the diagnostic value of the respective LV strain values and the layer-specific strain gradient to discriminate FD and CA.

Results
A total of 38 FD and 40 CA patients were included in our analyses. In patients with FD, GSepi showed a marked impairment. LV radial and layer strain were significantly reduced in CA compared to FD patients [GSradial −12.0 (−16.2 to −9.9) in CA vs. −17.7 (−20.5 to −14.6) in FD; p&lt;0.001); GSendo (−20.6 (−27.0 to −15.7) in CA vs. −30.0 (−32.0 to −25.6) in FD; p&lt;0.001); and GSepi (−7.4 (−8.9 to −4.8) in CA vs. −9.1 (−11.86 to −7.6) in FD; p&lt;0.001)]. The gradient of GSendo and GSepi was significantly lower in patients with CA compared to FD (−14.0±5.6 in CA vs. −19.4±4.3 in FD respectively; p&lt;0.001). GSendo held the highest diagnostic accuracy to discriminate CA and FD (area under the curve [AUC] 0.83, 95% confidence interval [CI] 0.73–0.92). The layer-specific strain gradient GSendo − Gsepi showed an AUC of 0.79 (CI 0.69 to 0.89).

Conclusion
Layer-specific strain analysis demonstrated significantly reduced strain values in CA patients compared to FD. The analysis of GSendo held a high diagnostic accuracy to discriminate FD and CA in patients. The integration of layer-specific LV strain indices into the diagnostic work-up may improve the management of patients with an unclear thick heart pathology in future.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Alnylam Pharmaceuticals (Cambridge, MA, USA)
Global longitudinal strain improvement after iron replacement in stable heart failure patients – FER-Strain study
Authors: Benavent Garcia C , Romero Valero A , Garcia Suarez A , Peris Castello F , Rodriguez Santiago F M , Del Rio Lopez M , Vicente Ibarra N , Garcia Honrubia A , Valero Medrano M C , Quintana Aguilar M M , Martinez Moreno M , Gomez Martinez M , Castilla Cabanes E , Tamayo Obregon A S , Morillas Blasco P 
Published: October 2022

Abstract

Background
Iron deficiency in patients with heart failure with reduced left ventricular ejection fraction (LVEF) confers a poor prognosis in terms of hospital admissions and mortality, worsening functional class and quality of life. Its replacement with ferric carboxymaltose (FCM) has demonstrated to improve clinical parameters, however, the way it is achieved remains unclear. Improvement of myocardial contractility is proposed as possible hypothesis and global longitudinal strain (GLS) could behave as an early and high sensitive parameter to assess this improvement in myocardial deformation due to increased iron availability after replacement of iron deficiency.

Purpose
Evaluate the effect of replacement of iron deficiency with FCM on left ventricular global longitudinal strain in patients with stable heart failure with left ventricular ejection fraction &lt;50%.

Methods
Observational, analytical, longitudinal and prospective study that enrolled 45 patients with stable heart failure with LVEF &lt;50% who presented iron deficiency without anemia defined as serum ferritin &lt;100 μg/L or between 100 and 300 μg/L and the transferrin saturation &lt;20%. Transthoracic echocardiogram, 3D, tissue Doppler imaging and strain were performed, by the same cardiologist, before and four weeks after the iron deficiency replacement with FCM.

Results
The study population's median age was 71 years, 67% were men, 76% had high blood pressure, 62% dyslipemia and 33% diabetes. At baseline they presented LVEF 32% ±8.75%, LV systolic volume index 62.3ml±29.56ml and LV GLS −9.09%±3.44%. Four weeks after iron deficiency replacement, they had a significant improvement in LVEF (difference 2.51%; 95% confidence interval [CI], 1.74% to 3.29%; P&lt;0.0001), LV systolic volume index (difference −6.68ml; 95% CI −1.91ml to −11.45ml; P=0.007) and LV GLS (difference −1.11%; CI 95%, −0.4% to −1.81%; P=0.003), with a relative benefit in LV GLS of 10.57%. Other echocardiography parameters didn't show significant differences.

Conclusion
In patients with stable heart failure and LVEF &lt;50%, replacement of iron deficiency with FCM improves systolic parameters, especially left ventricular global longitudinal strain.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fundaciόn Fisabio (Fomento de la Investigaciόn Sanitaria y Biomédica de la Comunidad Valenciana)
Resynchronization of the left atrium may play an important role in cardiac resynchronization therapy
Authors: Hammersboen L E R , Aalen J , Puvrez A , Larsen C K , Remme E W , Donal E , Duchenne J , Voigt J U , Galli E , Khan F H , Sletten O J , Penicka M , Stugaard M , Smiseth O A 
Published: October 2022

Abstract

Introduction
Left atrial (LA) dyssynchrony is a predictor of response to cardiac resynchronization therapy (CRT). It is unknown, however, if LA resynchronization contributes to response to CRT. We hypothesize that there is a relationship between correction of LA dyssynchrony and response to CRT.

Purpose
To investigate the association between LA resynchronization and response to CRT.

Methods
In a prospective study of 171 heart failure patients with LBBB, myocardial strain was measured by speckle-tracking echocardiography, before and 6 months after CRT. As indicated by the white arrows in Figure 1, LA dyssynchrony was measured as the time delay between onset systolic stretch of the interatrial septum and the LA lateral wall. Response to CRT was defined as at least 15% reduction in left ventricular (LV) end systolic volume at 6 months follow up.

Results
119 (70%) patients responded to CRT. The panels in Figure 1 shows LA strain traces in a representative LBBB patient that did respond (upper panels), and a patient that did not respond (lower panels). The white arrows in the left panels indicate that both the responder and the non-responder had marked LA dyssynchrony before CRT (198 and 171 ms, respectively). However, after 6 months with CRT, there was recovery of LA synchrony only in the responder (time delay −40 ms), and still marked LA dyssynchrony of 191 ms in the non-responder (right panels).
Figure 2 confirms similar results for the whole study population: CRT response was associated with marked reduction of LA dyssynchrony (p=0.0001). In the CRT non-responders there was, however, only a modest, non-significant reduction of LA dyssynchrony.

Conclusions
Positive CRT response was associated with resynchronization of the left atrium. These findings suggest LA resynchronization as a potential additional target for CRT.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Institute for Surgical Research, Oslo University HospitalThe Intervention Centre, Oslo University Hospital
Heart rate reserve complements regional wall motion abnormality for predicting outcome in hypertensives during stress echocardiography
Authors: Peteiro Vazquez J C , Ciampi Q , Zagatina A , Cortigiani L , Arbucci R , Saad A K , Celeutkiene J , Citro R , Rodriguez-Zanella H , Gaibazzi N , Djordjevic-Dikic A , Boshchenko A , Wierbowska-Drabik K , Bartolacelli Y , Picano E 
Published: October 2022

Abstract

Background
Stress echocardiography (SE) was recently upgraded to include imaging-independent heart rate reserve (HRR) which assesses cardiac sympathetic balance and is simply based on one-lead electrocardiogram present in the echo monitor. The value of HRR for risk stratification of hypertensive patients remains undetermined.

Aim
To assess the prognostic value of SE with HRR in hypertensive patients in a prospective, large scale, multicenter, international, effectiveness study.

Methods
From July 2016 to December 2020, we enrolled 2747 hypertensives (age 66±10 years, 1599 males, 58.2%; ejection fraction 61±8%) referred from 12 certified laboratories. All patients underwent clinically indicated SE. The employed stress modality was exercise (n=754) or pharmacological stress (n=1993). Exercise modality was either semi-supine bike (n=674) or treadmill (n=80). Pharmacological stress was either vasodilator (n=1695, 1661 with dipyridamole and 34 with adenosine) or dobutamine (n=298). SE response included the evaluation of regional wall motion abnormality (RWMA) and non-imaging HRR (peak/rest heart rate), with stress-specific cutoff values abnormal response &lt;1.80 for exercise or dobutamine, &lt;1.22 for dipyridamole or adenosine. All-cause death was the only end-point.

Results
Rate of abnormal results was 17% for RWMA and 40% for HRR. During a median follow-up of 624 days (interquartile range: 380–1037 days), 60 deaths occurred. Global X2 was 25.0 considering clinical and resting echocardiographic variables, with no change after stress-induced RWMA and a significant increase after HRR (Figure 1). Annual mortality rate was 0.7% person/year for patients (n=1496) with normal HRR and absence of stress-induced RMWA, 0.4% for patients (n=151) with RWMA and normal HRR, up to 2.1% person/year for patients (n=1101) with abnormal HRR with (n=321) or without (n=780) RWMA. At multivariable analysis, only age (HR: 1.070, 95% CI: 1.039–1.101, p&lt;0.001) and abnormal HRR 2.651 (HR: 2.651, 95% CI: 1.550–4.543, p&lt;0.001) showed independent value in predicting survival.

Conclusion
SE with either exercise or pharmacological stress allows an effective prediction of survival in hypertensive patients with chronic coronary syndromes, but only when the conventional criterion of RWMA is complemented with imaging-independent HRR.

Funding Acknowledgement
Type of funding sources: None.
Left atrial volume, function and B-lines at rest and during vasodilator stress echocardiography
Authors: Prota C , Ciampi Q , Cortigiani L , Campagnano E , Wierzbowska-Drabik K , Kasprzak J D , Djordjevic-Dikic A , Merli E , Arbucci R , Gaibazzi N , D'Andrea A , Citro R , Villari B , Picano E 
Published: October 2022

Abstract

Background
Left atrial volume index (LAVi), left atrial reservoir function assessed with global peak amplitude longitudinal strain (PALS), and B-lines at lung ultrasound are supplementary markers of left ventricular filling pressures.

Aim
To assess the relationship between LAVi, PALS and B-lines at rest and peak vasodilator stress.

Methods
A comprehensive dipyridamole stress echo was completed in 266 patients (187 male, 71%, age 65±10 years) with chronic coronary syndromes. LAVi was measured with the biplane disk summation method. PALS was measured from a single vendor with 2-dimensional speckle tracking echocardiography and expressed in % values as the mean of the 12 atrial segments from 4- and 2-chamber values. B-lines were assessed with the simplified 4-site scan in the third intercostal space, with global score from 0 to 40, and considered significant with global score ≥2 units.

Results
During dipyridamole, LAVi decreased (rest= 26±14 ml/m2 vs stress= 24±12 ml/m2, p&lt;0.001), PALS increased (rest= 33±8 vs stress= 38±10%, p&lt;0.001), and B-lines were more frequent (rest= 0.4, median interquartile range 0–30, vs stress= 0.7, median interquartile range 0–30, units, p&lt;0.001). There was a significant, linear, inverse correlation between LAVi and PALS both at rest (r=−0.301, p&lt;0.001) and at peak stress (r=−0.279, p&lt;0.001, see figure). At group analysis, peak B-lines were directly correlated with peak LAVi (r=0.151, p=0.017) and inversely correlated with peak PALS (r=−0.234, p&lt;0.001). At individual patient analysis, 4/93 patients (4.3%) showed stress B-lines (black dots in figure) with normal LAVi (&lt;34 ml/m2) and preserved PALS (&gt;42%).

Conclusion
Vasodilator stress echocardiography with combined assessment of left atrial volume, function and pulmonary congestion is feasible with high success rate in patients with chronic coronary syndromes. Pulmonary congestion is more frequent with dilated left atrium with reduced atrial contractile reserve, but it may occur in a minority of patients with normal LAVi and normal PALS.

Funding Acknowledgement
Type of funding sources: None.