bluuebunny/crossref_metadata_2025_split huggingface dataset:
Same-day air pollution and ABCDE stress echo results: nitrogen dioxide increases vulnerability to pulmonary congestion
Authors: Ciampi Q , Russo A , Villari B , Mangia C , D"alise C , Ballirano A , Campagnano E , Picano E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
StressEcho 2030 study group

Background
Air pollution affects same-day hospital admissions for acute coronary syndromes, decompensated heart failure and arrhythmias. The present study hypothesis is that air pollution also may affect results of comprehensive cardiac functional testing unmasking a pre-clinical vulnerability.

Aim
To assess the effects of air pollution on stress echocardiography (SE) performed with ABCDE protocol

Methods
We enrolled 1292 patients with chronic coronary syndromes referred for clinically-driven dipyridamole ABCDE-SE (score results from 0= all parameters normal, to 5, all abnormal). Same day values of 5 pollutants were obtained on the same morning of testing (average of 4 hours) from publicly available data sets of regional authority of environmental protection. Air pollution score (APS) of 5 items included fine (PM 2.5) and &lt;10 µm diameter particulate matter, ozone (O3), sulfur dioxide and nitrogen dioxide (NO2). According to predetermined, internationally established thresholds, APS ranged from 0 (all parameters normal or near normal, index value ≤3 in the 1 to 10 scale of UK government air quality index 2014) to 5 (all parameters abnormal).

Results
There was no significant correlation (r=-0.032, p = 0.276) between SE score (0.82 ± 1.08) and APS (1.96 ± 1.09). When individual pollutants were evaluated with individual items (from A to E) of SE score, NO2 concentration was correlated with rest (r=.089; p = 0.001) and peak stress B-lines in step B (r=.099; p &lt; 0.001). Patients with abnormal (&gt; 2) B-lines at peak stress (n = 247) were compared with those with normal (≤ 1) response (n= 1, 045). B-liners showed higher values of same-day NO2 (median value 23.1 [I.Q. range 16.2-31.0] vs 19.7 [12.5-27.4] µg/m3, p&lt; 0.001) and PM 2.5 (22.0 [9.1-23.5] vs 17.6 [8.6-22.2] µg/m3, p&lt; 0.001), with lower values of O3, a secondary pollutant destroyed by NO2 (44.9 [26.7-59.5] vs 48.4 [28.5-67.4] µg/m3, p= 0.040). At multivariable logistic regression analysis (Figure), NO2 predicted stress B-lines with age, hypertension, diabetes, and reduced (&lt; 50%) ejection fraction.
Conclusion Air pollution may modulate cardiac functional testing results. Higher concentration of NO2 and PM 2.5 are associated with more frequent pulmonary congestion mirrored by B-lines at rest and during stress. The increased inflammatory stress mediated by NO2 and PM 2.5 may increase the permeability of the alveolar capillary barrier to any given rise in pulmonary wedge pressure. Abstract table
Dobutamine stress echocardiography during covid-19 pandemic: impact on volume and positivity rates in a tertiary hospital
Authors: Dimitroglou Y , Kalompatsou A , Tsartsalis D , Giannoulis E , Koukos M , Solomou E , Angelis A , Patsourakos D , Valatsou A , Zisimos K , Fragkoulis C , Christofi A , Liakos C , Aggeli C , Tsioufis K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The emergence of coronavirus 2019 infection (covid-19) was accompanied by severe social and economic restrictions and applied significant pressure to the healthcare systems. The first pandemic wave started in March to May 2020 and was characterized by the peak of confinement measures and lockdown application. The second wave started in September and peaked in November to December 2020 and was characterized by improved healthcare organization but significant burden for the hospitals and intensive care units. Dobutamine stress echocardiography (DSE) is used for evaluation of ischemia in patients with known or suspected coronary artery disease.

Purpose
To compare DSE volume and positivity rates between 2019 and 2020 time periods in a department of a public tertiary hospital.

Methods
We retrospectively analysed DSE studies performed in our department in 2020 including the peak of covid-19 restrictions and compared the data to the 2019.

Results
Volume of DSE studies decreased from 1516 in 2019 to 996 in 2020 (-34.3%). The study volume reduction was greater in April (-93.7%) and May (-54.5%) when the covid-19 restrictions were at the peak. Great decreases were also recorded in November (-46.8%) and December (-53.5%) when the second wave of covid-19 disease emerged. Conversely, small increases were recorded in September (7.1%) and October (10.6%) (figure 1). Regarding positivity rates, a statistically non-significant increase was recorded (33.6% vs 34.2% in 2019 and 2020 respectively, p = 0.73). Interestingly a statistically significant increase in positivity levels was recorded during the period March to May 2020 compared to the same period of 2019 (44.7% vs 36.9%, p = 0.029). On the contrary, positivity rates were decreased at the period September to December (27.1% vs 34.2%, p = 0.019) (figure 2).

Conclusions
Volume of DSE studies was significantly reduced in 2020 when compared to 2019 during respective peaks of the pandemic and the accompanying restriction measures. Positivity rates were higher during the first pandemic wave, possibly due to decreased hospital attendance of mildly symptomatic patients in combination with stricter admission criteria at the emergency department. Lower positivity rates during the second pandemic wave possibly reflect an adjustment of both healthcare systems and patients to the new conditions imposed by the covid-19 pandemic. Abstract Figure 1 Abstract Figure 2
Prognostic value of different echocardiographic indices reflecting right ventriculo-arterial coupling in a large cohort of patients with various cardiac diseases
Authors: Florescu D , Muraru D , Florescu C , Volpato V , Tomaselli M , Caravita S , Gavazzoni M , Parati G , Badano LP 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction – Non-invasive parameters used to assess right ventricular (RV) function, i.e. tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), RV ejection fraction (RVEF), and RV free-wall longitudinal strain (RVFWLS) have shown their prognostic implications. However, since they are extremely load dependent, they do not provide an accurate representation of the RV intrinsic performance. On the other end, invasive indices of RV-arterial coupling (RVAC) derived from pressure-volume loops are not routinely performed, rising the urgency for more feasible, and reliable non-invasive estimates of RVAC.
Purpose – To: i. evaluate the prognostic value of echocardiography-derived RVAC surrogates: RVEF/systolic pulmonary artery pressure (sPAP), RVFWLS/sPAP, TAPSE/sPAP, FAC/sPAP, and RV stroke volume/end-systolic volume (SV/ESV), ii. identify the cut-off values associated to all-cause mortality; and iii. compare their prognostic value with that of classical parameters of RV function.
Methods – We prospectively enrolled 366 patients with various cardiac diseases, undergoing clinically-indicated comprehensive two- and three-dimensional echocardiography.
Results – During a mean follow-up of 7.6 ± 1 years, 80 (21.9%) patients died. At univariable Cox regression, most of the echocardiographic parameters were related to all-cause mortality. The echocardiographic parameters with significance at univariable analysis (p &lt; 0.01) were included in a multivariable regression model. Left ventricular ejection fraction (LVEF), RVEF, TAPSE, RVEF/sPAP and RVFWLS/sPAP remained independently associated to all-cause mortality (p &lt; 0.05 for all). Subsequently, they were tested in receiving operator characteristics (ROC) curves. At ROC analysis, RVEF/sPAP (area under the curve, AUC = 0.807, p &lt; 0.001) and RVFWLS/sPAP (AUC = 0.743, p &lt; 0.001) showed the greatest predictive value (p &lt; 0.001 between them). However, all RV parameters significantly improved their prognostic values after indexing for sPAP (p &lt; 0.01 for all). The best cut-offs to predict the outcome were 1.5 for RVEF/sPAP (specificity 71%, sensitivity 83%) and 0.67 for RVFWLS/sPAP (specificity 72%, sensitivity 68%). At Kaplan-Meier analysis, patients with reduced RVAC (less than the predefined cut-offs) had significantly lower probability of survival (p &lt; 0.001 for all).
Conclusion – RVAC surrogates provide incremental prognostic value compared to standard RV functional measurements. RVEF/sPAP, with a cut-off value of 1.5, was the best parameter for risk stratification, and was independently related to all-cause mortality. Abstract Figure. Prognostic value of RVAC surrogates Abstract Figure. Kaplan-Meier curves survival probability
Impact of endocardial leads on the effectiveness of interventional edge-to-edge repair of tricuspid regurgitation
Authors: Goebel B , Salomon C , Abdulrahman M , Richter S , El Garhy M , Costello-Boerrigter L , Lapp H , Lauten P 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
A considerable proportion of patients who are considered for percutaneous tricuspid valve edge-to-edge repair (pTVR) interventions have endocardial lead induced tricuspid regurgitation (TR). The aim of this study was to examine the impact of lead-leaflet interaction on the effectiveness of pTVR.

Methods
For each patient, the lead position within the tricuspid valve (central, commissural, or towards one of the three leaflets) and the type of lead-leaflet interaction (leaflet impingement or adhesion) were identified during thorough 2D/3D transthoracic and transesophageal echocardiography examinations. Before and after pTVR, echocardiographic data, including 3D full-volume datasets, were obtained and quantified. TR severity was graded from 1+ to 5+, based upon the effective regurgitant orifice area by the PISA method (EROAPISA) and the vena contracta area (VCA3D) as measured by multiplanar reconstruction from a 3D color Doppler loop. Maximal diastolic tricuspid annulus area from a 3D zoom image, tricuspid tenting area, and right atrial volume were quantified. Right ventricular assessments included ejection fraction (RVEF3D) and diastolic (RVVd3D) and systolic (RVVs3D) volumes.

Results
Out of 99 patients who underwent pTVR at our hospital, 38 patients had implanted cardiac devices of the following types: pacemakers (n = 25, 66%), cardiac defibrillators (n = 7, 18%), and biventricular pacemakers (n = 6, 16%). In 24 (63%) of these device patients, TR grade was ≤2+ after pTVR. In 14 of the device patients, TR grade remained severe after intervention (Grade 3+ in 15%, grade 4+ in 11%, and Grade 5+ in 11% of the device group). In comparison, in 78% of patients without endocardial leads, moderate TR was achieved after pTVR. Figure 1 shows the distribution of lead positions within the tricuspid valve. A relevant lead-leaflet interference (rLLI) for pTVR interventions was defined as impingement or adhesion in the target area of the coaptation device (anteroseptal or posteroseptal). Binary logistic regression analysis showed an increase risk (Odds ratio 11, R2 0.34, 95% CI 0.019-0.44, p = 0.003) for a suboptimal pTVR result (TR grade &gt; 2+ after intervention) in patients with rLLI. Although patients with rLLI (n = 17) had significantly higher VCA3D values as compared to patients without rLLI (n = 21), it was not predictive for pTVR results. Echocardiographic parameters of right ventricular and tricuspid valve dimensions showed only a trend to higher values in the group with rLLI (Table 1).

Conclusion
Endocardial lead induced TR negatively impacts the effectiveness of pTVR irrespective of the initial degree of TR. Abstract Figure. Abstract Table 1 Echocardiographic parameters
Percutaneous paravalvular leak closure: a single-centre experience of 54 cases
Authors: Vertesaljai M , Denes M , Temesvari A , Fontos G , Andreka P 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Clinically significant paravalvular leak (PVL) occurs in 5-10% of patients undergoing surgical aortic and 5-17% patients undergoing surgical mitral valve replacement and even more often after trancutaneous aortic valve implantation (TAVI). Surgical repair of a PVL is associated with a 30-day mortality of approximately 10%. Percutaneous closure of PVL (pPVLC) has emerged as an alternative to surgical repair.

Aim
We retrospectively analysed the success rate and clinical outcomes of patients with significant PVL, who were turned down from re-do cardiac surgery, and treated with pPVLC at our tertiary referral centre.

Methods
Patients who were admitted for pPVLC between 27th of September, 2009 and 21st of April, 2021 were enrolled into the study. 30-day and 1-year mortality rates were assessed. Technically successful pPVLC was defined as stable device position, and minimum 1 grade reduction in PVL severity.

Results
pPVLC was performed in 54 cases (32 males, 22 females, mean age: 69.5 ± 10.9 yrs). The main indication for closure was heart failure (81%) and haemolysis (19%). The median time since valve surgery was 4.5 yrs (IQR: 0.9-15.2 yrs). Regarding the leaks, 70% (n = 38) were in mitral position (mechanical vale: 33 cases, bioprosthesis: 5 cases) and 30% (n = 16) in aortic position (mechanical valve: 12 cases, bioprosthesis: 2 cases, TAVI: 2 cases). A total of 53 leaks were identified in mitral position (one leak: 25 cases, two leaks: 11 cases, three leaks: 2 cases), and 25 leaks in aortic position (9 cases, 5 cases and two cases resp.). In mitral position 1 device was used in 73% of cases, 2 devices in 21%, and 3 devices in 6%. In aortic position: 62%, 19%, and 19 % resp. Techinal succes was achieved in 49 case (91%). The 30-day mortality was 8%, the 1-year mortality 21%.

Conclusions
Patients with significant PVL represent an extreme or even prohibitive surgical risk cohort. In these high risk individuals percutaneous PVL offers a safe alternative to surgical PVL repair and appears particularly effective in patients presenting with heart failure or haemolysis.
Echocardiography is inferior to computed tomography in predicting balloon expandable transcutaneous implantation valve size in routine clinical setting-single centre study
Authors: Medilek K , Bis J , Polansky P , Dusek J , Brtko M , Kvasnicka T , Tuna M , Praus R , Ballon M , Stasek J 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background
Transcatheter aortic valve replacement (TAVR) became standard of care for selected patients with severe aortic stenosis. Computed tomography (CT) and 2D/3D echocardiography (ECHO) are used for aortic annulus sizing. As a result of increasing number of TAVR more imaging specialists participate in pre-procedural TAVR assessment.
Purpose
The aim of this study was to compare accuracy of ECHO aortic annulus measurements vs CT based parameters for Edward Sapiens TAVR in such environment.
Methods
Data of 145 consecutive patients with TAVR (Sapiens XT or Sapiens 3S) were analysed retrospectively. One radiologist and six echocardiographers trained in aortic annulus size measurements participated in pre-procedural aortic anulus assessment. Aortic annulus area and area derived diameter were measured/calculated in each patient from 3D ECHO data set acquired from mid-oesophageal view and from CT data set, using multiplanar reconstruction. 2D ECHO aortic annulus size was measured from mid-oesophageal 120º view in early systole.
Results
139 (96%) patients had favourable TAVR result (max. mild aortic regurgitation, single valve implanted). 3D ECHO aortic anulus area and area derived diameter were smaller than corresponding CT parameters (464 ± 99 vs 479 ± 88 mm2, p &lt; 0.001 and 24.2 ± 2.7 mm vs 25.0 ± 5.5, p = 0.002, respectively) and differed between echocardiographers (p &lt; 0.001). 2D ECHO anulus measurement were smaller in comparison to both CT and 3D ECHO area derived diameter (22.6 ± 2.9 vs 25.0 ± 5.5mm, p = 0,013 and 22.6 ± 2.9 vs 24.2± 2.7mm, p &lt; 0.001, respectively). In implanted valves with favourable procedure result, concordance of CT and 3D ECHO aortic annulus area with manufacturer recommended ranges was 79.4% vs 61% (p= 0.001) and for area derived diameter 80.1% vs 61.7% (p = 0.001). Using 3D ECHO measurements 33% of the patients would have hypothetically received inappropriate valve size.

Conclusion
3D ECHO aortic annulus measurements are generally smaller then CT ones. If 3D ECHO based parameters only were used for TAVR (Edward Sapiens) size selection, it would have resulted in underestimation of the valve size in up to 1/3 of the patients. CT aortic annulus size assessment should be preferred method over 3D ECHO in daily practice. Abstract Figure 1 Abstract Table 1
Variability of right ventricular linear measurements of size and function using a standardized echocardiographic protocol
Authors: Strachinaru M , Ren C , Geleijnse ML , Spitzer E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Right ventricular size and function have a prognostic value not only in right heart conditions (pulmonary hypertension, congenital heart disease), but also in left ventricular (LV) disease states. The right ventricle (RV) has a unique shape, for which a simple geometrical model is not achievable as is the case for the LV. In clinical practice simple measurements are used for the RV, since these are considered to be most reliable and reproducible: linear cavity dimensions, tricuspid annular plane systolic excursion (TAPSE) and tissue Doppler systolic velocity s’ at the tricuspid annulus. The latest RV quantitation guidelines made important modifications to RV measurements, in particular, by shifting from the apical 4-chamber view to the RV focused apical view. Very scarce data exist on the variability of these measurements.

Purpose
In this study we aim to analyze the intra and inter-observer variability of the linear measurements of RV size and function using a standardized methodology.

Methods
A mixed cohort, randomly selected from the echocardiographic database, comprising 50 patients, was retrospectively analyzed. We measured linear diameters (basal = 1, longitudinal = 2, mid = 3) in apical RV-focused view, TAPSE and s’. Based on computer simulations, we propose a step-by-step approach: tracing the longitudinal diameter as perpendicular to the mid of the basal and generally parallel with the interventricular septum, and the mid as perpendicular to the middle of the longitudinal (Figure). Two observers measured independently the same images at baseline, three (inter-observer) and six months (intra-observer).

Results
The longitudinal diameter had the lowest relative bias (3% inter and 4% intra-observer), followed by the basal (7% and 2%), and mid (6% and 6%). The limits of agreement (LOA) were small for s’ (-3 to 1 intra and -1 to 1mm inter-observer), TAPSE (-6 to 5 and -3 to 3mm), and larger for diameters (1=-5 to 10 and -8 to 6; 2=-13 to 17 and -11 to 6; 3=-11 to 7 and -9 to 4mm). ICCs for individual measurements were very good (1= 0.94 intra and 0.94 inter; 2 = 0.78 and 0.94; 3: 0.72 and 0.56; TAPSE: 0.86 and 0.94; s’=0.94 and 0.98), p &lt; 0.001 for all (Table).

Conclusion
A systematic approach to linear RV-focused apical view measurements may lead to reproducible results. It is essential that size measurements be performed in the RV focused view. Our study shows best consistency and reproducibility for the basal diameter and the linear functional parameters. Echocardiographic laboratories may benefit from implementing a consistent analysis protocol and assessing its reproducibility. Abstract Figure: linear RV measurements Abstract Table: variability results
Geometrical changes of the left ventricle and cognitive impairment in hypertensive patients
Authors: Pal T , Preg Z , Nemes-Nagy E , Balint-Szentendrey D , Nyulas K , German-Sallo M 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
From the view of the heart-brain axis, several biomarkers have been suggested for the assessment, eventually for the prevention of cognitive impairment. Remodeling of the left ventricular (LV) structure could be such a marker. Purpose: This study aimed to investigate the relationship between cognitive functions and left ventricular geometrical structure. Methods: We enrolled 512 consecutive hypertensive patients (mean age 68 ±9.5 years, females: 51%, males 49%), the mean blood pressure was 135/81 mmHg (±19/11 mmHg). Cognitive abilities were measured with two questionnaires the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), considering cognitive impairment under 24 and 26 points respectively. Measures of the left ventricular structure were performed with transthoracic echocardiography using left ventricular mass indexed to body surface area (LVMI) and relative wall thickness (RWT). Cut off value for LV geometrical changes were: LVMI 115 g/m2 in males and 95 g/m2 in females and RWT 0.42 mm. IBM SPSS v20. was used for statistical analyses. Results: Normal geometry of LV was present in 7.4% and remodeling of LV in the studied group was: concentric remodeling in 16.8%, concentric hypertrophy in 61.9% and eccentric hypertrophy in 13.9%. Lower MoCA scores were observed in LV hypertrophy (22.6 vs. 23.4, p = 0.08). Patients with LV concentric hypertrophy had significantly lower cognitive scores compared to eccentric hypertrophy (mean MoCA 22.4 vs. 23.8 p = 0.02; mean MMSE 26.1 vs. 27.0 p = 0.02). Increased RWT alone were associated with poorer cognition (mean MoCA 22.58 vs. 23.89 p = 0.009; mean MMSE 26.17 vs. 26.99 p = 0.02). Higher LVMI negatively correlated with MoCA scores (p = 0.018, r=-0.105), but not with MMSE scores (p = 0.216, r=-0.006). Conclusions: Left ventricular hypertrophy and even changes in relative wall thickness may cause cognitive impairment. Preventing LV geometrical changes may prevent the deterioration of cognitive abilities.