bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic assessment of diastolic dysfunction in elderly patients with severe aortic stenosis before and after aortic valve replacement
Authors: Rosner A , Caglayan HA , Kjonaas D , Malm S , Schirmer H 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Helse Nord

Background
The 2016 guidelines of the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) for evaluation of left ventricular (LV) diastolic dysfunction do not adjust assessment of high filling pressures for patients with aortic stenosis (AS). However, most of the studies on this patient group indicate age independent specific diastolic features in AS.

Purpose
The aim of this study is to identify disease-specific range and distribution of diastolic functional parameters and their ability to identify high N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels as a marker for high filling pressures.

Methods
In this study, 169 patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were prospectively enrolled. Resting echocardiography was performed including Doppler of the mitral inflow, pulmonary venous flow, tricuspid regurgitant flow and tissue Doppler in the mitral ring and indexed volume-estimates of the left atrium (LAVI). Echocardiography, and NT-proBNP levels were assessed before TAVR/SAVR and at two postoperative visits at 6 and 12 months.

Results
Pre- and postoperative values were septal e´; 5.1 ± 3.9, 5.2 ± 1.6 cm/s; lateral e´ 6.3 ± 2.1; 7.7 ± 2.7 cm/s; E/e´19 ± 8; 16 ± 7 cm/s; E velocity 96 ± 32; 95 ± 32 cm/s; LAVI 39 ± 8; 36 ± 8 ml/m2, pulmonary artery pressure (PAP) 39 ± 8; 36 ± 8 mmHg, respectively. The scoring recommended by ASE/EACVI detected elevated NT pro-BNP with a specificity of 25%. Adjusting thresholds according to the cut-off values of the table increased prediction of NT-proBNP levels ≥ 500 ng/L with substantially increased specificity (&gt;85%).

Conclusion
Diastolic echocardiographic parameters in AS indicate persistent impaired relaxation and NT-proBNP indicate elevated filling pressures in most of the patients, improving only modestly 6-12 months after TAVR and SAVR. Applying the 2016 ASE/EACVI recommendations for detection of elevated filling pressures to patients with AS, elevated NT pro-BNP levels could not be reliably detected. However, adjusting thresholds of the echocardiographic parameters increased specificities to useful diagnostic levels. Abstract Table Cut-off values for high ProBNP Abstract Figure. Examples for diastolic parameters in AS
Right ventricular dysfunction in patients with non-severe ischemic mitral regurgitation qualified to cardiosurgery treatment
Authors: Piatkowski R , Budnik M , Kochanowski J , Grabowski M , Opolski G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Right ventricular (RV) dysfunction worsens prognosis in patients (pts) after myocardial infarction (MI).

Purpose
The purpose of this study was to assess RV function as a predictor of mortality and hospitalizations due to exacerbation of HF in pts with ischemic mitral regurgitation (IMR) qualified for cardiosurgical treatment - coronary artery by-pass grafting alone (CABGa) or CABG with mitral reconstruction (CABGmr).

Methods
We prospectively analyzed 104 pts (M 57, 64 ± 7 years) with non-severe IMR, 3-24 weeks after MI. Effective regurgitation orifice (ERO) was used for quantitative IMR assessment (non-severe ≥10-20 mm²). All the pts were qualified for CABG (multiple vessel coronary disease, ejection fraction (EF)-44 ± 8%). The patients were referred for CABGa (gr.1; n = 77) or CABGmr (gr.2; n = 27) based on clinical assessment, 2D and 3D echo at rest and exercise. Tricuspid annular plane systolic excursion (TAPSE) was acquired to evaluate RV function (measured with M-mode imaging in the 4-chamber view). RV function was related to clinical outcome (median follow-up: 12 months).

Results
During the follow-up period of 12 months, 5 deaths (5 %) and 8 hospitalizations (8%) due to exacerbation of HF occurred. With use of the following cut-off points of TAPSE ≤ 12 mm (group I), and TAPSE &gt;12 mm (group 2)—an association was found between the lower TAPSE and increased mortality. In group 1 (n =54 pts), 5 pts (9.2%) died and 6 pts was hospitalized due to HF (11.1%); in group 2 (n =50), no patient died, and 2 pts was hospitalized (4%). There was a significant difference (p = 0.02) in clinical outcomes between group I and II. ROC analysis identified TAPSE ≤12 mm as predictive cut-off for prediction adverse clinical outcome in all study group: (death: sensitivity 80%, specificity 76%, area under curve [AUC] = 0.807 (Fig.1); death and HF hospitalizations: sensitivity 69%, specificity 79%; AUC =0.767).

Conclusion
TAPSE is simple and useful quantitative measurement of RV function and have a predictive value in pts with non-severe IMR referred for cardiosurgery treatment. Abstract Figure 1
Validation of a new intuitive software for automatic heart function analysis. An intraobserver variability study
Authors: Di Candia A , Castaldi B , Cati A , Basso A , Fumanelli J , Sabatino J , Di Salvo G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital of Padua
Background/Introduction: In recent years there has been a growing interest in artificial intelligence (AI) applications in the echocardiography field. This is in order to simplify, reduce time and amplify the use of advanced analyses in the echo lab.

Purpose
to compare results of the fully automated analysis and manual tracing analysis using a new intuitive software.

Methods
28 consecutive previously healthy patients less than 18 years old who were screened at our Center for cardiac evaluation within 6 months after an asymptomatic or paucisymptomatic COVID19 infection were enrolled. All they were in sinus rhythm. Standard transthoracic echocardiography (TTE) was performed for each patient using Canon Aplio i900, software 2D Wall Motion Tracking. Optimized apical 4-, 3- and 2- chamber views, mitral valve inflow pattern and LVOT Doppler interrogation were collected. Off-line data analysis of each examination was performed by both fully automated analysis (AI) and pediatric cardiologists with experience in echocardiography i.e. by manual tracing, evaluation and adjustment of the track by the operator (Echocardiographers). Operators were blinded to the AI analysis. To measure intraobserver variability, evaluations of 16 patients datasets were performed twice by both operators and AI.

Results
Patients’ demographic data were: age 9,8+/-4,7 years; males 22 (78%); height 134,3+/- 34,9 cm; weight 41,8+/-28,7 kg; BSA 1,2+/-0,4 mq, HR 85+/-15/min.
The time taken for off-line analysis by AI and echocardiographers was 4-5 and 13-20 minutes, respectively.
Reproducibility of echocardiographers’ analysis was found to be excellent for left ventricle assessment (IC from 0,88 to 0,98); moderate for LVOT mean gradient (IC 0,73), RV end diastolic area (IC 0,69) and right atrial strain (IC 0,59); poor for deceleration time (IC 0,5), left ventricle strain (IC 0,49), RV FAC and strain (IC from 0,27 to 0,45).
Conversely, reproducibility of the AI analysis was found to be excellent for any parameter (ICC from 0,87 to 0,99) (Table 1).
About the mitralic valve inflow pattern assessment, despite the excellent reproducibility of AI analysis, the margin of error was found to be high. Particularly, a systematic error was observed with a tendency of the AI to overestimate deceleration time (DT-AI 176,6 ± 63,8 vs DT-Ecocardiographers 150,4 ± 24,3).
Conclusion(s): Fully automated analysis is technically simple, less time consuming and highly reproducible. AI analysis of the mitralic inflow pattern should be optimized, having found a systematic error in the calculation of deceleration time. Reproducibility is the strong point of AI. This reduces the variability of manual measurements between different sonographers and at different times. Abstract Table 1. Echocardiographic measurements
Transcatheter tricuspid valve-in-valve: evolution of tricuspid hydraulic performance and respective changes of right ventricular anatomy and function
Authors: Armenis I , Leontiades E , Tsiapras D , Karatasakis G , Iakovou I , Voudris V , Athanassopoulos GD 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction
Transcatheter tricuspid valve-in-valve replacement (TVIV) is an emerging therapy for dysfunctional surgically implanted bioprostheses. There are few data about the evaluation of hydraulic performance of these valves.
Purpose
Purpose of this single-center study was to evaluate the evolution of the right ventricular anatomy and function and the respective changes of TVIV hydraulics.
Methods
Six patients who underwent Sapien S3 TVIV (size 29mm) were studied (age 57 ± 11years, 3/6 in sinus rhythm, all in NYHA class III/IV). Inspiratory (insp) and expiratory (exp) TV mean gradients (mGR) , respective heart rate (HR), right ventricular end-diastolic diameter (RVEDd mm), RV fractional area change (FAC%) and RV free wall longitudinal strain (RV strain) were estimated at baseline (B), 1 month (1m) and later than 6 months (&gt;6m).
Results
NYHA class fell by at least 1 scale at 1m and remained either stable or further improved at 6m.
RVEDd increased early at 1m (B: 33.5 ± 5.3mm vs 1m: 41.3 ± 3.3mm, p = 0.018) and remained unchanged at &gt;6m (&gt;6m: 41 ± 4.2mm vs 1m: 41.3 ± 3.3mm, p = ns). FAC improved late at 6m (B: 42.6 ± 2.8% vs 6m: 56 ± 6.2% p = 0.04). RV strain remained unchanged (B: -17 ± 5.5% vs 1m: 16 ± 7% vs &gt;6m: -20 ± 6%, p = ns).
The improvement in both mGR-exp and mGR-insp was evident at 1m and remained unchanged afterwards: (mGR-exp: B 9 ± 4mmHg, 1m: 3 ± 2, &gt;6m: 5 ± 1, both p &lt; 0.05 vs B, mGR-insp: B 15 ± 5mmHg, 1m: 6 ± 2, &gt;6m: 8 ± 2, both p &lt; 0.05 vs B). The respective heart rates during measurements at inspiration and expiration were similar (HR-exp: B 72 ± 22bpm, 1m: 81 ± 22bpm, &gt;6m: 65 ± 9bpm, HR-insp: B 75 ± 27bpm, 1m: 79 ± 18bpm, &gt;6m: 69 ± 3bpm)
Absolute values for both mGR-insp and mGR-exp, despite progressive improvement, showed variations exceeding the conventional cut-off for TV prosthetic valve dysfunction of 6 mmHg, despite preserved clinical improvement. Variations of mGR were not related with the respective HR.

Conclusion
Following TVIV, early clinical improvement was related with a concomitant increase in RV volume, whereas RV functional indices showed a delayed response. Conventional echocardiographic hydraulics showed variability, often exceeding threshold for definition of prosthetic valve dysfunction. Thus, the significance of TV gradient after TVIV should be interpreted in the clinical context, taking into account respiratory changes.
The role of echocadiography in the differential diagnosis between PRKAG2 syndrome and Fabry disease
Authors: Pena JL , Diniz MVP , Moura ICG , Cristovao PMM , Linhares FM , Sternick EB 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Storage of glycogen and glycosphingolipids occurs in the heart with PRKAG2 Syndrome and Fabry Disease (FD), respectively. Identification of specific echocardiographic parameters could contribute to early diagnosis, which is fundamental to initiate appropriate treatment and improve prognosis. Material and methods: Prospective, transversal, observational study involving 45 patients, 30 genetically identified with the PRKAG2 gene mutation and 15 with FD. Conventional transthoracic, bi-, and tridimensional echocardiography as well as strain/strain rate speckle tracking were measured during one examination. Specific echocardiographic measurements were obtained and the data exported to a workstation for subsequent evaluation. Analyses were performed with 5% significance using the R program, version 3.1.3. Results: Compared to FD patients, PRKAG2 patients presented increased left atrium volume index, mean LV septum, posterior wall thickness, right ventricle (RV) dimensional values, and RV thickness in diastole. LV hypertrophy was found in varying degrees in 25 (86%) of PRKAG2 and 8 (53%) of FD Pts. We detected a binary appearance of LV endocardial border ("binary sign") and hypertrophy of the anterolateral papilary muscle in 60% of FD Pts. PRKAG2 Pts showed reduced global longitudinal strain (2DGLS), 4D GLS, 4D global radial strain (GRS), and aortic diameter compared to FD patients. In PRKAG2 Pts the bull’s-eye plot showed a stripe-like pattern. In FD Pts, however, it showed a peak systolic strain reduction in basal and mid- anterolateral segments. Conclusion: Echocardiography is an important technique in differentiating both diseases to determine adequate treatment and prognosis. We have demonstrated that PRKAG2 Pts present moderately greater cardiac involvement than FD Pts.
Diagnostic and prognostic implications of myocardial work in cardiac amyloidosis and in genetic and non-genetic cardiomyopathies with hypertrophic phenotype
Authors: Palmiero G , Rubino M , Monda E , Lioncino M , Verrillo F , Vetrano E , Caiazza M , Fusco A , Cirillo A , Dongiglio F , Ascione L , Caso P , Limongelli G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
BACKGROUND & PURPOSE. Cardiac amyloidosis (CA) is an infiltrative disorder characterized by left ventricular (LV) thickening with early systolic and diastolic dysfunction. Due to it poor prognosis, and the beneficial impact of novel treatments when started in early stages of disease, its forward detection is crucial. Aim of this study is comparing the diagnostic accuracy of classical and novel echocardiographic parameters in detecting CA among other forms of genetic and non-genetic cardiomyopathies with hypertrophic phenotype.
METHODS. We enrolled 50 pts with CA (26 AL and 24 wtATTR) and 75 phenocopies (LVH group) [25 hypertrophic cardiomyopathy (HCM) pts, 25 hypertensive (HypCM) pts, and 25 pts with non-severe aortic stenosis (AS)]. Standard and novel LV morpho-functional echo parameters [LV ejection fraction (LVEF), myocardial contraction fraction (MCF), global longitudinal strain (GLS), relative regional strain ratio (RRSR), ejection fraction on strain ratio (EFSR)], and novel Myocardial Work (MW) parameters [Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), Global Work Efficiency (GWE)] were analyzed.
RESULTS. LV standard, novel and MW-derived systolic parameters were more impaired in CA compared to LVH group. At ROC curve analysis, GCW showed the best performance in discriminating CA from other forms of LVH (AUC 0.886; 95% CI: 0.819-0.954; P &lt; 0.0001), with a cut-off value &lt; 1473 mmHg% showing 90% of sensitivity and 82% of specificity). At linear regression analysis, GCW correlated with many echocardiographic parameters (IVSD, PWD, RWT ratio, LVMi, MCF, LVESV, LVEF, EFSR and RRSR). At multivariate analysis, PWD (P &lt; 0,029) and RWT ratio (p &lt; 0,014) were the only parameters associated with GCW. At 24 months follow-up, there were 15 deaths in CA and 4 in LVH group. At Kaplan-Meier analysis the overall survival free of cardiovascular death was reduced in the lowest GCW interquartile ranges (log-rank χ2 21.5; p &lt; 0.0001). At Cox hazard ratio analysis, GCW was the only prognostic parameter associated with cardiovascular mortality (β 1.006; 95% CI: 1.003-1.009; P &lt; 0.0001).
CONCLUSIONS. Despite CA and LVH patients shows a similar phenotype, the systolic function differs greatly. In the present study, the GCW showed the best ability in detecting CA among other forms of LVH. Its reduction in CA seems reflect the infiltrative burden and its consequences on myocardial deformation properties, while its reduction in LVH group has been attributed elsewhere to fibrotic derangement. GCW showed to be a promising novel diagnostic and prognostic factor in this setting. Abstract Figure 1 Abstract Table 1
Right heart function in patients with viral pneumonia of varying severity caused by SARS-n-COV-2
Authors: Karasev AA , Krylova N , Poteshkina NG , Kovalevskaya EA , Nikitina TA , Svanadze AA , Beloglazova IP 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
the purpose of this study was to estimate condition of right heart in patients with COVID-19 and viral pneumonia.

Material and methods
87 patients were included (age 53 ± 13, 58% male) with established diagnosis of COVID-19 via PСR and viral pneumonia on CT scans. Patient’s clinical condition was assessed by SHOCS-COVID and NEWS scales. Transthoracic echocardiography was performed on 12 ± 4.6 day from the first symptoms of disease. Levels of high-sense Troponin I and NT-proBNP were measured in blood samples.

Results
Patients were divided into 3 groups according to pattern of viral pneumonia severity on CT scans. Group I with CT 1 grade (involvement of the pulmonary parenchyma 0-25%) - 11(12.6%) patients; mid age- 48.9 ± 17 years; NEWS score – 1.4 ± 0.9; SHOCS-COVID score – 7.5 ± 3.7.
Group II with CT 2 grade (involvement of the pulmonary parenchyma 25-50%). 48 (55.2%) patients; mid age- 51.6 ± 13.1 years; NEWS score - 2 ± 1; SHOCS-COVID score - 9 ± 2.1.
Group III with CT 3 grade (involvement of the pulmonary parenchyma 50%-75%). 28 (32.2%) patients; mid age- 57.1 ± 10.3 years; NEWS score – 3.2 ± 1.5; SHOCS-COVID score – 12.4 ± 2.
Groups didn’t differ in age (p-value &gt;0.05). Highest NEWS and SHOCS-COVID scores were observed in group III (p &lt; 0.0001 and p = 0.01, accordingly). All patients had preserved LV ejection fraction (62 ± 4.2%). Range of right heart echocardiography parameters was higher in patients with more severe grade of viral pneumonia:
- pulmonary artery systolic pressure in group I – 26,3 ± 4 mmHg, in II ­– 28.7 ± 4 mmHg, in III – 29.1 ± 13.2 mmHg (pI-III= 0.002), r = 0.4, p &lt; 0.0001;
- myocardial systolic velocity (s’) of free tricuspid annulus site by TDI in group I–11 ± 0.5 cm/s, in II–13 ± 2 cm/s, in III –14 ± 2 cm/s (pI-III= 0.02), r = 0.4. p &lt; 0.0001;
- GLS of right ventricle (RV) in group I -18.6 ± 3%, in II – 21.6 ± 3.9%, in III – 21 ± 3.9% (pI-III = 0.038), r = 0.4, p = 0.005;
- RV mid diameter in apical position in group I– 27 ± 2.8 mm, in II – 31 ± 5.1 mm, in III – 29 ± 4.2 mm (pI-III = 0.03), r = 0.3, p = 0.002.
TAPSE and right heart areas didn’t differ between groups (p &gt; 0.05). Levels of high-sense Troponin I were under 0.2 ng/ml in all groups (p &gt; 0.05). NT-proBNP level were elevated only in group III – 172 [97,7;330] ng/l (pI-III = 0,03) and correlated with SHOCS-COVID scores (r = 0.4, p = 0.04), CT grade (r = 0.3, p = 0.01) and RV Tei index from pulse-wave Doppler (r = 0.3, p = 0.02).

Conclusion
perhaps, RV hyperfunction is compensatory reaction in response to increased afterload of right heart in patients with severe viral pneumonia caused by SARS-n-COV-2. Increased level of NT-proBNP indirectly confirms presence of myocardial stress in patients with severe viral pneumonia caused by SARS-n-COV-2.
The long term prognostic value of peak left atrial strain in cardiac transplant patients
Authors: Appadurai V , Chamberlain R , Edwards NFA , Mulligan A , Platts D , Hamilton-Craig C , Chan J , Scalia GM 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial (LA) dysfunction is associated with poorer outcomes in many disease processes. Left atrial strain (LAS) is a novel two-dimensional (2D) quantitative analysis of LA function. Cardiac transplantation directly involves the LA during implantation of the donor heart. Traditional echocardiographic indices after transplantation have demonstrated value in correlating with acute cellular rejection (ACR), morbidity and mortality over short- and long-term follow-up. The prognostic value of LA strain has not been previously investigated in this cohort.

Purpose
We hypothesized that incrementally impaired LA strain in post cardiac transplant patients with varying degrees of ACR may be prognostic of poorer outcomes on long term follow-up.

Methods
87 Heart transplant patients, assessed between 2009 and 2015, underwent transthoracic echocardiography and endomyocardial biopsy. 2D strain analysis on the LV and LA were performed along with traditional echocardiographic parameters. Patients were grouped according to peak LAS (PALS) tertiles and rejection burden history was assessed and grouped according to ACR burden at a median of 12 (±5.4) months post transplantation. The primary endpoint was all-cause mortality at follow-up.

Results
12 patients met the primary endpoint over a median follow-up of 66 ± 51 months. The mean LA PALS was significantly different across the tertiles (lowest tertile 12.29 ± 2.5% vs middle tertile 17.89 ± 1.1% vs highest tertile 24.54 ± 4.2%; p &lt;0.0001). LA strain dispersion was also significantly different between the tertiles (61.03 ± 25.8ms vs 41.8 ± 15.8ms vs 44.8 ± 18.8ms; p &lt;0.001). All other clinical and echocardiographic parameters were non-significant between the tertiles however, there was a trend towards a lower PALS in the higher rejection burden group. Kaplan Meier curves demonstrated that survival over follow-up was significantly worse in the lower tertile LA PALS group compared to the highest tertiles LA PALS group (Log-rank test = p &lt; 0.0001). The lowest LA PALS tertile had a significantly higher risk of reaching the primary endpoint compared with patients in the highest LA PALS tertile (hazard ratio [HR] 9.802; 95% CI 1.832-52.45; p &lt;0.008). Higher LA PALS and LV GLS (LA PALS HR 0.610 95% CI 0.401-0.926; p 0.02; LV GLS HR 0.638 95% CI 0.418-0.972; p 0.037) were significantly associated with a reduction in reaching the primary endpoint in a multi-variate regression model including clinically relevant traditional and strain-based echocardiographic parameters.

Conclusions
Lower LA PALS is significantly associated with poorer long-term outcomes in cardiac transplant patients with ACR. Non-invasive LA PALS may be a useful predictor of long-term outcome in patients post cardiac transplantation. Abstract Figure. Survival curves for LA PALS tertiles