bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right ventricle-pulmonary artery coupling in repaired tetralogy of fallot with pulmonary regurgitation: clinical implications
Authors: Panaioli E , Birritella L , Graziani F , Lillo R , Grandinetti M , Di Molfetta A , Przybyleka B , Lombardo A , Lanza G , Secinaro A , Perri G , Amodeo A , Massetti M , Crea F , Delogu AB 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background
The right ventricle-pulmonary artery (RV-PA) coupling is a strong prognostic marker in
several clinical settings, but only few studies focused on its role in repaired Tetralogy of
Fallot (rToF) with pulmonary regurgitation (PR). Aim of this study was to assess
whether differences exist in RV-PA coupling, estimated as by echocardiography,
between patients with rToF and PR with (i-PVR) or without (ni-PVR) indication for
pulmonary valve replacement (PVR).
3
Materials and Methods
The study population included 40 rToF patients allocated to two groups: 20 i-PVR and
20 ni-PVR; 40 healthy controls were also included. All subjects underwent
echocardiogram, while Cardiac magnetic resonance (CMR) was available in 27/40
rToF patients. RV-PA coupling was assessed by echocardiographic TAPSE/PASP and
RV stroke volume/RV end systolic volume (RVSV/RVESV) by CMR.
Results
TAPSE was similar in i-PVR vs ni-PVR (19.0 ± 3.4 vs 18.8 ± 2.7 mm, p = 0.85) while RV-PA coupling
was significantly worse in i-PVR vs ni-PVR (TAPSE/PASP 0.8 ± 0.3 vs 1.1 ± 0.5
mm/mmHg, p = 0.009) as well as in i-PVR vs controls (p = 0.02) while there was no
difference between ni-PVR and controls (p = 0.29). CMR data confirmed the echo
results, with a significant difference in RV-PA coupling between i-PVR and ni-PVR
(RVSV/RVESV 0.9 ± 0.2 vs 1.2 ± 0.3 mL/min/mL, p = 0.01).
Conclusions
This study shows the presence of worse RV-PA uncoupling, despite normal RV systolic
function, in rToF patients with indication to PVR. RV-PA coupling could be a sensitive
marker of a progressive maladaptive RV response to long-standing volume overload in
rToF prior to the onset of clinical symptoms and RV systolic dysfunction. Abstract Figure. example of an i-PVR patient
Safety and reliability of dobutamine stress echocardiography in pediatric and young adult patients with coronary arteries abnormalities
Authors: Bianco F , Bucciarelli V , Colaneri M , Surace FC , Berton E , Baldoni M , Arcieri L , Baldinelli A , Gallina S , Pozzi M 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was conducted with the support of Regione Marche, Italy

Background
Risk stratification in coronary arteries abnormalities (CAA), both anomalous aortic origin of a coronary artery (AAOCA) and myocardial bridges (MBs), is still challenging. A reliable method to detect myocardial ischemia is missing in these anomalies. We studied the safety and feasibility of dobutamine stress echocardiography (DSE), compared with exercise stress echocardiography (ESE), in pediatric and young adult patients with CAA.

Methods
In 2019-21, N = 27 CAA [median age 16 years (Q1–Q3: 11, 22)] (n= 23 AAOCA, n = 4 MBs) were assessed. ESE was performed 1-2 days before the DSE examination, double-blinded for examiners and patients. Hemodynamic response and major (cardiac arrest, myocardial infarction, ventricular arrhythmia) and minor [hypertension (≥ 200/120 mmHg), paradoxical bradycardia, chest pain, nausea/vomiting, skin rash, anxiety, dizziness, dyspnea] events were recorded. Differences between rest/stress and DSE/ESE for wall motion abnormalities (WMA) and global longitudinal strain (GLS) were evaluated. Inter-observer agreement was also tested using the kappa (k) coefficient.

Results
Heart rate and blood pressure increased significantly from baseline (p &lt; 0.001) in both DSE and ESE exams. Only DSE tests reached a heart rate ≥ 150 bpm (p &lt; 0.001), while younger patients barely reached the heart rate target and frequently showed less compliance to the test. No patient had major events, while 5 (18.5%) had minor events, the majority during DSE. Inducible WMA were observed only at DSE examinations. Inter-observer agreement for WMA and GLS changes was good for both examinations (95%, k = 0.85, p &lt; 0.001).

Conclusions
DSE is feasible in pediatric and young adult patients with AAOCA and MBs to assess inducible WMA and GLS rest/stress changes. It can be performed safely with a low incidence of major/minor events, with a better performance when compared to ESE. DSE is potentially a valuable test for detecting myocardial ischemia and probably helpful in managing CAA patients.
Dynamic myocardial response to exercise in children with transposition of the great arteries post arterial switch operation
Authors: Henry M , Grotenhuis H , Slorach C , Fan S , Grosse-Wortmann L , Mertens L , Cifra B 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The arterial switch operation (ASO) has improved outcomes for patients with transposition of the great arteries (TGA) however the long-term impact on myocardial function and functional reserve during exercise remains poorly described. The aim of this study was to evaluate left (LV), and right ventricular (RV) myocardial response to exercise in children post ASO using semi-supine cycle ergometry stress echocardiography (SSCE).

Methods
This is a single-center cross-sectional study. Participants prospectively underwent exercise stress echocardiography using a semi-supine bicycle and a stepwise exercise protocol. Systolic (s’) and diastolic (e’) tissue Doppler velocities, as well as myocardial acceleration during isovolumic contraction (IVA) were measured at rest and during exercise at incremental heart rates (HR) in the basal segments of the RV lateral wall, IVS and LV lateral wall. Systolic and diastolic reserve were evaluated by plotting s’ and e’ against HR while contractile reserve was assessed by plotting IVA values against HR which represents the force-frequency relationship (FFR).

Results
A total of 40 patients with TGA and 29 controls were included. There were no differences between groups in age (14.6 ± 2.9 vs 14.3 ± 3.1 years, p= 0.75), sex (male= 30/40 vs 20/29 p= 0.58), and resting HR (67 ± 12 vs. 71 ± 12 bpm, p = 0.31). Peak HR was lower in the ASO group (142.2 ±12.4 vs 157 ± 12.3 bpm, p&lt; 0.01). At rest, the ASO group showed lower s’ in the RV and IVS (RV s’: 5.7 ± 1.4 vs. 10.2 ± 2.1 cm/s, p &lt;0.001; IVS s’: 4.2 ± 1.3 vs. 6.2 ± 1.8 cm/s, p&lt; 0.001); lower IVA in the IVS and LV (IVS: 1.01 ± 0.37 vs. 1.23 ± 0.4 m/s2, p= 0.03; LV: 0.86 ± 0.32 vs. 1.1 ± 0.4 m/s2, p =0.02), and reduced e’ in all segments. At peak exercise the ASO group showed reduced s’, e’, and IVA in all segments (table1). When plotted against HR, there was blunting of the s’ slope in RV and septal segments while the LV s’ slope was similar between groups. There were no differences in e’ slope when compared to controls (figure 1). The ASO group showed a blunted IVA response to HR in all measured segments compared to controls.
Conclusion(s):
Our data demonstrate patients post ASO have reduced RV and LV contractile reserve in response to exercise. The etiology and long-term implications of these abnormalities however remains to be described. Abstract Figure. Doppler velocities at baseline and peak Abstract Figure. Dynamic response to exercise
Classical and myocardial deformation echocardiographic indices in chronic kidney disease patients; effects of aging and comparison to healthy controls
Authors: Lakkas L , Naka KK , Bechlioulis A , Girdis I , Duni A , Theodorou I , Koutlas V , Moustakli M , Katsouras CS , Dounousi E , Michalis LK 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background Patients with chronic kidney disease (CKD) are at high risk for cardiovascular disease compared to the general population. Classic echocardiographic indices of left ventricular (LV) function may not be sensitive enough in detecting early myocardial deterioration in CKD patients while LV speckle tracking (2DSTE) analysis has shown promising results. Dipyridamole stress echocardiography (DIPSE), mostly used to measure coronary flow reserve (CFR), assesses coronary macrovascular and/or microvascular dysfunction in a non-invasive way.
Purpose To investigate differences in classic, 2DSTE-related indices, CFR and other DIPSE-induced changes in various echocardiographic parameters between 1) healthy controls and age-matched (younger) CKD patients, 2) younger versus older CKD patients with similar clinical characteristics.
Methods We prospectively evaluated 30 healthy controls and 60 consecutive CKD patients 40-75 years old who were followed-up at the CKD outpatient clinic of a University Hospital in Western Greece. A standard echocardiographic analysis including 2DSTE analysis was performed in all subjects before and after dipyridamole infusion. CFR in left anterior descending artery was also assessed.
Results The median age of the CKD patients was 63 years and most of them were males (70%). Younger patients with CKD (i.e. &lt;60 years old) had higher E/e" ratio (7.80 ± 2.71 vs 6.06 ± 1.37, p = 0.019), LVMI (114.7 ± 41.1 vs 89.6 ± 21.2, p = 0.017) and relative wall thickness (0.47 ± 0.08 vs 0.40 ± 0.06, p = 0.031) and lower E" (10.6 ± 2.6 vs 2.3 ± 2.9 cm/s, p = 0.045) compared to age and gender-matched healthy controls. Older CKD patients had lower E/A (0.80 ± 0.19 vs 1.03 ± 0.33, p = 0.007) and E" (8.5 ± 1.8 vs 10.6 ± 2.6 cm/s, p = 0.003) compared to younger CKD patients. CFR was higher in healthy controls compared to both younger (3.93 ± 1.25 versus 3.1 ± 0.75, p = 0.009) and older CKD patients (3.93 ± 1.25 versus 2.89 ± 0.88, p &lt; 0.001); no significant difference in CFR was observed between younger and older CKD patients. Dipyridamole-induced changes in other studied echocardiographic indices did not differ significantly among groups. Conclusions In the current study, impaired coronary microcirculation, LV diastolic function and increased LV mass with concentric remodeling were shown to be the principal findings early in the process of CKD. These results may have pathophysiological implications for cardiorenal syndrome type 4 and targeted cardiac assessment in CKD patients. Future studies are needed to assess whether any therapeutic efforts aiming to delay or reverse these changes may have an impact on the cardiovascular prognosis in CKD patients.
Right ventriculoarterial coupling as a marker of subclinical myocardial damage in rheumatoid arthritis
Authors: Miranda Aquino T , Cepeda-Rocha M , Rosal-Arteaga CA , Perez-Topete SE , Cerpa-Cruz S , Hernandez-Del Rio JE 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The lung involvement in autoimmune diseases has been described previously. Currently the incidence of pulmonary hypertension in patients with rheumatoid arthritis (RA) ranges from 1-25%. Right ventriculoarterial coupling (RVAC) is altered early before presenting right ventricular dysfunction and pulmonary hypertension, its measurement in patients with RA has been barely studied.

Objectives
To determine if there is a difference in RVAC in patients with RA. Analyze if there are differences in patients with normal vs abnormal right RVAC. To investigate if there is an association in patients with RA to present abnormal RVAC.

Methods
A single-center, analytical, cross-sectional, observational study was performed. Patients with diagnosis of RA were included according to the ACR / EULAR 2010 classification criteria, without any other comorbidity. An ACUSON SC2000 echocardiogram was used. Patients were compared with healthy controls matched by age and gender. The clinical, laboratory and echocardiographic variables were contrasted. Among the echocardiographic variables, the left ventricular ejection fraction, the left ventricular volume index, the left atrial volume index, right ventricular diastolic area, right ventricular fractional area change (RV FAC), right atrial volume, pulmonary artery systolic pressure (PASP), right ventricular free wall longitudinal strain (RVFWLS) and right atrial global longitudinal strain (RAGLS). The RVAC was determined with the RVFWLS / PSAP ratio. A RVAC less than 0.8 was classified as abnormal. The quantitative variables were contrasted with Student"s t-test or Mann-Whitney"s u test, according to the normality of the variables; qualitative variables were compared with x2. The association with an abnormal RVAC was determined with univariate and multivariate analysis.

Results
Thirty-four patients were included in each group. Among the echocardiographic variables, it was found that patients with RA had a greater right ventricular diastolic area and the PASP; while the RV FAC, the RVFWLS and the RVAC were lower. 68% of the RA patients had an abnormal RVAC, and C-reactive protein (CRP) levels were higher in patients with an abnormal RVAC. In the multivariate analysis, we found that patients with RA and CRP levels were independently associated to an abnormal RVAC.

Conclusion
The right ventricular subclinical myocardial damage, determined by the RVAC, is present in patients with rheumatoid arthritis. CRP levels and rheumatoid arthritis were associated with an abnormal ventriculoarterial coupling. Abstract Table 1 Abstract Table 2
Age- and sex-specific characteristics of right ventricular compacted and trabeculated myocardium by cardiac magnetic resonance
Authors: Szucs A , Kiss AR , Gregor ZS , Furak A , Szabo LE , Dohy ZS , Grebur K , Merkely B , Vago H 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry for Innovation and Technology in Hungary within the framework of the Therapeutic Development and Bioimaging Programs of Semmelweis University. National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme.
The sex-specific characteristics of right ventricular compacted (RV-CM) and RV-trabeculated myocardial mass (RV-TM) over time and the determinants of RV myocardium are less well studied; however, in different conditions, these might provide additional information to the diagnosis.
We aimed to describe the age- and sex-specific characteristics of RV-CMi, RV-TMi, and RV volumetric and functional parameters and investigate the determinants of RV myocardial mass with CMR.
Two hundred healthy Caucasian volunteers free of known cardiovascular or systemic diseases were enrolled in this study. Four different age groups were established with equal numbers of males and females: Group A (n = 50, 20-29 years, mean age: 24.3 ± 3.2 years), Group B (n = 50, 30-39 years, mean age: 33.6 ± 2.6 years), Group C (n = 50, 40-49 years, mean age: 44.7 ± 2.7 years), and Group D (n = 50, ≥ 50 years, mean age: 55.1 ± 3.9 years). RV volumetric and functional, RV-CMi and RV-TMi values were measured with a threshold-based postprocessing method for CMR.
The volumetric parameters, RV-CMi, and RV-TMi were larger in males, and the ejection fraction (EF) was higher in females. The RV-CMi did not correlate with age in either of the sexes, while the RV-TMi decreased with age in females but remained stable in males. The RV-TMi and RV-CMi correlated positively with RV volumetric parameters, the left ventricular (LV)-CMi, the LV-TMi, and each other in both sexes. LV-TMi, LV-CMi, RV end-systolic volume, and sex were independent predictors of RV-TMi.
Understanding the natural history of RV-trabeculated and RV-compacted myocardium might have additive value in diagnosing different conditions with RV hypertrophy or hypertrabeculation.
Layer-specific regional circumferential strain as prognostic marker of cardiovascular events
Authors: Pezel T , Bluemke D , Wu C , Lima J , Ambale Venkatesh B 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
Left ventricular (LV) circumferential strain (Ecc) is an accurate indicator of regional myocardial function. Recent studies have emphasized the potential superiority of regional Ecc, particularly using the layer-specific strain. To date, no studies have assessed the prognostic value of layer-specific regional Ecc in the general population.

PURPOSE
This study aimed to investigate the prognostic value of the layer-specific regional Ecc for predicting the incident of heart failure (HF) and coronary heart disease (CHD) in a population without a history of cardiovascular disease at baseline.

METHODS
Data from participants in the Multi-Ethnic Study of Atherosclerosis (MESA) who underwent tagged magnetic resonance imaging for strain determination were analyzed. Using −17% and −10% as Ecc cut-offs, each segment was rated from 0–2 points according to the Ecc value of each layer. The endo-Ecc, mid-Ecc, and epi-Ecc values from the 16-segment model were used to calculate three indexes: Endo-MyoHealth, Mid-MyoHealth, and Epi-MyoHealth, respectively, which were defined as a percentage of good LV regional function. The Intramyocardial-MyoHealth index was the sum of these three MyoHealth indexes. Cox proportional hazard models were used to evaluate the association between each MyoHealth index and incident HF and hard CHD.

RESULTS
Among the 1,506 participants (63.3 ± 9.4 years, 54.6% men), 122 cases of hard CHD and 91 cases of HF were observed (median [IQR] follow-up 15.9 [12.9-16.6] years). After adjustment, Mid-, Epi-, and Intramyocardial-MyoHealth index values &lt;50% were independently associated with HF (adjusted HR 1.43; 95% CI [1.08-2.87], p = 0.004; HR 1.80; 95% CI [1.12-3.07], p &lt; 0.001; and HR 2.01; 95% CI [1.19-3.20], p &lt; 0.001). After adjustment, Endo-, Mid-, Epi-, and Intramyocardial-MyoHealth &lt;50% were also independently associated with hard CHD (adjusted HR 1.31; 95% CI [1.03-1.51], p = 0.04; HR 1.79; 95% CI [1.26-2.57], p &lt; 0.001; HR 2.03; 95% CI [1.45-3.40], p &lt; 0.001; and HR 2.28; 95% CI [1.51-3.53], p &lt; 0.001).

CONCLUSIONS
Layer-specific regional Ecc, assessed via MyoHealth indexes, provides a robust, independent predictive value for incident HF and hard CHD in asymptomatic participants without any history of previous clinical cardiovascular disease.
Unique identifier Clinical.gov : NCT00005487. Abstract Figure. Abstract Figure. Kaplan Meier curves
Mitral paravalvular leak 3D printing from 3D-transesophageal echocardiography - proof of concept
Authors: Jedrzejek M , Kozlowski M , Pysz P , Wojakowski W , Smolka G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministry of Science and Higher Education

Background
Paravalvular leak (PVL) may occur in almost 15% of patients undergoing surgical mitral valve replacement. This complication can cause congestive heart failure and hemolysis. Multimodal imaging including computed tomography (MSCT) and 3D-transesophageal echocardiography (3D-TEE) is essential for assessment of PVLs. 3D-TEE-based 3D-printing might be useful in preprocedural planning of PVL closure for the optimization of transcatether procedures. In contrast to 3D-printing based on MSCT, use of 3D-TEE for segmentation and printing is not standardized.

Purpose
A proof of concept study to evaluate 3D printing of mitral PVLs using 3D-TEE.

Methods
A case of a 64-year-old woman with 2 clinically significant PVLs around a mitral prosthetic valve is presented. In 3D-TEE (Philips Epiq) anteromedial defects were visualized (surgical view). Qlab Station was used to export the 3D recording of PVLs with surrounding tissue in cartesian DICOM format. Next Slicer, a free open-source software, was used for segmentation and preparation of a STL (stereolithography) file. The PVL model was printed with Starsys Objet 30 printer using Med620 material. Diameters PVLs were the same in 3D Echocardiography and 3D printed model (12mm and 9mm).

Results
Printed PVL model and corresponding 3D-TEE image are shown in Figure 1 and Figure 2, respectively.
Conclusion(s)
Proof of concept study confirms feasibility of using standard 3D-TEE and open source software for preparation of 3D models of anatomically complex mitral PVLs. Further studies to assess cost-effectiveness and clinical applicability of the presented methodology are ongoing. Abstract Figure 1. Abstract Figure 2.
Evaluation of energy loss in patients with severe primary valvular heart disease before cardiac valve intervention
Authors: Pugliese NR , Del Punta L , Falcetta G , Besola L , De Biase N , Mazzola M , Giannini C , Petronio AS , Taddei S , Masi S , Colli A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Valvular heart disease (VHD) determines non-physiological, inefficient blood flow within the left ventricle, resulting in abnormal vortex formation and energy loss (EL). EL evaluation could provide valuable insights in addition to more common parameters of left ventricle systolic and diastolic dysfunction. Vector flow mapping (VFM) is a novel, non-invasive echocardiographic technique that measures EL through the study of intraventricular flow.
Purpose. To assess EL throughout the whole cardiac cycle in patients with severe primary left-sided VHD before cardiac valve intervention.
Methods. VFM is based on the continuity equation applied to colour Doppler and speckle tracking echocardiography, acquired from the apical long-axis view. VFM estimates blood flow velocity and vortex characteristics to quantify energy dissipation (i.e., EL) due to blood viscosity in a turbulent flow. EL was calculated frame by frame and averaged over three beats.
Results. We enrolled 20 healthy controls (55 ± 19 years old, 65% male) and 73 patients (70 ± 17 years old, 59% male) with severe VHD before cardiac surgery: 30 with primary mitral regurgitation (MR), 8 with mitral stenosis (MS), 15 with aortic regurgitation (AR), 20 with aortic stenosis (AS). All patients had a left ventricle (LV) ejection fraction ≥50% and no wall motion abnormalities. We observed an increased number of vortexes in patients with VHD when compared to controls, especially in mid-diastole (p = 0.003). This is reflected in a significantly higher EL during the whole cardiac cycle in VHD patients than controls (p &lt; 0.0001), with the highest values observed in MS and AR (post-hoc test: all p &lt; 0.0.1; Figure 1 and Figure 2). The differences were driven by the diastolic EL (p &lt; 0.0001), while the systolic EL values were similar between patients with VHD and controls (p = ns).
Conclusions. In addition to standard baseline echocardiography, VFM can quantitatively evaluate the energy dissipation in different subsets of VHD. EL is not uniform during the cardiac cycle, as diastole seems significantly more affected than systole. The assessment of EL after valve intervention is ongoing. VFM could provide further insights into the pathophysiology of heart valve disease and help to evaluate the efficacy of the procedure (repair/replacement) performed. Abstract Figure 1 Abstract Figure 2