bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of artificial intelligence system for prescriptive acquisition guidance of transthoracic echocardiography by novice users combined with automated quantification of ejection fraction
Authors: Singh A , Yamat M , Guile B , Mor-Avi V , Lang RM 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Caption Health

Background
Artificial intelligence (AI) has the potential to expedite the acquisition of transthoracic echocardiograms (TTE) and provide automated quantitative data including left ventricular ejection fraction (LVEF). Specifically, AI-based imaging systems may permit less experienced individuals to obtain quantitative measurements of LVEF, with important implications for clinical workflow.

Purpose
We sought to evaluate the accuracy of an AI-based imaging system for the evaluation of LVEF in a spectrum of novice TTE imagers in a real-world clinical setting, and hypothesized that after appropriate training, it can perform as well as experienced sonographers.

Methods
Consecutive exams (N = 102; BMI 29 ± 7; most common indications for TTE: heart failure, arrhythmia, valve assessment) were performed by a cohort of physician trainees (MD) and nurses (RN) with no prior TTE experience, using an AI-guided imaging system equipped with real-time prescriptive guidance software that automatically measures LVEF. Guided imaging included 3 views: parasternal long-axis (PLAX), apical 4-and apical 2-chamber (AP4, AP2), with the software recognizing when a satisfactory imaging window is obtained and then auto-capturing and automatically generating an AI based LVEF. AI-EF measurements were compared against the reference standard EF (Ref EF) measured by 2 expert sonographers according to ASE chamber quantification guidelines. Bland-Altman analysis was performed to determine inter-technique agreement.

Results
Feasibility was 80%. AI-EF and Ref EF demonstrated strong correlation when all 3 views were obtained, with a small bias (Table). In cases when &lt;3 views were available, the combination of PLAX and AP4 views achieved comparable results, with a slight increase in bias and limits of agreement. When results were stratified by cohort (MD vs RN), MD AI-EF attempts showed greater feasibility (100%, n = 51) with stronger correlation (r = 0.93) and smaller bias (-1.9%) compared to RN (feasibility of 61%; n = 31 and r= 0.85, bias -2.1%).

Conclusions
Use of an AI-assisted imaging system for limited TTE imaging by novices is feasible in a real-world setting, with the AI based EF in good agreement with reference standard. Acquisition of all 3 views provided optimal results, but the combination of AP4/PLAX views performed reasonably well, without the AP2 view that is more difficult to acquire for less skilled users. Untrained MD were more successful when compared to RN, suggesting additional training may be needed for specific user groups. Abstract Figure.
Effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors on left ventricular remodelling and longitudinal strain: a prospective observational study
Authors: Gonzalez Teston F , Gamaza Chulian S , Diaz Retamino E , Gaitero Reina JC , Gonzalez Caballero E , Martin Santana A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) can reduce cardiovascular events in type 2 diabetes mellitus (T2DM) patients, although the mechanisms underlying these benefits are not clearly understood.

Purpose
The aim of this study was to analyze the effects of SGLT2i on left ventricular remodelling and longitudinal strain.

Methods
Between November 2019 and April 2020 we included 52 patients ≥18 years of age with T2DM, HbA1c between 6.5% and 10.0%, and estimated glomerular filtration ≥45 ml/min/1.73 m2. Patients were classified into SGLT2i group and control group, according to prescribed treatment by their referring physician. Conventional and speckle tracking echocardiography were performed by blinded sonographers, at baseline and after 6 months of treatment.

Results
Among the 52 included patients (44% females, mean age 66.8 ± 8.6 years, mean HbA1c 7.40 ± 0.7%), 30 patients were prescribed SGLT2i and 22 patients were classified as control group. Mean change in indexed left ventricular mass (LVM) was -10.85 ± 3.31 g/m2 (p = 0.003) in the SGLT2i group, and +2.34 ± 4.13 g/m2 (p = 0.58) in the control group. Absolute value of Global Longitudinal Strain (GLS) increased by a mean of 1.29 ± 0.47 (p = 0.011) in the SGLT2i group, and 0.40 ± 0.62 (p = 0.34) in the control group. We did not find correlations between changes in LVM and GLS, and other variables like change in HbA1c.

Conclusions
In patients with T2DM, SGLT2i were associated with a significant reduction in indexed LVM and a significant increase in longitudinal strain measured by speckle tracking echocardiography, which may explain in part the clinical benefits found in clinical trials.
Correlation between the left ventricular strain and the severity of coronary atherosclerosis in patients with coronary artery disease
Authors: Alieva RB , Bekmetova FM , Fozilov KHG , Donierov SN , Mukhamedova MG , Bekmetova SI , Ilkhomova LT , Khoshimov SHU 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
The purpose of this study was to assess the properties of left ventricular myocardial deformation in patients with coronary artery disease (CAD) with various degrees of coronary lesions.
Methods and Results: The study included 74 patients with stable angina pectoris Class II-IV aged between 40 and 70 years. All patients underwent the following examinations: assessment of traditional risk factors, physical examination, general clinical and laboratory blood tests, 12-lead ECG, 24-hour ABPM, transthoracic echocardiography, two-dimensional speckle tracking echocardiography (STE), and coronary angiography (CAG). The SYNTAX score was calculated retrospectively according to
the SYNTAX score algorithm. All patients were divided into 3 groups: Group 1 included 21 patients with a low SYNTAX score (0–22), for whom standard drug therapy was recommended; Group 2 included 28 patients with an intermediate SYNTAX score (23–32), to whom PCI was recommended; Group 3 included 25 patients with a high SYNTAX score (≥33), to whom CABG was recommended.
Left ventricular ejection fraction (LVEF) obtained using the modified biplane Simpson’s method was significantly lower in Group 3 than in Groups 1 and 2 (P = 0.001); it should be noted that this indicator was within the normative values in Groups 1 and 2, and belonged to the gradation "mild dysfunction." A more objective quantitative assessment of the contractile function of the LV myocardium was obtained by assessing the GLS and SR. The comparative analysis of the LV myocardial deformation properties
in the three studied groups showed that in Group 3 the GLS and SR indicators were significantly lower than in Group 1 (P = 0.000 and P = 0.0020). Moreover, GLS (global longitudinal strain) and SR (strain rate) were significantly higher in Group 1 than in Group 2 (P = 0.0001 and P = 0.0133, respectively). GLS significantly correlated with LVEF (r = 0.57; P &lt; 0.05), E/A (r = 0.22; P &lt; 0.05), and SYNTAX score (r=-0.63; P &lt; 0.05). SR significantly correlated with LVEF (r = 0.49; P &lt; 0.05) and SYNTAX score (r=-0.37; P &lt; 0.05)

Conclusion
The results obtained indicate the diagnostic value of STE with the determination of GLS and SR in a comprehensive assessment of the severity of CAD. GLS and SR significantly correlate with the clinical course of the disease, as well as indicators of LV remodeling and LV diastolic dysfunction. STE analysis of GLS and SR has incremental diagnostic value over transthoracic echocardiography in predicting significant CAD
Impact of surgical myectomy on electrocardiographic changes in patients of hypertrophic obstructive cardiomyopathy
Authors: Badran H , Faheem N , Galal A , Yacoub MY 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Hypertrophic cardiomyopathy (HCM) is the commonest genetically inherited cardiac condition affecting 1 in 500 of the population. [1] The amelioration of patient symptomatology and decreased morbidity after surgical myectomy is previously documented. [2]. However, no data is available regarding the associated electrocardiographic changes that may occur after surgical myectomy, especially in patients showed improvement of functional status.
Aim of study: The study was conducted to investigate the electrocardiographic changes following surgical myectomy in hypertrophic obstructive cardiomyopathy (HOCM) patients, and its relation to cardiac mechanics

Methods
The study included 25 patients (mean age: 35.44 ± 12.3 years, 52% male) with HOCM who were subjected to successful surgical myectomy. 12-lead surface ECG and echocardiographic examination including 2D strain imaging were performed pre and post myectomy.

Results
Postoperatively, 84% of patients developed new complete left bundle branch block (LBBB), 4% developed right BBB (RBBB) and 4% developed complete AV block necessitating permanent pacing. These Changes were associated with increased QRS width and QT interval prolongation in almost all patients (p &lt; 0.001). Following surgery, there was significant reduction in left atrium size, left ventricle mass, LV outflow tract gradient, mitral and annular systolic & diastolic velocities (S’, E’, A’) and EF%(p &lt; 0.001 for all) compared with its preoperative values. At segmental level only LV septal εsys% showed significant inverse correlation to QRS duration (r = 0.47, P &lt; 0.02). No significant correlation was detected between QRS & QTc duration and any other LV wall εsys%. In contrast: QTc intervals showed inverse correlation to the magnitude of reduction in RV εsys %, r=-0.59,P &lt; 0.001 and the magnitude of reduction in RV TTP-SD (r=-.42, P &lt; 0.03).

Conclusion
Left bundle branch block is a common conduction abnormality after septal myectomy but it did not influence the clinical improvement or structural remodeling. Post myectomy, prolongation of QRS duration was a powerful aspect of mechanical dysfunction especially of septal mechanics than QT interval prolongation. Electrical and mechanical dysfunction is commonly associated while mechanical heterogeneity is not always coexisting.
Automated left atrial volume measurement by two-dimensional speckle-tracking echocardiography: feasibility, accuracy and reproducibility
Authors: Florescu D , Badano LP , Tomaselli M , Torlasco C , Florescu C , Tartea GC , Balseanu TA , Volpato V , Parati G , Muraru D 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction - A by-product of left atrial (LA) strain analysis is the automated measurement of LA maximal volume (LAVmax), which may decrease the time of echocardiography reporting, and increase the reproducibility of the LAVmax measurement. However, the automated measurement of LAVmax by two-dimensional speckle-tracking analysis (2DSTE) has never been validated.
Purpose – Accordingly, we sought to: i. assess the feasibility of automated LAVmax measurement by 2DSTE; ii. compare the automated LAVmax by 2DSTE with conventional two-dimensional (2DE) biplane and three-dimensional echocardiography (3DE) measurements; and iii. evaluate the accuracy and reproducibility of the three echocardiography techniques.
Methods – LAVmax (34­-197 mL) were prospectively obtained from 198/210 (feasibility 94%) consecutive patients with various cardiac diseases (median age 67 years, 126 men) by 2DSTE, 2DE and 3DE.
Results – 2DE and 2DSTE measurements resulted in similar LAVmax values (bias = 1.5 mL, limits of agreement, LOA ± 7.5 mL), and slightly underestimated 3DE LAVmax (biases=-5 mL, LOA ± 17 mL, and -6 mL, LOA ± 16 mL, respectively). LAVmax by 2DSTE and 2DE were strongly correlated to those obtained by cardiac magnetic resonance (CMR) (r=.946, and r=.935, respectively; p&lt;.001). However, LAVmax obtained by 2DSTE (bias=-9.5 mL, LOA ± 16 mL), and 2DE (bias=-8 mL, LOA ± 17 mL) were significantly smaller than those measured by CMR. Conversely, 3DE LAVmax were similar to CMR (bias=-2 ml, LOA ± 10 mL). Excellent intra- and inter-observer intraclass correlation coefficients were found for 3DE (0.995 and 0.995), 2DE (0.990 and 0.988), and 2DSTE (0.990 and 0.989).
Conclusion – Automated LAVmax measurement by 2DSTE is highly feasible, highly reproducible, and provided similar values to conventional 2DE calculations in consecutive patients with a wide range of LAVmax. Abstract Figure. Echocardiography and CMR correlations Abstract Figure. Echocardiography techniques correlations
Normal values of strain in a Spanish paediatric population
Authors: Aristizabal Duque C , Fernandez Cabeza J , Blancas Sanchez IM , Delgado Ortega M , Aparicio Martinez P , Fonseca Del Pozo FJ , Romero Saldana M , Pan Alvarez-Osorio M , Ruiz Ortiz M , Mesa Rubio MD 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The analysis of systolic-diastolic function by two-dimensional ultrasound speckle-tracking strain (2DSTE) in the paediatric population is becoming progressively more available. Its use can be helpful in the diagnosis of subclinical pathology in paediatric disease, both in acquired cardiovascular pathology, congenital heart disease and especially in cardio-oncology1-4. However, there is a lack of normal reference strain values in our paediatric population.

Purpose
To provide the normal values of strain in our paediatric population and its relationship with gender, age, and body surface area.

Methods
A cross-sectional study was carried out in a population in Andalusia, Spain. Of 265 children who agreed to participate, 156 healthy children aged 6-17 years were selected by excluding congenital or acquired heart disease. Analysis using the new auto-strain software of the left ventricle, right ventricle, and left atrium. Normal values are given for our population, stratified by age, gender and body surface area (BSA).

Results
Tables 1,2,3 shows the strain values of the different cardiac chambers, categorized by gender, age groups and BSA. Figure 1 presents the bivariate correlations of the strain and the different cardiac chambers with age and BSA. Average strain values were significantly higher in females, except for LALScd. We also found a significant tendency to lower mean strain values with higher age, except for LALScd. Finally, higher BSA was also inversely related to mean strain values for most variables in bivariate correlations although these associations were only significant for right ventricle strain and LALSr when BSA was categorized in tercile groups.

Conclusions
We provide for the first time in our region normal strain values for left ventricle, right ventricle, and left atrium in the paediatric population through the usage of new auto-strain software. A discrete positive correlation of strain values with respect to female gender and a negative correlation with respect to BSA and age was found. Abstract Figure. STRAIN VALUES CATEGORIZED Abstract Figure. BIVARIATE CORRELATIONS
Layer-specific global longitudinal strain as predictor for arrhythmic subrogates in arrhythmic risk of arrhythmogenic cardiomyopathy: beyond ejection fraction
Authors: Segura Rodriguez D , Bermudez-Jimenez FJ , Gonzalez Camacho L , Moreno Escobar E , Bautista-Paves A , Oyonarte-Ramirez JM , Tercedor Sanchez L , Jimenez-Jaimez J 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Arrhythmogenic Cardiomyopathy (AC) is a life-threatening disease which predispose to malignant arrhythmias and sudden cardiac death (SCD) even in early stages of the disease. Risk stratification relies on electrical, genetic and imaging data. Our aim is to investigate how myocardial deformation parameters may identify subjects at risk of ventricular arrhythmias.

Methods
A cohort of 45 subjects with definite or borderline diagnosis of AC was characterized using advanced transthoracic echocardiography (TTE) and cardiac magnetic resonance and divided into groups according
surrogates such as non-sustained ventricular tachycardia (NSVT), late gadolinium enhancement (LGE) and genetic status. Layer-specific global longitudinal strain (GLS) by TTE 2D Speckle Tracking was compared in patients with and without these arrhythmic risk markers.

Results
Twenty-three (51.1%) patients were men, mean age 43 ± 16 years. Next-generation sequencing identified a potential pathogenic mutation in 39 (86.7%) patients. Thirty-nine patients presented LGE (73.3%), mostly located at the subepicardial-to-mesocardial layers. Layer-Specific-GLS analysis showed worse GLS values at the epicardial and mesocardial layers in subjects with NSVT and LGE. Epicardial GLS values of -15.4% and -16.1% were the best cut-off values for identifying individuals with NSVT and LGE, respectively (figure 1, panel A and B, respectively) regardless of left ventricular ejection fraction.

Conclusions
Layer-specific GLS assessment identified subjects with high-risk arrhythmic features in AC such as NSVT and LGE. Epicardial GLS may emerge as potential instrument for detecting subjects at risk of SCD in AC. Abstract Figure. ROC curves.Layer-specific GLS (NSVT&LGE)
A novel sphygmomanometer for central venous pressure assessment during stress echocardiography
Authors: Campagnano E , Ciampi Q , Bortolani B , Cercenelli L , Lodi S , Marcelli E , Bologna A , Bombardini T , Villari B , Picano E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
StressEcho 2030 study group
Background. Central venous pressure (CVP) is important in the hemodynamic phenotyping of failing heart, and the usual invasive assessment can be surrogated by a sphygmomanometer for venous pressure (SVEN) which has been recently prototyped and validated.

Aim
To assess the technical success rate and correlates of CVP measurements by SVEN during stress echocardiography (SE)

Methods
We evaluated 22 consecutive patients (age 66 ±11 years, 15 men, ejection fraction 60 ±6%) referred for clinically-driven dipyridamole (n = 20, for chest pain) or treadmill (n = 2, for dyspnea) SE with ABCDE protocol (score range from 0= all steps normal, to 5= all steps abnormal). Step A assesses regional wall motion abnormalities (RWMA); step B, B-lines (diastolic function); step C, left ventricular contractile reserve based on force; step D, coronary flow velocity reserve (CFVR) in left anterior descending artery; step E, heart rate reserve (HRR). In each patient, the usual setting of echocardiographic, electrocardiographic and arterial blood pressure monitoring was integrated with CVP measurement by SVEN (right arm, contralateral to the arterial sphygmomanometer arm) with personalized cuff sizes. SVEN measurements of CVP were obtained at rest and peak stress.
Results. SVEN preparation and automated analysis required &lt; 5 minutes for positioning, inflation-deflation, acquisition and off-line reading for single measurement. SVEN success rate was 22/22 (100%). CVP did not change during SE (rest = 2.4 ± 0.5 vs stress= 3.7 ± 0.8 mmHg, p = 0.106). Resting CVP was correlated inversely to ejection fraction at rest (r=-0.489, p = 0.021) and at peak stress (r=-0.545, p = 0.001), CFVR (r=-0.505, p = 0.023), HRR (r=-0.503, p = 0.017) and directly to RWMA (r = 0.431, p = 0.045), B-lines at peak stress (r= 0.626, p = 0.002) and left atrial volume index at rest (r= 0.552, p =0.012) and at peak stress (r = 0.648, p = 0.002). CVP was significantly higher in patients with B-Lines at peak stress (Figure). ABCDE score was directly related to CVP (r = 0.560, p = 0.007).
Conclusion. SVEN assessment is feasible at rest and during stress with extremely high success rate and only minimal increase in preparation and analysis time. Changes observed are consistent with the expected hemodynamic profile, with CVP increase associated with more B-lines (a sign of pulmonary congestion and elevated pulmonary capillary wedge pressure) and larger left atrium (an integrated barometer of left ventricular end-diastolic pressure). Abstract Figure.
Impact of an inconclusive exercise stress echocardiogram on cardiovascular outcomes
Authors: Cardoso A , Lourenco MR , Von Hafe P , Dias G , Pereira T , Tinoco M , Fernandes M , Azevedo O , Lourenco A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Exercise stress echocardiography (ESE) is used for the assessment of suspected or known coronary artery disease (CAD); however, a certain percentage of ESE studies are inconclusive. We aim to evaluate the prognostic impact of an inconclusive ESE on cardiovascular outcomes.

Methods
Single-center retrospective study of consecutive patients (pts) who performed an ESE between 2018 and 2019 for diagnosis or stratification of CAD. All pts performed a symptom-limited Bruce protocol. ESE was considered inconclusive when 85% of age-predicted maximum HR was not reached. Primary endpoint was a composite of admission for acute coronary syndrome (ACS), coronary revascularization and cardiovascular death during the follow-up.

Results
A total of 141 pts were included (76% male; mean age 60 ± 9 years). ESE was inconclusive in 51 (36%) pts, positive in 11 (8%) and negative in 79 (56%).
The mean exercise time of pts with inconclusive ESE was 7 ± 2 minutes and 76% had normal functional capacity. Fatigue (25 pts; 49%) and lower extremities pain (11 pts; 22%) were the main reasons for ESE stopping. Five pts (10%) complained of chest pain during exam.
Pts with an inconclusive ESE were more diabetic (inconclusive 43%, positive 9%, negative 13%; p=.001), had more chronic obstructive pulmonary disease (COPD) (14%, 0%, 2.5%; p=.026), performed more frequently the exam under beta blocker (BB) therapy (59%, 27%, 18%; p=.041) and had less ST-segment depression fulfilling electrocardiographic criteria for ischemia (10%, 64%, 27%, p&lt;.001). Their functional capacity was worse than negative ESE pts (p&lt;.001).
During a median follow up of 22 months (IQR 15-27), 13 (9.2%) pts had the primary endpoint, including 5 pts (3.5%) with ACS.
Pts with an inconclusive ESE had a lower incidence of the primary outcome than pts with a positive ESE and a higher incidence of events than pts with negative results (figure).
In multivariate analysis, after adjusting for functional capacity and electrocardiographic criteria for ischemia, an inconclusive ESE was an independent predictor of the primary endpoint (HR 9.7, IC95% 1.1-87,6 p= .042)

Conclusions
The frequency of inconclusive ESE is not negligible (36%). These pts had more diabetes and COPD and performed the exam under BB therapy more frequently, highlighting the importance of proper patient selection. An inconclusive ESE was associated to a higher risk of cardiovascular events compared to negative ESE. Abstract Figure.