bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of two ultrasound contrast agents for left ventricular opacification
Authors: Becher HH , Mannani N , Choy M , Paterson I , Pituskin E , Choy J 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Several ultrasound contrast agents have been approved and used for measurement of LV volumes and ejection fraction (EF). However, there has been no direct comparison between these agents.

Purpose
To compare different imaging parameters between two widely used ultrasound contrast agents for LV opacification when imaged with a low power contrast specific imaging modality

Methods
A retrospective study was performed using recordings of the local echocardiography registry for patients undergoing chemotherapy for cancer treatment. Patients were included who underwent follow-up echocardiograms (3 months) with 2 different ultrasound contrast agents and had only minor changes in the LV ejection fraction (EF) between the studies (&lt;5%). Qualitative and quantitative analysis of the contrast effect was performed in apical four- and two chamber views (4CV,2CV). For quantitative analysis of the LV opacification square regions of interest (ROI) were placed in the apical and basal regions of the ventricle in each echocardiographic recording and the arithmetic mean and standard deviation of pixel intensity within each ROI was recorded throughout the entire loop. Qualitative visual assessment was performed using a three step visual score in order to assess the endocardial border delineation, basal attenuation and apical swirling. Wilcoxon signed-rank test was used to compare the measurements obtained with different contrast agents.

Results
41 patients fulfilled the inclusion criteria. In all patients suitable recordings for measurement of LV volumes and EF were obtained. The mean + standard deviation of the EF was 61 + 9%. Both contrast agents provided intensive LV opacification in the basal and apical cavities. The video intensities (mean + standard deviation) in the apical and basal cavities were comparable across both contrast agents in the 2CV apical ROI (219.96 + 21.42 vs 224.69 + 20.23, p = 0.32), the 2CV basal ROI (114.55, 42.02 vs 112.79, 42.57, p = 0.81), the 4CV apical ROI (228.02, 17.80 vs 225.51, 20.37, p = 0.30), and the 4CV basal ROI (100.05, 41.11 vs 92.84, 42.54, p = 0.37). Visual assessment of endocardial delineation on end-diastolic and end-systolic frames revealed no statistical difference between the contrast agents.

Conclusion
In patients with normal LV function no clinically relevant differences were found between the two contrast agents regarding LV opacification and endocardial border delineation.
Speckle tracking echocardiography strain analysis for the assessment and monitoring of myocardial mechanics after pediatric cardiac surgery
Authors: Cantinotti M , Marchese P , Franchi E , Assanta N , Van Den Eynde J , Shelby K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Speckle-tracking echocardiography (STE) is a relatively new ultrasound technique that exploits acoustic reflections and artifacts within the ultrasonic window, with the aim of analyzing global myocardial deformation and segmenting. STE has proved to be more sensitive in identifying a myocardial dysfunction so gained increasing value in the evaluation of congenital heart diseases (CHD) even though its use, in pediatric cardiac surgery, is still limited. The present study aims to evaluate the global and left ventricular (LV) systolic impairment after pediatric cardiac surgery by STE strain (ε) analysis.

Methods
We prospectively enrolled 120 children undergoing cardiac surgery for CHD. Echocardiography was performed at four different times: pre-operatively, 12-36 hours (Time-1), 3-5 days (Time-2), 6-8 days (Time-3). Images were obtained in the 4-2-and 3 apical chamber’s views to derive LV global and regional (basal/mid/apical) ε values.
Results. We collected data from 332 examinations in 120 children (mean age: 2.33 ±3.91, range: 0-16 years) at different post-operative times. 120 age-matched healthy children (3.1 ± 4.2 years) served as controls. All global, basal, and mid LVε values reduced after surgery; the lowest values were at Time-1 (p &lt; 0.0001) but increased thereafter. At discharge, all global, basal, and mid LVε values persisted lower than pre-operatively and healthy children (p &lt; 0.05). Instead, apical segments (lowest at baseline), increased after surgery (p &lt; 0.0001), but remained lower compared to controls. LV ejection fraction (LVEF) decreased at Time-1 (p = 0.0003) but promptly recovered to Time-2, to standardize at Time-3.
Conclusions. Despite LVEF was normalized by the discharge, STE ε has shown a systolic impairment after cardiac surgery that disclosed a gradual improvement but still uncomplete normalization at discharge.
Regional STE differences revealed a discrepancy base-apex: apical segments, contrary to all the other regions, showed hypercontractility after surgery. The slower recovery of LVε values compared to LVEF, suggests that STE ε analysis may be more accurate in the follow-up of mild LV post-surgical impairment. Abstract Figure. LV ventricular ε values
Modeling of intra-arterial hemodynamics in main arteries atherosclerosis
Authors: Germanova O , Galati G , Germanov AV , Shchukin YV , Fedorina MA 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Aim. To study intra-arterial hemodynamics of the main arteries in atherosclerosis using the original device for modeling of intra-arterial circulation.
Material and methods. To study hemodynamics inside an arterial vessel, we used an original device developed by us for modeling of intra-arterial circulation (Document of invention № RU 202780 U1). The main part of the device is a prototype of an artery - a glass tube of a rotameter with a length of 365 mm, an inlet end with a diameter of 20 mm, an outlet end - 16.5 mm. Flexible silicone tubes are attached to the rotameter on both sides, with free ends connected to an electric pump, with various modes of work (imitation of pulse waves at the regular rhythm (RR), extrasystole (ES), atrial fibrillation (AF)). An aqueous solution of glycerin was introduced into a closed system diluted with water corresponding to the viscosity of the blood. A 5 mm long silk thread was alternately installed inside the tube, an intravascular piezoelectric crystal pressure sensor connected to an oscilloscope was injected with a dye - clerical ink. Plastic diaphragms 15 mm long with stenosis of the internal lumen of 50%, 70%, and 90% were alternately hermetically installed in the rotameter.
Results. When imitating ES in the first post-extrasystolic contraction (1PEC), the speed of fluid flow through the diaphragms increased in the 1PEC in comparison with the RR. So, with a stenosis of 50%, the speed with a RR was 2.09 m/s, with an ES 0.03 m/s, with 1PEC 3.83 m/s; with 70% stenosis, the speed at RR 3.24 m/s, with ES 0.04 m/s, with 1PEC 5.26 m/s; with 90% stenosis, the speed at RR 8.96 m / s, with ES 0.10 m/s, with 1PEC 12.36 m/s. The pressure increased proportionally to the speed. We observed the appearance of reflected, standing waves in the edge zones of the diaphragm and a turbulent flow of liquid behind the diaphragm.
Conclusion. These changes in hemodynamics are characterized by the concept of "hydraulic shock". Intense mechanical effect of 1PEC pressure waves in the marginal zones of the diaphragm can contribute to the further growth and progression of atherosclerosis in arterial vessels. Abstract Figure.
Prognosis implications of quantified mitral regurgitation stratified by left atrial function in HFrEF population
Authors: Benfari G , Rossi L , Zanni A , Sticozzi C , Piepoli MF , Malagoli A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
The debate about the independent prognostic responsibility of functional mitral regurgitation (FMR) is still in turmoil. Growing findings about the predictive role of left atrial (LA) function are emerging in several scenarios.

PURPOSE
This study aims to define FMR linkage to cardiovascular (CV) outcomes and the interplay with LA function in a prospective cohort of consecutive heart failure patients with reduced ejection fraction (HFrEF).

METHODS
286 consecutive outpatients with chronic HFrEF were enrolled. FMR was quantified by effective regurgitant orifice area (EROA). Global peak atrial longitudinal strain (PALS) was measured by speckle tracking echocardiography (STE). The primary endpoint was defined as a composite of congestive HF hospitalization and CV death.

RESULTS
The majority (81%) of patients were men (mean age: 67 ± 11 years, mean LVEF: 32 ± 6%). The median global PALS was 17.7% ranging from 2.7% to 49.2%. FMR was quantifiable in 240 (84%) patients. During a median follow-up period of 6.4 (IQR 3.9-7.7) years, the primary endpoint occurred in 88 (31%) patients (35 HF admissions, and 53 deaths). EROA showed independent prediction for the primary endpoint (HR 1.30 [1.05-1.57], P = 0.01). The spline modeling of the risk by EROA values showed an excess event risk starting at about the EROA value of 0.1 cm2 (Figure 1). There was a remarkable graded association between the EROA strata, even if tested per 0.1 cm2 increase, and the risk of congestive HF hospitalization and CV death (P = 0.0004). Any FMR grade presenting with reduced LA function (PALS &lt; 14%) was associated with dismal outcome (event rate of 63 ± 10% for EROA exceeding 0.3 cm2 and 49 ± 6% for EROA ≥0.1 cm2 at 5 years). Conversely, the presence of EROA ≥0.1 in the context of preserved global PALS showed a better outcome (Figure 2).

CONCLUSIONS
Our results refine the independent association between FMR and CV outcome among HFrEF outpatients. The risk of CV events starts at a low EROA value, reaching a severe level above the threshold of 0.3 cm2. Within a moderate EROA range, the LA function mitigates the clinical consequences of the mitral regurgitation, providing measurable proof of the interplay between the regurgitation and the LA compliance. Abstract Figure 1 Abstract Figure 2
Long-term follow-up of percutaneous balloon mitral valvuloplasty for mitral stenosis: an old but needed player
Authors: Ferreira V , Rodrigues I , Almeida Morais L , Cacela D , Bernardes L , Patricio L , Moura Branco L , Galrinho A , Leal A , Castelo A , Garcia Bras P , Viegas J , Cruz Ferreira R 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In the era of innovative transcatheter valve interventions, percutaneous balloon mitral valvuloplasty (PBMV) remains the primary treatment option in anatomic suitable patients.

Purpose
This study aimed to evaluate longterm follow-up (FU) of PBMV and to determine predictors of MACE.

Methods
Between 1991 and June 2021, 202 consecutive patients underwent PBMV in a single tertiary centre. Clinical data, echocardiographic parameters, and MACE (cardiovascular mortality, need for percutaneous or surgical mitral reintervention and hospitalization for heart failure) were analysed. Predictors of MACE were determined by Cox regression analysis.

Results
Mean age was 47.3 ± 13.6 years, 89.6% female, 47.3% patients presenting atrial fibrillation. Mean Wilkins score was 7.6 ± 1.4, 51.5% had mild or moderate mitral regurgitation and mean pulmonary artery systolic pressure (PASP) of 46.7 ± 17.1 mmHg. Mean pre MVA and mean mitral valve (MV) gradient were 1.1 ± 0.2 cm2 and 10.8 ± 5.6 mmHg, respectively. Successful PMBV was achieved in 89.1%.
During a mean FU of 12.0 ± 8.8 years, there were 25 deaths (12.4%) and 33.3% needed MV reintervention (6.5% underwent PBMV and 29.7% needed MV surgery). At univariate analysis, previous MV intervention [HR = 1.95 (1.02–3.72), p &lt; 0.05], Wilkins score [HR = 1.22 (1.01–1.47), p &lt; 0.05], pre mean MV gradient≥8 [HR = 0.62 (0.38–1.00), p &lt; 0.05], mean MV gradient after procedure [HR = 1.37 (1.19–1.58), p &lt; 0.05] and PASP &gt;45 mmHg [HR = 3.29 (1.13–9.55), p &lt; 0.05] were predictors of MV reintervention. At multivariate analysis, pre mean MV gradient≥8 [HR = 0.17 (0.037–0.81), p &lt; 0.05] and mean MV gradient after procedure were independent predictors of MV reintervention [HR = 1.74 (1.21–2.49), p &lt; 0.05]. Wilkins score [HR = 1.29 (1.06–1.57), p &lt; 0.05] and mean MV gradient after procedure [HR = 1.41 (1-21–1.63), p &lt; 0.05] were independent predictors of MACE. Cumulative event-free survival at 10 and 20 years were 72.0 and 46.0%, respectively.

Conclusions
PBMV remains a reliable and efficient therapeutic option of mitral stenosis, warranting event-free survival at 10 years in most patients selected for the procedure. Mean MV gradient after procedure was independent predictor of MV reintervention and MACE during follow-up. Abstract Figure. Abstract Figure.
Pathophysiological mechanism of worsened clinical outcome by lowered left ventricular cardiac power output in heart failure
Authors: Aoyagi H , Tsujinaga S , Iwano H , Ishizaka S , Tamaki Y , Motoi K , Chiba Y , Murayama M , Nakabachi M , Nishino H , Yokoyama S , Sato T , Kaga S , Nagai T , Anzai T 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac power output (CPO) is a measure of cardiac pumping function, and CPO during exercise is known to be a powerful prognostic marker of heart failure. Despite its prognostic significance, pathophysiological mechanism of the association between reduced CPO and worse clinical outcome is unknown. We hypothesized that reduced CPO is associated with worse outcome through the reduced exercise capacity and enhanced ventilatory response.

Methods
Cardiopulmonary exercise testing and exercise stress echocardiography were performed in consecutive 64 patients with chronic heart failure who admitted to our department for the management of heart failure [60 ± 14 years old, left ventricular (LV) ejection fraction 39 ± 16%, ischemic etiology 16%, brain natriuretic peptide 124 pg/ml (51-313)]. Peak oxygen uptake (peak VO2) and the lowest minute ventilation / carbon dioxide production ratio (VE/VCO2) were measured as a parameter of exercise tolerance and that of ventilatory response, respectively. LV ejection fraction was measured by disk summation method at peak exercise. By using Doppler images, E/e" at peak exercise was measured as a marker of LV filling pressure, and CPO normalized by LV mass was obtained as 0.222 × cardiac output × mean blood pressure / LV mass [W/100 g]. Cardiac events defined as hospitalization for heart failure, cardiac death, or implantation of a LV assist device after the examinations were recorded.

Results
CPO at rest was weakly correlated with peak VO2 (r = 0.25, p = 0.046) but not with VE/VCO2. In contrast, CPO at peak exercise was positively correlated with peak VO2 (r = 0.50, p &lt; 0.001) and inversely correlated with VE/VCO2 (r=-0.40, p = 0.002). Moreover, CPO at peak exercise determined both peak VO2 (b = 0.50) and VE/VCO2 (β=-0.54) independently of LV ejection fraction and E/e" at peak exercise. During a median follow-up period of 1211 days, 12 cardiac events were observed. Each of reduced peak VO2 (hazard ratio 0.78, 95% confidence interval 0.66-0.90) and increased VE/VCO2 (hazard ratio 1.10, 95% confidence interval 1.02-1.18) was associated with worse clinical outcome.

Conclusions
In patients with chronic heart failure, CPO during exercise was associated with prognosis of heart failure through the reduced exercise capacity and enhanced ventilatory response.
Combined assessment of septal scar and septal flash by cardiac magnetic resonance identifies responders to cardiac resynchronization therapy
Authors: Kjellstad Larsen C , Duchenne J , Galli E , Aalen JM , Lederlin M , Bogaert J , Kongsgaard E , Linde C , Penicka M , Donal E , Voigt J-U , Smiseth OA , Hopp E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): South-Eastern Norway Regional Health Authority. Research grants of the University of Leuven.

Background
Left ventricular (LV) scar, particularly in the lateral wall and septum, reduces response rate to cardiac resynchronization therapy (CRT), whereas a dyssynchronous LV contraction pattern (septal flash) suggests good response. Lateral wall scar abolishes septal flash. Therefore, a combined approach of septal scar and septal flash may characterize the myocardial substrate responsive to CRT. Cardiac magnetic resonance (CMR) may assess both scar and contraction pattern.

Purpose
The present study aimed to determine if combined assessment of septal scar and septal flash by CMR as single image modality identifies responders to CRT.

Methods
We investigated all CRT recipients with available CMR from a prospective, multicenter study (n = 136), with both ischemic and non-ischemic heart failure. Septal scar was assessed by late gadolinium enhancement (LGE) from a stack of short axis slices (n = 128) and septal flash determined visually on ordinary cine sequences (n = 136). CRT response was defined as ≥15% reduction in LV end-systolic volume by echocardiography at 6 months follow-up. We also assessed heart transplantation or death of any cause 39 ± 13 months after device implantation.

Results
In multivariate analysis including percentage septal scar (LGE), septal flash, QRS-duration and QRS-morphology, septal LGE and septal flash were the only independent predictors of CRT response (both p &lt; 0.001). A combined approach of septal LGE and septal flash predicted CRT response with area under the curve 0.86 (95% confidence interval (CI): 0.78-0.94) and long-term survival without heart transplantation with hazard ratio 0.18 (95% CI: 0.05-0.61).
A practical approach to selection of CRT candidates by septal LGE and septal flash is illustrated in the present figure. As shown, absence of septal LGE indicated excellent response rate (93%) to CRT independent of other parameters. When septal LGE was present, however, overall response rate was substantially lower (58%), but presence or absence of septal flash separated responders from non-responders with high accuracy. This sequential approach correctly classified 86% of patients. Importantly, the approach was equally accurate in patients with intermediate QRS duration (130-150ms), where 93% of patients were correctly classified.

Conclusions
Combined assessment of septal LGE and septal flash by CMR as single image modality identifies CRT responders with high accuracy and predicts long-term survival. Abstract Figure.
Simple echocardiographic parameters could be helpful in the identification of new-onset atrial fibrillation in acute myocardial infarction
Authors: Raczkowska-Golanko M , Raczak G , Gruchala M , Danilowicz-Szymanowicz L 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
New-onset atrial fibrillation (NOAF) is a significant complication of acute myocardial infarction (AMI) associated with a poor prognosis. The knowledge of NOAF risk factors in nowadays AMI patients is still the subject of interest. Our study aimed to investigate which echocardiographic, additionally to other clinical, routinely checked parameters could impact NOAF occurrence in AMI.

Patients and methods
This single-center, retrospective study was conducted on all consecutive patients admitted to the University Clinical Center from January 2017 to December 2018 with an AMI diagnosis. Detailed medical history, routinely checked laboratory and echocardiography parameters, invasive and pharmacological treatment, as well as complications and in-hospital mortality, were taken into further analysis in NOAF detection.

Results
NOAF was documented in 106 of 954 (11%) AMI patients and was significantly associated with in-hospital mortality [odds ratio [OR] 4.54, 95% confidence interval [CI] 2.50 – 8.33, p &lt; 0.001). Left atrium size ≥ 41 mm and left ventricular ejection fraction (LVEF) ≤ 44 % were significantly associated with NOAF in univariate logistic analysis (OR 2.14 [1.37 – 3.33], p &lt;0.001 and 2.99 [1.98 – 4.53], p &lt; 0.001 respectively); whereas LVEF maintained their significance in multivariate analysis (OR 1.93 [1.12 – 3.12], p = 0.020). Age, B-type natriuretic peptide (BNP), C- reactive protein (CRP), high-sensitivity troponin I, total cholesterol, low-density lipoprotein cholesterol, potassium level, hemoglobin, leucocytes, and neutrophil to lymphocyte ratio, were another predictors of NOAF.

Conclusions
NOAF is a multifactorial, significant complication of AMI, leading to a worse prognosis. Simple echocardiographic parameters could be helpful in the identification of high-risk patients.
Systemic inflammation in the acute myocardial infarction can predict early negative left ventricular remodeling assessed by myocardial work analysis
Authors: Danet R , Rimbas RC , Bratu V , Magda S , Mihalcea D , Mihaila S , Lungeanu L , Velcea A , Gheorghiu L , Dragoi R , Corlan A , Schiopu A , Simionescu M , Vinereanu D 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): UEFISCDI
Background. Left ventricular (LV) remodeling after acute myocardial infarction (AMI) is an important predictor of heart failure (HF). Systemic inflammatory response in the acute phase of AMI is of particular interest, while the relation to the remodeling process is still under debate. New imaging techniques derived from speckle tracking echocardiography (STE), such as myocardial work (MW), are attractive tools since they can detect myocardial remodeling before decrease of global LVEF. However, there is insufficient data regarding MW in AMI patients, and its relation to the inflammatory process.
Methods. We assessed 57 patients (53 ± 9 years, 45 men, 64% smokers, 59% hypertensive, 54% with type 2 diabetes) with AMI, by clinical, 2D echo, and STE. Biomarkers panel was evaluated within the first 24 hours from admission: hsTpI and CRP. A second visit with clinical and echo assessment was performed at 6-8 weeks from the baseline visit. Exclusion criteria were unstable patients, non-sinus rhythm, significant valvular disease (&gt;grade 2), other significant pathologies leading to decreased life expectancy, and low quality 2DE. At both visits, global longitudinal stain (GLS) and MW by 2DSTE were measured, on top of conventional echo parameters: global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) (Figure 1: upper panel - an example of a patient with increase of GWE from baseline to visit 2 ; lower panel - an example of a patient with decrease of the GWE from baseline to visit 2).
Results. At baseline, myocardial necrosis by hsTpI significantly corelated with GLS (r = 0.44, p = 0.001) and MW (GWI: r=-0.44, p = 0.001; GCW: r=-0.40, p = 0.002), but not with LVEF. However, systemic inflammation by CRP did not correlate with LVEF or any of the STE parameters. Interestingly, systemic inflammation by CRP significantly correlated with changes of MW between the two visits: for GWE r=-0.53, p &lt; 0.001; and for GWW r = 0.48, p &lt; 0.001 (Figure 2). A CRP level &gt;28 mg/l was able to predict decrease of GWE from baseline to visit 2.
Conclusions. Magnitude of necrosis, expressed by hsTpI, corelates only with GLS and MW parameters, but not with LVEF. CRP level in the acute phase of AMI correlates with myocardial work changes, as an early marker of negative LV remodeling. Abstract Figure 1 Abstract Figure 2