bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of coronary flow and heart rate reserve in emergency department chest pain
Authors: Cortigiani L , Vecchi A , Bovenzi F , Picano E 
Published: October 2022

Abstract

Aims
To estimate the prognostic value of stress echo (SE) with the assessment of coronary flow velocity reserve (CFVR) and heart rate reserve (HRR) in patients admitted for chest pain with non-diagnostic EKG, negative troponin, and without inducible regional wall motion abnormalities (RWMA).

Methods
658 patients (age 67±12 years) admitted to our Emergency Department with chest pain, non-diagnostic EKG, and negative serial troponin underwent dipyridamole (0.84 mg/kg in 6') SE with simultaneous assessment of RWMA, CFVR in the left anterior descending artery, and HRR as peak/rest heart rate. The outcome measure was all-cause mortality.

Results
Of the 658 patients initially enrolled, 20 (3%) showed RWMA during SE and were referred to ischemia-driven revascularization. In the remaining 638, CFVR was abnormal (&lt;2.0) in 148 patients (23%). HRR was abnormal (&lt;1.22 in patients in sinus rhythm, or &lt;1.17 in patients with permanent atrial fibrillation) in 196 patients (31%). The main clinical and echocardiographic characteristics according to CFVR and HRR response are shown in Table 1. During a follow-up of 7.3±4.3 years, 151 (24%) patients died. Survival at 8 years was 93% in patients with normal CFVR and HRR, 76% in patients with abnormal CFVR only, 73% in patients with abnormal HRR only, and 38% in those with abnormal CFVR and HRR (p&lt;0.0001) (Figure 1). At multivariable analysis, abnormal CFVR (HR 1.49, 95% CI 1.05–2.10, p=0.02) and abnormal HRR (HR 2.01, 95% CI 1.43–2.84, p&lt;0.0001) were independent predictors of survival.

Conclusions
In admitted patients with non-ischemic EKG, negative serial troponin, and whitout RWMA during dipyridamole SE, a reduced CFVR and blunted HRR independently identify a subset with worse survival in the long-term.

Funding Acknowledgement
Type of funding sources: None.
Assessment of the right ventricular-pulmonary circulation unit during stress in ankylosing spondylitis and psoriatic arthritis patients
Authors: Morvai-Illes B , Burcsar S Z , Monoki M , Varga A , Kovacs L , Balog A , Agoston G 
Published: October 2022

Abstract

Background
Cardiopulmonary complications are common in ankylosing spondylitis (AS) and arthritis psoriatica (APs), which have an unfavourable impact on mortality and quality of life. APs may be connected with pulmonary hypertension, while AS is linked to interstitial lung disease and chest wall restriction.
We aimed to assess the response of the pulmonary circulation unit during stress in AS and APs patients.

Methods
A total of 71 patients were enrolled in the study: 28 of them had AS (age 50.8±11.8 years), 17 APs (age 52.1±13.5 years), and 26 were healthy individuals (age 54.23±9.9 years). To the maximally tolerated workload, all subjects underwent resting and exercise stress echocardiography on a supine bicycle ergometer. Echocardiographic measurements were taken at rest, at 50 watts workload, and at maximal exercise.

Results
AS patients had significantly higher pulmonary artery systolic pressure (PASP; AS: 32.6±16.8 mmHg, APs: 21.6±12.7 mmHg, p&lt;0.05) and pulmonary vascular resistance (PVR; AS: 1.3±0.4 WU, PsA: 1.1±0.3 WU, p&lt;0.05) at maximal workload, while the right ventricular-pulmonary arterial (RV-PA) coupling at peak stress was higher in APs patients (AS: 1.2±0.6 mm/mmHg, PsA: 1.8±1.1 mm/mmHg, p&lt;0.05). Comparing to the control group, AS and PsA patients had significantly higher resting PASP (control: 12.6±6.4 mmHg; AS: 22.8±7.6 mmHg, p&lt;0.001; PsA: 21.4±7.0 mmHg, p&lt;0.001), lower resting RV-PA coupling (control: 2.7±1.4 mm/mmHg; AS: 1.3±0.4, p&lt;0.001; PsA 1.3±0.4 mm/mmHg, p&lt;0.001), and higher peak PVR (control: 0.6±0.4 WU; AS: 1.3±0.4, p&lt;0.001; PsA: 1.1±0.3 WU, p&lt;0.005). One-way analysis of variance of the three groups also showed significant differencies in the resting PASP (p&lt;0.001), peak PASP (p&lt;0.05), resting RV-PA coupling (p&lt;0.001), peak PVR (p&lt;0.001).

Conclusion
Stress echocardiography is a promising, radiation-free method for assessing the subclinical cardiopulmonary changes among AS and PsA patients. The changes of PVR during stress may highlight the pulmonary complications in the subclinical stage.

Funding Acknowledgement
Type of funding sources: None.
Left ventricular myocardial and cavity velocity disturbances are stronger predictors of stress induced ischaemia in patients with significant coronary artery disease
Authors: Bytyci I , Alves L , Lopes L , Henein M Y 
Published: October 2022

Abstract

Background and aim
Dobutamine stress echocardiography (DSE) is a well-established non-invasive investigation for significant coronary artery disease (CAD). The aim of this study was to evaluate the accuracy of cardiac Doppler parameters in predecting CAD.

Methods
We prospectively studied 103 consecutive patients with suspected CAD based on typical symptoms, 59 proved to have CAD and 44 patients proved to have no-CAD (n=44). All patients underwent a complete stress Doppler echocardiographic examination, including tissue Doppler, long axis velocities and total isovolumic time (T-IVT) as a marker of cavity dyssynchrony, determined as [60 − (total ejection time (ET) + total filling time (FT))]. The wall motion score index (WMSI) was also calculated.

Results
CAD patients were older, had less females, less prevalent cardiac risk factors and higher CT calcium score compared to patients with no-CAD (p&lt;0.05, for all). At peak dobutamine stress the compromised LV longitudinal excursion (MAPSE), systolic septal and lateral velocities (s'), TAPSE and diastolic indices were more pronounced in the CAD patients compared to those without CAD, but LV dimension did not differ between groups (p&gt;0.05). The WMSI was higher and t-IVT more prolonged in patients with CAD (p&lt;0.01, for both). Similarly, the changes were more pronounced in patients with significant CAD compared to insignificant CAD.
On multivariate model, delta mean s' OR 2.016 (1.610–3.490, p&lt;0.001), delta E velocity OR 1.822 (1.179–2.360, p&lt;0.001), delta t-IVT OR 1.406 (1.180–2.180, p&lt;0.001), and delta FT OR 1.911 (1.401–2.710, p=0.001), were the most powerful independent predictors of the presence of CAD, particularly when significant (&gt;50%). Delta mean s' &lt;5.0 was 85% sensitive, 89% specific with AUC 0.92. Respective values for delta E velocity &lt;6.0 cm/s were 82%, 90% and 0.91; for delta t-IVT &gt;4.5, 78%, 77% and 0.81 and for delta FT ≥150ms, 76%, 78% and 0.84 in predicating significant CAD. WMSI≥0.7 was 75% sensitive, 77% specific with AUC of 0.81 in predicting significant CAD. The accuracy of DSE was higher in significant CAD compared to insignificant CAD (80% vs 74%; p=0.03).

Conclusions
Compromised LV longitudinal systolic function, lower delta E wave, prolonged t-IVT and increased WMSI were the most powerful independent predictors of the presence and significance of CAD. These finding strengthen the role of comprehensive DSE analysis in diagnosing ischaemic disturbances secondary to significant CAD.

Funding Acknowledgement
Type of funding sources: None.
Acute impact of transcatheter edge-to-edge repair for mitral regurgitation on left ventricular function
Authors: Kassar M , Madhkour R , Praz F , Hunziker L , Windecker S , Brugger N 
Published: October 2022

Abstract

Introduction
Transcatheter Edge-to-Edge repair (TEER) for the therapy of mitral valve regurgitation (MR) is an alternative to surgery for high risk patients. It is a minimal invasive procedure but the acute impact of the pre- and afterload decrease, due to the reduction of both MR and mitral valve area (MVA), on the left ventricle (LV) systolic function was never formally evaluated.

Method
Fifty patients with mixed MR etiologies from our TEER register with complete 3D datasets of the LV before and after TEER were included in this study. LV volumes and function, as evaluate by ejection fraction (LVEF), global longitudinal strain (LV-GLS) and global circumferential strain (LV-GCS), and the MR (3D vena contracta area, 3D VCA) were evaluated before and at the end of the therapy.

Results
The majority of patients suffered from secondary MR (54%), one TEER device was implanted in 64% and two in 36% of the population. TEER leads to a significant reduction of all the LV volume and function parameters excepted for the end-diastolic volume which increased non-significantly (Table 1). The decrease of the LVEF was linked to a decrease of both GLS and GCS in a multivariate analysis (r 0.85), the decrease of GCS having a higher influence (beta −0.606 vs −0.435). In the univariate linear analysis, the reduction of LVEF, GLS and GCS were inverse proportional to the LVEF before TEER and direct proportional to the reduction of the 3D VCA. LVEF decrease was also directly linked to MVA percental reduction. After multivariate evaluation, LVEF reduction kept linked to LVEF before TEER and VCA 3D reduction (r=0.51, p=0.001), GCS decrease only to VCA 3D reduction (r=0.371, P=0.08) and GLS diminution only to LVEF before TEER (r=0.313, p=0.027).

Conclusion
After TEER, left ventricular function reduction seems principally linked to the afterload increase (i.e. the MR reduction); the circumferential function and the left ventricles with the highest ejection fractions being apparently maximally impacted.

Funding Acknowledgement
Type of funding sources: None.
Tricuspid annulus deformation indices predicting severe functional tricuspid regurgitation: 3D echocardiographic study
Authors: Krivickiene A , Verikas D , Kreckauskiene R , Gujyte G , Vaskelyte J J , Ereminiene E 
Published: October 2022

Abstract

Introduction
In these past few years tricuspid valve (TV) got its appreciation due to the latest focus of complications driven by tricuspid regurgitation (TR). Even though severe TR may require surgical repair, precise analyses performed by 3D echocardiographic tools to determine severe functional TR (FTR) are scarce.

Aim
To determine the accuracy of 3D echo-derived TV parameters in predicting severe FTR.

Methods
Prospective observational cohort study enrolled 90 patients (pts) with functional moderate (70%) or severe (30%) TR. Pts with FTR of various aetiologies (due to left-sided valvular heart disease, pulmonary arterial hypertension [invasively measured pulmonary capillary wedge pressure &lt;15 mmHg]) were included in this study. Pts with ischemic heart disease (assessed by coronary angiography) were excluded from the analysis. TR severity was measured quantitatively: severe FTR was defined by 2 parameters: vena contracta ≥7 mm and TR effective regurgitant orifice area ≥40 mm2. The transthoracic echocardiography was performed and included the following 2D and 3D-derived TV parameters: the systolic and diastolic 4-chambers (septal – lateral), 2-chambers (anterior-posterior), major and minor axis TA diameters, TA area, perimeter, leaflet tenting height and volume. The 3D TV analysis was made using the 4D Auto TVQ quantification software package. Receiver Operating Characteristic (ROC) curves, area under the curve (AUC), specificity and sensitivity were analysed.

Results
Study cohort included 66% females; mean age was 65±11 years. The results of the ROC analysis are shown in Table 1. Of all TA 3D parameters, septal-lateral systolic (AUC 0.859) and diastolic (AUC 0.840) diameter, major axis systolic (AUC 0.816) and diastolic (AUC 0.810) diameter, as well as leaflet tenting volume (AUC 0.769) have the highest predictive value for severe FTR. 3D TA analysis provides 75–88% sensitivity for defying pts with severe FTR. Meanwhile, septal-lateral diameter, major axis diameter and annulus perimeter are the most specific to determine severe FTR. 2D echo-derived TA 4-chamber diastolic diameter index has a lower predictive value with worse sensitivity and specificity, compared to 3D parameters.

Conclusions
Analysis of three-dimensional echocardiographic parameters is an accurate method, suggesting that dilation of tricuspid annulus is a precise measure for identifying patients with severe FTR.

Funding Acknowledgement
Type of funding sources: None.
Response and long-term outcomes with resynchronization therapy: the role of heart failure etiology
Authors: Brandao M , Goncalves Almeida J , Fonseca P , Santos E , Rosas F , Tavares A J , Nogueira Ribeiro J , Oliveira M , Goncalves H , Primo J , Fontes-Carvalho R 
Published: October 2022

Abstract

Background
Resynchronization therapy (CRT) reduces mortality across all etiologies of heart failure (HF). Reverse left ventricular (LV) remodelling has been reported to occur more often in non-ischemic patients.

Purpose
To compare response and outcomes after CRT in non-ischemic (NIHF) and ischemic (IHF) HF patients.

Methods
Single-center retrospective study of consecutive patients submitted to CRT implantation (2007–2018). Major adverse cardiac events (MACE) included HF hospitalization or all-cause mortality (ACM). Clinical response was defined as New York Heart Association (NYHA) class improvement without MACE in the 1st year of follow-up (FU). Echocardiographic (echo) response implied left ventricle end-systolic volume reduction of &gt;15% at 1-year. LV ejection fraction [LVEF] ≥50% during 1st year of FU defined superresponse. Survival analysis with Kaplan-Meier method and Log-rank test was performed to compare outcomes. Multivariate analysis was performed to assess if HF etiology predicted response to CRT.

Results
295 patients (mean age 67±11 years, 91.5% left bundle branch block, baseline QRS 171±22 ms) were included. Patients in NIHF group (n=208, 72.5%) were more often female (35.6% vs 15.6%, p&lt;0.001), tended to be younger (67 vs 70 years, p=0.05), had more valve disease (36.7% vs 23.6%, p=0.037) and kidney disease (32.9% vs 18.5%, p=0.015). In NIHF patients, right ventricular dysfunction (tricuspid annular plane systolic excursion &lt;17 mm) was less common (25.6% vs 47.1%, p=0.039). Addition of defibrillator was identical (53.8% vs 55.7%, p=0.882).
NYHA class improvement (79.4% vs 78.4%, p=0.987) and echo response (71.2% vs 74.4%, p=0.860) were similar. NIHF patients were more often superresponders (25.7% vs 9.5%, p=0.006), with greater improvement in LVEF (Δ 11.6% vs 7.6%, p&lt;0.001). Clinical response was more frequent in NIHF patients (66.3% vs 50.6%, p=0.023).
After multivariate analysis, HF etiology was not predictive of clinical (p=0.960) or echo response (p=0.075). During a mean FU of 3.8 years, occurrence of MACE (Log rank test, p&lt;0.001) and ACM (Log rank test, p&lt;0.001) were lower in NIHF [Figure 1]. Ventricular arrythmias (6.4% vs 7.5%, p=0.993) or appropriate defibrillator therapies (5.3% vs 7.5%, p=0.743) did not differ.

Conclusions
In this cohort, consisting mostly of patients with LBBB and QRS ≥150 ms, HF etiology did not predict clinical or echo response to CRT. Still, NIHF patients showed a greater extent of LV remodelling. Lower MACE and ACM rates were also observed in non-ischemic patients.

Funding Acknowledgement
Type of funding sources: None.
Biventricular or left univentricular pacing in heart failure patients: is there a better strategy
Authors: Barradas M , Duarte F , Coutinho Dos Santos I , Resendes De Oliveira L , Serena C , Xavier Fontes A , Viveiros Monteiro A , Machado C , Dourado R , Santos E , Pelicano N , Pacheco M , Tavares A , Martins D 
Published: October 2022

Abstract

Background
Cardiac resynchronization therapy (CRT) is a cornerstone in treatment of heart failure (HF) with reduced left ventricular ejection fraction (LVEF) and ventricular dyssynchrony. Biventricular (BiV) pacing is often the preferred method and corrects electrical and mechanical dyssynchrony but Left ventricular (LV) preferential pacing is may preserve conduction via the right bundle branch, preventing deleterious effects from right ventricular. The evidence is sparse and there is doubts whether which programming strategy is better.

Purpose
We hypothesized that BiV is non-inferior to preferential LV pacing in HF patients with reduced LVEF and CRT devices in cardiovascular death and HF hospitalizations.

Methods
We retrospectively evaluated 147 patients with HF patients with reduced LVEF and CRT devices. Two groups were defined: LV pacing (group 1) and BiV pacing (group 2). Primary outcome was defined as cardiovascular death and secondary outcome as HF hospitalizations and NYHA class after CRT.

Results
Mean age was 70,26±10,6 years, 68,1% were males and follow-up was 52,22±44,51 months. One hundred and twenty six (85,7%) patients had implantable cardiac resynchronization therapy (CRT) defibrillator (CRT-D) and 21 (14,3%) CRT pacemaker (CRT-P). Mean LVEF was 31,1±8,5% and mean QRS duration before CRT implantation was 149,5±48,6 ms. Thirty-nine (36,4%) patients were in NYHA III–IV. HF aetiology was idiopathic in 51 (47,2%), ischemic in 36 (33,3%) and alcoholic cardiomyopathy in 9 (8,3%). Forty-five (40,5%) patients had atrial fibrillation and 37 (35,6%) coronary disease. Patients in group 2 were more frequently males than group 1 patients (46 (78,0%) vs 32 (56,1%) respectively, p=0,012). There were no differences in regard to age, LVEF, HF aetiology or other comorbidities between groups. In 57 (49,1%) CRT was programming in preferential LV pacing and 50 (50,9%) in BiV pacing. There were 2 deaths in group 1 and 3 in group 2 (OR 0.80, 95% CI 0.27–2.40). There were 0,98±3,17 hospitalizations per patient and there were no differences in HF hospitalizations between groups (OR 1.01, 95% CI 0.92–1.18) or NYHA after 6 months of CRT (p=0,364).

Conclusion
BiV pacing was not inferior to LV-only pacing in regard to cardiovascular death, HF hospitalizations and NYHA class improvement. There was no clear advantage for one pacing strategy over the other but more studies are still required.

Funding Acknowledgement
Type of funding sources: None.
Prediction of response to cardiac resynchronization therapy using cardiac magnetic resonance imaging in non-ischemic dilated cardiomyopathy
Authors: Kim S E , Chun K H , Oh J , Yu H T , Lee C J , Kim T H , Pak H N , Lee M H , Joung B , Kang S M 
Published: October 2022

Abstract

Background
Cardiac resynchronization therapy (CRT) is a well-established therapy for symptomatic heart failure with reduced ejection fraction, but the response is different for individuals. Although many modalities have been conducted to predict CRT response, cardiac magnetic resonance (CMR) to predict CRT response has still insufficient usefulness.

Purpose
We determine whether the parameters including late gadolinium enhancement (LGE) identified in CMR could act as predictors of CRT response.

Methods
We retrospectively investigated 124 patients with non-ischemic dilated cardiomyopathy who underwent CMR before CRT implantation between Jan 2010 and July 2021 in a single center. CRT response was defined as a decrease in left ventricular end-systolic volume (LVESV) &gt;15% on echocardiography after at least 3 months after CRT implantation.

Results
Among the study population (mean age 65.7±11.2 years, mean EF 25±6.5%, 50% of female), 85 (69%) patients were defined as CRT responder. The CRT responders had more left bundle branch block (LBBB) compared with non-responders [79 (92.9%) vs. 23 (59.0%), p&lt;0.001], but there was a no difference of QRS duration (158.7 vs 165.0ms, p=0.054) between two groups. CMR analysis showed that there were no significant differences in the left ventricular (LV) chamber volume and LV ejection fraction between CRT-responder and non-responder. However, the right ventricular (RV) chamber volume was smaller (RV end-diastolic volume index, 86.3 vs 103.5 ml/m2, p=0.039; RV end-systolic volume index, 49.3 vs 68.5 ml/m2, p=0.013) and the RV ejection fraction (RVEF) was higher (46.9 vs 37.6%, p=0.002) in CRT-responders compared with non-responders. The LGE on CMR was more shown in non-responders than in CRT-responders [33 (84.6%) vs 45 (52.9%), p&lt;0.001]. In CMR parameters, RV dysfunction (RVEF &lt;45%) [Odds ratio (OR), 0.21 (0.05–0.93), p=0.045] and LGE [OR, 0.21 (0.05–0.58), p=0.01] were significantly associated with poor CRT response.

Conclusions
The presence of LGE and RV dysfunction on CMR were associated with poor CRT response in patients with non-ischemic dilated cardiomyopathy. Further investigation with CMR for pre-CRT patients is needed to support these results.

Funding Acknowledgement
Type of funding sources: None.
Concomitant left atrial appendage closure with left ventricular assist device surgery can reduce ischemic cerebrovascular accidents
Authors: Nishida H , Jeevanandam V , Salerno C , Song T , Onsager D , Nguyen A , Grinstein J , Chung B , Smith B , Kalantari S , Sarswat N , Kim G , Pinney S , Ota T 
Published: October 2022

Abstract

Background
It remains unknown if concomitant left atrial appendage closure (LAAC) at the time of left ventricular assist device (LVAD) surgery can reduce ischemic cerebrovascular accidents.

Purpose
The purpose of this study is to assess the impact of LAAC at LVAD surgery on the incidence of ischemic cerebrovascular accidents.

Methods
Between January 2012 and November 2021, 310 patients underwent LVAD surgery with HeartMate II or III. Out of 310 patients, 98 patients (31.6%) underwent concomitant LAAC. The cohort was divided into two groups: patients with LAAC (Group A, n=98) and without LAAC (Group B, n=212). To minimize device bias, LVAD surgery with HeartWare HVAD device was excluded. The ischemic cerebrovascular accident was defined as ischemic stroke, hemorrhagic stroke or transient ischemic attack. We reviewed early and long-term clinical outcomes. The incidence of ischemic cerebrovascular accidents was compared between two groups using the Kaplan-Meier method. We also investigated if LAAC was associated with ischemic cerebrovascular accidents by Cox proportional hazards analysis.

Results
There were no significant differences in baseline characteristics between two groups including age (Group A: 55.0±12.3 years old, Group B: 56.9±14.1 years old, p=0.26), preoperative CHADS2 score (Group A: 2.40±1.1, Group B: 2.58±1.1, p=0.19) and history of atrial fibrillation (Group A: 42.9%, Group B: 42.5%, p=0.95). In-hospital mortality was not significantly different between the two groups (Group A: 7.1%, Group B: 12.3%, p=0.16). In terms of postoperative complications, there were no significant differences between two groups in requiring extracorporeal membrane oxygenation, re-exploration for bleeding and newly required hemodialysis. Median follow up period was 474 days. Thirty-five patients (11.2%) developed ischemic cerebrovascular accidents (5 patients in Group A and 30 patients in Group B). The rate of freedom from ischemic cerebrovascular accidents in Group A (94.1% at 500 days and 94.1% at 1500 days) was significantly higher than that in Group B (88.2% at 500 days and 77.4% at 1500 days; log rank=0.024). In a Cox proportional hazards regression analysis including LAAC, age, history of atrial fibrillation, diabetes mellitus and Heartmate 3 device implantation, LAAC was associated with reducing the incidence of ischemic cerebrovascular accidents (hazard ratio 0.37, 95% CI 0.13–0.89, p=0.02).

Conclusion
Concomitant LAAC at the time of LVAD surgery can reduce ischemic cerebrovascular accidents without increasing perioperative mortality and complications.

Funding Acknowledgement
Type of funding sources: None.