bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rate of transesophageal echocardiography related complications during 1229 TEE-guided structural heart disease procedures
Authors: Kronzer EK , Thaden JJ , Alkhouli MA , Eleid MF , Nkomo VT , Pislaru SV , Kane G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Transesophageal echocardiography (TEE) has long provided excellent diagnostic imaging of left-sided valvular pathology with an excellent safety profile; however, recent data has suggested an increased risk of injury related to TEE guidance.

Purpose
This study aims to evaluate the incidence and nature of TEE-related oropharyngeal or esophageal complications in patients undergoing TEE-guided structural heart procedures and identify associated risk factors.

Methods
We reviewed consecutive patients undergoing TEE-guided structural heart procedures from 2005-2020. All procedures were performed under general anesthesia. TEE-related oropharyngeal or esophageal complications were defined as those occurring within 30 days of the procedure resulting in i) persistent dysphagia, odynophagia, or upper gastrointestinal bleeding requiring prolonged endotracheal intubation, therapeutic endoscopic or surgical intervention, or diagnostic imaging that demonstrated oropharyngeal or esophageal injury. ii) upper gastrointestinal bleed requiring transfusion, hemodynamic compromise warranting mechanical or pharmacologic support; or iii) oropharyngeal or esophageal complications leading to death. For multivariate analysis, all variables with a p &lt; 0.15 at univariate analysis were included in the model.

Results
Among 1229 adult patients undergoing TEE-guided structural heart procedures between 2005-2020, 274 underwent a transcatheter aortic valve replacement (TAVR) with the remaining 955 undergoing either mitral valve transcatheter edge-to-edge repair (mTEER, n = 278), mitral paravalvular leak closure (PVLC, n = 354), mitral valve-in-valve replacement (VIV, n = 41), or left atrial appendage closure (LAAO, n = 282). Of these, 6 (0.5 %) had TEE-related complications; 0% TAVR, 0% VIV, 0.36% LAAO, 0.28% PVLC, 1.41% mTEER (p = 0.14). Of the six patients with complications 3 required at least one day of prolonged tracheal intubation and one a blood transfusion. None required surgical repair. Factors associated with increased complication risk (Table) included a prior history of gastrointestinal bleed (Odds ratio 5.44 [0.98-30.04; p = 0.05]) and longer procedural time (OR per 30 min 1.15 [1.01-1.31, p = 0.03]). Patients undergoing mTEER had an increased risk of complication (OR 6.76 [1.23-37.1 p = 0.03]) and longer procedural time (OR per 30 mins 1.15[1.01-1.31, p = 0.04]) compared to other all other procedures.
Conclusion(s): In a large series of patients undergoing cardiac structural interventions under general anesthesia with TEE-guidance, rates of TEE-induced injury were low. Risk of oropharyngeal or esophageal complications was increased with longer procedure times, prior gastrointestinal bleeding history, increased age, increased pre-procedural creatinine, procedural type being mTEER and in male patients, lower height. Abstract Table
Echocardiographic findings of filipino patients with COVID-19 pneumonia: a single-center experience
Authors: Loquias M , Santillan C , Locnen S 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
Acute respiratory injury is the main culprit for majority of the morbidity and mortality among COVID-19. However, there is a high prevalence of cardiovascular complication among these patients. Assessment of echocardiographic parameters provides clinical characteristics for utilization in the management of patients with COVID-19.

OBJECTIVE
To determine the predictors of mortality and analyze the echocardiographic findings of Filipino patients with COVID-19 Pneumonia and its correlation to the severity of the disease.

METHOD
This is a retrospective observational cohort study of the echocardiographic findings among 173 Filipino patients who acquired COVID-19 pneumonia from June to August 2020. Logistic regression analysis was used to identify predictors of dichotomous outcome variable.

RESULTS
The results showed that there was a significant direct correlation between the severity of COVID-19 and wall motion abnormality (r = 0.171; p = 0.024). There was also a significant direct correlation between length of hospital stay and the wall motion abnormality (r = 0.140; p = 0.050). Furthermore, there was a significant difference noted in the proportion of subjects with or without wall motion abnormality according to mortality (p = 0.007). The results also exhibit significant difference in the left ventricular end diastolic diameter (LVEDD), left ventricular ejection fraction (LVEF) and left atrium according to mortality as shown by the p values 0.001, 0.001 and 0.030 respectively. However, there is no significant correlation noted between the severity of COVID-19 and mortality to the right ventricular size and function. Multivariate analysis using logistic regression, two variables were found to be significant predictors of mortality, this includes LVEDD and LVEF.

CONCLUSION
Among Filipino patients with COVID-19 pneumonia, the study demonstrated that left ventricular end diastolic diameter and left ventricular ejection fraction are significant predictors for mortality.
Mild autonomous cortisol secretion portends similar cardiac compromise as overt endogenous Cushings syndrome
Authors: Morbach C , Hoffmann K , Sahiti F , Detomas M , Eichner F , Kroiss M , Gelbrich G , Frantz S , Fassnacht M , Heuschmann PU , Hahner S , Stoerk S , Deutschbein T 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): German Ministry of Research and Education within the Comprehensive Heart Failure Centre Würzburg

OnBehalf
CV-CortEx

Background
Endogenous Cushing’s syndrome (CS) results in increased cardiovascular morbidity and mortality. This risk seems to be lower in patients with incidentally discovered mild autonomous cortisol secretion (MACS) but without the clinical features of CS. We aimed to describe and compare the cardiac morphology and function in patients with overt CS and MACS to a representative sample of a local prospective population-based cohort (STAAB).
Methods/Results: We comprehensively characterized 40 patients with overt CS (mean age 47 ± 13 years, 75% women) and 18 patients with MACS (62 ± 11 years, 56% women; both p ≤ 0.001 when compared to CS) including detailed transthoracic echocardiography. Logistic regression adjusted for age and sex showed no significant differences between both groups regarding body mass index (BMI), systolic and diastolic blood pressure (BP), lipids, HbA1c, and echocardiographic parameters of cardiac morphology and function (table). The comparison with STAAB participants (n = 4965, 55 ± 12 years, 52% women; logistic regression adjusted for age and sex) revealed significantly higher BMI, triglycerides, HbA1c, and diastolic but not systolic BP (table). Compared to STAAB participants, patients exhibited a smaller left ventricle (LV) with thicker septal and posterior walls, and a less favorable diastolic function. LV ejection fraction (LVEF) was higher, although longitudinal contraction, measured by tricuspid annular plane systolic excursion (TAPSE), and LV global longitudinal strain (GLS) were lower in both ventricles compared to STAAB participants (table).

Conclusion
Patients with both MACS or CS exhibited a compromised metabolic profile and diastolic function pattern when compared to a population-based cohort. Higher LVEF despite lower GLS suggests a compensatory increase in LV radial contraction in states of hypercortisolism. Cardiac impairment was similar in patients with CS or MACS suggesting an adverse effect of hypercortisolism even at clinically inconspicuous levels. Abstract Figure.
Diastolic dysfunction worsen prognosis in patients with dilated cardiomyopathy independently of left ventricular systolic dysfunction
Authors: Dziewiecka E , Winiarczyk M , Karabinowska A , Gliniak M , Robak J , Kaciczak M , Wisniowska-Smialek S , Rubis P 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The heart failure (HF) symptoms and prognosis in patients with HF with reduced ejection fraction (LVEF; HFrEF) is mostly associated with left ventricle (LV) remodelling and systolic dysfunction. However, in HFrEF patients the LV diastolic function is usually also impaired and worsen the prognosis. The significance of LV dysfunction in dilated cardiomyopathy (DCM) is well recognised, but not the diastolic dysfunction.

Aim
The analysis of diastolic function in DCM with different systolic impairment and its impact on the prognosis.

Methods
Between 2010 and 2020 we retrospectively analysed out- and in-hospital records of 567 DCM patients (age 52 ± 13 years, 78% male, NYHA 2.4 ± 0.8) with complete echocardiographic and outcome data. Patients were divided into 3 groups based on LVEF (EF1 &lt;20%, EF2 20-29%, EF3 ≥30%) and into 3 groups according to diastolic function based on the ASE/EACVI 2016 recommendations.

Results
Most patients had no or mildly impaired diastolic function, however nearly 50% of EF1 patients had abnormal diastolic function (Table 1). During observation of 41 ± 27 months, 88 (16%) patients died (Table 1). Impaired diastolic function (G2 or G3) was found to be significant prognostic factor independently of LVEF (G2-3: HR 2.44 [95%CI 1.59-3.70], p &lt; 0.001; LVEF: HR 0.10 [95%CI 0.09-0.10] for every 10%, p = 0.002) (Figure 1).

Conclusion
Most DCM patients had severely impaired LV systolic function and no or mildly impaired diastolic function. In DCM patients the diastolic dysfunction significantly worsens the prognosis independently of LVEF. Abstract Table 1. Abstract Figure 1.
Is left ventricular function reduced after ultra-endurance exercise?
Authors: Witso M , Sletten OJ , Hisdal J , Melau J , Smiseth OA , Remme EW , Skulstad H 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Norwegian Health Association

Introduction
Ultra-endurance exercise can be harmful according to previous studies, indicated by reduction in functional parameters and increase in cardiac biomarkers. Changes in load and heart rate with exercise influence left ventricle systolic function, making assessment of standard echocardiographic examination difficult.

Purpose
We investigated the effect of ultra-endurance exercise on myocardial function acutely and at restitution.

Methods
We investigated 10 participants aged 46 ±7 years, before (baseline), within 142 ± 78 minutes after finish (post run) and 5-10 days after (restitution) an ultra-endurance race (3.8 km swimming, 180 km bicycling and 42 km running with a total elevation of 5200 m). Echocardiography was performed at the three time points, including cardiac morphology and -function. Ejection fraction (EF) and stroke volume (SV) were measured by Simpson biplane. Cardiac output was calculated from SV and heart rate (HR). Cardiac power was calculated as the product of CO, mean arterial blood pressure and the conversion factor to Watt (W) 0.00222. Global longitudinal strain (GLS) was calculated using speckle-tracking echocardiography, and myocardial work was calculated by non-invasive pressure-strain analysis.

Results
Acutely after exercise, myocardial function by GLS (p = 0.002), myocardial work (p &lt; 0.001), mitral annular plane systolic excursion (MAPSE, p = 0.003) and EF (p = 0.004) were substantially reduced compared to baseline, whereas cardiac power and cardiac output (CO) were maintained (see table and figure). Heart rate was moderately increased (p &lt; 0.001). End-diastolic volume (EDV) as an index of preload was numerically, but not significantly reduced. End systolic volume (ESV) was numerically increased (p = NS) even though systolic blood pressure (sBP) was reduced (p = 0.01) post race. After restitution all parameters returned to baseline levels.

Conclusions
The temporary reduced strain and EF may be a physiologic response due to the higher heart rate. However, despite reduced systolic pressure the heart did not contract to a lower end systolic volume. This suggests loss of contractile function compensated by increase in heart rate. The findings should be explored in further studies. Abstract Figure Abstract Table
Comparison of mitral regurgitant volume assessment between proximal flow convergence and volumetric methods in patients with significant primary mitral regurgitation
Authors: Altes A , Levy F , Iacuzio L , Dumortier H , Toledano M , Tartar J , Tribouilloy C , Marechaux S 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Discrepancies have been observed between transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (MRI) severity grading in primary mitral regurgitation (MR).
Purpose. To compare mitral regurgitant volume (RV) obtained by the proximal flow convergence method (PISA) method by TTE and by volumetric methods (TTE and MRI), and study the relationship between LV size and RV obtained by either the PISA or volumetric methods.
Methods and results. 188 patients from 2 heart valve clinics with at least moderate-to-severe primary MR due to prolapse in sinus rhythm who underwent evaluation with TTE and MRI were included. RV was estimated by either PISA or volumetric methods (Left ventricular [LV] stroke volume minus systolic aortic outflow volume)) by either MRI (MRI-RV) or TTE (TTE-RV)). PISA-RV and either MRI-RV or TTE-RV weakly correlated (r = 0.29 and 0.30,p &lt; 0.001). On multivariable analysis, LV end-diastolic volume (LVEDV) and bileaflet prolapse independently correlated with the magnitude of the difference between PISA and volumetric methods. While PISA-RV and LVEDV were unrelated, MRI-RV and TTE-RV strongly correlated with LVEDV (r = 0.66 and 0.68,p &lt; 0.001). In contrast, LVEDV and regurgitant fraction (RF = RV/LVEDV) either with TTE or MRI were poorly related (r = 0.17,p = 0.02 and r = 0.12,p = 0.10).
Conclusion. RV estimated by the PISA and volumetric methods are not comparable. The expected proportional relationship between volumetric RV and LV size, which is not observed with PISA-RV suggests the inaccuracy of PISA-RV. Given that RV by volumetric methods depends on LV size, determination of a unique RV threshold for severe MR is challenging. Calculation of RF may overcome this limitation. Abstract Figure. RV assessed by PISA or volumetric method Abstract Figure. Illustrative example
Intracardiac device associated interference with tricuspid valve apparatus on echocardiography: What can we learn from pathology?
Authors: Henry M , Abutaleb A , Jeevanandam V , Smith H , Belkin M , Husain A , Pinney S , Ota T , Mor-Avi V , Lang RM , Addetia K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
New or worsening tricuspid regurgitation (TR) is associated with right-sided heart failure and worsened outcomes. Cardiac Implantable Electronic Devices (CIEDs), which are being implanted at growing rates worldwide, are increasingly being recognized as associated with TR occurrence related to interference with the tricuspid valve (TV) apparatus. Purpose: We sought to identify echocardiographic features in the right ventricle and TV that differentiate patients who have anatomically demonstrated interference with the TV on direct pathology inspection.

Methods
Explanted hearts from 44 consecutive patients undergoing orthotopic heart transplant (55 ±13 yrs, 68% men) with known implanted CIEDs were dissected to assess the presence (n = 18) or absence (n = 26) of CIED interference with the TV (Figure). Echocardiographic measurements performed prior to transplantation, including left and right ventricular (LV, RV) size and performance metrics as well as TR severity, were compared between both groups using non-parametric testing.

Results
Echocardiographic features of patients with and without anatomically demonstrated TV interference are shown in the Table. Although overall LV dimensions and volumes were not different between the two groups and LV ejection fraction was severely reduced in both groups, patients demonstrating CIED interference trended towards larger right atrial volumes (Table) and also larger RV and tricuspid annular sizes. Importantly, however, they were more than 4 times likely to have abnormal right ventricular function. Lastly, patients with tricuspid apparatus interference tended to have more significant TR, although these differences have not reached statistical significance (Table).

Conclusion
CIED interreference with tricuspid valve apparatus occurs frequently (41%) among patients with CIEDs, who undergo orthotopic heart transplantation. This may be associated with worsening TV function with subsequent changes in right atrial and ventricular geometry and function. In light of prior data showing poor outcomes with CIED associated TR, this study emphasizes the importance of non-invasive assessment of CIED interference with the tricuspid valve, in order to improve device placement and patient outcomes. Abstract Figure Abstract Table
Right heart interplay with secondary tricuspid regurgitation. How can we predict clinical events?
Authors: Lofficial G , Chen E , Guerin A , Dreyfus J , Sportouch C , Galli E , Oger E , Donal E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
TRAP
Introduction. Secondary Tricuspid Regurgitation (TR) is a turning point in cardiac diseases. Symptoms occurred too late according to the right heart reverse remodelling capabilities. The ideal timing for proposing a valve repair remains a challenge. We sought to analyse characteristics of patients with significant secondary TR, seeking for changes in parameters over time that could be related to the risk of clinical event.
Material and method. We designed a prospective observational French multicentre study of 160 patients with significant secondary TR (effective regurgitant orifice area &gt; 30 mm²) and LVEF &gt; 40%; we collected clinical, echocardiographic, and EKG data at baseline, 1- and 2-year follow-up. All echocardiographies were centrally analyzed. The primary outcome was death or hospitalization for heart failure
Results. At 2-year 95 patients (59.3%) presented the primary outcome. They had significant morphological and functional alteration of the right heart parameters. Right Atrial Volume Index (RAVI) and right ventricular free wall Strain were respectively 73mL/m² and -19.8% versus 64.7mL/m² and 22.3% in the event-free group. None of them had significant group*time interaction. In the multivariable analysis, TAPSE/sPAP ratio &gt; 0.4 (OR = 0.41 95%CL 0.2 to 0.82) associated to RAVI &gt; 60mL/m² (OR = 2.13 95%CL 0.96 to 4.75) were the two independent parameters that enable the fairest and parsimonious evaluation.
Conclusion. We demonstrated that short analysis using RAVI and TAPSE/sPAP almost reached us to an easier patient assessment by limiting the number of involved parameters. These parameters are now to be for defining the best timing and response to interventions. Abstract Figure. LAVI and TAPSE/sPAP according to events
Prognostic value of left ventricular global longitudinal strain in patients with moderate aortic stenosis
Authors: Stassen J , Pio SM , Ewe SH , Singh GK , Hirasawa K , Butcher SC , Marsan NA , Delgado V , Bax JJ 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
Background
Impaired left ventricular (LV) global longitudinal strain (GLS) is associated with worse outcomes in patients with severe aortic stenosis, but its prognostic value in patients with moderate aortic stenosis (MAS) is largely unknown.
Purpose
To investigate the prognostic implications of LV GLS in patients with MAS and preserved LV ejection fraction (EF).

Methods
LV GLS was evaluated by speckle tracking echocardiography in 621 patients (age 71 ± 12 years, 59% men) with MAS (aortic valve area 1.0 – 1.5cm2) and preserved LVEF (≥50%). Impaired LV GLS was defined as an LV GLS value &lt;16%, based on spline curve analysis (i.e. where the hazard ratio for all-cause mortality was ≥1). Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement.
Results
Patients with LV GLS &lt;16% (n = 282) were significantly older, more likely to be male and had more comorbidities (diabetes mellitus, atrial fibrillation, more impaired renal function) compared to patients with LV GLS ≥16% (n = 339). In terms of echocardiographic data, patients with LV GLS &lt;16% had larger LV volumes, lower LVEF and higher E/e’. During a median follow-up of 53 (27 – 102) months, 199 (32%) patients died. For the composite endpoint, 409 patients (66%) underwent AVR (n = 290) or died (n = 119) during a median follow-up of 29 (IQR 14 – 54) months. Patients with LV GLS &lt;16% experienced significantly lower survival rates (p &lt; 0.001) and event-free survival rates (p = 0.001) compared to patients with LV GLS ≥16% (Figure 1). On multivariable analysis, LV GLS was independently associated with all-cause mortality (HR 2.442; 95% CI: 1.762 – 3.384; p &lt; 0.001) and the composite endpoint of all-cause mortality and aortic valve replacement (HR 1.862; 95% CI: 1.498 – 2.315; p = 0.040) (Figure 2).
Conclusions
In patients with MAS and preserved LVEF, reduced LV GLS is associated with an increased risk of all-cause mortality and the composite endpoint of all-cause mortality and AVR. Assessment of LV GLS may be useful in the risk stratification of these patients. Abstract Figure. Kaplan-Meier curves Abstract Figure. Cox regression analysis
Stress echocardiography in patients with ischemic mitral regurgitation and left ventricular dysfunction qualified to cardiosurgery treatment
Authors: Piatkowski R , Kochanowski J , Budnik M , Peller M , Grabowski M , Opolski G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Ischemic mitral regurgitation (IMR) is predominantly related to left ventricle (LV) remodeling and mitral valve deformation. Although coronary artery bypass grafting alone (CABGa) or with mitral annuloplasty (CABGmp) is considered the best therapeutic strategies for patients with IMR, some recurrences are still reported.

Purpose
The aim of this study was to evaluate use of the mitral deformation indices (MDI) as a predictor of recurrence of IMR in 1-year follow-up after surgery.

Methods
A total of 145 patients after myocardial infarction with significant IMR, eligible for CABG, were prospectively enrolled in the study. Patients were referred for CABGa (gr.1; n = 90) or CABGmp (gr.2; n = 55), based on clinical assessment and the results of rest and stress echocardiography. One year after surgery each patient underwent the evaluation of cardiovascular events. Univariable logistic regression analysis was used to identify factors of recurrence of IMR in 1 year follow-up.

Results
Logistic regression analysis revealed that in CABGa group preoperative changes of TA and CH during DBX remained the predictors of the recurrence of IMR in 12 months follow-up. TAdbx &gt; 1 cm2 provided sensitivity of 90% and specificity of 29%, (AUC 0.6436); The best cut-off value for CHdbx was 0.4 cm (sensitivity 90%, specificity 34%; AUC 0.6432). In both groups no significant differences were observed in 12-month mortality (1.2% vs 0%; p = 1.0), hospitalizations due to the heart failure (HF) exacerbation (5.9% vs 8.5%; p = 0.72) and in the incidence of the composite endpoint (deaths/CV hosp/stroke) (7% vs 8.5%; p = 0.742).

Conclusion
Preoperative assessment of MDI changes during dbx can be used to identify patients with IMR at increased risk of recurrence of significant IMR in 1 year follow-up. Abstract Figure 1 Abstract Figure 2