bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of non-infectious masses on intracardiac devices as incidental finding during transoesophageal echocardiography
Authors: Kuecken T , Jasaityte R J , Haase-Fielitz A H F , Butter C B 
Published: October 2022

Abstract

Background
Incidentally detected masses on the leads of cardiac implantable electronic devices (CIED) present a clinical dilemma and often raise the question whether they should be treated as a device infection. Indeed, they are considered as one of the major Duke criteria for the diagnosis of infectious device endocarditis. However, rather often incidental lead masses are detected in a routine transesophageal echocardiography (TOE) in patients without any signs of infection. Data on the prevalence of such findings are scarce and outdated.

Purpose
In this study, we aimed to determine the current prevalence and predisposing clinical factors of incidental non-infectious lead masses.

Methods
In this retrospective single center study, we analyzed all TOE examinations performed between 2020 and 2021 for the indications other than suspected infectious endocarditis. Patients with nonsuspicious leads and the ones with incidental non-infectious lead masses were compared with regard to clinical characteristics, presence of anticoagulation and indication for TOE.

Results
In total, 1361 TOE examinations were performed within the study period. From those 141 patients with CIED were selected. Thirty-nine patients (27.6%) presented with non-infectious CIED masses. The clinical characteristics of study patients and the TOE indications are listed in Table 1. Patients with incidental CIED mass showed a higher prevalence of dilated cardiomyopathy (38.5%) compared to patients with no CIED mass (16.7%), p=0.004 Table 1. The presence of laboratory sings of infection and cardiovascular risk factors, such as arterial hypertension, diabetes mellitus or chronic kidney disease did not differ significantly between both groups (Table 1). Also, incidental lead masses were less prevalent in patients with oral anticoagulation (Odds ratio 0.33, 95% CI: 0.11–1.00; p=0.048; Figure 1), whereas the distribution of CHA2DS2-VASc Scores did not show any differences.

Conclusion
The prevalence of incidental non-infectious CIED lead masses in TOE in our study was 27,6%, which is higher, than previously reported 5–10%. We did not observe any association between the incidental CIED lead masses and cardiovascular comorbidities. The absence of the oral anticoagulation seems to be the only clinical risk factor for such findings in our study, suggesting possible thrombogenic genesis. The high prevalence of incidental non-infectious lead masses should be kept in mind in order to avoid the overdiagnosis of CIED infection and unnecessary lead extraction.

Funding Acknowledgement
Type of funding sources: Public hospital(s).
The predictive value of carotid artery strain and strain-rate in assessing the 3-year risk for stroke and acute coronary syndrome in patients with metabolic syndrome
Authors: Arnautu D A , Vacarescu C , Arnautu S F , Gaita L , Cozma D , Gaita D 
Published: October 2022

Abstract

Purpose
The goal of this study is to see if carotid strain and strain rate can predict major cardio-vascular events (MACE) in people who have metabolic syndrome (MS) over a 3-year period of time.

Methods
In this prospective observational research, we enrolled 220 adult MS patients (60.7±7.5 years old, 53% male). Bilateral 2D common carotid carotid artery (CCA) speckle-tracking ultrasound was used to determine the peak circumferential strain (CS) and the peak circumferential strain rate (CSR). Clinical outcomes were assessed throughout a three-year follow-up period.

Results
After a 3-year follow-up period follow-up, 14 (7%) experienced MACE: Eight (4%) suffered an atherothrombotic ischemic stroke, four (2%) had acute coronary syndrome, and two (1%) were hospitalized for heart failure. Univariate regression analysis of the clinical and echocardiographic features of the MS patients found that age, systemic hypertension, diabetes mellitus, and the CCA circumferential strain and strain rate were significantly associated with the risk of MACE. Multivariate logistic regression identified two independent predictors of MACE in patients with MS, namely the CCA-related CS (%) and CSR (1/s), P&lt;0.01. The ROC curve analyses of these independent predictors of MACE indicated appropriate sensitivities and specificities. CS (AUC = 0.806, sensitivity = 82.6%, specificity = 79.2%, P&lt;0.0001); CSR (AUC = 0.779, sensitivity = 82.6%, specificity = 72.4%, P&lt;0.0001). The cut-off values were ≤2.9% for carotid CS and ≤0.35 s–1 for carotid CSR. Using these cut-off values, we obtained Kaplan-Meier survival curves, and these showed that MACE, ischemic stroke, and ACS-free survival was significantly lower among the MS patients with lower carotid CS and CSR (P&lt;0.0001).

Conclusion
Carotid CS and CSR were independent predictors of major cardio- and cerebrovascular events in prospectively monitored MS patients without established cardiovascular disease. Carotid deformation could be valuable as an early prognostic indicator for the cardiovascular risk in this population group.

Funding Acknowledgement
Type of funding sources: None.
The relative importance of left atria reservoir strain compared with components of HFA-PEFF diagnostic algorithm
Authors: Kim M , Jung I H , Bae S 
Published: October 2022

Abstract

Background/Introduction
The relative importance of the left atrial reservoir strain (LARS) compared to the parameters constituting the HFA-PEFF score developed as a diagnostic tool for patients with heart failure with preserved ejection fraction (HFpEF) is not well known.

Purpose
We aimed to identify the relative importance of LARS compared with variables associated with HFpEF and HFA-PEFF score including echocardiographic parameters, demographic data, and NT-proBNP.

Methods
From August 2021 to March 2022, we obtained data retrospectively from the participants visiting our clinic in a single cardiovascular center. The 1,252 participants with sinus rhythm and ejection fraction more than 50% were enrolled in the present study (61.8±16.6 years and 55% female). Multivariable regression analysis using backward elimination and random forest analysis, supervised learning algorithm, were performed to identify the relative importance of LARS on the HFA-PEFF score.

Results
The median HFA-PEFF score was 3 points (interquartile range 2 to 4 points). Two hundred forty-one subjects (19.2%) had more than 5 points. LARS showed a moderate correlation with the HFA-PEFF score (r=−0.632, p&lt;0.001). In multivariable regression analysis, LARS was independent variable affecting HFA-PEFF score with female sex, left atrial volume index (LAVI), septal e', E over e' (septal), the maximal tricuspid regurgitation velocity (TR-Vmax), left ventricular global longitudinal strain (LV-GLS), NT-proBNP, interventricular septal wall thickness (standardized β=−0.106; P&lt;0.001). In random forest analysis, LARS was a more relatively important variable than TR-Vmax, NT-proBNP, septal E/e', septal e', the major echocardiographic components of HFA-PEFF score estimating more than 5 points of HFA-PEFF score.

Conclusions
LA reservoir strain is one of the important factors with components of the HFA-PEFF score which is a useful tool to assess the patients with HFpEF.

Funding Acknowledgement
Type of funding sources: None.
Cardiac structure and function in veteran recreational endurance athletes
Authors: Sorensen E , Myrstad M , Oie E , Solberg M G , Tveit A , Aaronaes M 
Published: October 2022

Abstract

Background
Even though physical activity is inversely associated with cardiovascular disease, long-term endurance exercise increases the risk of AF in middle-aged and older men, and has been linked to cardiac structural changes mimicking arrhythmogenic cardiomyopathy on susceptible individuals. Healthy younger athletes adapt to the increased demands of exercise with symmetric enlargement of the cardiac chambers with preserved functional properties. Data describing cardiac structure and function in older veteran athletes after decades of performing endurance exercise are scarce and add essential information when wanting to discern physiological from pathological remodeling in this group.

Purpose
To investigate cardiac structural and functional remodeling in relation to long-term endurance exercise in veteran athletes.

Methods
To cover the entire range of physical activity in the population, the study comprised two independent cohorts; Veteran male athletes who had participated in the annual 54 km Birkebeiner cross-country ski race and men who had participated in a population-based health survey. Individuals with a history of cardiac arrhythmias were excluded. Regular endurance exercise was defined as exercise for ≥30 minutes at least three times weekly with the purpose of increasing physical endurance capacity and self-reported as categories of years of regular endurance exercise. All participants underwent a resting echocardiographic examination. A One-way ANOVA with polynomial contrasts was conducted to explore the effect of years of endurance exercise on cardiac size and function.

Results
178 men with a mean age of 70.9±6.5 years were included in the study, 89 veteran athletes, who had practiced regular endurance exercise for an average of 40–50 years, and completed an average of 19 annual Birkebeiner ski races and 89 individuals from the general population. Fifty-seven had never performed regular endurance exercise, 29 1–20 years of exercise, 25 20–40 years of exercise, and 67 &gt;40 years of endurance exercise.
Left atrial, left ventricular, right atrial, and right ventricular dimensions increased with cumulative years of exercise (p&lt;0.001), while function remained similar in all cardiac chambers.

Conclusion
Atrial and ventricular dimensions increased with cumulative years of endurance exercise. Atrial and ventricular function assessed by strain, however, seemed to be unaffected by long-term exposure to exercise. These results suggest recreational endurance athletes preserve normal cardiac function despite athletic remodeling.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): A Ph.D. grant from the DAM foundationA grant from the Raagholt foundation
The prognostic value of right ventricular free wall and global longitudinal strain in the general population
Authors: Espersen C , Hauser R , Skaarup K G , Lassen M C H , Johansen N D , Olsen F J , Jensen G , Schnohr P , Moegelvang R , Biering-Soerensen T 
Published: October 2022

Abstract

Background
Right ventricular free wall (RVFWLS) and global longitudinal strain (RV4CLS) have been shown to be prognostic of adverse events in various patient groups including patients with heart failure (HF).

Purpose
We sought to investigate the prognostic value of RVFWLS and RV4CLS for the development of incident HF in participants from the general population.

Methods
Participants from the echocardiographic substudy of the 5th Copenhagen City Heart Study (2011–2015) without chronic ischemic heart disease or heart failure at baseline were included. RVFWLS and RV4CLS were obtained using two-dimensional speckle-tracking echocardiography from the RV-focused apical 4-chamber view. The primary endpoint was incident HF.

Results
Among 2,804 participants (mean age 55, 42% male), 45 (1.6%) developed HF during a median follow-up of 5.4 years (IQR 4.5–6.3). Both RVFWLS and RV4CLS were associated with increased risk of HF in univariable cox regression analysis (HR 1.07, 95% confidence interval (CI) 1.02–1.12, p=0.003, and HR 1.21, 95% CI 1.11–1.31, p&lt;0.001, respectively). Upon adjustment for age, sex, hypertension, diabetes and body mass index (BMI), both RVFWLS and RV4CLS remained associated with increased risk of incident HF (HR 1.05, 95% CI 1.00–1.11, p=0.038 and HR 1.13, 95% CI 1.04–1.22, p=0.004, respectively).

Conclusion
RVFWLS and RV4CLS were associated with an increased risk of incident HF in participants from the general population independent of age, sex, hypertension, diabetes and BMI.

Funding Acknowledgement
Type of funding sources: None.
Long-term prognostic value of left atrial longitudinal strain in a low-risk community-based cohort
Authors: Zhubi Bakija F , Bagyura Z , Fabian A , Ferencz A , Lakatos B , Ujvari A , Kiss L , Csobay-Novak C , Jermendy A , Szelid Z , Soos P , Kovacs A , Merkely B 
Published: October 2022

Abstract

Numerous studies established the significant predictive value of left ventricular (LV) global longitudinal strain (GLS) on adverse clinical outcomes in various cardiac diseases. Despite the well-known importance of left atrial (LA) mechanics in diastolic function, data are scarce regarding the prognostic power of LA longitudinal strain and its potential added value in the risk stratification of a low-risk population.
Accordingly, our aim was to determine the long-term prognostic importance of 2D speckle-tracking echocardiography-derived peak atrial longitudinal strain (PALS) in a community-based screening sample comprising of low-risk adult individuals.
Three hundred fourteen volunteers were retrospectively identified from a population-based screening program (mean age 62±11, 58% female) with a median follow-up of 9.5 years. All subjects who participated in the screening program underwent 2D echocardiography to measure LV volumes and ejection fraction (EF), LV GLS and PALS, as well as low-dose cardiac CT to determine the Agatston score. The primary endpoint was all-cause mortality.
Thirty-nine subjects (12.4%) met the primary endpoint. Subjects with adverse outcome had significantly decreased LV GLS (dead vs. alive; −19.2±4.3 vs. −20.6±3.5%, p&lt;0.05) and PALS (32.3±12.0 vs. 41.8±14.2%, p&lt;0.001), whereas LV EF did not show a difference between the two groups (51.1±7.0 vs. 52.1±6.2, %, p=NS). By multivariable Cox regression analysis, PALS (hazard ratio 0.970 [95% CI: 0.943–0.998], p&lt;0.05) and Agatston score were independently associated with all-cause mortality, whereas GLS was not (hazard ratio 1.008 [95% CI, 0.919–1.105], p=NS). Furthermore, we dichotomised the population based on PALS values using a guideline-directed cut-off of 39%. In subjects with lower PALS values, the risk of all-cause mortality was almost 2.5 times higher than in subjects with PALS values above 39% (hazard ratio 2.499 [95% 1.334–4.682], p&lt;0.05) as shown on the Kaplan-Meier curve (Figure 1).
Beyond the assessment of LV EF and LV GLS, PALS offers incremental value in cardiovascular risk stratification in a community-based cohort. PALS was found to be the only significant and independent predictor of long-term mortality among other echocardiographic functional parameters. Our results emphasize the importance of a thorough evaluation of LA mechanics even in a low-risk population.

Funding Acknowledgement
Type of funding sources: None.
Analysis of myocardial function by deformation imaging in patients with transthyretin gene mutation
Authors: Comparato F , Di Lisi D , Puglisi C , Portelli M C , Cannizzo N , Damerino G , Di Caccamo L , Ortello A , Galassi A R , Novo G 
Published: October 2022

Abstract

Introduction
Hereditary transthyretin (TTR) amyloidosis is a rare disease that can affect various organs. The early identification of cardiac involvement through echocardiography allows to corroborate the diagnosis and to start therapy at an early stage.

Purpose
The aim of our study was to detect early signs of cardiac involvement in patients with TTR gene mutation and neurological phenotype or absence of any organ disease (carriers) compared to patients with TTR gene mutation and cardiac amyloidosis (CA).

Material and methods
An observational study was conducted on a sample of 31 patients with TTR gene mutation. Patients were divided into 3 groups (23% CA, 42% amyloid neuropathy and 35% carriers). All patients underwent echocardiography with evaluation of left ventricular myocardial deformation indices (apical/basal strain ratio and relative apical sparing).

Results
Carriers and patients with amyloid neuropathy had normal left ventricular systolic and diastolic function. Analyzing left ventricular longitudinal global strain (GLS) we didn't find significant differences between carriers and neuropathy, but we found a significant difference about apical/basal strain ratio and relative apical sparing (respectively 1.33±0.20 vs 1.58±0.25, p value 0.001 and 0.62±0.07 vs 0.72±0.08, p value 0.039).

Conclusion
Relative apical sparing is specific to identify CA; the apical/basal ratio seems to gradually increase from carriers to patients with cardiac amyloidosis and it could be used to monitor patients with TTR mutation, before developing CA.

Funding Acknowledgement
Type of funding sources: None.
The impact of cardiovascular risk factors on left atrial strain over a decade
Authors: Saed Alhakak A , Skaarup K G , Lassen M C H , Johansen N D , Jensen G B , Schnohr P , Mogelvang R , Biering-Sorensen T 
Published: October 2022

Abstract

Background
Peak atrial longitudinal strain (PALS) has previously been shown to predict cardiovascular morbidity and mortality in the general population. However, the impact of cardiovascular risk factors on PALS over a decade in participants from the general population is unknown.

Purpose
The aim of this study was to investigate the impact of cardiovascular risk factors (age, sex, mean arterial pressure (MAP), body mass index (BMI), smoking, total plasma cholesterol, HbA1c, physical activity level, socioeconomic and psychosocial status) on change in PALS over a 10-year period in participants from the general population.

Methods
The present study included a total of 208 (mean age 61±14 years, 60% female) participants from the general population, who underwent a health examination including two-dimensional speckle tracking echocardiography of the left atrium at baseline examination and follow-up examination. The median time between the examinations was 10 years (interquartile range, 10.2–10.7 years). PALS was calculated as the average from the three apical views.
Crude and multivariable linear regression analyses were performed to determine the impact of cardiovascular risk factors on the change in PALS. The multivariable regression model was adjusted for age, sex, MAP, BMI, smoking, total plasma cholesterol, HbA1c, heart rate, eGFR, proBNP and previous ischemic heart disease. All analyses were adjusted for baseline value of PALS (baseline value). Restricted cubic spline curves were constructed to illustrate the relationship between the PALS and continuous cardiovascular risk factors.

Results
During 10-year follow-up, the average decrease in PALS was 4±16%. In the crude regression model increasing age (standardized = −0.27, p&lt;0.001), MAP (standardized = −0.19, p&lt;0.001), BMI (standardized = −0.19, p&lt;0.001), smoking (standardized = −0.12, p=0.013), higher cholesterol levels (standardized = −0.16, p=0.001), and higher levels of HbA1c (standardized = −0.14, p=0.004) were associated with an accelerated decrease in PALS. Relationship between the PALS and significant continuous cardiovascular risk factors are displayed in restricted cubic spline curves (Figure 1).
In the multivariable regression model, age (standardized = −0.19, p=0.001), BMI (standardized = −0.18, p=0.001) and smoking (standardized = −0.15, p=0.003) remained independent predictors of an accelerated decrease in PALS.

Conclusion
In the general population, increasing age, BMI and smoking were independently associated with an accelerated decrease in PALS over a decade.

Funding Acknowledgement
Type of funding sources: None.
The prognostic value of speckle tracking echocardiography in patients hospitalized with COVID-19
Authors: Cwiek-Rebowska E , Kasprzak J D , Filipiak-Strzecka D , Szymczyk E , Wdowiak-Okrojek K , Wejner-Mik P , Cygulska K , Kupczynska K , Michalski B , Miskowiec D , Lipiec P 
Published: October 2022

Abstract

Introduction
In COVID-19 patients, both preexisting cardiovascular disease as well as cardiac injury resulting from SARS-CoV-2 infection are associated with increased mortality. We hypothesized that novel parameters of myocardial function may be useful in the assessment of in-hospital and long-term prognosis.

Aim
The aim of study was to determine the prevalence of myocardial dysfunction revealed by speckle tracking echocardiography and its association with in-hospital and one-year mortality.

Methods
The study group comprised 192 patients hospitalized in the cardiology department due to COVID-19. All patients underwent transthoracic echocardiographic examination with off-line analysis. Using speckle tracking technique, we measured the following parameters: left ventricular global longitudinal strain (GLS), right ventricular global longitudinal strain (RV-GLS), right ventricular free wall strain (RV-FWS) and myocardial work parameters – global work index (GWI), global wasted work (GWW), global constructive work (GCW) and global work efficiency (GWE). The primary outcome was in-hospital and one-year mortality.

Results
112 patients (mean age 68±14 years, 76 (68%) male) had adequate image quality to evaluate strain-derived parameters. 27 patients died during hospitalization and 44 patients died within one-year after discharge. In-hospital non-survivors were older, had lower baseline oxygen saturation (SpO2) and had higher NTproBNP (Table 1). In non-survivors speckle-tracking echocardiography revealed significant impairment of left and right ventricular function compared to the group of survivors (Table 1). The independent predictors of in-hospital death were GWE (OR 0.85; 95% CI 0.78–0.93) and SpO2 on admission (OR 0.91; 95% CI 0.86–0.96). Based on the ROC curve analysis, the optimal cut-off points for predicting in-hospital death were identified: GWE ≤87% (sensitivity 63%, specificity 89%) and baseline SpO2 value ≤88% (sensitivity 81%, specificity 71%).
The independent predictors of one-year mortality were: age (OR 1.28 [1.13–1.46]), NTproBNP (OR 1.002 [1.001–1.003]), baseline SpO2 (OR 0.71 [0.59–0.86]) and RV-GLS (OR 1.32 [1.12–1.55]). Based on the ROC curve analysis, the cut-off points optimal for predicting death within 12 months after COVID-19 were also identified: baseline SpO2 value ≤88% (sensitivity 69.8%, specificity 77.3%), age &gt;60 years (sensitivity 90%, specificity 43%), NTproBNP &gt;500 pg/ml (sensitivity 95%, specificity 41.8%), RV-GLS &gt;−18.5 (sensitivity 93%, specificity 64.2%).

Conclusions
Two-dimensional speckle tracking echocardiography is a useful technique to evaluate myocardial function in COVID-19 patients and provides good prognostic value for identifying patients at risk of death during hospitalization and in long term follow-up.

Funding Acknowledgement
Type of funding sources: None.