bluuebunny/crossref_metadata_2025_split huggingface dataset:
Wasted myocardial work may affect left ventricular remodelling occurrence after primary percutaneous coronary revascularization
Authors: Caminiti R , Vetta G , Parlavecchio A , Pelaggi G , Lofrumento F , Licordari R , Cusma M , Manganaro R , Pucci M , Radano I , Citro R , Carerj S , Di Bella G , Zito C 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Left ventricular function recovery (LV-REC) or left ventricular adverse remodelling (LV-REM) after acute myocardial infarction (AMI) play an important role for identifying patients at risk of heart failure.

Purpose
In this study we aim to evaluate the usefulness of non-invasive myocardial work (MW), a new index of global and regional myocardial performance, to predict LV-REC or LV-REM after AMI.

Methods
Fifty patients with AMI (mean age, 63,8 ±13,4 years), treated by primary percutaneous coronary intervention (PCI), were prospectively enrolled. They underwent a baseline transthoracic Doppler echocardiography (TTE) within 48 hours after PCI and a second TTE after a median of 31 days during the follow-up. MW was derived from the strain-pressure loops, integrating in its calculation the non-invasive arterial pressure, according to standard speckle tracking echocardiography recommendations. LV-REC was defined as an absolute improvement of left ventricular ejection fraction (LVEF) ≥ 5% from LVEF at baseline, whereas LV-REM was defined as an increase of ≥ 20% of the LV end diastolic volume (LVEDV) at 1 month follow up.

Results
We overall found a significant improvement from baseline to one-month follow-up for values of LVEF (49,8 ± 9,5 % vs 52,8 ± 9,3 %, p = 0.001), Global Longitudinal Strain (GLS) (-13,4 ± 3,9 % vs -18,7 ± 5,4 %, p = 0.016), Global Work Index (GWI) (1368,6 ±435,2 vs 1788 ±493 mmHg/%, p = 0.0001), Global Work Efficiency (GWE) (89,96 ± 9,3 % vs 91,3 ± 6,4 %, p = 0.001), Global Constructive Work (GCW) (1619,16 ± 497,9 mmHg/% vs 2008,6 ± 535,3 mmHg/%, p = 0.0001), Global Wasted Work (GWW) (188,8 ± 19,8 mmHg/% vs 149,2 ± 16,5 mmHg/%). However, LV-REC at 1 month of follow-up was observed only in 36 % of the population enrolled, whereas LV-REM was described in 18% of cases. Using ROC curve analysis, we identified a cut off value of 202 mmHg/% for baseline GWW (Sensitivity 75%, Specificity 62%, AUC 0.6667, CI 95%: 0,51618 - 0,81715, p =0.0001) to identify patients with LV-REM at 1 month. With regards to conventional echo parameters, patients with LV-REC showed lower baseline Wall Motion Score Index (WMSI) than those without LV-REC (1,73 vs 1,38, p = 0.007).

Conclusions
Among standard and advanced TTE parameters, only baseline GWW is able to predict early LV-REM at 1 month after primary PCI. Therefore, it could be used during baseline evaluation of AMI patients for a more accurate stratification of those at higher risk of heart failure. However, further larger scale studies are needed to validate these findings. Abstract table 1 Abstract table 2
Assessment of anthracycline-induced cardiotoxicity in patients with childhood cancer survivor for long-term follow-up
Authors: Hosono Y , Takahashi K , Shigemitsu S , Akatsuka Y , Akiya A , Akimoto S , Ifuku M , Yazaki K , Yaguchi A , Tomita O , Fujimura J , Saito M , Yoneoka D , Shimizu T 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Anthracycline cardiotoxicity is an important prognostic determinant in childhood cancer survivors (CCSs). That has been reported to improve with early therapeutic intervention, and because it is dose-dependent and progressive, early diagnosis and long-term follow-up are important. In adult survivors of cancer, the longitudinal strain (LS) is useful as a sensitive index of cardiac function. In childhood cancer survivors, strain abnormalities are also observed at both short-term and long-term follow-up. Global longitudinal strain (GLS) abnormalities are common during or early after chemotherapy, whereas changes in global circumferential strain (GCS) are more significant and consistent on long-term follow-up.

Purpose
In this study, we aimed to conduct a cross-sectional study using strain analysis in childhood cancer survivors of a wide age range to clarify the mode of progression of anthracycline-induced cardiotoxicity and to identify useful indicators for long-term follow-up.

Methods
In total, 116 patients (median age: 15.5 [range: 4.7-40.2] years) with childhood cancer who had passed at least 1 year after chemotherapy with anthracycline, and 116 control patients of similar age. Strain measurements were assessed for longitudinal strain (LS) and circumferential strain at the apical, papillary and basal levels using speckle tracking imaging. Estimated value at 5, 15, 25 and 35 years old were mathematically calculated.

Results
Results were shown in tables and figures. Most of conventional echocardiographic parameters were not significantly different between CCCs and controls. LS, papillary CS and basal CS in CCCs decreased compared to normal controls at all age. The difference of estimated value between CCCs and normal controls in LS at all age were relatively constant. However, those in basal CS tended to increase with aging. Furthermore, basal CS in CCCs decreased with aging (r = 0.212, p &lt; 0.001) and the duration after completion of anthracycline treatment (r = -0.244, p &lt; 0.008).

Conclusions
In childhood cancer survivors, strain analysis is a more sensitive indicators of cardiac function than conventional parameters. In addition, basal CS may decrease most markedly over time and could be useful indicator in long-term follow-up. Longitudinal studies should be conducted in the future to improve the accuracy of predicting anthracycline cardiotoxicity. These are new findings regarding the decline in cardiac function in childhood cancer survivors. Abstract Figure. Relationship between age and strains Abstract Figure. Estimated values for each age group
Predicting maintenance of sinus rhythm after cardioversion - novel versus conventional left atrial parameters
Authors: Kupczynska K , Michalski B , Miskowiec D , Lipiec P , Kasprzak JD 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The successful electrical cardioversion (EC) in patients with atrial fibrillation (AF) improves cardiac mechanical function and enables early assessment of atrial activity by echocardiography.

Purpose
To analyze conventional and novel parameters characterizing left atrium (LA) within 24 hours after the restoration of sinus rhythm (SR) and their prognostic value during 2-years follow-up.

Methods
Prospective study involved 71 patients with nonvalvular AF (mean age 64 ± 13 years, 61% male). All patients underwent echo 24 hours after conversion to SR. In addition, standard echocardiographic and Doppler parameters were assessed. Using speckle-tracking method we analysed LA longitudinal strain in reservoir and contractile phase. The clinical endpoint was predefined as AF recurrence.

Results
During a 24-months follow-up we noticed AF recurrence in 48 (68%) patients. The median time-to-event was 2.4 months (IQR 1 to 6.9). Standard echo measurements revealed a median of LV ejection fraction 55% (IQR 45-58) and median of LA volume indexed to body surface area 42 ml/m2 (IQR 34-51). Median mitral A wave was 0.46 m/s (IQR 0.39-0.5) vs 0.35 m/s (IQR 0.28-0.5) in patients without and with AF recurrence, respectively (p = 0.04). Patients without AF recurrence had also higher mitral annular A’ velocity obtained by tissue Doppler imaging (7.4 ± 2.8 cm/s vs 3.5 cm/s, IQR 2.8-4.8; p &lt; 0.0001), LA reservoir strain (19.4 ± 7.3% vs 11%, IQR 9.6-15.3; p = 0.0003) and LA contractile strain (9.4 ± 4.1% vs 2.8%, IQR 1.2-4.4; p &lt; 0.0001). The table presents results derived from univariate Cox regression analysis.

Conclusion
LA activity assessed early after the restoration of sinus rhythm is the predictor of AF recurrence. The strongest association was proven for LA contractile strain. Abstract Figure. Univariate Cox regression analysis
The ischemic cascades in contemporary patients: five distinct phenotypes assessed by ABCDE stress echocardiography
Authors: Zagatina A , Ciampi Q , Cortigiani L , Wierzbowska-Drabik K , Haberka M , Djordjevic-Dikic A , Boshchenko A , Rigo F , Simova I , Dodi C , Gaibazzi N , Morrone D , Barbieri A , Pellikka PA , Picano E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI)

Background
The classical pathophysiological cornerstone of stress cardiac imaging is the ischemic cascade: alterations in coronary flow velocity reserve (CFVR) come first, regional wall motion abnormalities (RWMA) second, and global alterations of left ventricular diastolic and systolic function last.

Aim
To evaluate the ischemic cascade with stress echo (SE) assessed with ABCDE protocol.

Methods
We analyzed 1616 patients (age 66 ± 10 years, 1156, 72% males) with chest pain and angiographically documented coronary artery disease (CAD): 928 (57.4%) with previous myocardial infarction and 1451 (89.8%) with previous coronary revascularization. CAD patients were studied with ABCDE-SE protocol by 13 certified laboratories of 5 countries. Stress modality was exercise in 427 (26.4%) dobutamine in 173 (10.7%) and vasodilator stress in 1016 (62.9%) patients (dipyridamole in 982 – 60.8% and adenosine in 34 – 2.1% patients). Step A assessed RWMA; step B, B-lines (diastolic function); step C, left ventricular contractile reserve based on force; step D, CFVR in left anterior descending artery; step E, heart rate reserve. SE response ranged from score 0 (all steps normal) to score 5 (all steps abnormal). Follow up was obtained in all patients.

Results
Results were abnormal in 350 (21.7) % for step A, 572 (35.4%) for B, 666 (41.2%) for C, 546 (33.5%) for D and 643 (39.8%) for E. The distribution of positivity is shown in figure. The dominant "solitary phenotype" (only one biomarker abnormal during the test) was step A in 10 (0.6%), step B in 124 (7.7%) step C in 100 (6.2%), step D in 64 (4.0%) and step E in 157 (9.7%) patients. The overall sensitivity for CAD detection including each step of ABCDE score (≥1) was 95.7%. During median follow-up of 22 months [IQ range: 13-37 months] 279 coronary revascularizations occurred. ABCDE score predicted coronary revascularization with score 1: HR: 3.182, 95% CI: 1.699-6.067; score 2: HR: 4.921, 95% CI: 2.571-9.420; score 3: HR: 7.234, 95% CI: 3.743-13.979; score 4: HR: 24.570, 95% CI: 13.390-45.086; and score 5: HR: 38.720, 95% CI: 20.975-71.478

Conclusion
Inducible ischemia with CAD is characterized by the complexity and multiplicity of diagnostic phenotypes. The overall ABCDE score predicts clinically driven revascularization. Abstract Figure. The 5 circles of ischemia biomarkers
Regadenoson stress echocardiography: a road ahead
Authors: Romero Castro M , Fernandez Galindo M , Garcia Robles JA , Musa LA , Fernandez Herrero I , Priego Rodenas MA , Sanchez V , Jimenez Lopez-Guarch C , Corros-Vicente C , Carbonell San-Roman AS , Arribas Ysaurriaga F , Solis J 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Drugs use in stress echocardiography (SE) have important limitations due to side effect and contraindications. Regadenoson (R) is emerging as a selective coronary vasodilator for pharmacological stress tests. Several studies have analyzed its diagnostic accuracy, but its prognostic value has not yet been studied.

Purpose
The objective is to assess safety and short-medium term prognosis in patients (p) who underwent SE with R.

Methods
Retrospective observational study. 126 patients were included from 2017 to 2020 and SE to study the detection of myocardial ischemia with R were performed. A positive SE test were consider if presented at least one of the follow: segmental changes in myocardial contractility, electrocardiography ischaemic changes or ischaemic symtomps. Adverse events (AE) were collected. To assess prognosis, we evaluated cardiovascular events (CV) with a median follow-up of 23 months, considering heart failure, angina, myocardial infarction (AMI) o cardiovascular death. We compare negative result SE test group (NG) with group of positive results (PG).

Results
Sixteen (13%) patients, presented AE, generally mild, with nausea in 4 patients. Two patients (1.6%) required the use of aminophylline for severe AE type bronchospasm.
Nineteen studies (15%) were positive: 17 (89%) showed echocardiographically positive results, 5 of them also had clinical or electrocardiographic positivity, one (5%) was considered positive only by electrocardiographic criteria and another by clinical criteria.
There were no CV deaths at follow-up. In the NG, 6 events were observed versus 2 in the PG (6 vs 11%). Time to event of the NG was a median of 90 [3-600] days versus 110 [40-180] days in the PG. The most frequent event was HF (4 NG vs 1 PG), coronary angiography was performed in only 2 patients with HF of the NG and did not show significant lesions. In the NG there were 2 IAM (2 vs 0), one had severe stenosis in the right coronary artery and the other several moderate diffuse stenosis. There was no events for angina in the NG (0 vs 1). The annual cumulative incidence was 11% in the PG compared to 4% in the NG.

Conclusions
Stress echocardiography with regadenoson is a safe test with a low serious adverse events rate. As concern as prognosis, In our sample, NG presented a lower proportion of events with a lower annual cumulative incidence than PG and also in a 23-month follow-up. Abstract Figure.
Prevalence and clinical impact of latent obstruction in hypertrophic cardiomyopathy
Authors: Cardoso A , Lourenco MR , Von Hafe P , Dias G , Pereira T , Tinoco M , Fernandes M , Azevedo O , Lourenco A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
Hypertrophic cardiomyopathy (HCM) is characterized by varying degrees of left ventricular outflow tract obstruction (LVOTobs). We aim to define the prevalence, clinical profile and impact of LVOTobs under physiological exercise in HCM patients (pts).

METHODS
Single center retrospective study of consecutive HCM pts without LVOTobs at rest (resting gradient &lt;30mmHg), referred for exercise stress echocardiogram (ESE) between 2015 and 2019. Significative latent obstruction was defined as a LVOT gradient ≥50 mmHg during exercise or at early recuperation.

RESULTS
A total of 56 pts were included (64% men, mean age 57 ± 11 years, 61% septal HCM). The majority of pts (47; 84%) were in NYHA I functional class, 20 (36%) had history of syncope or pre-syncope (S/pS) and 7 (13%) had an implantable cardioverter defibrillator (ICD). Twelve (21%) pts had systolic anterior motion (SAM) of the mitral valve at rest.
Thirty-five (63%) pts performed ESE under beta-blocker (BB) therapy. Mean exercise time was 8 ± 3 min. During ESE, 2 (4%) pts developed a LVOT gradient between 30 to 50 mmHg and 17 pts (30%) developed a significative LVOTobs gradient (mean 85 ± 18 mmHg).
Pts with significative latent LVOTobs had more previous complaints of S/pS (59% vs 26%, p=.017), a tendency for a higher NYHA functional class (p=.082) and were more frequently on BB therapy (82% vs 18%, p=.043). Mean septum thickness was similar between groups (17 ± 0.7 vs 16 ± 0.6 mm, p=.536). The presence of SAM at rest was more frequent in the significative latent LVOTobs pts (p&lt;.001). No differences were noted in exercise tolerance (p=.526).
During a median follow-up of 43 (IQR 15-53) months, 7 (41%) pts with significative latent LVOTobs had a pre-syncope, 3 (18%) were diagnosed with atrial fibrillation and 2 (12%) had a cardiovascular admission . There was up-titration/initiation of BB therapy in 5 (29%) pts, referral for septal myectomy in 3 (18%) and ICD implantation for primary prevention in 3 (18%) pts. No proper ICD shocks, sustained ventricular arrythmias or deaths occurred.
Comparing significative latent to non LVOTobs pts, the first ones had more ICD implantation (log rank p =.04) and performed a surgical myectomy more frequently (log rank p= .018) during the follow-up.

CONCLUSION
In our study, significative latent LVOTobs was observed in 30% of pts. Its presence can have clinical implications in HCM pts approach and should be suspected in more symptomatic pts and when SAM is present at rest.
Prognostic value of E/e ratio changes with exercise in symptomatic patients referred for exercise echocardiography
Authors: Peteiro J , Bouzas-Mosquera A , Barbeito-Caamano C , Souto-Cainzos B , Martin-Alvarez E , Bas-Gonzalez M , Vazquez-Rodriguez JM 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
We have previously noticed that some patients with decrease of the ratio of early LV inflow velocity to early tissue Doppler annulus velocity (E/e`) with exercise might have better outcome than others that exhibit raised values at both rest and exercise. In this research, we aimed to assess the prognostic value of E/e´ change with exercise in patients with normal or abnormal resting diastolic function (DF) referred for a clinically indicated ExE.

Methods
LV systolic and diastolic function (DF) according to ASE/EACVI guidelines, were evaluated at rest in 750 patients (age 67 ± 12 years) with preserved LV ejection fraction (≥50). We assessed regional/global LV systolic function at peak exercise, while E/e’ was evaluated in the immediate post-exercise period. Abnormal ExE was defined as ischemia or fixed wall motion abnormalities, and raised E/e´values as &gt;15 at rest and at exercise (e´ at the septal level). Patients were grouped as having raised E/e´ at both rest and exercise (R-RestEx, n = 77), raised E/e´ only at exercise (R-Ex, n = 47), raised only at rest (R-Rest, n = 71) and non-raised (NR, n = 555). Events were overall mortality, myocardial infarction, admission for unstable angina or cardiac failure, coronary revascularization, pulmonary thromboembolism, and stroke.

Results
Abnormal resting DF was present in 219 patients (29%), indeterminate in 70 (9%). Percentages of abnormal resting DF were 13% in group NR, 90% in group R-Rest, 28% in group R-Ex and 88% in group R-RestEx (p &lt; 0.001), whereas the percentages of indeterminate DF were similar (9, 10, 13, and 12%, respectively). Abnormal ExE was present in 21% of group NR, 32% of group R-Rest, 36% of group R-Ex, and 40% of group R-RestEx (p &lt; 0.001). During a median follow-up of 0.9 years (25-75th percentiles 0.4-1.7) there were 108 events. Independent predictors included peak exercise LVEF (HR = 0.93, 95% CI = 0.91-0.94, p &lt; 0.001), and exercise E/e´ (HR= 1.04, 95% CI = 1.01-1.08, p = 0.01). Neither resting E/e´ values nor resting abnormal DF by ASE/EACVI guidelines, were independent predictors. Annualized event-rates were similar in groups NR (6.9%) and R-Rest (5.6%), but higher in groups R-Ex (10.9%) and R-RestEx (27.2%).

Conclusions
E/e´ changes during exercise may help to reclassify risk of patients. Patients with normal E/e´ values at exercise have better outcome, despite resting values. Abstract Figure.
Evaluation of right ventricular contractile reserve in healthy subjects using stress echocardiography
Authors: Alborikan S , Badiani S , Van Zalen J , Lloyd G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The assessment of right ventricular (RV) systolic functional augmentation in healthy subjects is not well described. The objective of this study was to evaluate normal augmentation of RV systolic functional parameters in relation to maximum predicted oxygen uptake (VO2) during stress echocardiography in healthy adults.

Methods
Untrained healthy volunteers were recruited prior starting their first time London Marathon and underwent cardiopulmonary exercise test with echocardiography focussed on left ventricular assessment. Patients with satisfactory RV windows were included in this analysis. 20 participants with good RV delineation were evaluated retrospectively at baseline and at peak level of exercise. We defined RV systolic function by tricuspid lateral annular systolic velocity (RVS’) using Doppler tissue imaging, Tricuspid Annular Plane Systolic Excursion (TAPSE) using M-mode echocardiography, and Fractional Area Change (FAC) using 2D echocardiography to calculate the percentage of change in RV area between systole and diastole. All parameters were evaluated at baseline and at peak stress.

Results
There was statistically significant augmentation of all RV systolic functional parameters between baseline and peak stress (10.3 ± .8 vs 16.4 ± .7 cm/s, p &lt;.000), (21 ± 2.6 vs 32 ± 3.3, mm, p &lt;.000) and (41 ± 2.7, % vs 55 ± 5.1, %, p&lt;.000) for RVS’, TAPSE and FAC respectively. At peak stress, RVS’ increased by 59 ± 11.1, %, TAPSE by 53 ± 15.4, %, and FAC by 34 ± 11.8, %. Mean peak VO2 was 107 ± 17, %. The augmentation of RV longitudinal function showed moderate correlation with peak VO2 throughout exercise for the RVS’ and TAPSE (r= .54, p 0.001), (r=.45, p0.04) respectively, and this was not observed in FAC (r=.15, p&gt;.05).

Conclusion
In normal individuals, we have demonstrated that the RV augments by 59% for RVS’, 53% for TAPSE, and 34% for FAC. Longitudinal RV augmentation by RVS’ and TAPSE was correlated with maximum exercise capacity suggesting that these parameters could be able to predict VO2 peak values in larger context. Abstract Figure.