bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiovascular magnetic resonance in light-chain amyloidosis to guide treatment
Authors: Martinez-Naharro Ana , Patel Rishi , Kotecha Tushar , Karia Nina , Ioannou Adam , Petrie Aviva , Chacko Liza A , Razvi Yousuf , Ravichandran Sriram , Brown James , Law Steven , Quarta Cristina , Mahmood Shameem , Wisniowski Brendan , Pica Silvia , Sachchithanantham Sajitha , Lachmann Helen J , Moon James C , Knight Daniel S , Whelan Carol , Venneri Lucia , Xue Hui , Kellman Peter , Gillmore Julian D , Hawkins Philip N , Wechalekar Ashutosh D , Fontana Marianna 
Published: October 2022

Abstract

Aims
To assess the ability of cardiovascular magnetic resonance (CMR) to (i) measure changes in response to chemotherapy; (ii) assess the correlation between haematological response and changes in extracellular volume (ECV); and (iii) assess the association between changes in ECV and prognosis over and above existing predictors.

Methods and results
In total, 176 patients with cardiac AL amyloidosis were assessed using serial N-terminal pro-B-type natriuretic peptide (NT-proBNP), echocardiography, free light chains and CMR with T1 and ECV mapping at diagnosis and subsequently 6, 12, and 24 months after starting chemotherapy. Haematological response was graded as complete response (CR), very good partial response (VGPR), partial response (PR), or no response (NR). CMR response was graded by changes in ECV as progression (≥0.05 increase), stable (&lt;0.05 change), or regression (≥0.05 decrease). At 6 months, CMR regression was observed in 3% (all CR/VGPR) and CMR progression in 32% (61% in PR/NR; 39% CR/VGPR). After 1 year, 22% had regression (all CR/VGPR), and 22% had progression (63% in PR/NR; 37% CR/VGPR). At 2 years, 38% had regression (all CR/VGPR), and 14% had progression (80% in PR/NR; 20% CR/VGPR). Thirty-six (25%) patients died during follow-up (40 ± 15 months); CMR response at 6 months predicted death (progression hazard ratio 3.82; 95% confidence interval 1.95–7.49; P &lt; 0.001) and remained prognostic after adjusting for haematological response, NT-proBNP and longitudinal strain (P &lt; 0.01).

Conclusions
Cardiac amyloid deposits frequently regress following chemotherapy, but only in patients who achieve CR or VGPR. Changes in ECV predict outcome after adjusting for known predictors.
Left atrial appendage mechanical dispersion assessed by speckle-tracking echocardiography as a determinant of left atrial appendage stasis in patients with non-valvular atrial fibrillation
Authors: Mao Y K , Zhao H J , Yu C , Yang Y , Ma M M , Wang Y H , Jiang R H , Zheng Z L , Jiang C Y 
Published: October 2022

Abstract

Background
We sought to investigate the relationship of left atrial appendage (LAA) mechanical dispersion (MD) with LAA dense spontaneous echo contrast (SEC) or thrombus, and to compare its usefulness in the identification of thrombogenesis with left atrial (LA) MD or LA/LAA strain parameters in patients with nonvalvular atrial fibrillation (AF).

Methods
We conducted a cross-sectional study of 493 consecutive patients with AF (median age 65, male 66.9%) who underwent echocardiography prior to catheter ablation. We measured the LAA and LA global longitudinal strain (GLS) using speckle-tracking echocardiography (STE). LAA MD and LA MD was defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval.

Results
Patients with LAA dense SEC/thrombus (n=70) had significantly higher LAA MD than controls (n=423) (median 14.20% vs 9.35%). Areas under the receiver-operating curve for CHA2DS2-VASc score plus LAA MD, LAA GLS or LA GLS were comparable (0.830, 0.843 and 0.809) and superior to that combined with LA MD (0.762, all p&lt;0.01). Multivariable analysis showed that LAA MD was an independent determinant of LAA dense SEC/thrombus in four different models (Odds ratio, 1.23–1.24; P&lt;0.001), and provided additional diagnostic value over clinical and standard echocardiographic parameters. Whereas LA MD was not independently associated with LAA dense SEC/thrombus and had no incremental predictive value.

Conclusion
LAA mechanical dispersion provided incremental information over conventional risk factors in the identification of LAA dense SEC or thrombus in AF patients and is superior to LA mechanical dispersion.

Funding Acknowledgement
Type of funding sources: None.
Post-systolic shortening index by echocardiography evaluation of dyssynchrony in the non-dilated and hypertrophied left ventricle
Authors: Wang T K M , Saijo Y , Chan N , Sperry B , Phelan D , Desai M Y , Griffin B P , Grimm R A , Popovic Z B 
Published: October 2022

Abstract

Background
Post-systolic shortening index (PSI) is defined as myocardial shortening that occurs after aortic valve closure, and is an emerging measure of regional LV contractile dysfunction. PSI measurement variability amongst software vendor and its relationship with mechanical dyssynchrony and mechanical dispersion index (MDI) remains unknown. We evaluated PSI by speckle-tracking echocardiography from several vendors in patients with increased left ventricular wall thickness, and associations with MDI.

Methods
This is a prospective cross-sectional study of 70 patients (36 hypertrophic cardiomyopathy [HCM], 18 cardiac amyloidosis and 16 healthy controls) undergoing clinically indicated echocardiography. PSI was measured using QLAB/aCMQ (Philips), QLAB/LV auto-trace (Philips), EchoPAC (GE), Velocity Vector Imaging (Siemens), and EchoInsight (EPSILON) software packages, and calculated as 100% × (post systolic strain − end-systole strain)/post systolic strain.

Results
There was a significant difference in mean PSI among controls 2.1±0.6%, HCM 6.1±2.6% and cardiac amyloidosis 6.8±2.7% (p&lt;0.001). Variations between software vendors were significant in patients with pathologic increases in LV wall thickness (for HCM p=0.03, for amyloidosis p=0.008), but not in controls (p=0.11), as seen in Figure 1. Furthermore, there were moderate correlations between PSI and both MDI (r=0.77) and left ventricular global longitudinal strain (r=0.69), as seen in Figure 2.

Conclusion
PSI was greater in HCM and cardiac amyloidosis patients than controls, and a valuable tool for dyssynchrony evaluation, with moderate correlations to MDI and strain. However, there were significant variations in PSI measurements by software vendor especially in patients with pathological increase in LV wall thickness, suggesting that separate vendor-specific thresholds for abnormal PSI are required.

Funding Acknowledgement
Type of funding sources: None.
Myocardial work impairment in children with Wolff-Parkinson-White syndrome
Authors: Borrelli N , Di Salvo G , Ciriello G D , Sabatino J , Grimaldi N , Barracano R , Fusco F , Merola A , Correra A , Romeo E , Colonna D , Palma M , Scognamiglio G , Russo M G , Sarubbi B 
Published: October 2022

Abstract

Background
Wolf-Parkinson-White Syndrome (WPW) has been associated with reduced local myocardium deformation during systole. According to guidelines, when the left ventricle (LV) dysfunction is present catheter ablation of the accessory pathway may be required, even in asymptomatic patients.

Purpose
The study aimed to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in children with WPW.

Methods
Eighty pediatric patients (age 7.91±3.2 years) were included in the study: 20 cases with manifest WPW and 60 age- and sex-matched controls (CTR). Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated. In addition, standard echocardiographic parameters of LV function were evaluated.

Results
Patients characteristics are summarized in the table. Despite normal LV EF and GLS, children with WPW had worse MWI (WPW 1292.90±307.67 mmHg% vs CTR 1658.73±241.74 mmHg%, p=0.0000005), MCW (WPW 1844.15±267.96 mmHg% vs CTR 2104.90±237.85 mmHg%, p=0.00009), MWW (WPW 101.5 [85–148.25] mmHg% vs CTR 72 [54.75–109.25] mmHg%, p=0.004) and GWE (WPW 94 [91.75–95] mmHg% vs 96 [95–97] mmHg%, p=0.00012) (table). In the WPW group, MWE (r=−0.6, p=0.009) and MWW (r=0.6, p=0.01) was found to correlate with a prolonged QRS (figure).
A multiple regression model was generated to identify the relation between abnormal myocardial work indices (worst interquartile range as dependent variable) and several independent variables. QRS was the best independent predictor of impaired myocardial work. In particular, a QRS&gt;110 msec showed an 86% sensibility and 85% specificity for abnormal MWE (AUC of 0.85), and a 75% sensibility and 83% specificity for abnormal MWW (AUC of 0.83) (figure).

Conclusion
In children with WPW, myocardial work indices were found significantly reduced, even in presence of normal LV EF and GLS. Prolonged QRS independently predicted myocardial impairment. In pediatric patients with WPW, myocardial work may represent a sensitive measure of LV dysfunction and help in the decision-making.

Funding Acknowledgement
Type of funding sources: None.
Sequential left ventricular electro-mechanical changes in left bundle branch pacing vs right ventricular pacing a two-center study
Authors: Mao Y K , Yang Y , Duchenne J , Garweg C , Sheng X , Zhang J F , Yang Y E , Wang M , Yang Y , Voros G , Sun Y X , Ma M M , Fu G S , Voigt J U 
Published: October 2022

Abstract

Background
Left bundle branch pacing (LBBP) has been proved to maintain electrical synchrony better than RVP during mid to long-term follow-up, but little is known about the left ventricular (LV) mechanical changes over time. This study investigates if LBBP causes less sequential electro-mechanical alterations in LV that develop over time, compared with both conventional (CRVP) and leadless (LRVP) RVP.

Methods
Sixty-five patients with pacing indication for bradycardia were prospectively enrolled: Twenty-two were treated with LBBP, 23 with CRVP and 20 with LRVP. QRS duration (QRSd) was measured at baseline and during follow-up. All patients underwent echocardiography at baseline, one week after implantation and at one-year follow-up. LV volumes, ejection fraction (EF) and global longitudinal strain (GLS) were measured. Septal flash (SF), apical rocking and septal longitudinal strain patterns were assessed visually by two experienced readers.

Results
All the patients presented with normal strain pattern and no signs of SF or apical rocking at baseline. 100% of CRVP and 95% of LRVP patients had stage1 or 2 septal deformation patterns at week 1, and the majority (72.3% CRVP and 83.3% LRVP) progressed to stage≥2 at 12 months. On the contrary, over 2/3 of LBBP patients preserved normal strain patterns at week 1, and less than 1/3 had stage-1 pattern, 2 out of whom progressed to stage-2 during follow-up (Figure 1). At week 1 and 12 months, all RVP patients had SF, and most of them also exhibited apical rocking (87%-94.4% in CRVP and 80%-94.4% in LRVP). However, much less septal flash and apical rocking was induced in LBBP patients at week 1 and last follow-up (27.3%-37.5% and 22.7%-25%, P&lt;0.001 vs RVP). Baseline QRSd were similar among three groups. At week 1, the paced QRSd increased least in LBBP compared to CRVP and LRVP and remained as such at 12 months. During one year follow-up, LVEF and LV GLS decreased more in CRVP group compared to LBBP (both P&lt;0.05) (Figure 2).

Conclusion
LBBP causes less sequential changes in LV deformation patterns, septal flash and apical rocking, compared to CRVP and LRVP. With this, LBBP appears to preserve LV function better than RVP. CRVP and LRVP did not differ in electro-mechanical changes or LV remodeling.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research Foundation Flanders (FWO) project grant
Left atrial strain predicts heart failure in the general population
Authors: Nielsen A , Skaarup K , Hauser R , Johansen N , Lassen M , Inciardi R , Jensen G , Schnohr P , Moegelvang R , Biering-Soerensen T 
Published: October 2022

Abstract

Background
Left atrial (LA) function has shown to be a significant predictor of cardiovascular outcomes. We sought to determine the prognostic value of LA strain in relation to incident heart failure (HF) in the general population.

Methods
The present study includes 3,540 participants from the general population without prevalent atrial fibrillation or HF. All participants underwent health examinations and echocardiography including measures of LA function by means of peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and LA strain during the conduit phase (LACS). Cox proportional hazards regressions were utilised to access the association between incident HF and LA strain parameters.

Results
Median age of the study population was 57 years (interquartile range: 40, 69) and 2,015 (57%) were female. During follow-up (median 5.4 years), 66 (2%) participants were diagnosed with HF. Participants who developed HF had lower PALS (26.4% vs. 36.6%, p&lt;0.001), PACS (15.6% vs. 16.5%, p=0.016), and LACS (11.4% vs. 19.3%, p&lt;0.001) at baseline. Lower values of all three LA strain parameters were associated with a higher risk of developing HF in univariable analysis (Figure 1 & 2). After multivariable adjustments for Framingham Risk Score and global longitudinal strain, PALS (HR=1.06, 95% CI [1.03; 1.09], p&lt;0.001, per 1% decrease), PACS (HR=1.07, 95% CI [1.02; 1.12], p=0.003, per 1% decrease), and LACS (HR=1.05, 95% CI [1.01; 1.10], p=0.016, per 1% decrease) remained significantly associated with incident HF. However, in participants with normal-sized LA (LA volume index &lt;34 ml/m2) and no ischemic heart disease (n=3,046), only PALS and PACS remained independent predictors of HF (Figure 2).

Conclusion
LA strain provides independent prognostic value regarding the risk of incident HF in the general population.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The Danish Heart Foundation and The Metropolitan Region of Denmark
A new way to explore ventricular-arterial coupling in young patients with untreated hypertension
Authors: Trimarchi G , Lofrumento F , Mandraffino G , Verachtert S , Cusma'-Piccione M , De Sarro R , Mancinelli A , Spano' F , Certo G , Morabito A , Di Bella G , Carerj S , Zito C 
Published: October 2022

Abstract

Introduction
Commonly assessed as arterial elastance (Ea) to ventricular end-systolic elastance (Ees) ratio, ventricular-arterial coupling (VAC) has independent prognostic value in hypertension.

Aim
To investigate whether new coupling indices may be able to identify left ventricular (LV) performance changes induced by blood pressure (BP) overload earlier than conventional ones.

Materials and methods
50 young individuals were prospectively enrolled: 25 (40±8 years) newly diagnosed untreated hypertensives and 25 controls (38±9 yrs). All underwent at the same time carotid-femoral pulse wave velocity (PWV) measurement through a tonometer and an echocardiogram to calculate global longitudinal strain (GLS) and myocardial work efficiency (GWE). Two new indices of VAC were derived: PWV/GLS, previously validated and PWV/GWE, still unknown.

Results
ESV/SV ratio was lower in hypertensive (0.48±0.17) than in controls (0.57±0.14) but without any significant difference (p=0.18), whereas PWV/GLS was significantly lower in hypertensives than in controls (−0.45±0.19 vs −0.35±0.09 m/sec%; p=0.02). PWV/GLS ratio correlated with Ea/Ees (r=0.52; p&lt;0.01), diastolic dysfunction degree (r=−0.59; p&lt;0.001), age (r=−0.64; p&lt;0.001), systolic BP (r=−0.41; p=0.002), diastolic BP (r=−0.39; p=0.005) and mean arterial pressure (MAP) (r=−0.40; p=0.004). PWV/GWE was higher in hypertensives than in controls (0.10±0.02 vs 0.08±0.01 m/sec%; p=0.001) and it was associated with Ea/Ees (r=−0.55; p=0.006), age (r=0.59; p&lt;0.001), diastolic dysfunction degree (r=0.55; p&lt;0.001), systolic BP (r=0.8; p&lt;0.001), diastolic BP (r=0.5; p&lt;0.001) and MAP (r=0.52; p&lt;0.001).

Conclusions
Innovative indices of ventricular-arterial coupling could be more sensitive for investigating the impact of hypertension on LV performance.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): G. Martino University Hospital, Department of Clinical and Experimental Medicine - Cardiology Unit, University of Messina, Messina, Italy
Phenotyping Acute Decompensated Heart Failure (ADHF)by a cardiac speckle tracking analysis
Authors: Barki M , Losito M , Bandera F , Alfonzetti E , Caracciolo M M , Rovida M , Guazzi M 
Published: October 2022

Abstract

Background
The global longitudinal strain (GLS) evaluation by Speckle Tracking Echocardiography (STE) is an established non-invasive, highly reproducible echocardiographic prognostic index in Heart Failure (HF). In acute decompensated heart failure (ADHF), GLS has proved to have greater prognostic value than left ventricular ejection fraction (LVEF) in the categorization of HF. However, how GLS may change over hospital staying in ADHF and how it correlates with Left Atrial (LA) functioning and contractile reserve in this cohort of subjects is currently undefined.

Aims
To evaluate, in a cohort of ADHF patients, GLS extent of changes after targeted anti-congestion therapy and its correlation with LA mechanics and reservoir function.

Methods
Eighty-five ADHF patients (mean age 75.6±10.4 years, 59% males) were prospectively enrolled within 24 hours from admission to the emergency department (ED). In either the acute phase and at pre-discharge all patients underwent laboratory tests, Lung Ultrasonography (LUS), M-Mode, 2-Dimensions and Doppler Echocardiography. LA dynamics assessment was based on the evaluation of LA strain, particularly through Global-Peak Atrial Longitudinal Strain (GPALS). Strain analysis by STE was performed offline.

Results
From admission to discharge, despite decongestion as shown by a significant reduction of the number of B-lines measured at LUS and NT-proBNP at blood tests (B-lines: 22.2±17.1 vs. 6.5±5 p&lt;0.001; NT-proBNP: 8738±948 ng/l vs 4227±659 ng/l p&lt;0.001), we observed only minimal and non-significant changes in the average GLS (from −12.2±4% at admission to −12.5±3.8% at discharge; p=0.8) and GPALS (from 13.2±7.6% at admission to 13.6±7.8% at discharge; p=0.77) (Table 1). Interestingly, when evaluated with Pearson's coefficient, in the whole population a significant direct correlation was observed between GLS and GPALS values at discharge (r=0.6, 95% Confidence Interval (CI) 0.55–0.7; p&lt;0.001) (Figure 1) as well as between ΔGLS and ΔGPALS (r=0.42 95% CI 0.21–0.59, p=0.02).

Conclusions
In patients hospitalized for ADHF a significant impairment of GLS occurs and no improvement is observed at discharge after decongestion. The LA dynamics correlates with, and is likely involved in, this lack of changes. In this subset of patients, the dissociation between decongestion and LV and LA dynamics evaluated by strain analysis suggest the importance to monitor these functional indicators in order to improve risk stratification and reduce early re-hospitalization for AHF.

Funding Acknowledgement
Type of funding sources: None.
Global longitudinal strain to predict myocardial fibrosis in patients in carbon monoxide poisoning
Authors: Kim Y , Cho D H , Cha Y S , Son J W 
Published: October 2022

Abstract

Background
Carbon monoxide (CO) inhibits oxygen delivery and subsequently causes ischemic changes that can lead to myocardial damage. Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) reflects myocardial fibrosis and detects subclinical myocardial damage in patients with acute CO poisoning. However, CMR is expensive and hard to perform in patients with neurologic deficit. Therefore, this study aims to investigate which echocardiographic parameters could predict the presence of myocardial fibrosis represented by LGE in CO intoxication patients.

Methods
This prospective observational study included 128 consecutive patients (Mean age: 52.2±16.2) with acute CO poisoning and elevated troponin I (defined as &gt;0.045 ng/mL) at the emergency department of a tertiary university hospital. All participants underwent hyperbaric oxygen therapy (HBOT). CMR and conventional echocardiography with 2D speckle-tracking were performed within 7 days. Subjects were categorized into late gadolinium enhancement (LGE) and no LGE group according to the CMR findings.

Results
Mean left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS) were 57.0±10.0% and −16.3±3.7% respectively. LGE was observed in 89 (69.5%) patients and the most common pattern was mid-wall involvement. Clinical characteristics such as age, sex, shock, time elapsed from rescue to HBOT, and the level of troponin I were not different between groups with LGE and without LGE. Among echocardiographic parameters, LV EF was not significantly different between groups (LGE: 56.0±10.5% vs 59.3±8.1%, p=0.089). LV GLS was more impaired in patients with LGE compared to those without LGE (−15.7±3.8% vs −17.9±3.0%, p=0.003). In multivariate logistic analysis, LV GLS was independently associated with the presence of LGE [Odds ratio (OR) 1.279, 95% confidence interval (CI) (1.047–1.563), p=0.016], but not LV EF.

Conclusion
In patients with acute CO poisoning and elevated troponin I, LV GLS predicted the presence of LGE in CMR. These finding suggest that subclinical myocardial dysfunction represented by LV GLS may reflect the burden of CO induced myocardial fibrosis.

Funding Acknowledgement
Type of funding sources: None.