bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of 3D echocardiography-determined atrial volumes in predicting elevated left ventricular filling pressure
Authors: Jenei C , Kadar R , Balogh L , Gyory F , Borbely A , Csanadi Z 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Hungarian Government Research Fund, Szív- és érkutatási kiválóságközpont (IRONHEART)

Aims
Atrial sizes are considered markers of ventricular filling pressures. The studies focused on left atrial (LA) maximum volume (LAV max), however during diastole the left ventricular (LV) diastolic pressure affects the LA minimum volume (LAV min) instead. Therefore, we aimed to test the clinical applicability of atrial volumes measured by transthoracic three-dimensional echocardiography (3DE) in predicting elevated LV filling pressure.

Methods
Eighty-eight consecutive patients with and without left-sided heart disease were prospectively examined with transthoracic 3DE who underwent right heart catheterization because of clinical indication. Elevated LV filling pressure was determined as the pulmonary artery wedge pressure was higher than 15 mm Hg. The atrial volumes were measured offline with dedicated commercial software.

Results
Thirty-eight patients (24 males, age 62 ± 8 y) had left-sided heart disease (group A) and 50 (20 males, age 62 ± 15 y) had pulmonary hypertension because of lung disease (Group B). The left atrial indexed maximum (LAVi max) and minimum (LAVi min) volumes were significantly larger in group A than in group B (LAVi max: 64 ± 31 ml/m² vs. 40 ± 22 ml/m², p = 0.001; LAVi min: 51 ± 22 ml/m² vs. 25 ± 21 ml/m², p &lt; 0.0001). The LA minimum volume correlated with the pulmonary artery wedge pressure [r = 0.6 (p &lt; 0.0001) for LAV min vs. r = 0.47 (p &lt; 0.0001) for LAV max]. In the receiver operating characteristic (ROC) curves of parameters predicting the elevated LV filling pressure, the areas under the curve (AUC) for LAVi min and LAVi max were 0.86 (95% CI, 0.79-0.94), 0.79 (95% CI, 0.70-0.89), respectively. The ROC analysis indicated a possible cutoff value of 28 ml/m² for LAVi min to elevated LV filling pressure (AUC = 0.86; sensitivity = 87%, specificity = 74%).

Conclusion
The left atrial minimum volume measured by transthoracic 3DE is a useful parameter for predicting elevated left ventricular filling pressure.
Multiparametric assessment of the intraprocedural result after transcatheter mitral valve edge-to-edge repair proceduret
Authors: Melillo F , Colopi M , Falsasconi G , Ancona F , Pannone L , Stella S , Ingallina G , Castiglioni A , De Bonis M , Beneduce A , Godino C , Buzzatti N , Montorfano M , Denti P , Agricola E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Research grant

OnBehalf
n/a
Background. Quantification of residual mitral regurgitation (MR) after transcatheter edge-to-edge mitral valve repair (TMVr) is challenging.
Objectives. To evaluate the feasibility and the performance of an intraprocedural multiparametric approach based on echocardiographic and invasive hemodynamic parameters and to develop a multiparametric scoring system for MR grading after TMVr, and to compare this approach against currently recommended methods.
Methods. Ninety-three consecutive patients treated with MitraClip (April 2019-July 2020) were enrolled. The protocol of MR evaluation included: 2D and 3D color-Doppler (3D-vena contracta area- 3D-VCA), pulsed-wave Doppler (pulmonary vein- PV flow, stroke volume), continuous-wave Doppler (jet density), morphological parameters (spontaneous echocontrast) and invasive hemodynamic (mean left atrial pressure-LAP, V-wave) at baseline and after clip implantation. A multiparametric score (M-score) was calculated by including the significant predictors (3D-VCA, dense jet on CWD, final LAP, final V wave) of primary endpoint (CV death or HF related hospitalization) at one year follow-up, weighted according to the corresponding odds ratio, to predict the clinical outcome at one-month and one-year follow-up.
Results. The final study population included 86 pts (mean age 78.3 +8.9yrs, 54.6% primary MR). Procedural success was achieved in 78 pts (90.7%). 3D-VCA (AUC 0.808) and current method for MR grading (AUC 0.801) were comparable predictors of lack of symptom improvement (&lt;5 point change in KCCQ-OS score) at one-month (p = 0.398, DeLong’s test). The M-score performed similarly as predictor of one-month follow-up but was a better predictor of primary endpoint at 1-year (AUC 0.919) compared to single parameters (p = 0.005 vs 3D-VCA DeLong"s test) and currently recommended methods for MR grading (p = 0.006 DeLong"s test). The optimal cut-off was 2 points with 86.7% sensitivity and 83.1% specificity.
Conclusion. We evaluated intraprocedural TMVr result in a multiparametric approach showing that 3D-VCA alone is comparable to current recommended method for MR grading. However, the integration of echocardiographic and invasive hemodynamic parameters into a multiparametric score provided a further added value for predicting clinical outcome at one-year compared to currently recommended methods for MR grading and to 3D-VCA.
Is flow better in mL/m2 or mL/s - a practical reflection on aortic stenosis
Authors: Dias Claudio F , Santos M , Custodio P , Ferreira B , Quadrado M , Manuel A , Francisco AR , Neves B , Cruz I , Almeida AR , Fazendas P , Joao I , Pereira H 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Severe aortic stenosis is characterized for a high mean gradient (&gt;40mmHg) and an aortic valve area (AVA ≤1cm2). There is a population of patients with discordant findings. These patients present with a lower mean gradient (&lt;40mmHg) and area (AVA ≤1cm2). This states are explained by a low flow (indexed SV ≤35ml/m2). Some studies demonstrated that a flow rate (determined by dividing SV by ejection time) inferior to 200 mL/s is also associated with poor prognosis. Can this be an alternative in stratifying patients with an AVA ≤1cm2?

Purpose
This paper aims to compare flow assessment by the conventional way with flow calculated in ml/s in patients with AVA ≤1cm2

Methods
We present a retrospective study from all consecutive patients to whom an echocardiogram was performed in our hospital during the years 2017 and 2018 which meet the criteria for low gradient aortic stenosis. Comorbidities were analysed for each subgroup as well as echocardiographic variables to properly characterize aortic stenosis.

Results
A total of 118 patients met the criteria for severe aortic stenosis with a valvular area ≤1cm2. This population was made up of 18 patients with severe aortic stenosis low flow, low gradient with depressed ejection fraction and 32 patients with preserved ejection fraction. The other 68 patients represented patients with a normal flow, low gradient aortic stenosis. There is a strong correlation between the variable SVi and Flow Rate (r = 0,796, p &lt; 0,001). A linear regression shows that the flow rate equivalent to a SVi of 35mL/m2 in our sample is 203mL/s, near the value of other studies. 10 (31.3%) patients with severe aortic stenosis low flow, low gradient with preserved ejection fraction, 3 (16.7%) patients with severe aortic stenosis low flow, low gradient with depressed ejection fraction and 53 (77.9%) patients with normal flow, low gradient aortic stenosis would have a flow superior to 200mL/s.

Conclusion
The use of flow rate systematically would downgrade the severity of valvular lesions with possible need for intervention. However, in certain dubious cases its application may identify a subpopulation with need for further study and probable treatment, such as the patients with normal flow, low gradient aortic stenosis. Further studies of this subgroup of patients are warranted to reach any final conclusions. Abstract Figure.
Increasing transvalvular flow with passive leg rise as an add-on to dobutamine in patients with paradoxical low-flow, low-gradient aortic stenosis
Authors: Buffle E , Papadis A , De Marchi SF , Seiler C 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Gottfried und Julia Bangerter-Rhyner Foundation

Background
Projected aortic valve area (AVA), used in case of low-flow, low-gradient aortic stenosis is reliable if the transvalvular flow can be substantially augmented. Moreover it depends on the calculated valve compliance, which should remain constant, irrespective of the change in transvalvular flow.

Methods
We prospectively compared 3 different stress methods to increase transvalvular flow in patients with low-flow, low-gradient aortic stenosis: maximal dobutamine infusion rate ("Dmax"), passive leg-raise ("PLR") and the combination of the two ("Dmax + PLR") with the velocity time integral (VTI) method. The primary endpoint was the percentage of patients with ΔQ ≥20%. The percentage of patients with the pseudosevere classification and the mean slope between transvalvular flow and AVA - corresponding to the valve compliance - for each stress methods were the secondary endpoints.

Results
"Dmax + PLR" yielded the highest percent of patient with Δtransvalvular flow ≥20% implying the highest validity to the projected AVA between all the stress methods. In the "Paradox" group (LVEF ≥50%, n = 25), the percentage of patients classified as pseudosevere aortic stenosis was the lowest using "Dmax + PLR". This was also the case in the "lowEF" group with the Simpson’s method (LVEF &lt;50%, n = 20). The mean slope of Q with respect to AVA consistently decreased with higher Δtransvalvular flow.

Conclusion
Projected AVA was obtained with the highest reliability with the "Dmax + PLR" stress method. This same stress method yielded the lowest percentage of classification in pseudosevere in the "Paradox" group. This implies that the valve compliance, capturing the relationship between transvalvular flow and AVA might be non-constant and rather inversely proportional to translvalvular flow. Abstract Figure. Echo parameters and classification Abstract Figure. Projected AVA and valve compliance
Stuck mechanical valve complication in non-COVID-19 patients during COVID-19 pandemic: single center experience
Authors: Vriz O , Fawzy N , Eltayeb A , Galzerano D , Anwar M , Mushtaq A , Shaik A , Elshaer A , Kinsara A , Feras K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Stuck valve is a very rare and severe complication that occurs in mechanical valve replacement patients with ineffective anticoagulation. However, with COVID-19 restriction measures, it became challenging to regularly assess INR to make sure it falls within the target therapeutic range to prevent this complication.

Purpose
We wanted to explore how did the COVID-19 pandemic restrictions impacted mechanical valve replacement patients on chronic anticoagulation and the long-term consequences of limiting their access to health service.

Methods
We present a series of 10 patients on warfarin anticoagulation therapy who either underwent transthoracic echocardiography for a suspected stuck valve or were seen at the outpatient valve clinic with the residual consequences of a stuck valve during the COVID-19 restriction measures in our institute.

Results
Eight patients were female, two of whom were pregnant at the first trimester and eventually went on to receive an abortion; six patients received urgent valve replacement cardiac surgery; four patients were managed medically e.g. with heparin; none had thrombolytic therapy. Stuck prosthetic valves incident has increased significantly during this period, particularly those in the mitral position for which urgent replacement and prolonged hospitalization including intensive care admission, with high in-hospital mortality rates and high costs were necessary. Mean hospital admission time was 27.5 ± 18.5 days. The cost of treatment, as average estimated reimbursement, was 11,000 USD for medical admission only, and 43,200 USD when surgery was required, up to 64,000 USD when ECMO was part of patient management.

Conclusion
Despite governments’ efforts to implement telemedicine and virtual clinics, COVID-19 restrictions and health-messaging affected the routine follow-up of non-COVID-19 patients. We report dramatic consequences to this drastic change in healthcare: clinical complications, lost lives and inflated healthcare costs in patients with a prosthetic valve. We believe that non-COVID-19 patients have paid, and will continue to pay in the future, a price that is much greater than those patients who have suffered from COVID-19. Active engagement of patients should be implemented in a time of emergencies, and further studies should address the efficacy and cost-effectiveness of public policies aimed to decrease the burden of avoidable complications and missed diagnoses. Abstract Figure. Fluoroscopy in a 70 years old patient
Prognostic significance of left atrial reservoir strain in patients undergoing transcatheter aortic valve implantation
Authors: Von Roeder M , Maeder M , Wahl V , Stachel G , Thiele H , Desch S , Lurz P , Abdel-Wahab M 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial reservoir strain (LARS) provides prognostic information in various patient groups and might help to detect elevated filling pressures. Patients with diastolic dysfunction experience worse outcomes after transcatheter aortic valve implantation (TAVI), but Doppler-derived measurements might be hampered by atrial fibrillation, mitral valve disease or impaired image quality. Aim of the current study is to elucidate the prognostic value of LASR in patients undergoing TAVI.

Methods
All consecutive patients undergoing TAVI at a single tertiary care hospital between 01/2018 and 12/2018 were included if discharge echo and follow-up was available. LASR was derived from 2-D-speckle-tracking averaged apical 2- and 4-chamber view. Patients were grouped in 3 tertiles according to LASR. Primary outcome was a composite of all-cause death and readmission for worsening heart failure.

Results
Overall, 606 patients were available (Age 80 years (IQR 77-84)), including 53% woman.
LASR was significantly impaired over tertiles (T1 21.4 (IQR 18.3-24.5), T2 13.0 (IQR 11.3-14.6), T3 7.1 (IQR 5.4-8.4), p &lt; 0.0001). The primary outcome occurred more often with impaired LASR (T1 7,4%, T2 13.4%, T3 25,7%).
On multivariable Cox-regression analysis LASR was a significant factor to predict outcome (HR 0.95, CI 0.91-0.99, p = 0.02).

Conclusion
Impaired LASR is associated with impaired outcomes in patients undergoing TAVI.
Classic pattern dyssynchrony predicting outcome in patients with Fontan circulation
Authors: Rosner A , Mc Elhinney DB , Friedberg MK , Lui GK 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Helse Nord, Norway

Background
Morbidity and mortality increase as Fontan patients age into adulthood. Limited studies have examined cardiac magnetic resonance and echocardiographic parameters to predict death and transplantation in children after Fontan operation.

Purpose
The aim of the study was to investigate echocardiographic parameters in adolescents and adults after Fontan operation including myocardial mechanics including classic pattern dyssynchrony (CPD) as predictors of transplantation or death.

Methods
In a cross-sectional retrospective study, strain analysis was performed on echocardiography studies performed between 2001 and 2014 of 110 patients with single ventricle physiology after the Fontan procedure. Strain curves were measured and visually assessed for the presence of CPD. The primary end point was death or transplantation after a follow-up period of 85 ± 35 months after echocardiography.

Results
Median age at date of echocardiography was 20, range 3 to 45 years. Of 110 patients 28 patients were transplanted. During the study-period 3 patients died after transplantation and 7 patients died without being transplanted. CPD was seen in 16 and protein losing enteropathy (PLE) in 21 of 110 patients. By multivariate-analysis, CPD (HR 9.4 CI 2.6-34.6), PLE (HR 10.6 CI 3.4-33.2); systolic blood pressure (HR 0.954 CI 0.913-0.996), systolic/diastolic duration ratio (HR 6.83 CI 1.33-35.0) and E wave deceleration time (HR 0.98 CI 0.97 - 0.99) were independently associated with the primary end point.

Conclusion
CPD, PLE, systolic and diastolic ventricular dysfunction are significantly associated with transplantation or death in Fontan operated patients. In selected patients, the presence of CPD may be a basis to investigate cardiac resynchronization therapy as a treatment strategy. Abstract Figure: Mortality in patients with CPD
Myocardial work indices and ventricular dyssynchrony in adults with aortic coarctation
Authors: Fusco F , Scognamiglio G , Merola A , Roma AS , Del Giudice C , Abbate M , Palma M , Correra A , Borrelli N , Barracano R , Grimaldi N , Colonna D , Romeo E , Sarubbi B 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Adults with coarctation of the aorta (CoA) may present residual aortic obstruction and develop arterial vasculopathy and subclinical left ventricular (LV) dysfunction. Myocardial work (MW) is a novel non-invasive index of myocardial efficiency calculated from echocardiographic LV pressure-strain loops, which yields incremental information over ejection fraction and global longitudinal strain. (GLS)

Purpose
Aim of the present study is to analyze LVMW in a cohort of adult patients with operated aortic CoA

Methods
CoA patients aged &gt; 18 years who underwent transthoracic echocardiography between September 2020 and July 2021 at our tertiary centre were included. Exclusion criteria were significant recoarctation, impaired LVEF, significant valvular disease and suboptimal image quality. A group of healthy individuals with no cardiac abnormalities. GLS and peak strain dispersion(PSD) were measured. MW indices were calculated using the blood pressure measured in the right arm at the time of the exam.

Results
Sixty patients (26[22-33]years, 66%male) were included. Data on previous medical history, clinical status at last assessment and Coa-related echocardiographic findings are showed in table 1. No significant differences in traditional parameters of LV systolic and diastolic function were found between groups (EF 60[57-64] vs 57[53-61],p = 0.6), however Coa patients had higher LVmass (84[75-97] vs 68[56-75]g). GLS and MW indices in the study population and in the control group are reported in table 2. Coa group showed lower GLS values and higher PSD (p &lt; 0.0001 for both). Global work index(GWI) and global constructive work(GCW) values were not significantly different between groups, whereas CoA group showed significant increase of global wasted work(GWW) and impaired global work efficiency(GWE,p = 0.003 and 0.0005 respectively). Spearman’s linear method illustrated that both GCW and GWI had a moderate positive relation with mean gradient across the descending aorta at continuous wave Doppler. PSD was positively related to GWW and inversely related to GWE(Figure 1). Using linear regression model with the log of GWE values as dependent variable,PSD,age(β:-0.002,p = 0.03) and LVmass(β:-0.06,p = 0.004)were related to GWE. However, only PSD retained a significant relation on multivariable analysis(β:-0.002,p &gt; 0.0001).

Conclusion
MW indices assessment is feasible in Coa patients may provide a more comprehensive understanding of the overall myocardial mechanics and performance. In particular, MW demonstrated impaired LV efficiency, which was strongly related to increased mechanical dispersion in Coa patients. Abstract Figure. Abstract Figure.
Ventricular mechanics in adolescents with Fontan circulation: comparison to healthy controls
Authors: Aly S , Mertens L , Friedberg M , Dragulescu A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
While preserved torsion was demonstrated in very young patients with single ventricle (SV) physiology immediately post Fontan completion, there is very limited data about the changes in univentricular mechanics during adolescence and its association with outcomes.

Objective
We aimed to a) examine changes in ventricular strain and torsion in adolescents and young adults with SV in comparison to healthy controls, and b. examine its association with markers of myocardial fibrosis on cardiac magnetic resonance (CMR).

Methods
This is a retrospective single center study of adolescents with Fontan circulation in comparison with controls. Speckle-tracking echocardiography was used to assess ventricular strain, torsion, and untwist. Torsion was measured as difference between apical and basal rotations. CMR volumetric and T1 relaxometry data closest to echocardiograms were obtained. Patients were compared to controls in 1:2 match.

Results
50 SV patients (27 LV, 17 RV, and 6 co-dominant) were compared to 100 controls. Demographics, echocardiographic, and CMR measurements are shown in table 1. Median duration from Fontan completion was 13.8 (10.6-16.6) years. Compared to controls, adolescents with SV demonstrated reduced global longitudinal strain [-17.1% (-7.4 to -20.1) vs -20.1%(-12.3 to -24.5), p = 0.01], circumferential strain [-15.2% (-9.1 to – 20.3) vs -19.2% (-12.3 to -23.7), p = 0.007], and radial strain
[25.2% (15.8 to 54.3) vs 39.4% (25.7 to 62.1), p = 0.01]. Torsion was reduced in patients compared to controls [5.2˚/cm (-4.5 to 16.1) vs 9.2˚/cm (-6.8 to 17.4) vs, p = 0.01] with decreased apical rotation [3.9˚/cm (-10.2 to 14.8) vs 5.7˚/cm (1.6 to 15.6), p = 0.001] and basal rotation [-1.5˚/cm (-7.5 to 3.7) vs -3.9˚/cm (-0.3 to -8.5), p = 0.04], respectively. T1 values were higher in SV patients compared to controls [1009 ± 36ms vs 958 ± 40ms, p = 0.004] and correlated with worse circumferential strain (r = 0.59, p = 0.04) and inversely correlated with torsion (r=−0.71, p = 0.02).

Conclusion
Adolescents with SV demonstrated a significant decrease in ventricular torsion compared to controls. The increased T1 times and its association with decreased ventricular strain and torsion in SV patients highlights a potential role for myocardial fibrosis in impairment of ventricular mechanics of these patients. Abstract Figure.