bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial strain: a sensitive whistleblower lost in translation
Authors: Van Loon T , Van Osta N , Koopsen T , Lumens J 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): This work was supported by the Netherlands Organisation for Scientific Research (NWO- ZonMw, VIDI grant 016.176.340 to J.L.) and the Dutch Heart Foundation (ERA-CVD JTC2018 grant 2018T094; Dr. Dekker Program grant 2015T082 to J.L.)

Background
Left atrial (LA) function measured by peak/reservoir strain (PLAS) has been shown to be of prognostic value in various cardiac pathologies, including heart failure (HF). However, the underlying mechanisms leading to reduced PLAS remain poorly understood.

Purpose
To investigate how various combinations of left ventricular (LV) systolic-, diastolic, and LA failure affect PLAS.

Method
The CircAdapt computational model of the human heart and circulation is used to simulate the abovementioned LV and LA substrates, starting from a healthy reference simulation. LV systolic failure was simulated by a 25% decrease of LV contractility and LV eccentric hypertrophy (simultaneous increase of LV wall mass and area by 30%). LV diastolic failure was simulated by increasing LV myocardial stiffness by 100%, impairing LV relaxation function (increasing relaxation time constant from 35ms to 60ms, and LV concentric remodeling (increasing LV wall mass by 30%). LA failure was simulated by a fully non-contractile LA myocardium.

Results
LV systolic failure was characterized by reduced LV GLS (21 to 12%) and LVEF (54 to 34%), with marginal increase in PLAS (42 to 46%; Figure top row, first vs second column). LV diastolic failure was characterized by reduced PLAS (42 to 23%; Figure first vs third and fourth columns) with LA dilation (i.e. peak LA volume: 50 to 80 ml). Furthermore, LV concentric remodeling increased LVEF (54 to 64%). LA failure led to LA dilation and reduction of PLAS, regardless of LV substrate. Lastly, LV diastolic dysfunction and LA failure did not affect LV GLS (Figure bottom row).

Conclusion
Simulations showed that acute LV systolic failure hardly affected PLAS, but predominantly decreased LV GLS and LVEF. On the contrary, both LV diastolic dysfunction and LA failure reduced PLAS, rather than LV GLS and LVEF. Hence, LA strain can be considered as a whistleblower sensitive to various LV and/or LA abnormalities, which may explain why it is a rather nonspecific diagnostic marker. Abstract Figure. LA and LV strain in various substrates
Left ventricular forces distribution in patients with heart failure and reduced ejection fraction
Authors: Monosilio S , Filomena D , Sannino M , Birtolo IL , Cimino S , Tonti G , Pedrizzetti G , Benedetti G , Fedele F , Maestrini V , Agati L 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Hemodynamic forces (HDFs) are the forces exchanged between the blood and the myocardium. Estimation of their magnitude and alignment could be a novel marker of cardiac dysfunction.

Purpose
To describe left ventricular (LV) HDFs values and distribution in patients with heart failure with reduced ejection fraction (HFrEF) and to compare them with those of a group of healthy controls.

Methods
A cohort of 26 non-ischemic patients with an initial diagnosis of HFrEF was enrolled. All of them underwent basal 2D echocardiography evaluation. Off-line HDFs estimation using a dedicated software based on speckle-tracking echocardiography was conducted. HDFs were normalized for the LV volume and expressed as a percentage of the force of gravity. HDFs were assessed over the entire cardiac cycle, in systole and diastole, both in apex to base (A-B) and latero-septal (L-S) directions. The distribution of LV HDFs was evaluated by L-S over A-B HDFs ratio (L-S/A-B HDFs ratio). HDFs of HFrEF patients were compared with those of 24 healthy volunteers.

Results
HFrEF patients showed smaller values of A-B HDFs during the entire cardiac cycle (5,2 ± 1,24% vs 12,3 ± 3,6%; p = 0,001), in systole (7,2 ± 2% vs 16,6 ± 6,3%; p = 0,001) and diastole (3,3 ± 0,8% vs 7,1 ± 3,6%; p = 0,001). Moreover, comparing HFrEF subjects with healthy volunteers , the former had lower L-S HDFs during the entire cardiac cycle (1,6 ± 0,4% vs 2 ± 0,7%; p= 0,022) and in systole (1,6 ± 0,5% vs 2,3 ± 0,8%; p = 0,003), while in diastole they showed inappropriate high values of L-S HDFs (1,7 ± 0,6% vs 1,8 ± 0,9%; p = 0,999). Consequently, HFrEF patients had higher values of L-S/A-B ratio during the entire cardiac cycle (32 ± 6,9 vs 15 ± 7,7; p = 0,001), in systole (23,5 ± 7,4 vs 14,7± 4,2; p = 0,001), but particularly in diastole (52 ± 10,8 vs 28 ± 13,6; p = 0,001), showing an important HDFs misalignment.

Conclusion
When compared with healthy controls, HFrEF patients presented intraventricular fluid alterations characterized by lower HDFs magnitude and a significant HDFs misalignment, especially in diastole. Further studies are needed to confirm these initial results and to assess the effects of therapy on these new parameters. Abstract Figure. Abstract Figure.
Normative values of the mitral valve apparatus: a 3D multicenter WASE study exploring age and sex differences
Authors: Henry M , Cotella JI , Mor-Avi V , Investigators WASE 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The mitral valve (MV) is a complex and dynamic structure that can be best evaluated by 3D imaging. Recent advances in mitral percutaneous interventions have escalated the need for a more quantitative and comprehensive assessment of the MV. Understanding normal valve size, structure and function is essential for differentiation of healthy from disease states.

Purpose
Using data from the World Alliance of Societies of Echocardiography (WASE) normal values study, we aimed to determine how normative values for the MV apparatus vary across ages and sexes.

Methods
3D full volume data sets obtained with transthoracic echocardiography in 618 normal subjects (50% male) were analyzed using commercial MV analysis software (TOMTEC) to determine annular and leaflet dimensions and areas (Figure). The subjects were divided into groups by sex (301 men and 311 women) and by age: 18-40 years (N = 211), 41-65 years (N = 201) and &gt;65 years (N = 206) to identify sex- and age-related differences. Inter- and intra-observer variability was assessed in a subset of 30 subjects and expressed as mean absolute difference between pairs of repeated measurements.

Results
Compared to women, men had larger annular dimensions in both the anterior-posterior and anterolateral-posteromedial planes, as well as larger annular circumference and area, larger tenting size parameters, and larger leaflet length and area (Table, bottom left). Age-related differences in multiple parameters were statistically significant (Table, bottom right). Of note, sex- and age-related differences in most MV parameters were comparable to or smaller than the corresponding measurement variability (Table, top right).

Conclusion
This analysis of the WASE data provides normative values of the mitral apparatus size and morphology for male and female subjects. While sex- and age-related differences were noted, they need to be interpreted with caution in view of the associated measurement variability. Abstract Figure. Abstract Figure.
Acute hemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis
Authors: Graziani F , Cialdella P , Lillo R , Locorotondo G , Genuardi L , Ingrasciotta G , Nesta ML , Bruno P , Aurigemma C , Romagnoli E , Calabrese M , Giambusso N , Lombardo A , Burzotta F , Trani C 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. There are limited data about the intraprocedural hemodynamic study performed immediately before and after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS). Purpose. We aimed to evaluate the acute hemodynamic impact of TAVI in patients with severe AS and to investigate invasive and non-invasive parameters predicting all-cause mortality. Methods. A total of 245 consecutive AS patients undergoing TAVI were enrolled. Intraprocedural left heart catheterization (LHC) and echocardiogram before and after TAVI were performed. The clinical endpoint was the death for any cause. Results. LHC after TAVI revealed significant changes in aortic and LV pressures, including indexes of intrinsic myocardial contractility and diastolic function such as positive dP/dT (1128.9 ± 398.7 vs 806.3 ± 247.2 mmHg/sec, p˂0.001; Figure 1A) and negative dP/dT (1310.7± 431.1 vs 1075.1 ± 440.8 mmHg/sec, p˂0.001; Figure 1B). Post TAVI echo showed a significant reduction in LV end diastolic volume index (54.6 ± 18.4 ml/m2 vs 51.7 ± 17.5 ml/m2; p = 0.017; Figure 1C), improvement in left ventricle ejection fraction (from 55 ± 12 to 57.2 ± 10.5%, p˂0.001; Figure 1D) and pulmonary artery systolic pressure (42.1 ± 14.2 vs 33.1 ± 10.7 mmHg, p &lt; 0.001; Figure 1E). After a mean follow-up time interval of 24 months, 47 patients died. Post-TAVI aortic regurgitation (2- 3- 4+) at echocardiography was the only independent predictor of mortality (HR 4.43, C.I. 1,71 – 11,45, p = 0.002; Figure 2). Conclusions. LHC performed immediately before and after prosthesis release offers a unique insight in the assessment ofLV adaptation to severe AS and the impact of TAVI on LV, catching changes in indexes of intrinsic contractility and myocardial relaxation. Aortic regurgitation assessed by echocardiography was the only independent predictor of mortality in patients undergoing TAVI.
FIGURE LEGEND
Figure 1. A-B: Impact of TAVI on haemodynamic parameters: Box plot with median and interquartile ranges of positive dP/dT and negative dP/dT values pre vs post TAVI. C-D-E: Impact of TAVI on echocardiographic parameters: Box plot with median and interquartile ranges of left ventricular end diastolic volume index (LVEDVi), left ventricular ejection fraction (EF) and pulmonary artery systolic pressure (PASP) values pre vs post TAVI.
Figure 2. Kaplan-Meier curves for survival showing that AR (2-3-4+) assessed with echocardiography had the strongest association with mortality. Abstract Figure 1. Abstract Figure 2.
Normal flow, low gradient aortic stenosis - is LVOT the determinant?
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). These patients present with a lower mean gradient (&lt;40mmHg) and area (AVA ≤1cm2). However, the treatment strategies focus on the population with a reduced indexed stroke volume (≤35mL/m2). There is less clarity concerning those with a normal stroke volume. An important determinant of the area and stroke volume is the LVOT diameter, which may have a significant impact in the classification of the severity. There is some literature supporting an expected diameter according to the body surface area.

Purpose
This paper aims to analyse the population with normal flow, low gradient aortic stenosis, as well as compare the impact of the expected LVOT diameter in the classification of patients.

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 as well as echocardiographic variables to properly characterize aortic stenosis.

Results
A total of 79 patients met the criteria for normal flow, low gradient aortic stenosis with a valvular area ≤1cm2. Mean age was 79.5 ± 8.6 years-old and 38% was male. The mean LVOT diameter was 2.11 ± 0.18 cm which correlated to a mean AVA of 0.88 ± 0.10 cm2. Should the LVOT diameter align with the expected diameter according to the formula [(5,7× BSA +12,1)/10], the mean LVOT diameter would be 2.18 ± 0.11 cm, which correlated to a mean AVA of 0.96 ± 0.22cm2. This represents a statistically significant difference in the value, with the expected diameter being 0.075cm higher than the measured (p = 0.002), which translates in a statistically significant higher AVA (+0.085, p &lt; 0,001). With the above data, 31 (38.8%) patients would have been reclassified as moderate aortic stenosis, according to the recalculated AVA alone. Taking into account the indexed AVA, only 22 (27.8%) patients would be reclassified. 8 other patients (10.1%) would have been reclassified as low flow, low gradient aortic stenosis as the recalculated stroke volume would be lower than 35mL/m2.

Conclusion
This paper reminded us of the importance of an appropriately measured LVOT diameter, and the potential impact in reclassification of valvular heart disease. This is more important when the classification may alter our conduct. Other imaging techniques, such as transoesophageal echocardiogram or CT scan, may obviate the squared error of the LVOT measurement as well as account for the geometry of the LVOT, especially in dubious cases. Abstract Figure.
Relationship between right ventricular geometry and function parameters and tricuspid annuloplasty efficacy
Authors: Krivickiene A , Verikas D , Norvilaite R , Ereminiene E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

INTRODUCTION
The prevalence of untreated moderate and severe functional tricuspid regurgitation (TR) eventually leads to heart failure and is associated with poor prognosis. Therefore, tricuspid annuloplasty (TA) is offered as a first-line treatment for significant functional TR. However, studies to investigate factors leading to recurrent TR after TA are still scarce.
AIM
The aim is to investigate the relationship between right ventricular (RV) geometry and function parameters and recurrent TR after TA.

METHODS
Prospective observational cohort study enrolled patients with moderate or severe functional TR caused by left heart valvular disease who underwent surgical tricuspid valve (TV) repair. The dominant pathology was severe mitral regurgitation. Patients with ischemic heart disease (assessed by coronary angiography) were excluded from the analysis. The current study included 60 patients with full sets of preoperative 2D and 3D echocardiographic parameters. Echocardiographic quantification included the following parameters: the RV and RA geometry, functional (velocity of the tricuspid annular systolic motion [S’] and RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE] and RV ejection fraction (EF)). The severity of TR was measured quantitatively according to the recent ESC guidelines. Patients were divided into two groups according to the outcomes of TA: effective (38 pts.) and ineffective (22 pts.) TV repair. Effective TA was considered if TR 1 year after surgery was mild, while ineffective – TR was moderate or severe (recurrent TR). The statistical analysis was performed using SPSS statistical software, univariate logistic regression was used.

RESULTS
In 60 patients of current analysis 67% were female, mean age was 67 ± 9 years. The odds ratio for risk of ineffective TA are shown in Table 1. Age, gender, body mass index, left ventricular (LV) functional, as well as left atrial parameters did not differ between effective and ineffective TA groups. When analysing echocardiographic parameters in univariate logistic regression, RV and RA geometry, TV annulus diameter had predictive value for ineffective TA. Preoperative effective regurgitant orifice area (EROA) did not differ significantly between two groups (ineffective TA vs. effective TA; 31 [60] mm2 vs. 24 [17] mm2, p = 0.308 respectively). Meanwhile, none of the RV functional parameters were significant.

CONCLUSION
Recurrent moderate or severe functional tricuspid regurgitation after tricuspid annuloplasty is associated with preoperative tricuspid annulus size, RA and RV geometry, but not with changes of RV function. Abstract Figure.
Novel method of diastolic stress echocardiography during bottle-feeding for infants with congenital heart disease
Authors: Iwashima S , Katuki J , Katuki J , Hayno S , Hayno S , Seki K , Seki K , Takahashi K , Takahashi K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Recent studies have demonstrated the utility of diastolic stress echocardiography in evaluating diastolic dysfunction during exercise in adults. However, there have been no such reports in infants. This study determined whether measuring cardiac function using echocardiography during bottle feeding is a valid method of stress testing in infants with congenital heart disease.

Methods
The study population comprised 25 infants with congenital heart disease (Table 1). Echocardiographic measurements of the infants were taken during and after bottle feeding (Figure 1A). Active feeding (AF) was defined as the start of feeding during which the heart rate started increasing. End of feeding (EF) was defined as the time of completion of feeding during which the heart rate slowed down. The 25 infants were divided into two groups according to brain natriuretic peptide levels: less than 50 pg/ml (low group) and more than 50 pg/ml (high group). Cardiac function was compared between the groups using 2D speckle tracking analysis, and intraventricular pressure differences (IVPD) via color M-mode Doppler (Figures 1B and 1C) and 2D echocardiography. We compared the fractional change (FC%), defined as (AF and EF measurements)/EF measurements, between the two groups.

Results
Heart rate increased AF comparing with EF, significantly in both groups, the low group from 162 to 139 bpm; the high group from 152 to 140 bpm. The FC_IVPD was higher in the low group than in the high group (Figure.2). There were negative correlations between brain natriuretic peptide levels and the FC_IVPD (Figure 3). There were 4 cases were performed the intra-cardiac repair (ICR). In 2 cases, VSD and right ventricular outflow tract obstruction (RVOTO) velocity were increased during feeding. Indication of ICR, VSD case was aortic regurgitation with aortic cusp prolapse, TOF case was RVOTO. In VSD peak velocity in 2 cases did not increase during feeding (Table2). Indication of
ICR, two VSD cases were moderate left to right shunt, or pulmonary hypertension.

Conclusions
Our findings indicate that stress echocardiography during bottle-feeding might be a substitute for diastolic stress echocardiography in infants. The VSD or RVOT peak velocity, and FC% in IVP D and IVPG are sensitive markers for cardiac function in infants with congenital heart disease. Abstract Table1 Abstract Figure.
Exercise stress echocardiography in paediatric and adolescent patients
Authors: Avesani M , Calvo G , Sabatino J , Sirico D , Castaldi B , Reffo E , Cerutti A , Biffanti R , Borrelli N , Piccinelli E , Fraisse A , Padalino M , Vida V , Di Salvo G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

INTRODUCTION
Exercise stress echocardiography (ESE) is still underused in paediatric patients, and very little data is available for congenital heart diseases (CHDs).

PURPOSE
To describe the current application of ESE in our Paediatric Cardiology Departments.

METHODS
Data from patients who underwent ESE in our Centres, including baseline and under stress symptoms, vital parameters, ECG, and echocardiograms were retrospectively analyzed and compared, as well as clinical management plans formulated based on ESEs results.

RESULTS
Forty-five patients from Centre 1 (median age 16 years), including 87% of patients with CHDs, and 20 patients from Centre 2 (median age 11 years), mainly tested to rule out myocardial ischemia, were included. Among patients from Centre 1, 28 had previously been treated surgically, 6 percutaneously and 11 were under follow-up. Indications for ESE/patients’ native diagnosis are illustrated in the picture.
Centre 1: Exercise was maximal in 17 patients, with 2 of them having symptoms at the peak of exercise. It was stopped beforehand in 28 patients because of dyspnea (3) and muscle fatigue (25). No arrhythmia was detected. ESE was considered as positive in 14 patients; after that, 3 patients underwent percutaneous interventions, 2 underwent cardiac surgery, 3 received indication for cardiac catheterization, 4 for advanced cardiac imaging and 2 for exercise restriction and medical therapy.
Centre 2: Fifteen patients (75%) completed the exercise, and none of them developed symptoms. In the remaining 25%, exercise was stopped because of muscle exhaustion. No arrhythmia was detected, and all the ESEs were negative.
Comparing the cohorts, no significant differences in terms of ejection fraction were noticed at rest and under stress. Patients in cohort 1 were older (p = 0,002), they achieved lower average maximal heart rate (p = 0,0001), performed less lasting exercise (p = 0,05) and ESE was maximal less frequently (p = 0,005). Lastly, they had significant changes in clinical decisions (p = 0,004).

CONCLUSIONS
ESE is a feasible and promising technique in paediatric cardiology, particularly in children with congenital heart diseases, and could influence significantly clinical management plans. Abstract Figure.
An atrioventricular septal defect with an Ebsteinoid right atrioventricular valve
Authors: Hall S , Deri A , Delle Donne MG 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
The combination of an atrioventricular septal defect (AVSD) with an Ebsteinoid atrioventricular valve is incredibly rare with only a handful of cases being described in the literature (1, 2). In this poster we describe the diagnosis of this anatomy in a neonate born at our centre.
The baby was antenatally diagnosed with a chromosome 8p23.1 microdeletion which is associated with congenital heart disease and developmental delay (3). Although fetal echo had revealed a high suspicion of congenital heart disease, maternal BMI had prevented a precise diagnosis. The baby was born in good condition at thirty-nine weeks gestation weighing 2.4kg. She had been admitted to the neonatal unit where she was self-ventilating in room air with saturations above 90%. The echocardiogram was performed at one hour of age.
The initial echo revealed a normal atrial arrangement with the heart in the left chest and the apex pointing to the left. There was normal pulmonary and systemic venous drainage. There was a complete AVSD with sizeable atrial and ventricular components. The left atrioventricular valve was dysplastic with at least moderate regurgitation. The right atrioventricular valve was displaced caudally and rotated into the right ventricular outflow tract. The right atrioventricular valve was also regurgitant. The right ventricle above the displaced atrioventricular valve was atrialized with the true right ventricle limited to the outlet portion. The great arteries were normally related. The ventricular component of the AVSD opened into the sub-pulmonary area along with two smaller muscular ventricular septal defects.
These findings raised many clinical concerns including the insufficiency of the right ventricle to support a biventricular repair. Similarly, the severe left atrioventricular valve regurgitation precluded single ventricle palliative surgical techniques. After discussion between the multidisciplinary team and a second opinion sought from another centre, the family was counselled that this was a complex and life limiting form of congenital heart disease. Although surgical options were discussed with the family, the family opted for comfort care and the baby passed away at three weeks of age.
Image 1: A complete AVSD with an Ebsteinoid right atrioventricular valve displaced caudally (a) resulting in an atrialized right ventricle (b). In addition, the left atrioventricular valve which straddles the ventricular septum is severely dysplastic (c) and regurgitant (d). Abstract Figure. Image 1: An Ebsteinoid AVSD