bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left bundle branch pacing is superior in preserving ventricular mechanical synchrony and cardiac function than right ventricular pacing: a two-center experience
Authors: Mao Y K , Yang Y , Duchenne J , Garweg C , Sheng X , Zhang J F , Yang Y , Wang M , Yang Y , Voros G A B O R , Fu G S , Voigt J U 
Published: October 2022

Abstract

Background
Left bundle branch pacing (LBBP) has emerged as a novel pacing modality. Although it has been proved to maintain electrical synchrony better than right ventricular pacing (RVP), little is known about the impact on mechanical synchrony. This study investigates if LBBP preserves mechanical synchrony and cardiac function better compared to 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. All patients underwent echocardiography before and after implantation and at one-year follow-up. Left ventricular (LV) volumes, ejection fraction (EF) and global longitudinal strain (GLS) were measured. Regional septal (SW) and lateral wall work (LW) was calculated as the average from the respective basal and mid-ventricular segments in the apical four-chamber and three-chamber view. The lateral-septal work difference (LSWD) was used as a measure of mechanical dyssynchrony.

Results
At baseline, the QRS duration and LSWD were similar in all three groups. During follow-up, the QRS duration increased least in LBBP compared to CRVP and LRVP (+28.1±18.3ms vs +58.2±31.4 and 47.1±26.1ms, both P&lt;0.01). SW was markedly decreased in CRVP and LRVP while LW work remained unchanged, resulting in a large LSWD compared to LBBP (1308.4±732.9 mmHg*% and 1451.3±606.1 mmHg*% vs. 286.0±479.9mmHg*%, both P&lt;0.001). During one year follow-up, LVEF and LV GLS decreased more in CRVP compared to LBBP (both P&lt;0.05).

Conclusion
LBBP causes less LV dyssynchrony than CRVP and LRVP as it preserves a more physiologic conduction pattern. With this, LBBP appears to preserve LV function better than CRVP. CRVP and LRVP did not differ in mechanical dyssynchrony or LV remodelling.

Funding Acknowledgement
Type of funding sources: None.
Impact of post-transplant diabetes on left ventricular function following heart transplantation
Authors: Borgenvik S , Jumatate R , Giesdal G , Werther Evaldsson A , Braun O , Smith G , Radegran G , Meurling C , Ingvarsson A 
Published: October 2022

Abstract

Background
Orthotopic heart transplantation (OHT) is an end-stage treatment option for heart failure (HF). Although post-transplant diabetes (PTDM) is a well-described complication following immunosuppressive treatment, the impact on LV function post-OHT has not been evaluated. The purpose of this study was to analyse the influence of PTDM on LV function in OHT patients using conventional and speckle tracking echocardiography. Furthermore, we aimed to compare echocardiographic LV function parameters to HbA1c levels in OHT recipients with or without PTDM.

Methods
The study included 104 (n=77 male, mean age 51±15 years) consecutive OHT patients (PTDM n=36) examined at their routine 3-year follow-up. Blood pressure, heart rate, and HbA1c levels were recorded in conjunction with the echocardiographic examination.

Results
Participants with PTDM demonstrated impaired LV function measured by global longitudinal strain (p=0.002). Patients with PTDM also revealed increased septum diameter (p=0.008), and a lower diastolic EA-ratio (p=0.04) compared to the non-PTDM patients. A weak correlation between high HbA1c levels and poor LVGLS was detected (r=0.30, p&lt;0.05). No correlation was found when comparing echocardiographic parameters to blood pressure and heart rate.

Conclusion
A subtle LV dysfunction, including remodelling of the heart (i.e., increased wall thickness), reduced longitudinal contractile function, and altered diastolic function, was present in OHT patients with PTDM. Our findings suggest that sub-clinical myocardial dysfunction is present in OHT patients with PTDM and may progress to clinical LV dysfunction and HF. Hence, analysing secondary cardiac effects of PTDM in OHT patients may have a therapeutic and prognostic value and could potentially influence long-term patient survival.

Funding Acknowledgement
Type of funding sources: None.
New echocardiographic approaches to differentiate cardiac amyloidosis and Fabry disease: the right heart and mitral valve thickness
Authors: Mattig I , Steudel T , Romero Dorta E , Barzen G , Frumkin D , Laule N , Al-Daas M , Spethmann S , Stangl K , Knebel F , Canaan-Kuehl S , Hahn K , Brand A 
Published: October 2022

Abstract

Background
Infiltrative cardiomyopathies such as cardiac amyloidosis (CA) and Fabry disease (FD) are associated with high cardiovascular morbidity and mortality. Diagnosis is often challenging as CA and FD may present similar cardiac phenotypes on standard echocardiographic imaging, especially in early stages of disease.

Purpose
Our study focuses on right ventricular (RV) two-dimensional speckle tracking imaging and mitral valve thickness as diagnostic strategies to discriminate CA from FD. Here, we report preliminary data of our study registry of CA and FD patients.

Methods
We retrospectively screened patients with diagnosed CA or with genetically confirmed FD from our study registry. Global and free wall RV strain and mitral leaflet thickening in both groups were analysed using 2D speckle tracking echocardiography and linear measurements from a parastenal long axis view, respectively (Vivid E9 or E95, GE Vingmed, Horton, Norway, M5S 1.5–4.5MHz transducer). The diagnostic accuracy for discriminating CA and FD in both groups was evaluated using receiver operating characteristic (ROC) curve analysis.

Results
A total of 33 FD and 27 CA patients, including 17 patients with wild-type transthyretin-related (ATTR) CA, 8 patients with hereditary ATTR CA, one patient with light chain CA, and one patient with AA CA, were included. RV function was significantly reduced in CA compared to FD patients as measured by global longitudinal RV strain (−13.6±5.1 in CA vs. −18.4±3.9 in FD, p&lt;0.001) and free wall longitudinal RV strain (−17.5±5.7 in CA vs. −21.3±4.4 in FD, p=0.005). Significantly lower longitudinal RV strain was observed in the basal to mid ventricular region in CA compared to FD patients, while RV apical strain was not significantly different between the two groups. RV global longitudinal strain had the highest diagnostic accuracy of strain analyses (area under the curve [AUC] 0.79, 95% confidence interval [CI] 0.66–0.93) to discriminate CA from FD. Additional measurement of the mitral valve in mid diastole in the parasternal long axis view revealed a significantly thickened leaflet in CA patients (4.6±1.2 mm in CA vs. 2.9±1.0 mm in FD, p&lt;0.001) corresponding to an AUC of 0.84 (95% CI 0.72–0.96) in ROC analysis.

Conclusion
Global longitudinal RV strain was significantly reduced in CA patients while the mitral valve leaflets were significantly thickened compared to FD patients. Therefore, both parameters may be useful to discriminate CA from FD in the echocardiographic workup of patients with unclear left ventricular wall thickening.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Alnylam Pharmaceuticals (Cambridge, MA, USA)
The prognostic value of the ratio of early transmitral filling velocity to early diastolic strain rate in a large general population cohort
Authors: Lassen M H , Skaarup K G , Johansen N D , Qasim A N , Jensen G B , Schnohr P , Moegelvang R , Biering-Soerensen T 
Published: October 2022

Abstract

Background
The ratio of early transmitral filling velocity (E) to early diastolic strain rate (e'sr) (E/e'sr) has recently been proposed as a novel non-invasive measure of early LV filling pressure. Using two-dimensional speckle tracking derived e'sr instead of Doppler-derived e' circumvents several of the limitations known to the Doppler-based method including angle-dependency and the high susceptibility to sampling location. The prognostic value of E/e'sr in relation to cardiovascular morbidity and mortality has previously been demonstrated in a range of specific patient populations including patients with type 2 diabetes, heart failure, atrial fibrillation, and a smaller general population study.

Purpose
To investigate the prognostic value of E/e'sr in relation to major adverse cardiovascular events (MACE) in a large low-risk general population.

Methods
A total of 3,782 participants were included in the present study. All participants had a comprehensive echocardiographic examination performed and analyzed. Two-dimensional speckle tracking analysis was performed to determine e'sr. Additionally, participants answered a questionnaire and underwent a general health examination. The outcome was MACE defined as a composite of incident heart failure, acute myocardial infarction, and cardiovascular death. Cox proportional hazards regression models were used to assess the relationship between E/e'sr and MACE.

Results
The mean age of the study population was 56±17 years and 57.2% were female. Mean E/e'sr was 63.4±19.6cm, mean E/e' was 7.6±2.8, and mean left ventricular ejection fraction was 56.8±5.9%. During follow-up (median: 3.5 years, IQR: 2.6, 4.3) a total of 133 (3.5%) met the composite outcome. Increasing E/e'sr was significantly associated with MACE in a univariable model (Figure 1) with a Harrel's C-statistic of 0.73. Increasing E/e'sr remained significantly associated with MACE in a multivariable model adjusted for age, sex, smoking status, hypercholesterolemia, hemoglobin, diabetes, history of ischemic heart disease, hypertension, heart rate, LVEF &lt;50%, systolic blood pressure, and left atrial volume index (HR=1.09 [95% CI: 1.03; 1.16], p=0.002, per 10cm increase). A total of 824 participants had an E/e' in the indeterminate zone (E/e' between 9 and 14). In this subgroup, E/e'sr remained significantly associated with MACE (HR=1.14 [95% CI: 1.01; 1.29], p=0.038, per 10cm increase). This was also the case in all participants with a E/e &lt;14 (n=3,649) (HR=1.12 [95% CI: 1.02; 1.23], p=0.018, per 10cm increase).

Conclusion
In this large general population sample, E/e'sr provides independent prognostic information in relation to MACE. This was even the case in participants with normal E/e'.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Gentofte University Hospital
Combined left and right atrial stiffness index as an independent predictor of rehospitalization in dilated cardiomyopathy
Authors: Vijiiac A E , Scarlatescu A , Cojocaru C , Verinceanu V , Petre I , Onciul S , Dorobantu M , Vatasescu R 
Published: October 2022

Abstract

Background
Left atrial stiffness index (LASI) derived from speckle-tracking echocardiography (STE) is a marker of pressure transfer to the pulmonary circulation and a predictor of symptoms in patients with heart failure (HF). However, the role of the right atrial stiffness index (RASI) in the setting of left-sided HF is incompletely understood.

Purpose
We sought to evaluate the left, right and combined bi-atrial stiffness index (BASI) in a cohort of patients with dilated cardiomyopathy (DCM) and to assess their prognostic role.

Methods
We prospectively enrolled 60 consecutive patients with DCM in sinus rhythm, who underwent transthoracic echocardiography. As previously described, LASI was defined as the ratio between early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e') and left atrial reservoir strain derived from STE. RASI was defined as the ratio between early diastolic tricuspid flow velocity/lateral tricuspid annulus myocardial velocity (Et/e't) and right atrial reservoir strain. BASI was defined as the sum of LASI and RASI. Patients were followed for 19±9 months for an endpoint of HF decompensation requiring hospitalization.

Results
29 patients reached the endpoint. Patients with rehospitalization had higher LASI (2.50±2.15 vs. 1.23±1.61, p=0.01), higher RASI (0.76±0.77 vs. 0.36±0.41, p=0.02) and higher BASI (3.25±2.65 vs. 1.59±1.71, p=0.006). In univariate Cox regression, all three stiffness indices were predictors of adverse outcome: HR=2.63 [95% CI, 1.22–5.66], p=0.014 for LASI, HR=2.86 [95% CI, 1.26–6.48], p=0.012 for RASI, HR=3.49 [95% CI, 1.49–8.20], p=0.004 for BASI. A multivariable model was constructed using well-established event predictors in DCM. After adjustment for age, left ventricular ejection fraction and indexed maximal left atrial volume, BASI was the only stiffness index that remained an independent predictor of rehospitalization for HF: HR=2.76 [95% CI, 1.08–7.03], p=0.03. In ROC analysis, a BASI greater than 1.25 had a 75.9% sensitivity and 64.5% specificity for event prediction (AUC=0.716, p=0.004).

Conclusion
Stiffness of both atria is significantly greater in patients with DCM who get hospitalized for HF decompensation. Combining the left and right atrial stiffness indices provides a better prognostic stratification than left or right atrial stiffness alone, since BASI was the only stiffness index that remained an independent predictor of rehospitalization after adjustment for confounders.

Funding Acknowledgement
Type of funding sources: None.
Assessment of atrial conduction times in patients with frequent premature venticular complex
Authors: Kahraman E , Keles N , Parsova K , Bastopcu M , Karatas M 
Published: October 2022

Abstract

Background
Premature ventricular complex (PVC) is common in general population. The atrial conduction time (ACT) represents the interval between electrocardiographic P wave and atrial mechanical contraction, and the prolongation of ACT called atrial electromechanical delay (EMD). In the present study, we investigated atrial conduction parameters through echocardiography in patients with frequent PVC.

Methods
The study involved 54 patients with PVC and 54 healthy volunteers as a control group. A comprehensive echocardiographic examination was done. The time difference between the onset of the p wave and septal Am wave was the PA septal, the time difference between the onset of the p wave and the lateral Am wave was the PA lateral, and the time difference between the onset of the p wave and the tricuspid annulus Am wave was the PA tricuspid. The interatrial EMD was the time difference between the PA lateral and the PA tricuspid, the left atrial (LA) intraatrial delay was the time difference between the PA lateral and the PA septal and the right atrial (RA) intraatrial delay was the time difference between the PA septal and the PA tricuspid.

Results
LA anterior-posterior dimension and LA maximum volume were significantly larger in the patient group. Left intraatrial EMD, right intraatrial EMD, and interatrial EMD were significantly longer in the patient group. PA lateral, PA septal, PA tricuspid durations were significantly prolonged in the patient group.

Conclusions
Atrial conduction times were prolonged in patients with frequent PVC.

Funding Acknowledgement
Type of funding sources: None.
Speckle tracking-derived left atrial strain rate – undervalued and useful predictor of adverse events
Authors: Kupczynska K , Miskowiec D , Michalski B W , Wejner-Mik P , Lipiec P , Kasprzak J D 
Published: October 2022

Abstract

Background
Strain rate reflects the rate of change of the distance between two points of the myocardium occurring in the cardiac cycle. It is a time-dependent parameter requiring higher temporal resolution than standard strain assessment. Because of this limitation, speckle tracking-derived left atrial (LA) strain rate analysis is of less interest in the literature.

Purpose
To analyze the prognostic value of LA strain rate during 2-years follow-up in patients with atrial fibrillation (AF).

Methods
The prospective study involved 80 patients with nonvalvular AF scheduled for elective electrical cardioversion (mean age 63.5±13 years, 60% male). All patients underwent echo before cardioversion and 24 hours after conversion to sinus rhythm. We analyzed standard echocardiographic parameters. Using the speckle-tracking method, we assessed LA strain rate during ventricular systole LA-SSR, in the early stage of ventricular diastole LA-ESR, and during atrial active pump phase LA-ASR. The last one is possible to measure only in the sinus rhythm. The analysis included 4-chamber and 2-chamber views. The clinical endpoint was predefined as AF recurrence.

Results
Median time of the current AF episode was 2.1 (IQR 0.5–5) months. Standard echo measurements revealed a median left ventricular ejection fraction of 55% (IQR 46–58) and the median of LA volume indexed to body surface area 42 ml/m2 (IQR 33–51). The successful cardioversion rate was 90%. During follow-up, we noticed AF recurrence in 49 (68%) patients. The median time-to-event was 2 (IQR 1 to 6.9) months. Receiver operating characteristic curve analysis revealed that LA-SSR &lt;−0.73 s–1 (AUC=0.745; p=0.0004) and LA-ESR &gt;−1 s–1 (AUC=0.703; p=0.0015) assessed during AF as well as LA-ESR &gt;−0.88 s–1 (AUC=0.644; p=0.04) and LA-ASR &gt;−1 s–1 (AUC=0.837; p&lt;0.0001) measured in sinus rhythm were the optimal cut-off values for predicting AF recurrence. The figure presents Kaplan-Meier survival analysis for AF recurrence.

Conclusions
Speckle tracking-derived LA strain rate predicts the recurrence of AF after successful electrical cardioversion.

Funding Acknowledgement
Type of funding sources: None.
Predictors of shear wave propagation speed assessed by shear wave elastography
Authors: Bezy S , Cvijic M , Petrescu A , Werner A E , Orlowska M , Duchenne J , D'hooge J , Voigt J U 
Published: October 2022

Abstract

Background
Cardiac shear wave elastography (SWE) is a novel ultrasound-based method that assesses the propagation speed of shear waves travelling in the myocardium induced by e.g. mitral valve closure (MVC). The propagation speed of these waves is related to the stiffness of the myocardium. The capability of SWE to evaluate myocardial stiffness has already been demonstrated in several publications. However, which factors beside the intrinsic mechanical properties of the myocardium influence shear wave speed in vivo has not been extensively investigated.

Purpose
The aim of this study was to investigate the influence of clinical parameters as well as echocardiographic indicators of myocardial tissue properties and left ventricular (LV) filling pressures on shear wave propagation speed after MVC.

Methods
219 subjects (59±17 years; 140 males) were included in the study. Of those, 49 were healthy volunteers, 25 were patients with cardiac amyloidosis, 42 with hypertrophic cardiomyopathy, 35 with hypertensive heart disease and 68 with coronary artery disease. Subjects were scanned with an experimental ultrasound scanner using diverging wave imaging to acquire images at a high temporal resolution (average frame rate: 1167±414 Hz). Shear waves after MVC were visualized on M-mode maps along the interventricular septum which were colour coded for tissue acceleration (Figure 1). The propagation speed was calculated by semi-automatically measuring the spatiotemporal slope of the shear wave. Univariate and multivariate linear regression analysis was performed to identify variables associated with shear wave propagation speed.

Results
Univariate regression analysis revealed an association of the following variables with shear wave speed: age, BMI, systolic blood pressure, E wave, average e', E/e', left atrial volume index (LAVI), grade of diastolic dysfunction, isovolumic relaxation time, septal wall thickness, LV wall mass and presence of cardiomyopathy. These variables were added to a multivariate model. Predictors of shear wave speed after MVC were BMI, E wave, average e', LAVI, LV wall mass and presence of cardiomyopathy (R2=0.53) (Table 1).

Conclusions
The results of this study indicate that both myocardial structural properties (reflected by predictors LV wall mass and presence of cardiomyopathy) and LV filling pressures (reflected by predictors E wave, average e' and LAVI) affect shear wave speed. These findings suggest that SWE has the potential to assess structural as well as functional changes to the LV, which should be further explored.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Research foundation Flanders - FWO
Changes of RV-PC coupling during negative for myocardial ischemia dobutamine stress echocardiography
Authors: Koukos M , Giannoulis E , Solomou E , Poulidakis E , Dimitroglou I , Patsourakos D , Chatzigeorgiou V , Liakos C , Tsartsalis D , Kalompatsou A , Valatsou A , Aggeli C , Tsioufis K 
Published: October 2022

Abstract

Background
Coupling between RV contractile function and pulmonary circulation (PC) reflects the comprehensive performance of the RV by integrating afterload and contractility. RV-PC coupling is nowadays frequently expressed by the non-invasively measured ratios TAPSE/RVSP and RVFWLS/RVSP. It has been shown that it decreases slightly during exercise, whereas no known data exist on how dobutamine does affect it.

Purpose
The aim of this study was to evaluate the changes in RV-PC coupling and RV mechanics during the different stages of dobutamine stress echocardiography (DSE) in cases without known coronary artery disease (CAD) and negative for myocardial ischemia DSE.

Methods
Patients with a low-to-intermediate risk for CAD were referred for and underwent DSE. RV systolic function was evaluated with TAPSE, S' and RV Free Wall (RVFW) Strain. The non-invasively measured RV-PC coupling was evaluated by indexing TAPSE and RV free wall longitudinal strain to right ventricular systolic pressure (RVSP) during baseline echocardiogram, low dose (inotropic dobutamine effect) and peak dose (chronotropic effect) stages of DSE.

Results
Initially, a total of 53 patients underwent DSE. Eight patients had a positive for ischemia response and were excluded.
The remaining 45 patients {mean age 65±8.7, 28 (63%) male}, 24 (53%) had hypertension, 24 (53%) were smokers, 33 (74%) had dyslipidemia, 15 (34%) had family history of CAD and 7 (15%) had diabetes mellitus. TAPSE, S' and RVFW Strain increased from baseline to peak dose [23.55±2.91 vs 28.76±1.9 (p&lt;0.001), 13.13±1.79 vs 23.83±4.87 (p&lt;0.001) and 19.7±5.87 vs 23.46±5.42 (p=0.044) respectively].
TAPSE/RVSP showed a significant steady decrease between baseline and low dose (0.88±0.14 vs 0.79±0.19) and peak dose (0.88±0.14 vs 0.74±0.12) stages with a difference of 0.09 (p value 0.013) and 0.14 (p value 0.000) respectively. On the other hand, RVFW Strain/ RVSP exhibited a significant decrease (0.60±0.15, p value 0.000) only between baseline and peak dose.
There was no significant correlation of the change in TAPSE/RVSP with the change in E/E' or change in Systolic Blood Pressure.

Conclusions
RV-PC coupling decreases during negative for ischemia DSE independently of LV dynamic changes and therefore, future studies should be oriented to evaluate the incremental role of this novel index not only for the assessment and evaluation of myocardial ischemia and RV disease that affects RV coupling, but also as a prognostic marker for patients with no evident ischemia.

Funding Acknowledgement
Type of funding sources: None.