bluuebunny/crossref_metadata_2025_split huggingface dataset:
The link between left atrial mechanics and the pulmonary circulatory-right ventricular uncouplings in acute decompensated heart failure
Authors: Barki M , Losito M , Caracciolo M M , Rovida M , Alfonzetti E , Guazzi M 
Published: October 2022

Abstract

Background
The worsening of right ventricular (RV) function and its uncoupling to pulmonary circulation (Pc) represents a turning point in terms of clinical outcome in heart failure (HF) patients. Relate to this In this context, the deterioration of Left Atrial (LA) function, which physiologically act as a watershed between the LV and the right heart cavities, favors the development of pulmonary venous congestion and vascular remodeling, triggering congestion. This is most apparent in the setting of Acute Decompensated Heart Failure (ADHF), where LA dysfunction unmask pulmonary capillary hypertension. The link between the acute changes in LA dynamics and the adaptive/maladaptive hemodynamic RV-to-Pc coupling is not defined in the acute decompensated (AD) HF.

Purpose
To investigate, in a cohort of ADHF patients, the association between the degree of RV-to-Pc uncoupling, assessed by the ratio between tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP), and LA mechanics, evaluated with Speckle Tracking Echocardiography (STE).

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. In the acute phase all patients underwent cardiac echocardiography and laboratory blood testing. Patients were then stratified in tertiles according to TAPSE/PASP ratio (group I: &lt;0.4 mm/mmHg; group II: 0.4 to 0.6 mm/mmHg and group III: &gt;0.6 mm/mmHg) correlating the degree of RV-to-Pc with LA mechanics. LA function was evaluated analyzing LA strain at peak relaxation and STE analysis was performed offline.

Results
At baseline, patients exhibited a high prevalence of RV dysfunction, increased PASP and an impairment in terms of RV coupling to PC (average TAPSE/PASP at admission: 0.44±0.18 mm/mmHg). When stratified in tertiles according to TAPSE/PASP ratio (group I: &lt;0.4 mm/mmHg; group II: 0.4 to 0.6 mm/mmHg and group III: &gt;0.6 mm/mmHg), exhibited an exponential direct relationship between LA-Strain values at admission, with levels increasing progressively with the increment of the ratio (Figure 1). A linear correlation between the degree of RV-to-Pc uncoupling and a more severely depressed LA functioning was noticed (r=0.4, CI 95% 0.21–0.57; p&lt;0.001) (Figure 2).

Conclusions
In ADHF, there is a strong association between RV to Pc uncoupling and echo-derived measures of LA mechanics. These data underscore the importance to detect and treating the LA mechanical properties to blunt the negative repercussions on the right heart ultimately impacting on the clinical evolution.

Funding Acknowledgement
Type of funding sources: None.
High resting coronary flow velocity predicts worse survival in chronic coronary syndromes
Authors: Ciampi Q , Cortigiani L , Zagatina A , Gaibazzi N , Rigo F , Picano E 
Published: October 2022

Abstract

Background
Coronary flow velocity (CFV) in the mid-distal left anterior descending coronary artery (LAD) can be easily assessed with transthoracic echocardiography (TTE). Although high resting CFV is associated with a reduced coronary flow velocity reserve which is a predictor of poor outcome, the prognostic significance of resting CFV remains unknown.

Aim
To assess the relationship between resting CFV and outcome.

Methods
Out of 11,410 initially screened, we prospectively enrolled 10,023 patients (age 64±12 years, 5,902 men, left ventricular ejection fraction [LVEF] 58±10%) with chronic coronary syndromes referred for resting TTE and with interpretable CFV. Recruitment (years 2004–2020) involved 5 accredited laboratories, with inter-observer variability &lt;10% for CFV at study entry. Baseline peak diastolic CFV was obtained by pulsed-wave Doppler in mid-distal LAD. All-cause death was the only end-point.

Results
The feasibility of CFV was 95%. The mean CFV of LAD was 32±14 cm/s. By multivariable logistic regression analysis diabetes mellitus, prior myocardial infarction, lower LVEF and higher age, heart rate, and systolic blood pressure were associated with the highest quintile of CFV. During a mean follow-up of 4.6±3.7 years, 1,066 died. Mortality at 10-years was lowest (15%) in patients in the lowest quintile (≤24 cm/s) and highest (34%) in patients in the highest (≥38 cm/s) quintile of CFV. Age (HR 1.057, 95% CI 1.053–1.062; p&lt;0.0001), diabetes mellitus (HR 1.845, 95% CI 1.573–2.164; p&lt;0.0001), prior coronary surgery (HR 1.350, 95% CI 1.064–1.712; p=0.01), LVEF (HR 0.973, 95% CI 0.963–0.982; p&lt;0.0001), the 4th quintile (HR 1.267, 95% CI 1.010–1.589; p=0.04), and the 5th quintile of CFV of LAD (HR 1.311, 95% CI 1.040–1.652; p=0.02) independently predicted mortality. At incremental analysis, CFV of LAD added prognostic information to clinical findings and LVEF.

Conclusion
CFV imaging in mid-distal LAD is highly feasible with TTE. High resting CFV predicts worse survival in the long-term.

Funding Acknowledgement
Type of funding sources: None.
Combined cardiopulmonary test and exercise Doppler echocardiography in systemic sclerosis
Authors: Quevedo N M , Simbine R E B , Bellagamba C C A , Torres M 
Published: October 2022

Abstract

Background
Cardiopulmonary exercise test (CPET) and exercise Doppler echocardiography (EDE) may be useful for the early detection of pulmonary hypertension in systemic sclerosis (SSc)

Aim
To assess the feasibility of CPET and EDE in detecting early changes in gas exchange and/or pulmonary hemodynamics in SSc

Methods
From 2016 to 2021, we evaluated 19 SSc patients (Group 1, age = 52.58±11.27, women 17 (89.5%)), and age 32.10±6.67, men 17 (89.4%) matched healthy controls (Group 2). Simultaneous CPET and EDE were performed. With CPET, we assessed peak oxygen uptake (VO2), peak respiratory quotient (RQ), respiratory equivalent ratio for carbonic gas (VE/VCO2), and maximal respiratory equivalent divided by maximal ventilatory ventilation (V̇E Max/VVM). With EDE, we assessed tricuspid regurgitant velocity (TRV) jet and pulmonary flow acceleration time (ACT) to derive systolic pulmonary arterial pressure (SPAP).

Results
Exercise duration was similar in the 2 groups (Group 1 = 9.2±2.93 vs Group 2 = 10.14±1.78 minutes). Among CPET parameters, SSc patients showed lower peak VO2 (Group 1 = 1.23±0.55 vs Group 2 = 2.45±0.7, p&lt;0.001), similar RQ (1.10±0.10 vs 1.17±0.09;. p=0.036), VE/VCO2 (Group 1 = 31.90±3.65 vs Group 2 = 23.79±2.64, p&lt;0.001) and V̇E Max/VVM (Group 1 = 1.93±0.60 vs Group 2 = 1.76±0.36, p=NS). With EDE, feasibility at peak stress was low for TRV (Group 1 = 42% vs Group 2 = 58%, p=NS), moderate for ACT (Group 1 = 53% vs Group 2 = 78%, p=NS) and high when at least one was technically adequate (Group 1 = 73% vs Group 2 = 100%, p&lt;0.001). Rest TRV (Group 1 = 2.48±0.14 vs Group 2 = 2.08±0.12 m/s, p=0.033) and ACT (Group 1 = 100.14±10.63 vs Group 2 = 108.86±6.38 ms, p=0.482) showed similar values in the 2 groups (será que ficou similar?). During stress, TRV increased more markedly in SSc (Group 1 = 3.33±0.32 vs Group 2 = 2.34±0.09 m/s, p=0.004) and ACT decreased (Group 1 = 81.9±6.54 vs 73.39±5.18 ms, p=0.304), with estimated peak SPAP higher in SSc (Group 1 = 53.34±7.88 vs Group 2 = 43.33±5.49, p&lt;0.001): see figure.

Conclusion
CPET and EDE offer complementary information on gas exchange and pulmonary hemodynamics in SSc and can detect early alterations missed by resting assessment. The success rate of EDE increases significantly with the combination of TRV and ACT.

Funding Acknowledgement
Type of funding sources: None.
Additional value of left atrium remodeling assessed by three-dimensional echocardiography for the prediction of atrial fibrillation recurrence after cryoballoon ablation
Authors: Motoc A , Scheirlynck E , Roosens B , Luchian M L , Chameleva H , Galloo X , Von Kemp B , De Asmundis C , Magne J , Droogmans S , Cosyns B 
Published: October 2022

Abstract

Background
Atrial fibrillation (AF) is the most common cardiac arrhythmia and it is associated with a high risk of cardiovascular complications [1]. Cryoballoon ablation (CBA) has emerged as a safe and efficient therapeutic option for AF [2]. However, AF recurrence occurs in more than 25% of the patients, which leads to repeated ablations and increased rates of complications and hospitalizations [3]. Previous reports on the role of left atrial (LA) diameter and LA volume assessed by two-dimensional echocardiography (2DE) as predictors of AF recurrence after ablation have shown controversial results [4,5]. This might be explained by the fact that these methods imply geometrical assumptions of the LA remodeling, which is a three-dimensional process [6].

Purpose
The purpose of this study was to evaluate the additional value of LA remodeling assessed by three-dimensional echocardiography (3DE) to predict AF recurrence after CBA.

Methods
Consecutive patients with paroxysmal/persistent AF undergoing CBA were prospectively included. Echocardiography was performed before CBA, according to standard recommendations. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period.

Results
One hundred seventy two patients (62.2±12.2 years, 61% male) were included in the analysis. During the follow-up period of 11.7±1.6 months, fifty (29%) patients had AF recurrence after the blanking period. 3DE LA maximum volume index (LAVI) had the highest incremental predictive value for AF recurrence (HR 5.50, 95% CI 1.34–22.45, p&lt;0.001) (Figure 1). Twenty-two percent of the AF recurrences occurred in patients with non-dilated LA diameter index and LAVI by 2DE (68 (39.5% patients)). In this category of patients, LAVI by 3DE was able to discriminate AF recurrence with a sensitivity of 90% and a specificity of 66%, for an optimal cut-off value of 30.4 ml/m2.

Conclusion
This study showed that LAVI assessed using 3DE had an additional predictive value for AF recurrence after CBA. Moreover, LAVI by 3DE was able to discriminate AF recurrence even in patients with non-dilated LA by M-Mode and 2DE. These findings suggest that 3DE might reflect better and earlier the asymmetric and variable nature of LA remodeling and could be a potential tool in clinical practice for an improved risk stratification and pre-ablation selection of AF patients.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Universitair Ziekenhuis Brussel: Wetenschappelijk Fonds Willy Gepts of the UZ Brussel
Reduced 3D-left atrium ejection fraction predicts development of atrial fibrillation in patients with hypertrophic cardiomyopathy
Authors: Amador A , Martins Da Costa C , Calvao J , Pinto R , Proenca T , Carvalho J M , Cabrita A , Marques C , Pinho A , Santos L , Oliveira C , Moreira H , Palma P , Sousa C , Macedo F 
Published: October 2022

Abstract

Introduction
Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), occurring in approximately 25% of patients, related to left atrial (LA) dilatation and remodeling. HCM patients who develop AF have increased risk of HCM-related death, functional impairment, and stroke. Accurate risk stratification for AF in this population is crucial as contemporary treatments are highly successful.

Purpose
To assess if new echocardiographic parameters can predict the development of AF in HCM patients.

Methods
HCM patients who underwent comprehensive echocardiographic examination during 2011 were followed and checked for “de novo” AF until November 2021. We searched for associations between AF development and novel echocardiographic parameters such as LA Volume index, Left Atrioventricular Coupling Index (LACI, as LAVI/a'), 3D LA volumes and 3D LA ejection fraction (3D-LAEF).

Results
A total of 43 patients were included, with 62.8% male and mean age 56,1±6,2 years old. 55.8% had the septal asymmetric HCM type and mean LV mass was 326±127g. Mean LA diameter and biplane 2D volume was 46±7 mm and 78±37 mL, respectively. 11.6% of patients already had AF. During a median follow-up of 9.4 years, the incidence of “de novo” AF was 31,6%. Within the total 17 patients with AF, 35,2% took warfarin and the remaining direct oral anti-coagulation. No stroke was documented. There were 3 deaths (mortality rate of 7,0%), none from cardiac causes.
No association was found between AF development and LAVI, LACI or 3D LA volumes. We only found a statistically significant difference regarding 3D-LAEF, which was lower in patients who developed AF compared with those without AF (26±12% VS 39±19%, p=0.04).
Binary logistic regression analysis found that reduced 3D-LAEF predicts the development of AF (p=0.019, odds ratio [OR] 2.6, 95% confidence interval [CI] 1.0 to 1.1). The area under a receiver operating characteristic curve using 3D-LAEF as a predictive marker for AF development in HCM patients was 0.743 (p=0.004). When the cut-off value of 3D-LAEF was set at 34,5%, the sensitivity and specificity for AF diagnosis were 66% and 86%, respectively.

Conclusion
In our study, 3D LAEF predicted the development of AF in HCM patients – this may be a useful tool to identify patients at high risk of future AF who may benefit from more intensive rhythm monitoring and a lower threshold for oral anticoagulation.

Funding Acknowledgement
Type of funding sources: None.
Gender mismatch and outcomes following heart transplantation in the United States
Authors: Briasoulis A , Kourek C , Kampaktsis P , Doulamis I 
Published: October 2022

Abstract

Background
Available literature indicates the possible detrimental effect of gender mismatching on mortality in patients undergoing heart transplantion. Our objective was to examine the role of gender mismatching on mortality and graft rejection in patients undergoing heart transplantation in the US.

Methods
Data on adult patients January who underwent heart transplantation between January 2015 and October 2021, was queried from the United Network of Organ Sharing (UNOS) registry. The main outcomes were all-cause mortality, 1-year all-cause mortality and treated acute rejection.

Results
A total of 19,805 adult patients underwent heart transplant during the study period. Approximately, one out of ten patients in the M-F group had a PHM mismatch&lt;25%, while only four out of ten patients had such a mismatch in the F-M group. In both M-M and F-F groups, seven out of ten patients had a PHM mismatch&lt;25% (p=0.122). Proportion of PHM mismatch was similar throughout the study period. Unadjusted analysis showed that M-F was associated with increased risk for all-cause mortality (HR: 1.13; 95% CI: 1.02, 1.27; p=0.026) and 1-year mortality (HR: 1.26; 95% CI: 1.09, 1.45; p=0.002) compared to M-M. Graft failure incidence was higher in the M-F group compared to M-M (HR: 1.12; 95% CI: 1.01, 1.25; p=0.041).

Conclusions
Gender mismatching is associated with post-transplant mortality with transplantation of female donor grafts to male recipients demonstrating worse outcomes. Further research is required to elucidate pathways involved and possible changes in clinical practice.

Funding Acknowledgement
Type of funding sources: None.
The effect of cryothermic and radiofrequency Cox maze IV ablation on atrial size and function assessed by 3D echocardiography, a randomized trial. To freeze or to burn
Authors: Boano G , Farkas V , Astrom Aneq M 
Published: October 2022

Abstract

Background
The Cox maze procedures have been shown to be safe methods for restoring sinus rhythm (SR) in patient with atrial fibrillation and often performed concomitant to mitral valve (MV) surgery. Cryothermy (Cryo) and Radiofrequency (RF) are available techniques to achieve atrial linear scars. The differences between the effect of these energy sources on late left atrial (LA) reverse remodeling are not fully described.

Purpose
This study aims to compare the impact of Cryo and RF procedures on left atrial (LA) size and function one year after Cox-maze IV concomitant to MV surgery using 3-dimensional echocardiography (3DE).

Methods
Seventy-two patients with MV disease and atrial fibrillation were randomized to either Cryo (35) or RF (37) ablation. Another 33 patients were enrolled according to the protocol without concomitant ablation (NoMaze group). All patients had an echocardiogram before and one year after surgery.

Results
The 42 ablated patients who recovered sinus rhythm (SR) one year after surgery had comparable left and right systolic ventricular function and a mean reduction of LA size by 23% (LA volume index decreased from 66±24 to 54±13ml/m2, p=0.004). The 3DE extracted reservoir and booster function showed higher values after RF ablation compared to Cryo (37±10% vs 26±6%; p&lt;0.001 resp. 18±9 vs 7±4%, p&lt;0.001), while passive conduit function was comparable (24±11 vs 20±8%; p=0.17). Patients with restored SR without ablation had more preserved systolic atrial function but similar LA size reduction as those who underwent maze surgery.

Conclusions
SR restoration after MV surgery and maze results in LA size reduction irrespective of the energy source used. By 3DE we could show that, compared to RF maze, the extension of ablation area produced by Cryo implies a major LA structural remodeling affecting LA systolic function. The reverse size remodeling seems to be the least, the longer AF history.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ALF funding for clinical research-Sweden
A multidisciplinary program based on early follow-up in a day hospital after heart failure hospitalizations. Reduction of 30-day readmissions in a population analysis over a 6-year period
Authors: Vaqueriza Cubillo D , Beltran Herrera C , Dominguez Munoa M , Suberviola Sanchez-Caballero V , Gomez Mariscal E , Briongos Figuero S , Estevez Paniagua A , Sanchez Hernandez A , Cortina Camarero C , Sarrion Catala M , Jimenez Loeches S , Mora Yague L , Giganto Arroyo M L , Cano Moracho J M , Munoz Aguilera R 
Published: October 2022

Abstract

Introduction and objectives
Readmission rates at 30 days after heart failure (HF) hospitalizations are high. Disease management programs have shown to reduce them; however, the results of clinical trials are difficult to extrapolate to the entire population with HF. Our hospital has a multidisciplinary program for HF management (MHFP) led by the Cardiology Department, based on early post-discharge follow-up in a day hospital, for clinical-analytical assessment, optimization and titration of pharmacological treatment, structured education, promotion of self-care and intravenous treatment if appropriate. The objective of this study is to assess the impact of the MHFP on our patients all cause 30-day readmission rate (MHFP group), compared with the rest of our region (control group).

Methods
All discharges with HF as main diagnosis in our region were analysed through anonymized consultation of the Minimum Basic Data Set (an administrative public data base) in the period 2009–2015. The first admission of each patient in the period was identified as index admission. Patients who died in the index admission were excluded. Epidemiological characteristics, comorbidities and hospital stay were compared in the two groups. The outcome variable was the time to first readmission in the first 30 days after discharge. Quantitative variables were compared using Student's t and categorical variables with χ2. Cox method was used for multivariate analysis.

Results
We included 62,162 patients, 1,447 in the MHFP group and 60,715 in the control group. Epidemiological characteristics and main comorbidities were compared, and the results are shown in the table. Readmission rate was significantly lower in the MHFP group (13.5 vs 16%, HR 0.85, 95% CI 0.74–0.98 in multivariate analysis). The variables independently associated with an increase in readmissions at 30 days were age adjusted Charlson index, hospital length of stay in index admission and several comorbidities (obstructive pulmonary disease, myocardial infarction, and renal failure)

Conclusions
Over a period of 6 years, a MHFP significantly reduced 30-day readmissions after admission for HF, in its reference area. The generalization of these programs could have a relevant impact on costs reduction.

Funding Acknowledgement
Type of funding sources: None.
Figuring out complete left ventricular reverse remodeling in tachycardiomyopathy
Authors: Izquierdo Bajo A , Fernandez-Valenzuela I , Arroyo-Monino D F , Cozar-Leon R , Bastos-Amador P , Diaz-Infante E 
Published: October 2022

Abstract

Introduction
Tachycardiomyopathy is a common cause of left ventricular systolic dysfunction (LVSD), whose complete resolution after arrhythmia control is highly variable among patients.

Purpose
To assess the associated factors with complete left ventricular reverse remodeling (CLVRR) in patients with confirmed tachycardiomyopathy.

Methods
Retrospective single-centre, observational study of consecutive patients with diagnosed tachycardiomyopathy between January 2015–2022. CLVRR was defined by a recovered left ventricular ejection fraction (RLVEF) &gt;55% and a left ventricular end-dyastolic diameter (LVEDD) &lt;55 mm assessed by transthoracic echocardiography.

Results
134 patients were gathered in this period. Patients with previous known LVSD or LV dilatation were excluded from the analysis (n=6). Baseline characteristics are displayed in Image 1. Most frequent arrhythmia was atrial fibrillation (73.8%), followed by atrial flutter (25.4%), atrial tachycardia (2.2%) and ventricular extrasystole (5.2%). 99.2% of patients were treated with beta-blockers, 71.6% with ACEI/ARBs, 23.9% with neprilysin inhibitors and 64.2 with aldosterone receptor antagonist. Rhythm control was achieved in 82.1% of patients, of whom 80% underwent an ablation procedure after a mean of 8.2 months. After 10.8 months since LVSD, mean RLVEF was 55.4% (+6.3) and mean LVEDD 52.1 mm (+5.8). CLVRR was observed in 50% of patients. A multivariate analysis was performed in a stepwise fashion to assess associated factors, including baseline information (medical history, echocardiographic information and received treatment, both pharmacological and ablation). CLVRR was associated with female-sex (coefficient 1.18; p=0.009) and severe baseline left ventricular disfunction (coefficient −0.80; p=0.041), corrected by previous alcohol abuse history (coefficient 0.94; p=0.055) and a rhythm-control strategy (coefficient 0.98; p=0.052) which didn't reach complete statistical significance.

Conclusion
Women, patients without severe LV dysfunction at baseline, with history of previous alcohol abuse and receiving a rhythm-control strategy were associated with a complete left ventricular reverse remodeling in patients with tachycardiomyopathy.

Funding Acknowledgement
Type of funding sources: None.