bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left ventricular remodeling patterns in patients with moderate aortic stenosis
Authors: Stassen J , Ewe SH , Hirasawa K , Butcher SC , Singh GK , Ammanullah RA , Ding ZP , Pio SM , Chew NWS , Sia CH , Kong WKF , Poh KK , Marsan NA , Delgado V , Bax JJ 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
Background
Moderate aortic stenosis (MAS) is associated with an increased risk of adverse events. Although left ventricular (LV) adverse remodeling is associated with worse outcomes in patients with severe AS, the prognostic significance of different patterns of LV remodeling in MAS has not been investigated.
Purpose
To investigate the association between different patterns of LV remodeling on outcomes in patients with MAS.
Methods
Patients with MAS (aortic valve area &gt;1.0 and ≤1.5cm2) were stratified into 4 groups according to the pattern of LV remodeling: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH) or eccentric hypertrophy (EH). Clinical outcomes were defined as all-cause mortality and a composite of all-cause mortality and aortic valve replacement (AVR).
Results
Of 1931 patients (age 73 ± 10 years, 52% men) with MAS, 344 (18%) had NG, 469 (24%) CR, 698 (36%) CH and 420 (22%) EH. Patients with CH were more likely to be female, had more hypertension, were more symptomatic (NYHA ≥III) and had more pronounced LV diastolic dysfunction, whereas patients with EH had more coronary artery disease, were more symptomatic (NYHA ≥III) and had lower LV ejection fraction than patients with NG. Patients with CH had higher aortic mean pressure gradients and peak aortic jet velocities than patients with NG. During a median follow-up of 51 (IQR 25 - 83) months, 833 (43%) patients died. For the composite endpoint, 1286 (67%) patients underwent AVR (n = 613) or died (n = 673) during a median follow-up of 35 (IQR 14 - 60) months. Patients with CH and EH had significantly lower survival rates (p &lt; 0.001; Figure 1) and event-free survival rates (p = 0.004) compared to patients with NG/CR. On multivariable analysis, CH was independently associated with all-cause mortality (HR:1.267; 95% CI:1.024 – 1.568; p = 0.029), whereas both CH (HR:1.293; 95% CI:1.090 – 1.533; p = 0.003) and EH (HR:1.222; 95% CI:1.013 – 1.474; p = 0.036) were associated with the composite endpoint of AVR and all-cause mortality (Figure 2).
Conclusions
In patients with MAS, different patterns of LV remodeling are observed with CH being independently associated with an increased risk of all-cause mortality. Risk stratification according to the different patterns of LV remodeling may help to identify patients with MAS who are at increased risk of adverse events and may benefit from closer follow-up. Abstract Figure. Kaplan-Meier curves Abstract Figure. Cox regression analysis
Right ventricular longitudinal strain remains unimpaired in severe primary mitral regurgitation and functional tricuspid regurgitation
Authors: Krivickiene A , Verikas D , Norvilaite R , Ereminiene E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

INTRODUCTION
The right ventricular global longitudinal strain (RV GLS) increasingly has been used for the prognosis of mortality in the heart failure patients. However, the relationship of RV strains to other RV functional parameters and its dependency of functional tricuspid regurgitation (TR) as a result of left heart valvular disease is not well studied.

PURPOSE
To investigate the relationship of RV geometry, functional and strain parameters to the predominant left heart aetiology in patients with functional TR as a result of left heart valvular disease.

METHODS
Prospective observational cohort study enrolled patients with functional TR caused by left heart valvular disease for whom surgical valvular repairment is scheduled. Patients with ischemic heart disease (assessed by coronary angiography) were excluded from the analysis. The current study included 52 patients with full sets of preoperative echocardiographic parameters. Echocardiographic quantification included the following parameters: the RV geometry (RV diameters, RV area), functional (velocity of the tricuspid annular systolic motion (S’) and RV fractional area change (FAC)) and strain parameters (RV GLS, longitudinal RV free wall strain (RVFWS) and longitudinal strains of each segment of RV free wall). The severity of TR was measured quantitively according the recent ESC guidelines. Patients were divided into groups according to the predominant left heart valvular disease causing moderate or severe functional TR: 1. TR caused by primary severe mitral regurgitation (MR) due to mitral valve (MV) prolapse and MV chordae rupture; 2. TR caused by other left heart valvular pathologies (severe aortic stenosis [16 pts.], severe rheumatic aortic and MV disease [11 pts], severe aortic regurgitation [3 pts]). The statistical analyses were performed using SPSS statistical software.

RESULTS
In 52 patients of current analysis 64% were female, mean age was 67 ± 9. The distribution of echocardiography parameters in study groups are shown in Table 1. The RV geometry parameters and parameter of TR severity (effective regurgitant orifice area (EROA) did not differ significantly between these two groups. The RV longitudinal function (S’) and RV strain parameters (RV GLS and longitudinal RVFWS) were better in severe MR group.

CONCLUSIONS
Although the right ventricular geometry and severity of functional tricuspid regurgitation does not depend on different predominant left heart valvular disease causing significant functional tricuspid regurgitation, the right ventricular longitudinal function and longitudinal right ventricular free wall strain are less affected and remains unimpaired in patients with functional tricuspid regurgitation caused by severe primary mitral regurgitation. Abstract Figure.
Acute and chronic changes in LV performance in patients with primary severe mitral regurgitation undergoing percutaneous mitral valve repair
Authors: Galli E , Hubert P , L"official G , Panis V , Donal E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The non-invasive assessment of myocardial work allow to evaluate LV performance by taking into account the effect of LV load. Aim of this study is to evaluate the acute and chronic impact of percutaneous mitral valve repair (PMVR) on left ventricular (LV) performance, in patients with severe primary mitral regurgitation (PMR).

Methods and Results
71 patients (age: 77 ± 9 years, females: 44%) with severe PMR (effective regurgitant orifice: 0.57 ± 0.31 cm2, regurgitant volume: 80 ± 34 ml) and preserved LV ejection fraction (LVEF: 60 ± 10%) underwent PMVR according to current recommendations. Myocardial work indices were evaluated before the procedure, 2 days after the procedure and at 1-year follow-up. PMVR was associated with an acute reduction in LVEF, global longitudinal strain (GLS), myocardial work index (MWI), and work efficiency (MWE), and a significant increase in myocardial wasted work (MWW) and mechanical dispersion (MD). 1-year after the procedure, LV size significantly decreased, GLS, MWI, MWE and MD improved, whereas GWW remained significantly reduced. LVEF improved but remained significantly altered compared with baseline values (Table 1).

Conclusions
In patients severe PMR undergoing PMVR, the acute reduction in LV preload causes a significant impairment of all parameters of LV performance. After 1-year, progressive LV remodeling is associated a significant improvement in MCW, counterbalanced by a persistently high MWW, which can explain the partial recovery of LVEF. Abstract Figure.
An in-vitro model of stiffened aortic valves to develop an iso-stiffness-lines graph for aortic stenosis classification
Authors: Buffle E , Stucki M , De Marchi SF , Obrist D 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Bern Center for Precision Medicine (BCPM)

Introduction
The echocardiographic diagnosis of aortic stenosis (AS) is established by assessing its maximal opening area (OA). The behavior of OA is dependent on transvalvular flow which can be low in case of low-flow, low-gradient AS. However, the complicated decision tree of the current guidelines for the assessment of AS does not consider flow but rather a stroke volume and does not take into account the size of the valve. This experiment was designed to create a graphical representation of the OA versus flow for various valve stiffness values to eventually build a model with iso-stiffness lines and simplify the assessment of aortic stenosis

Methods
We filmed a harvested porcine aortic valve mounted in a pulsatile flow loop during the ejection time with a high speed camera (2000Hz), measured for each time point OA and the instantaneous flow through the aortic valve at 10 different mean flow rates (ranging from 0.5 to 5.0 liters/min). We stiffened the valve by treating it with a protein cross-linking agent (formaldehyde) to yield a total of three stiffness grades (a, b, c) and repeated the procedure for each of those grades. We divided both OA and flow, by the area of left ventricular outflow tract (LVOT) in order to account for different valve sizes. We plotted each OA against its corresponding flow after correcting for the intersignal delay. In order to analyze the cycle portion corresponding to the most steady flow, we only included the 5% highest instantaneous flow rates (for each of the 10 mean flow rates). We then measured the relative stiffness by measuring the relative pump work between stiffness grades, 1 being defined as the native stiffness grade. We predicted relative stiffness grade of each valve in a k-fold validation algorithm (each valve being sequentially taken as the test set and all the other remaining valves in the training set), taking a sigmoid function model. Finally we performed a linear regression of each measured and predicted stiffness grade of each valve to assess the accuracy of the model.

Results
We could analyze 11 valves and performed an 11-fold cross validation. We could predict the relative stiffness of each of the valve with a good slope value (slope = 0.898) and a modest accuracy (r = 0.639).

Conclusions
We could predict with modest accuracy the inherent stiffness of the valve only with valve size, flow and opening area, all information available with echocardiography. This will allow to create iso-stiffness line to better classify valve stenosis and compare any patient on one single graph at any flow or valve" size, potentially simplifying the grading system of aortic stenosis, especially for patient with low-flow, low-gradient AS. Abstract Figure. Combination of Flow and OA Abstract Figure. 3 stiffness stages and Cross-validation
Echocardiographic assessment of the left ventricular systolic function in patients with inflammatory bowel disease
Authors: Karakosta M , Miaris N , Kasinos N , Destounis A , Linardakis S , Zahos P , Barmpagiannis D , Vassaki M , Grigoraki E , Kalesi AE , Maritsa D , Boukis D , Skouloudis E , Theodosis-Georgilas A , Pisimisis E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
Research data have shown evidence of association between inflammatory bowel disease (IBD) and cardiovascular disease (CVD). Early detection of CVD in IBD patients is crucial for their further management.

Purpose
In this case–control study, we assessed the left ventricular (LV) systolic function of IBD patients with no evidence of CVD and compared it with healthy volunteers.

Methods
The study population consisted of consecutive IBD patients with no evidence of CVD or relative medical history who were referred to our laboratory from January 2021 to July 2021 and a group of healthy volunteers. Standard 2-dimensional transthoracic echocardiography was performed in each group and LV systolic function was assessed by LV ejection fraction (LVEF) with modified Simpson’s rule and LV global longitudinal strain (LVGLS). As the normal distribution assumption was not met, the Mann Whitney U test (new procedure) was used to compare the variables within the two groups, while correlations between the 2 continuous variables were examined with the Spearman"s correlation analysis. A p value of &lt;0.05 was considered statistically significant.

Results
Twenty-four IBD patients (15 men, 9 women, 12 with Crohn’s disease, 12 with ulcerative colitis) of a mean age of 39.63 years [minimum = 23, maximum = 56, standard deviation (SD)=9.56] were enrolled in the study. The control group consisted of 24 healthy volunteers (15 men, 9 women) of a mean age of 37.75 years (minimum = 17, maximum = 58, SD = 12.12). For the IBD group, the mean LVEF was 57.71% and the median was 58% (minimum = 52%, maximum = 63%, SD = 3.56%), while the mean LVGLS was -18.23% and the median was -18.65% (minimum absolute value = 12.40%, maximum absolute value = 22.70%, SD = 2.48%). For the control group, the mean LVEF was 61.21% and the median was 60% (minimum = 55%, maximum = 68%, SD = 3.43%), while the mean LVGLS was -20.08% and the median was -20% (minimum absolute value = 17%, maximum absolute value = 25.2%, SD = 1.96%). The IBD patient group showed significantly lower LVEF measurements (mean rank = 18.98, Mann-Whitney U = 155.500, p = 0.006) and absolute LVGLS values (mean rank = 19.40, Mann-Whitney U = 165.500, p = 0.011) compared to the control group (LVEF mean rank = 30.02, LVGLS absolute value mean rank = 29.60). Correlation analysis revealed that LVEF was positively correlated with LVGLS absolute values in both groups (IBD patients: Spearman"s rs = 0.532, p = 0.008, control group: Spearman"s rs = 0.565, p = 0.004).

Conclusion
Subclinical LV systolic impairment seems to be evident in IBD patients and echocardiographic assessment may facilitate its early detection. Abstract Figure.
Left ventricular global longitudinal strain may foresee prolonged postoperative pericardial effusion
Authors: Bakalli A , Alihajdaraj R , Grbolar A , Krasniqi X , Bekteshi T , Sejdiu B , Cavolli R , Kutllovci A , Dula B , Brahimaj R 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pericardial effusion (PE) is a frequent finding in patients that undergo coronary artery bypass grafting (GABG). Postoperative PE may be found in as many as 85% of patients. Although postoperative PE is a frequent finding following CABG, fortunately its course is usually benign and they randomly disappear within 7-10 days. However, in some instances PE may persist for longer and cause complications. There are currently limited data in the medical literature providing information regarding the factors that may contribute to postoperative pericarditis. We aimed to analyze the main echocardiographic characteristics that may influence the presence of PE 6 to 8 weeks following CABG.
Material and methods: This was a prospective cross-sectional study that included 90 consecutive patients that underwent CABG procedure in the Cardio Surgery Department of our tertiary medical center. We excluded patients that underwent other cardiac surgery interventions, patients with CABG that had postoperative bleeding which required reoperation and patients that had PE prior to intervention. Patients in whom PE was registered formed the first group (32 patients), whereas those without PE formed the second group (58 patients). Echocardiography data obtained before the surgery were compared between the two groups.

Results
The average amount of PE was 5.11 ± 1.62 mm. The groups did not differ in regard to gender (males 65.62% vs 63.79%, p = 0.86), age (59.59 ± 9.29 vs 61.69 ± 10.71, p = 0.35), body mass index (27.13 ± 4.05 vs 28.62 ± 4.11, p = 0.1). Comparison between groups in respect to echocardiographic features are presented in table 1. As seen in this table, left ventricular global longitudinal strain (LV GLS) was the only echocardiographic feature analyzed with statistical significance (-14.64 ± 6.86 vs -16.96 ± 4.1, p = 0.04). Both groups had mean values outside reference range, which can be explained by coronary artery disease in both groups.

Conclusions
Postoperative PE in small amount may be found in a considerable number of patients, as long as two months following CABG. More severe LV GLS alterations may be associated with occurrence of PE in patients following CABG. Abstract Figure. Comparison of echocardiographic features
Effect of daily sodium consumption on hemodynamics in patients with hypertrophic cardiomyopathy
Authors: Maslova MY , Krylova NS , Poteshkina NG , Kovalevskaya EA 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Patients with hypertrophic cardiomyopathy (HCM) are advised to avoid dehydration and drink enough fluids to maintain circulating blood volume (BV) when LV volume is reduced. Salt (NaCl) intake is one of the main factors affecting BV and hemodynamics. At the same time, there have been no studies to find the optimal level of salt intake and identify its effect on hemodynamics in HCM patients.

Purpouse
To estimate the effect of salt (NaCl) intake on the clinical course and hemodynamics in hypertrophic cardiomyopathy patients (HCM).
Material and methods: 54 HCM patients aged between 18 and 81 (average age 60.1 ± 15.2 years), were examined. Medical history and complaints were mainly focused on the shortness of breath, dizziness, and nonarrhythmogenic syncope. ECG, Holter ECG monitoring and EchoCG were performed. The NT-proBNP level and the 24-hour urine sodium tests were taken.

Results
The average level of Na+ in the 24-hour urine sample was 128.2 ± 84.1 mmol/day; an inverse correlation was found between this parameter and syncope (r=-0.4, p = 0.03) and also with LV outflow tract obstruction (r=-0.3, p = 0.04). NT-proBNP level was found to be 1449 [444; 3807] ng/L, with a positive relationship between NT-proBNP and functional class of chronic heart failure by NYHA (r = 0.4; p = 0.009). In patients with daily natriuresis &lt;50 mmol/day, syncope was more common (60% vs 8%, p = 0.01), a lower LV stroke volume index (LV SVI) was revealed (19.8 ± 3.6 vs 27.1 ± 4, 8 ml/m², p = 0.006); daily natriuresis &gt;65 mmol/day corresponded to a higher right atrium volume index (21.7 ± 7.3 vs 29.1 ± 11.1 ml/m², p = 0.01), higher left atrium volume index (36.0 ± 13.8 vs 47.6 ± 13.8 ml/m², p = 0.01) and higher systolic pulmonary artery pressure (28.4 ± 6.3 vs 35.1 ± 7.9 mm Hg, p = 0.02). An increase in natriuresis &gt; 100 mmol/day was followed by a decrease in the frequency of obstruction (52% vs 22%, р=0.04), which persisted at natriuresis &gt; 110 mmol/day (58% vs 29%, р=0.03). Daily natriuresis &lt;50 mmol/day folowed by increased of syncope with OR 16.9 (95% CI: 2.2-132.5, p = 0.007), and &lt;65 mmol/day - OR 7.6 (95% CI: 1.4-41.7; p = 0.02). Obstruction frequency decreased with natriuresis &gt; 90 mmol/day - OR 3.7 (95% CI: 1.2-12.1, p = 0.03), with natriuresis &gt;100 mmol/day OR 3.9 (95% CI: 1.3-12.3, p = 0.02), with natriuresis &gt;110 mmol/day OR 5.2 (95% CI: 1.6-16.9, p = 0.007).

Conclusions
Low salt intake in the observed cohort of HCM patients was accompanied by a lower LV SVI and higher incidents of syncope. As salt intake in patients with HCM increases, the atria volume and the pressure in the pulmonary artery increase also. Frequency of obstruction was reduced with sodium levels in daily natriuresis &gt; 90 mmol/day.
Functional tricuspid regurgitation : a clustering analysis and prognostic validation of 3 phenotypes on an external cohort
Authors: Vely M , L"official G , Galli E , Lacout M , Leurent G , Oger E , Donal E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Functional tricuspid regurgitation (FTR) ≥ moderate is an independent risk factor of morbidity and mortality. FTR could be classified into 2 categories: "atrial functional-TR" (AF-TR) and "ventricular functional-TR" (VF-TR). Percutaneous procedures increase interest in best understanding and selecting patients eligible for intervention. We aim to study echocardiographic criteria associated with the prognosis in patients with severe TR, using a clustering method on a retrospective monocentric cohort that we applied to an external validation prospective multicentric cohort.
Methods and results: Ninety-two patients with severe TR (mean age 77.9 ± 13 years, 48.9% female, atrial fibrillation in 68.5%) were enrolled. A hierarchical clustering analysis was conducted. Four parameters explained the clustering categorization (right ventricular (RV) end-diastolic mid-cavity diameter, RV free-wall Strain, right atrial (RA) volume index, RA Strain; p = 0,0039). Three clusters were identified: Cluster 1 with better right ventricular, left ventricular, and right atrial function (related to AF-TR) compared with Cluster 2 (related to VF-TR). Cluster 3 includes patients with severely dilated heart chambers, and RV and RA dysfunction. When applying the 3 clusters in the validation cohort (149 patients), the primary endpoint (hospitalization for Heart failure and/or death from any cause) was significantly better in cluster 1 in 30.8% versus 48% and 58.8% in clusters 2 and 3 respectively (p &lt; 0.05).

Conclusion
Three phenotypes of FTR were built. Significant TR assessment should include RV and RA characteristics. AF-TR seems to have a better prognosis than VF-TR (under non interventional management). Abstract Figure. survival according to clusters