bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial functional reverse remodeling assessed by speckle tracking echocardiography in a real-life population of patients with chronic heart failure after therapy with sacubitril/valsartan
Authors: Magnesa M , Correale M , Correale M , Correale M , Mazzeo P , Mazzeo P , Mazzeo P , Fortunato M , Fortunato M , Fortunato M , Leopizzi A , Leopizzi A , Leopizzi A , Mallardi A , Mallardi A , Mallardi A , Tricarico L , Tricarico L , Tricarico L , Mennella R , Mennella R , Mennella R , Iacoviello M , Iacoviello M , Iacoviello M , Brunetti ND , Brunetti ND , Brunetti ND 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial (LA) enlargement has been demonstrated to be a predictor of adverse cardiovascular outcomes, such as atrial fibrillation (AF), heart failure (HF), and cardiovascular death (1). Previous studies showed left atrial structural reverse remodeling (LARR), defined as &gt;15% reduction in LA end-systolic volume index (LAESVi) (2), can be achieved after therapy with Sacubitril/Valsartan (S/V) in real-world settings. On the other hand, LA functional reverse remodeling is not well defined.

Purpose
We sought to investigate the association between left atrial (LA) structural and functional remodelling in patients with chronic heart failure after therapy with S/V.

Methods
Patients with chronic HF, LV dysfunction (EF &lt; 35%), NYHA class II-III were followed up between September 2019 and March 2020. All patients underwent clinical and echocardiography follow up at baseline and after 6 months of therapy with S/V. Measures of LA structure [LA end-systolic volume index (LAESVi)] and function [left atrial ejection fraction (LAEF), peak atrial longitudinal strain (PALS), LA conduit strain, and peak atrial contraction strain (PACS)] were calculated. We divided our population into two subgroups based on whether reverse remodeling was achieved (LARR+) or not (LARR-).

Results
Forty-seven consecutive outpatients (mean age 66 ± 8 years; 85% males) were enrolled in the study. At follow-up visit, a positive LARR was found in nearly half of patients treated with S/V, resulting in line with previous studies (3). Furthermore, global PALS was significantly improved in both groups compared to baseline (15 ± 7 vs 19 ± 8 %, p &lt; 0.001), but the LARR+ group showed an improvement that was twice higher (55 ± 66 vs 25 ± 26, p = 0.039), supporting the potential role of PALS as marker of functional LARR.

Conclusions
Treatment with S/V in patients with systolic dysfunction is associated with an improvement in LA structural and functional remodelling in a real-world scenario. Therefore, PALS could be the benchmark for the assessment of left atrial functional reverse remodeling.
Left atrial function after standalone totally thoracoscopic left atrial appendage exclusion in af patients with absolute contraindication to oral anticoagulation therapy
Authors: Tedoldi F , Branzoli S , D"onghia G , Fanti D , Sarao E , Guarracini F , Quintarelli S , Graffigna A , Bonmassari R , La Meir M , Monaco C , De Asmundis C , Marini M 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Left atrial appendage (LAA) is the source of more than 90% of thrombi in patients with atrial fibrillation (AF). The Totally Thoracoscopic (TT) LAA exclusion with epicardial clip has become a safe and effective procedure, but the effect on left atrial (LA) function remains unknown.

Purpose
The aim of this study was to assess the effect of TT LAA exclusion on LA function.

Methods
20 patients (15 males) with non-valvular AF and contraindication to oral anticoagulation therapy (OAT) or antiplatelet therapy underwent standalone TT LAA exclusion with the Atriclip Pro II device. All patients were screened preoperatively with 3D CT scan, trans-esophageal echocardiography, spirometry and cerebrovascular doppler ultrasound. Intraoperative Atriclip Pro II positioning and LAA exclusion were guided and confirmed by trans-esophageal echo. To objectify LA function, transthoracic echocardiography with 2D Speckle tracking was performed before surgery, at discharge and at 3-month follow-up. All patients were not on anticoagulation nor antiplatelet therapy at the time of surgery, at discharge and at control visit.

Results
Baseline characteristics are reported in Table I. There were no major complications during the procedures. One non cardiovascular death, one minor stroke and 4 hospitalizations occur at 1-year follow up. The reservoir LA function considering the strain measurements dramatically decreased few days after the procedure and it recovered at 3-month follow-up compared to baseline, even though the LA volume is augmented (Table II). Furthermore, NT pro-BNP increased and ventricular strain decreased significantly after the procedure recovering over time.

Conclusion
TT LAA exclusion with Atriclip Pro II device is a safe and effective procedure in preventing AF related stroke in patients with contraindication to OAT. Our findings suggest that the LAA epicardial clip impairs immediately the reservoir LA function that recovers over time. Abstract Table I Abstract Table II
Three-dimensional principal strain, twist and torsion as predictors of cancer therapeutics related cardiac dysfunction in breast cancer patients
Authors: Park CS 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research Foundation of Korea

Background
Breast cancer patients usually received anti-cancer chemotherapy even in the early stage. Main regimen includes anthracycline and trastuzumab which are known to have cardiotoxicity. Three-dimensional echocardiography can provide all conventional and deformational parameters in one image but its utility is limited.

Methods
The patients underwent adriamycin based chemotherapy and three-dimensional echocardiography before and 1 year after were included. All the analyses of 3-dimensioanl echocardiographic images were performed using 4D LV Analysis (TomTec, Unterschleissheim, Germany). Cancer therapeutics related cardiac dysfunction was defined as decrease in the value of longitudial strian more than 15 % in the follow up compared to the pre-chemotherapy exam.

Results
: The number of patients was 75. One patient was admitted due to symptoms related to heart failure. Multivariate logistic regression analysis showed that 3-dimensional longitudial strian measured before chemotherapy can predict CTRCD (Odds ratio; 95% confidence interval: 0.63; 0.42-0.93. p value = 0.02).

Conclusion
3-dimensional deformation parameters can be used as predictors of CTRCD in breast cancer patients and it should be applied more widely in clinical settings. Abstract Figure. Usefulness as a predictor
Myocardial work indices in living kidney donor population
Authors: Akdeniz C , Yurdakul S , Cetinarslan O , Canbolat IP , Ucar Z , Sinangil A , Barlas S , Akin B 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Living kidney donors represent a very special group of patients who are screened for cardiovascular morbidity preoperatively and remained with mildly reduced renal function after unilateral nephrectomy. The effect of unilateral nephrectomy on cardiovascular disease progression or subclinical cardiac dysfunction is still controversial. Myocardial deformation imaging allows left ventricular function quantification beyond ejection fraction. Non invasive assessment of myocardial work (MW) is a novel, promising speckle tracking- based method which can provide us to detect subtle myocardial dysfunction with advantages of load independency.
We aimed to assess the impact of mildly reduced renal function after kidney donation, on subclinical cardiac structural and functional status.

Methods
We included seventeen kidney donors and seventeen age and sex matched healthy controls. All participants underwent transthoracic echocardiography (TTE). In addition to standard TTE measurements, 2D speckle – tracking based strain analysis was performed for left ventricle (LV) and right ventricle (RV). We also calculated Global Work Index (GWI) as the area of LV pressure-strain loop as a product of strain and x systolic blood pressure. MW efficieny (MWE), Global Constructive Work (GCW) and Global Wasted Work (GWW) were also calculated.

Results
There was no difference between the patients and the control group, regarding conventional parameters such as LV ejection fraction, Tricuspidal annular systolic excursion (TAPSE) and systolic pulmonary artery pressure. Left ventricular global longitudinal strain (GLS) and right ventricular global longitudinal strain were both significantly reduced in patient group (LV GLS ; -17,4% ,-19% p = 0,002 , RV GLS -19%, -24% p= 0,002 ). We found GWI and GCW were significantly lower in patients (mean 1549 mmHg% to 1800 mmHg%, p = 0,008) (mean 1857 mmHg% to 2176 mmHg%, p = 0,008), while GWW and MWE did not differ between the groups. We could not detect any significant correlation between MW indices and glomeruler filtration rate(GFR), time after surgery or hypertension.

Conclusion
Kidney donation may be associated with increased risk of subclinical cardiac dysfunctions. Myocardial Work might be a valuable diagnostic tool to detect subtle cardiac changes in this unique population.
Diagnostic value of parameters of myocardial work in patients after myocardial infarction with ST segment elevation
Authors: Oleinikov V , Babina A , Golubeva A , Galimskaya V 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objective
to reveal the differences in the global parameters of myocardial work of the left ventricle (LV) in patients with preserved LV ejection fraction (EF) after ST-segment elevation myocardial infarction (STEMI) and healthy individuals.

Methods
the study included 45 people with primary STEMI (group 1): 13 women and 32 men aged 38 to 66 years (52.3 ± 7.4). The control group (group 2) consisted of 70 healthy individuals aged 39.3 ± 8.9 years, including 34 men and 36 women. Myocardial infarction was confirmed by ECG data, a diagnostically significant level of cardiospecific markers (troponin T, CPK-MB) and by the results of coronary angiography with the presence of one infarct-related coronary artery in the absence of hemodynamically significant stenosis of other arteries. Echocardiography was performed on the 7th-9th day and 6 months after STEMI using a Vivid GE 95 Healthcare ultrasound scanner (USA). Echocardiographic image analysis was performed using EchoPAC software version 202 (GE Healthcare). The standard echo parameters were determined: end-diastolic volume (EDV, ml), end-systolic volume (ESV, ml), LV myocardial mass index (LVMI, g / m2), EF by the Simpson biplane method,%. The preserved EF was considered the value of EF greater than or equal to 50%. The following indicators of myocardial work were assessed: global myocardial work index (GWI, mm Hg%), global constructive work (GCW, mm Hg%), global wasted work (GWW, mm Hg%), global work efficiency (GWE,%). Statistical data processing was performed using the Statistica 13.0 software package (StatSoft Inc., USA).

Results
6 months after STEMI, 26 subjects had an EF ≥50% (58.8 ± 5.8%). The mean LVEF in group 2 was 60.8 ± 4.6% (p = 0.12). EDV in group 1 was 122.5 [95% CI 104.4; 140.7] ml, in group 2 - 104.7 [95% CI 99.1; 110.3] ml (p = 0.003). ESV in group 1 - 83.8 [95% CI 28.5; 139.0] ml, in group 2 - 40.7 [95% CI 37.6; 43.7] ml (p = 0.02); in group 1, LVMI was 89.3 [95% CI 77.4; 101.1] g / m2, in group 2 - 67.4 [95% CI 63.7; 71.1] g / m2 (p = 0.03). GWI was 1890.1 [95% CI 1730.0; 2050.2] mm Hg% in group 1, in group 2 - 2039.8 [95% CI 1956.3; 2123.3] mmHg% (p = 0.002), GCW - 2132.4 [95% CI 1958.5; 2306.3] mmHg% and 2335.5 [95% CI 2251.7; 2419.4] mm Hg% (p = 0.003), respectively. GWE 95.4 [95% CI 94.1; 96.6] and 97.1 [95% CI 96.8; 97.4]% (p = 0.02), GWW 76.6 [95% CI 55.9; 97.3] and 50.0 [95% CI 44.0; 56.0] m Hg% (p = 0.06) in the corresponding groups.

Conclusion
Thus, despite the satisfactory values of LVEF, the indicators of myocardial work, except for global wasted work, had lower values in patients with STEMI compared with healthy individuals.
Impaired myocardial work in paediatric patients with wolff-parkinson-white syndrome
Authors: Borrelli N , Di Salvo G , Ciriello GD , Sabatino J , Bucciarelli V , Grimaldi N , Barracano R , Fusco F , Merola A , Correra A , Romeo E , Palma M , Scognamiglio G , Russo MG , Sarubbi B 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Wolff-Parkinson-White Syndrome (WPW) has been associated with reduced local myocardium deformation during systole. Left ventricle (LV) dysfunction due to electrical dyssynchrony may require catheter ablation of the accessory pathway, even in asymptomatic patients.

Purpose
The study aimed to assess the diagnostic value of non-invasive myocardial work in predicting subtle myocardial abnormalities in patients with WPW.

Methods
Forty-four paediatric patients (age 8.2 ± 4.3 years) were included in the study: 12 cases with manifest WPW and 32 age-, sex- and arterial pressure- matched controls (CTR). LV ejection fraction (EF) and global longitudinal strain (GLS) were evaluated. Global myocardial work index (MWI) was measured as the area of the LV pressure-strain loops. From MWI, global Constructive Work (MCW), Wasted Work (MWW) and Work Efficiency (MWE) were estimated.

Results
Despite normal LV systolic function by standard echocardiographic parameters, patients with WPW had lower MWI (1233.5 ± 281.6 mmHg% in WPW vs 1624.0 ± 305.8 mmHg% in CTR, p = 0.0004), MCW (1833.4 ± 257.9 mmHg% in WPW vs 2069.0 ± 319.9 mmHg% in CTR, p= 0.03), MWW (187.6 ± 117.7 mmHg% in WPW vs 90.9 ± 58.9 mmHg% in CTR, p= 0.0008) and GWE (90.5 ± 4.8% in WPW vs 95.2 ± 2.2% in CTR, p= 0.00006). There were no significant differences in GLS and EF between patients with WPW and controls.

Conclusion
Myocardial work indices were found significantly reduced in patients with WPW, even in presence of normal LV EF and GLS. In patients with WPW, MWI may represent a sensitive measure of myocardial dysfunction and help in the decision-making for catheter ablation. Abstract Figure. Myocardial work in WPW Abstract Figure. Myocardial work in control patient
Incidence and risk factors for mechanical injuries caused by the transesophageal ultrasound probe manipulation in the setting of transfemoral transcatheter tricuspid repair
Authors: Kuecken T , Bannehr M , Lalou E , Haase-Fielitz A , Butter C 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Leading right heart failure due to tricuspid regurgitation results in retrograde hepatic venous congestion with subsequent gastropathy and hyperemia of the gastric mucosa. Due to increased portal pressure as well as possible cirrhosis cardiaque, the risk for esophageal varices is greatly increased. In addition, associated with atrial dilatation, these patients usually suffer from atrial fibrillation and receive an oral anticoagulation/ direct anticoagulation (OAC/DOAC) as insult prophylaxis. Heparinization with a target ACT &gt; 250 seconds is necessary during transfemoral transcatheter tricuspid repair (TTTR). Alternation between transgastric and midesophageal view with the transesophageal ultrasound probe is usually performed to better guide TTTR. Sufficient wall contact is crucial for good imaging. All of these conditions increase the risk for periprocedural gastric and/or esophageal injury.

Purpose
The aim of this study was to assess the incidence and risk factors for mechanical irritation and bleeding caused by the TEE probe manipulation in the setting of TTTR.

Methods
In this prospective cohort study patients received gastroscopy preinterventional and on the first day after TTTR. Statistical analysis was performed with IBM SPSS.28, t-Test was used to compare patients with and without postinterventional lesions.

Results
From December 2020 to July 2021, 18 patients with indication for TTTR were included in this study. The mean age of the patients was 77.8 (± 7.5) years. Thirteen patients (72.2%) had antral gastritis and 4 patients (22.2%) had corpus gastritis preinterventionally. Esophageal varices were not detectable in any patient. Postinterventionally, 10 patients (55.6%) showed lesions (hematoma or coagulated pressure points) (Fig. 1), and 2 patients (11%) required interventional treatment with hemoclips. The main lesion sites were midesophageal at 20-25 cm, 1 lesion at the Z-line. A mean of 5.7 (± 2.5) position changes took place; the mean procedural duration was 88 (± 27.8) min.
The number of clips placed (p = 0.64), the procedural duration (p = 0.99) and the number of position changes (p = 0.48) did not differ between the group of patients with and without injuries after TTTR (Tab 1).

Conclusion
More than 50% of patients with TTTR showed postprocedural injuries (lesions) of the esophagus. Contrary to our assumption, mainly lesions midesophageal could be detected. Due to the procedure as well as the severe underlying disease, gastrointestinal bleeding is a potential complication in the context of a TTTR. Consideration should be given to implementing regular control gastroscopy after TTTR to reduce the procedure-related complication rate. Due to the high incidence of procedure-related lesions, further research in larger patient collectives is necessary. Abstract Figure. Abstract Figure.
Percutaneous closure of atrial appendage with thrombus - a strategy shift? Report of a case series
Authors: Kasprzak JD , Peruga JZ , Filipiak-Strzecka D , Szymczyk E , Wdowiak-Okrojek K , Lipiec P 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Percutaneous closure of left atrial appendage (LAAO) is a recent preventive modality in atrial fibrillation. (AF) However, presence of thrombus which is a strong stroke risk multiplier represented a standard contraindication to purely percutaneous approach.
Aim. To test the safety and feasibility of LAAO in patients (pts) with appendage blood stasis and distal thrombus.
Methods. Using a novel generation transvascular device allowing "shallow dive" implantation we tested the feasibility of LAAO in pts with appendage blood stasis and distal thrombus. Additionally, hybrid transvascular approach with arch protection device was also tested. Indications included development of heart failure in AF or recurrent cerebral events in pts with LAA thrombi.
Results. We successfully performed 3 procedures in pts (2F, 1M, age 73-76) with distal LAA thrombus confirmed in 3D TEE / CT. After 3D echocardiographic sizing omitting appendage angiogram, occluder was implanted from right femoral venous access via septal puncture. In 2 patients right radial access was additionally used to introduce commercially available arch protection device. In all cases the occluder did not engage distal appendage zone and was appropriately deployed. However in patients with arch protection 1-2 mm debris was captured by protection device. No neurological sequelae were noted.
Conclusion. Our initial experience documents safety and feasibility of percutaneous LAAO in presence of appendage blood stasis and distal thrombus based on 3DE sizing and novel genertaion device with optional percutaneous aortic arch protection. The long term efficacy of such unorthodox has yet to be determined in the setting of severely prothrombotic milieu, abnormal left ventricular function but with potential for risk reduction or even reopening options of cardioversion. Abstract Figure. Occlusion of LAA appendage with thrombus
Sex differences in athlete"s heart are evident from early adolescence
Authors: Forsaa M , Bjerring AW , Haugaa KH , Hallen J , Sarvari S , Edvardsen T 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority

OnBehalf
ProCardio Center for Innovation

Introduction
Athlete’s Heart (AH) is characterized by cardiac remodelling as a response to exercise, but data on sex differences in adolescent athletes is limited.

Purpose
To study the impact of sex on development of AH in adolescent athletes. We hypothesize that male adolescent athletes develop greater morphological changes than females, also when adjusted for body surface area (BSA).

Methods
We recruited 12-year-old cross-country skiers of both sexes in a longitudinal cohort study. We examined them with echocardiography at age 12, 15 and 18.

Results
We recruited 76 athletes (48 males and 28 females). We could follow 48 participants at age 15 (34 males and 14 females), and 34 participants at age 18 (23 males and 11 females). There were no sex differences in exercise hours at any time point. Adolescent males had greater indexed LV end-diastolic volume (LV EDVi) at all time points (Figure 1). Both sexes displayed LV enlargement already at age 12, and athletes of both sexes displayed LV EDVi close to or above upper reference values for the adult population. Only males increased their indexed LV mass (LVMI) from 12 to 18 years (LVM/BSA, Δg/m²; 33 ± 27 vs 4 ± 19, P = 0.006). Male adolescent athletes increased their LVMI by 7.4 grams more and LV EDVi by 4.0 ml more than female athletes did for every 1000 hours of exercise training. Cardiac function was within normal range in both sexes throughout the study period.

Conclusion
Sex-related differences in cardiac adaptation to exercise are evident from early adolescence. Both sexes demonstrate cardiac remodelling, but adolescent male athletes display greater morphological changes compared to female athletes. Abstract Figure 1