bluuebunny/crossref_metadata_2025_split huggingface dataset:
The prognostic value of reduced global longitudinal strain (GLS) on cardiac outcomes in patients on peritoneal dialysis: a prospective study
Authors: Kam K , Ng JKC , Kwong VWK , Szeto CC , Lee APW 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
This study aims to evaluate the capacity of left ventricular global longitudinal strain (GLS) in end stage renal failure patients on peritoneal dialysis (PD) to predict cardiovascular mortality and major adverse cardiac events (MACE). GLS has been an established parameter in detecting subclinical left ventricular systolic dysfunction in the setting of preserved ejection fraction (EF &gt; = 50%). We hypothesized that reductions of GLS (i.e. less negative value) are associated with adverse cardiovascular outcome.

Methods
We prospectively recruited a total of 60 PD patients from a single dialysis center in a tertiary hospital. GLS was determined by two-dimensional speckle-tracking echocardiography, under Philips QLab system. A less negative value reflects underlying subclinical LV dysfunction. The primary outcome was 4-point MACE, which was a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke and hospitalization for heart failure. Surrogate markers of inflammation (C-reactive protein [CRP], tumor necrosis factor [TNF]-alpha), nutrition (serum albumin), arterial stiffness (pulse wave velocity [PWV]), and serum N-terminal pro-brain natriuretic peptide (NT-proBNP) were also measured.

Results
16 (26.7%) and 34 (56.7%) PD patients had reduced GLS (≥ -18.3%) and left ventricular hypertrophy (LVH) respectively. In 12-month follow up, 4-point MACE occurred in 13.6% and 59.8% of normal and compromised GLS patients respectively (log-rank, P = 0.004), as illustrated by Kaplan-Meier curves (Fig 1). Patients with reduced GLS had higher proportion of uncontrolled blood pressure and higher prevalence of coronary artery disease. Their EF were significantly lower (53.6 ± 7.4% vs. 61.3 ± 4.1%, P= 0.001) compared with patients with normal GLS. In addition, GLS correlated with EF (r = -0.57, P &lt;0.0001) and PWV (r= 0.33, P = 0.01). There was a trend towards an association between GLS and ln(CRP) (r= 0.25, P = 0.057), and ln(NT-proBNP) (r = 0.22, P= 0.09), respectively.

Conclusions
Subclinical LV systolic dysfunction was present in one-fourth of peritoneal dialysis patients despite having preserved EF. Reduced GLS (less negative than 18.3%, illustrated in Fig 2) is a strong predictor of poor cardiovascular prognosis among PD population. Abstract Figure 1 Abstract Figure 2
The effect of exercise on left ventricular global longitudinal strain: a systematic review and meta-analysis
Authors: Murray J , Bennett H , Bezak E , Perry R , Boyle T 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
Cancer Research Institute, Allied Health and Human Performance, University of South Australia
Background/Introduction
Left ventricular global longitudinal strain (LVGLS) can detect early myocardial changes prior to clinical abnormalities arising, and is a strong prognostic indicator of future cardiovascular (CV) dysfunction and mortality. It is well established that exercise improves CV function and reduces risk of CV disease. However, the impact of exercise on LVGLS is currently unclear. If LVGLS increases in response to habitual exercise, it could offer a sensitive measure that can determine the effectiveness of an exercise regime on CV health.

Purpose
The aim of this systematic review and meta-analysis was to determine whether exercise impacts LVGLS across a range of healthy and diseased populations.

Methods
Four databases (Medline, Scopus, eMbase, SPORTDiscus) were searched in November 2020. Included studies assessed LVGLS before and after an exercise intervention (minimum 2 weeks) in adults aged 18 years and over, and were published in English from 2000 onwards. Random-effects meta-analyses were performed at a study level using Stata (v16.1) to calculate summary standardized mean differences (SMD) and 95% confidence intervals (CI). 39 studies met selection criteria, with 35 included in meta-analyses (1765 participants).
Primary meta-analyses included only studies that compared outcomes between one or more intervention arms to a standard (non-exercising) control arm (RCT’s, N-RCT’s, randomised crossover). Secondary analyses included data from studies with intervention arms only (single group pre-post studies, intervention group from RCT’s, N-RCT’s, randomised crossover).

Results
Primary:
In populations with CV disease, a moderate effect of exercise was observed compared to non-exercising controls (SMD = 0.59; 95% CI, 0.16-1.02; p = 0.01 – figure 1a). No significant effect of exercise was observed for CV risk (SMD = 0.07; 95% CI, -0.15-0.29; p = 0.56 – figure 1b) and healthy (SMD = -0.20; 95% CI, -0.73-0.33; p = 0.45) populations compared to non-exercising controls.

Secondary
In secondary meta-analyses, significant effects of exercise were observed in CV disease (SMD = 0.26; 95% CI, 0.07-0.46; p = 0.01), CV risk (SMD = 0.54; 95% CI, 0.15-0.93; p = 0.01), chronic kidney disease (SMD = 0.65; 95% CI, 0.03-1.28; p = 0.04) and athletic (SMD = 0.30; 95% CI, 0.20-0.41; p= &lt;0.001) populations.
Conclusion(s)
Increases in LVGLS observed in populations with CV disease may assist the prevention of secondary CV events. Secondary findings may support the use of exercise across a range of populations to increase LVGLS and enhance CV function. Future research must address the methodological limitations that currently exist, including improving upon study designs and reporting of individual data. Abstract Figure.
Non-invasive myocardial work indices in arterial hypertension: relevance to hypertension grade assessed by 24-hour blood pressure monitoring
Authors: Kolesnyk M , Dudko O 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. A novel approach to non-invasive myocardial work (MW) assessment was shown to be of clinical value in different scenarios. It based on left ventricle (LV) pressure-global longitudinal strain (GLS) loops computation. Systolic LV pressure is assumed to be equal to brachial cuff systolic pressure. However, single blood pressure (BP) measurement during echocardiography may be influenced by many factors, e.g. «white-coat» effect. The purpose of this study was to evaluate MW indices in patients from mild to severe arterial hypertension (AH) assessed by 24-hour ambulatory blood pressure monitoring.
Methods. The study enrolled 90 males (mean age 47 ± 9 years) with uncomplicated arterial hypertension (AH), divided into 3 groups (mild AH, moderate AH, severe AH). All patients underwent conventional echocardiography, speckle tracking echocardiography with LV pressure-strain loops computation and 24-hour BP monitoring at the same day. The AH grade was assessed by DABL criteria. MV indices were calculated with specific software by integrating LV global longitudinal strain data and non-invasively estimated LV pressure. The following parameters were calculated: global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). The values are given as median and interquartile range.
Results. The patients in groups were comparable by demographic and clinical characteristics. We didn"t find any difference between groups by conventional echocardiographic parameters, including LV wall thickness, LV mass index, LV ejection fraction and LV GLS. The significant difference was present between three groups in all MW indices (Table). The patients with severe AH had higher GWI, as well as GCW and GWW compared to patients with mild and moderate AH. The GWE was significantly decreased in patients with highest BP values.
Conclusions. Myocardial work indices are more sensitive markers of LV function in patients with AH compared to standard parameters. Integration of systolic BP, assessed by 24-hour BP monitoring in MW analysis may potentially give more precise characteristics of LV function in hypertensive patients. Abstract Figure.
Right ventricular involvement in breast cancer patients undergoing chemotherapy
Authors: Ferri L , Bergamini C , Niro L , Springhetti P , Cerrito LF , Schiavone A , Dal Porto M , Setti E , Benfari G , Rossi A , Fiorio E , Ribichini FL 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Trastuzumab (TZ) and Anthracyclines (AC) are widely used for their key role in breast cancer. However, they may have different side effects on the cardiovascular system. One of the most concerning complications is myocardial dysfunction. Many studies have highlighted the importance of the screening for cardiotoxicity using left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Nevertheless, there is little data about the right ventricular (RV) involvement.

Purpose
Aim of this study is to analyze the modification of RV systolic function in this setting.

Methods
105 women affected by HER-2 positive breast cancer treated with TZ referring to our echo-lab were enrolled in our single center prospective study. 3 patients were excluded due to an early TZ suspension not related to cardiovascular complications, thus 102 patients (97,1%) were eligible for analyses. 86 of these (84,3%) were treated also with AC. All patients underwent consecutive transthoracic echocardiography (TTE) before starting TZ and then every 3 months up to 12 months. 2D-Speckle tracking analysis was performed at baseline and at each examination using Tomtec software. A complete clinical evaluation was also performed at each follow up. LV systolic dysfunction was defined as an absolute reduction of LVEF &gt;10% from baseline to LVEF &lt;53% or a relative reduction of GLS &gt;15% from baseline and a reduction of LVEF &gt;10% from baseline. RV systolic dysfunction was defined as TAPSE &lt;17 mm, pulsed doppler S wave &lt;9,5 cm/s and/or RV free wall strain &lt;20%.

Results
LV systolic dysfunction occurred in 11 patients (10,8%). TAPSE and pulsed doppler S wave remained within the normal limits in all patients at follow up. On the contrary, RV free wall strain was reduced in 11 patients (10,8%), none of whom reported symptoms or signs of right-sided heart failure; 5 of these (45,5%) also presented LV dysfunction . LV and RV systolic dysfunction occurred mainly at the same time.

Conclusions
Cancer treatment also appears to impact on right chamber myocardium. RV free wall strain analysis seems more reliable in detecting RV systolic dysfunction rather than clinical examination or common echocardiographic parameters, such as TAPSE or pulsed doppler S wave, in the setting of patients with breast cancer treated with chemotherapy. However, further studies are needed to investigate its prognostic role.
Assessment of left ventricular contractile reserve during hyperventilation and exercise in patients with ANOCA
Authors: Dedic S , Boskovic N , Giga V , Nedeljkovic I , Tesic M , Jovanovic I , Aleksandric S , Beleslin B , Ciampi Q , Picano E , Djordjevic Dikic A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction. Mechanism of ischemia in patients with angina and no obstructive coronary artery disease (ANOCA), is often unrecognized since invasive tests are seldom done and proper noninvasive test is not established yet.
The aim of our study was to assess changes in ventricular function during hyperventilation test (HYP) designed to provoke vasoconstriction, immediately followed by supine bicycle exercise to increase ischemic stimuli in patients with ANOCA (HYP + EXE).
Methods. : In a prospective study, we enrolled 29 ANOCA patients (age 59.6 ±11 years, 27 females) with previously normal angiograms. All patients underwent SE testing with hyperventilation (HYP, respiratory rate of 30 per min for 5"), immediately followed by supine bicycle exercise (HYP + EXE). Ventricular function was assessed based on left ventricular contractile reserve (LVCR), calculated by ratio of the ventricular force at the peak of the each stress level and rest. Force was assessed as the quotient between systolic arterial pressure and end-systolic volume determined by two-dimensional echocardiography. Values range from normal (&gt; 2.0) to mild (1.5–2.0), moderate (1.01–1.49), and severe (≤1.0) dysfunction. For LVCR HYP values are shifted towards lower values (abnormal &lt; 1.1).
Results. Chest pain or dyspnea were present in 4/29 pts during HYP, and in 7/29 patients during HYP + EXE (13.8% vs 24.1 %, p = 0.001). Three patients showed wall motion abnormalities with hyperventilation and additional two patients with HYP + EXE. LVCR HYP response was normal in 19/29 (65.5%) pts and abnormal in 10/29 (34.5%) pts. LVCR HYP + EXE response was normal in 9/29 (31%) pts, 4/29 (13.8%) pts had mild, 11/29 (37.9%) pts had moderate and 5/29 (17.3%) pts had severe dysfunction.
Conclusion. In patients with ANOCA subtle changes in LV function occurred with HYP and EXE stress more often than wall motion abnormality. Measurement of contractile reserve might be a useful tool in assessment of ischemia and ventricular dysfunction in patients with ANOCA. Abstract Figure 1. Abstract Figure 2.
Dobutamine 3D strain in the left anterior descending subtended ventricular territory: evidence for relationship with the respective velocity flow reserve
Authors: Armenis I , Armenis I , Demerouti E , Demerouti E , Athanassopoulos GD , Motsi A , Athanassopoulos GD 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction
Three dimensional speckle tracking imaging (3DST), provides an evolving means to interrogate left ventricular (LV) function. However, its clinical application still remains limited.
Purpose
Purpose of the study was to interrogate the relationship between regional deformation by 3DST in left anterior descending artery (LAD) subtended territory and the respective coronary flow reserve (CFR).

Methods
Fifty patients aged 63 ± 6 years with chronic coronary syndromes were studied. Patients had no evidence of dobutamine (DOB) induced ischemia in LAD territory. Distal LAD CFR was estimated by adenosine Doppler echo (140mg/kg/min). 3DST derived integral strain (IS) and respective components (longitudinal -LS, circumferential –CS, radial -RS) were estimated by a full volume sweep (3.5 MHz sector probe) at &gt;20 volumes/sec. A 16 LV sectors (sc) polar map was provided (Artida,Toshiba) with 10/16 sectors (sc) analysed, 6 sc being the conventional LAD territory (sc: 3,4,5,6,7,8) and another 4 sc being adjacent ones (sc: 1, 2, 9, 10). 3D datasets acquired at rest (R) and low dose DOB (20mg/kg/min). LV mass was automatically measured from volumetric data sets and its variability during cardiac cycle was considered as an index of coherence for true LV borders recognition.
Results
CFR was &gt;2 in all pts (range 2.0-4.2, 2.74 + 0.46). Mean variability of LV mass between R and DOB was 0.044 (range: -0.090-0.008, p = ns). 3DST strain was related with LAD CFR as follows:
1.For IS: at R: sc1: r = 0.38, p = 0.023, sc3: r = 0.44, p = 0.006, sc5: r = 0.35, p = 0.03, sc9: r = 0.50, p = 0.002.

At DOB
sc7: r = 0.31, p = 0.05.
2.For LS: at R: sc5: r=-0.40, p = 0.01.
3.For CS: at R: sc5: r=-0.33, p = 0.02, sc5: r=-0.46, p = 0.004.
4.For RS: at R: sc9: r=-0.38, p = 0.08.
The % changes of regional IS post DOB compared to R were also related with CFR LAD in the sectors sc1 and sc3 (r = 0.34, p = 0.05, and p = 0.40, p = 0.002 respectively).

Conclusion
3DST derived LV deformation indices in the LAD territory are related with the respective CFR. LV regional integral strain has a stronger relationship with LAD CFR when compared to the partial vectors. The 3DST derived deformation indices seem sensitive enough to reproduce the flow function relationship in the LAD territory. Thus, potential applicability has to be supported.
The role of right ventricular longitudinal function in non-responder patient following cardiac resynchronization therapy
Authors: Jenei C , Toth A , Nagy L , Clemens M , Papp E , Csanadi Z 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Hungarian Government Research Fund, Szív- és érkutatási kiválóságközpont (IRONHEART)

Background
In approximately 30-40% of cases, the left ventricular systolic function does not improve following cardiac resynchronization therapy (CRT; non-responders). Currently, the role of right ventricular (RV) systolic function is yet not well established. Our aim was to assess the RV systolic function with 3D echocardiography in CRT patients.

Methods
We involved 24 patients (12–12 CRT responder and non-responder) who received CRT in our department, and whose 1-year follow-up data were available. We considered the patients "responder" when the left ventricular ejection fraction (LV EF) improved with at least 10% after CRT implantation. We characterized several 3D and 2D parameters of RV using a dedicated RV analysis software, such as RV ejection fraction (EF), body surface area-indexed end-diastolic (EDVi) and end-systolic (ESVi) volumes, free-wall longitudinal (RV GLS) and radial strains.

Results
After the follow-up, LV EF was 43 ± 8% in responders and 26 ± 7% in non-respoders (p &lt; 0.0001). RV EF was significantly higher (EF: 44 ± 9%; p = 0.003) in responders compared to non-reponders (EF: 32 ± 9%). There was no significant difference in RV EDVi: 65 ml/m² (IQR: 54-74) in responders and 53 ml/m2 (IQR: 42-67) in non-responders (p = 0.22). RV ESVi was also comparable between CRT responders (37 ml/m² - IQR: 28-39) and non-responders (36 ml/m² - IQR: 28-46), (p = 0.85). RV GLS was significantly higher in CRT responders (-13 ± 3% vs. -10 ± 4% in non-responders; p = 0.02) in parallel with the change of the RV EF, while the RV radial strains did not differ between the two groups (2.5 ± 1.7% in responders vs. 2 ± 1% in non-responders; p = 0.47).

Conclusions
The lower RV EF based on mainly the longitudinal function of RV indicates non-respondence to CRT, however, it is not associated with RV dilation, i.e. adverse remodelling. These results suggest mechanical abnormality of RV function in the background of impaired EF.
Echocardiographic assessment of ventricular function in chronic HCV patients receiving direct antiviral therapy
Authors: Ghoneim MA , Magdeldin Mohamed Abdelgawwad I , Tageldin A , Nasr GM 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Hepatitis C virus (HCV) infection is still a major public health burden in many parts of the world (1). Globally, an estimated 58 million people have chronic hepatitis C virus infection, with about 1.5 million new infections occurring per year (2).
Treatment for chronic HCV infection has evolved from interferon (IFN)-based therapy to direct-acting antivirals (DAAs) (3,4). With the development of DAA, treatment of HCV became better-tolerated and highly effective (5,6).
Several studies have attempted to explore their cardiac side effects, especially their impact of left ventricular (LV) function; however, these studies were limited by their design and the methods of assessment (7-10).

Aim
In this prospective study we aimed at evaluating the short effects of DAAs on left ventricular functions using 3D Echocardiography.

Methods
Patients with HCV infection planned to receive combination therapy of Sofosbuvir 400 mg daily plus Daclatasvir 60 mg daily for 12 weeks were assessed by echocardiography before starting and after 3 months after completion of treatment. Patients with other systemic or cardiac conditions or structural heart disease were excluded. Assessment of LV volume and EF was performed by 3D quantification and global longitudinal strain (GLS). Right ventricle size was assessed by 2D and systolic function was evaluated by TAPSE, S` and FAC.

Results
In 102 patients who were followed up at 3 months after DAA therapy, We found an increase in increase in both LV end diastolic dimensions and volumes (p∼0.02 & p∼0.045 respectively) as well as end systolic volumes (p∼0.005). There was no significant difference in neither LV systolic function as assessed by EF and GLS (62.25 ± 5.15 vs. 62.35 ± 5.77, p∼0.850, -22.97 ± 2.93 vs. -22.83 ± 2.59, p∼0.546 respectively), nor in diastolic function (p∼0.546). However, subgroup analyses revealed a significant negative correlation between age and GLS (P∼0.022) as well as the number of cardiovascular risk factors (P∼0.039). Hypertension was found to be the only predictor of the decrease in GLS in the regression analysis of risk factors (p∼0.001). There was no significant change in RV size and systolic function at follow up.

Conclusions
There was no significant change in LV systolic or diastolic function before and after DAA therapy as measured by EF and GLS. Nonetheless, subgroup analysis suggests a drop in GLS in older patients and those with more cardiovascular risk factors. An increase in LV size was also noted while no significant effect was noted with regards to RV size and function.
Tricuspid annular plane systolic excursion (TAPSE) is not an appropriate parameter for the evaluation of right ventricular systolic function after lung transplant
Authors: Serrano Lozano D , Ruisanchez Villar C , Cuesta Cosgaya JM , Lerena Saenz P , Mora Cuesta VM , Iturbe Fernandez D , Lozano Gonzalez M , Zubiaur Zamacola J , Margarida De Castro A , Molina San Quirico M , Fernandez Rozas S , Vazquez De Prada Tiffe JA , Gonzalez Vilchez F , Cifrian Gonzalez JM 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction. Tricuspid annular plane systolic excursion (TAPSE) is a widely used parameter for the assessment of right ventricular (RV) systolic function in candidates for lung transplant (LT). However, its accuracy after surgery is not well established. In our study, we aim to evaluate the feasibility of TAPSE after LT and compare it with other classic parameters of RV function.
Methods. 144 patients underwent LT between January 2014 and June 2017 in our center. Mean age was 55 years (65 % men). Double LT was performed in 65%, being most common etiology pulmonary fibrosis followed by chronic pulmonary obstructive disease. 9% of LT candidates had severe pulmonary hypertension (PH), defined as mean pulmonary artery pressure (PAP) over 45 mmHg on right heart catheterization.
We retrospectively analyzed echocardiographic studies at baseline and 4 weeks after LT in 94 patients. Nine of them had prior severe pulmonary hypertension. We measured RV fractional area change (FAC) and systolic displacement of tricuspid annulus-TAPSE as main parameters of RV systolic function, as well as right atrium (RA) area.
Results. We found a significant improvement in RV FAC (39 ± 9% vs. 44 ± 6%, p &lt; 0.001) and a reduction in RA area (16 ± 6 cm2 vs. 12 ± 5 cm2; p &lt; 0.001) after lung transplant in the global study group. This was remarkably significant when prior severe pulmonary hypertension was present (RV FAC 24 ± 9% vs. 43 ± 6%, RA area 27 ± 8 cm2 vs. 14 ± 4 cm2; p &lt; 0.000). However, postoperative TAPSE was significantly lower (21 ± 3 mm vs. 17 ± 2 mm; p &lt; 0.000), and it did not show any significant change in the PH subgroup (p = 0.89). We found a good correlation between TAPSE and RV FAC on pre-transplant echocardiographic study (r = 0.76; p &lt; 0.000), whereas this relation did not remain after LT (r = 0.26; p 0.06).
Conclusion. Right ventricular systolic function globally improved after LT, and this is particularly pronounced in candidates with severe PH. In contrast, TAPSE paradoxically deteriorates on post-surgery echocardiogram. According to our findings, TAPSE may not be a reliable parameter for the assessment of RV systolic function after lung transplant.