bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic significance of peak atrial longitudinal strain in patients with functional mitral regurgitation
Authors: Gomes D , Lopes P , Freitas P , Albuquerque F , Horta E , Reis C , Guerreiro S , Abecassis J , Trabulo M , Ferreira A , Ferreira J , Ribeiras R , Mendes M , Andrade MJ 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Chronic mitral regurgitation has been shown to promote left atrial (LA) dysfunction and remodeling. However, the significance of LA dysfunction in this setting has not been fully investigated. The aim of our study was to assess the prognostic impact of peak atrial longitudinal strain (PALS), a surrogate of LA function, in a cohort of patients with LV systolic dysfunction and functional mitral regurgitation (FMR).

Methods
Patients with at least mild FMR and reduced LVEF (&lt; 50%) under optimized medical therapy who underwent transthoracic echocardiography between 2010 and 2018 were retrospectively identified at a single-centre. FMR grading was undertaken according to the new 2021 valvular guidelines. PALS was assessed by 2D speckle tracking in apical 4-chamber view (as per EACVI current recommendations). Cox proportional hazards regression was applied for univariable and multivariable analysis to investigate the association between clinical and echocardiographic parameters, namely PALS, and all-cause mortality.

Results
A total of 307 patients (median age 70 years, 77% male) were included. Median LVEF was 35% (IQR: 27 – 40%) and median mitral regurgitant volume was 25mL (IQR: 14 – 34mL). According to the new ESC 2021 valvular guidelines, 32 patients had severe FMR (10%). During a median follow-up of 3.5 years (IQR 1.4 – 6.6), 148 patients died. Median PALS was 14% (IQR 8 – 20%). The unadjusted mortality incidence per 100 persons-years increased with progressively lower values of PALS (figure 1). On ROC curve analysis, the best PALS cut-off value associated with mortality was &lt; 15%. Kaplan-Meier survival curves according to FMR severity and PALS &gt; or &lt; 15% are depicted in figure 2. PALS remained independently associated with all-cause mortality on multivariable analysis (adjusted hazard ratio [aHR]: 0.94; 95%CI: 0.90 – 0.98; p = 0.004) even after adjustment for several (n = 14) clinical and echocardiographic confounders.

Conclusion
In a cohort of patients with reduced LVEF and functional mitral regurgitation, peak atrial longitudinal strain was associated with all-cause mortality. Abstract Figure 1 Abstract Figure 2
Left atrial strain determinants across heart failure stages; insight from MASCOT registry
Authors: Benfari G , Mandoli GE , Magne J , Miglioranza M , Ancona R , Reskovic Luksic V , Pastore MC , Santoro C , Michalski B , Muraru D , Donal E , Cosyns B , Edvardsen T , Popescu B , Cameli M 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
MASCOT investigators

Background
Few studies analyzed left atrial (LA) peak atrial longitudinal strain (PALS) determinants, particularly across heart failure (HF) stages. We aimed to analyze the pathophysiological and clinical PALS correlates in a large international prospective registry.

Methods
This is a multicenter prospective observational study enrolling 745 patients with HF stages 0-C from July to October 2018. Data included PALS and left ventricular global longitudinal strain (LV-GLS). Exclusion criteria were: valvular prosthesis; atrial fibrillation; cardiac transplantation; poor acoustic window.

Results
Median global PALS was 17% [24-32]. 29% of patients were in HF-stage 0/A, 35% in stage-B, and 36% in stage-C. Together with age, the echocardiographic determinants of PALS were LA volume and LV-GLS (overall model R²=0.50, p &lt; 0.0001). LV-GLS had the strongest association with PALS at multivariable analysis (beta:-3.60 ± 0.20, p &lt; 0.0001). Among HF-stages (Figure 1), LV-GLS remained the most important PALS predictor (p &lt; 0.0001) whereas age was only associated with PALS in lower HF-stage 0/A or B (R=-0.26 p &lt; 0.0001, R=-0.23 p = 0.0001). LA volume increased its association to PALS moving from stage 0-A (R=-0.11; P = 0.1) to C (R=-0.42; P &lt; 0.0001). PALS was the single most potent echocardiographic parameter in predicting HF stage (AUC for B vs. 0/A 0.81, and AUC vs. 0/A for C 0.76). PALS remained independently associated with HF stages after adjusting for ejection fraction, E/e’ ratio and mitral regurgitation grade (p &lt; 0.0001).

Conclusion
Although influenced by LV-GLS and LA size across HF-stages, PALS is incrementally and independently associated with clinical status. LA function may reflect a substantial part of the hemodynamic consequences of ventricular dysfunction. Abstract Figure 1
Prevention of trastuzumab-related cardiotoxicity in HER-2 positive breast cancer patients
Authors: Ferri L , Bergamini C , Springhetti P , Niro L , 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) is a key therapy for HER-2 positive breast cancer that may have different side effects on the cardiovascular system. One of the most concerning complications is cancer therapy-related cardiac dysfunction (CTRCD). In literature there are conflicting data about the efficacy of heart failure drugs like ACE-inhibitors, ARBs and beta-blockers to prevent such an event.

Purpose
Aim of this study is to describe our experience on cardioprotective drugs in preventing TZ-related CTRCD.

Methods
105 consecutive 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 also treated with Anthracyclines. 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.

Results
Overall, before starting TZ, 12 patients were taking ACE-inhibitors or ARBs (11,8%) and 5 patients beta-blockers (4,9%). CTRCD occurred in 11 patients (10,8%), among these 9 (81,8%) weren’t taking any heart failure drugs and 5 (45,5%) didn’t present any cardiovascular risk factor. We observed no significant association among cardiovascular risk factors. Use of potential cardioprotective drugs before TZ administration seems to reduce the risk of development of myocardial dysfunction (relative risk 1,67; 95% confidence interval [CI], 0,41 to 6,82; P &gt; 0.05). No clear association was found between any cardiovascular risk factors and CTRCD (relative risk 0,81; 95% confidence interval [CI], 0,26 to 2,47; P &gt; 0.05).

Conclusions
In HER-2 positive breast cancer patients treated with TZ an early treatment with ACE-inhibitors or ARBs and/or beta-blockers is associated to the prevention of CTRCD. CTRCD seems not to be related to the presence of cardiovascular risk factors. Abstract Figure. Baseline patient characteristics
Reduced longitudinal strain in the left ventricular inferior wall predicts malignant arrhythmia in non-ischemic heart failure. A DANISH substudy
Authors: Winslow UC , Thune JJ , Elming MB , Philbert BT , Svendsen JH , Pehrson S , Jons C , Bundgaard H , Kober L , Risum N 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

BACKGROUND
Small studies have suggested that poor regional myocardial function may be associated with malignant arrhythmias, in particular around the inferior-posterior region. We tested this hypothesis in a subgroup of patients from the DANISH trial.

METHODS
From two centers, 317 patients with non-ischemic heart failure (LVEF &lt; 35%) from the DANISH trial were evaluated by 2D-strain echocardiography. Regional strain was calculated as the average longitudinal strain in basal-, midventricular- and apical segments in each of the six left ventricular walls. Reduced regional function was defined as below-median regional strain. The endpoint was a composite of sudden cardiac death (SCD), sustained VT, admission with ventricular arrhythmia, and appropriate therapy from a primary prophylactic ICD. Time-to-first-event analysis was performed using Cox models.

RESULTS
Mean age at inclusion was 62 years (72% male), median LVEF was 25% (IQR 20-30) median inferior strain was -8.7% (IQR -12.3; -4.9). After a five-year follow-up, 43 events were observed. Reduced inferior strain was associated with the composite endpoint in univariate analysis with a HR 2.08(95% CI 1.11-3.90), P = 0.021. After multivariate adjustment for clinical and echocardiographic parameters, inferior strain remained an independent predictor with a HR 2.78(95% CI 1.39–5.56), P = 0.004. Strain measurements in no other region were associated with the endpoint in the multivariate analysis. In subgroup analysis of patients in the two lower age tertiles (&lt;68 of age) we found that reduced inferior- and posterior strain were associated with development of the composite endpoint after multivariate adjustment with HRs of 3.25(95% CI 1.41-7.53), P = 0.006 and 2.51(95% CI 1.14-5.53), P = 0.022.

CONCLUSIONS
Low inferior-posterior strain was associated with a 2-3-fold increase in risk of malignant arrhythmia and SCD in patients with non-ischemic heart failure. Abstract Figure.
CHA2DS2VASC score for predicting atrial fibrillation in patients with cryptogenic stroke
Authors: Vera Sainz A , Cecconi A , Ximenez-Carrillo A , Ramos C , Martinez-Vives P , Lopez Melgar B , Sanz A , Ortega G , Aguirre C , Gamarra A , Montes A , De Rueda C , Vivancos J , Alfonso F , Jimenez Borreguero LJ 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Spanish Society of Cardiology

Introduction
CHA2DS2-VASc Score is widely used to predict thromboembolic risk in patients with Atrial Fibrillation (AF). However the role of CHA2DS2-VASC score for predicting AF in patients with cryptogenic stroke (CS) remains unknown.

Methods
Sixty-three consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale≥4 of unknown etiology, were prospectively recruited. They were classified according to
CHA2DS2-VASc Score: group 1 (score ≤ 5), and group 2 (score &gt;5). The primary outcome measure was the occurrence of AF during clinical follow-up.

Results
Twenty-six (41%) patients had a CHA2DS2VASC score &gt; 5 (group 2). Patients in this group were older (81 ± 5.5 vs 75 ± 8 years; p &lt; 0.001) and more frequently female (73% vs 43% p = 0.019). Patients in group 2 present more often hypertension (84% vs 43% p = 0.001), diabetes (38% vs 11%, p = 0.009) , dyslipidemia 77% vs 49%, p = 0.024), and a prior history of coronary artery disease (27% vs 5%, p = 0.026). Notably, patients with higher CHA2DS2VASC showed worse left atrial ejection fraction (41.7 ± 13.1 vs 52.2 ± 15%, p = 0.009) and worse left atrial strain reservoir (21.5 ± 7.1 vs 33.8 ± 11%, p &lt; 0.001), conduct (9.5 ± 4.8 vs 16.6 ± 8.4%;p &lt; 0.001) and contraction (12 ± 4.6 vs 17.2 ± 7.3, p = 0.002). During follow-up AF was detected more often in group 2 (42% vs 11% p = 0.006). In multivariate analysis CHA2SD2VAS &gt; 5 was an independent predictor of AF in patients with CS (HR 7.3 [95% CI 1.2-45.6] p = 0.032)

Conclusion
A CHA2DS2VASC score &gt;5 is an independent predictor of AF in patients with CS. This score provides a new clinical tool to inform clinicians with regards to the optimal treatment of these challenging patients
Right ventricular free wall longitudinal strain (RVFWSL) a new outcome predictor in patients candiate for TAVI
Authors: Dellino CM , Pergola V , Torresan F , Baroni G , Cecchetto A , Aruta P , Florencis A , Fraccaro C , Tarantini G , Mele D , Iliceto S 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
right ventricular systolic dysfunction is considered an outcome predictor in various cardiac diseases, sometimes stronger than ejection fraction (EF). We assume that right ventricular dysfunction, calculated with echocardiography in patients candidate for trans-catheter aortic valve implantation (TAVI), could be an outcome predictor. Purpose: evaluate the prognostic value of pre-TAVI right ventricular free wall longitudinal strain (RVFWSL) in patients with severe aortic stenosis undergoing TAVI. Methods: retrospective analysis of 100 patient underwent transfemoral TAVI in our hospital from January 2015 to September 2019, with at least a pre-TAVI and post-TAVI echocardiography. For each patients we collected clinical and echo data before and after TAVI and during the follow-up; we measured RVFWSL off-line at the same time. We considered the value of [23.3]% the cut-off of normality for RVFWSL. The primary end-point was a composite of death from any cause and hospitalization for heart failure. Results: the median age of the patients was 81 years (79-83) and EF was preserved in most patients (median 56%, 55-58,28%). At a median follow-up of 1023 days (630-1387), the univariate analysis demonstrated a predictive of a reduced RVFWSL before TAVI (&lt; [23.3]%, P = 0.015) and EF &lt; 50% (P = 0.014). Cox regression analysis found that pre-TAVI reduced RVFWSL (HR 2.875, I.C. 95% 1.113-7.425; P = 0.03) and EF &lt; 50% (HR 2.511, I.C. 95% 1.07-5.892; P = 0.03) were independently associated with composite end-point of the study. Moreover, a reduced EF associated with RVFWSL &lt; [23.3]% had an incremental value in predicting the outcome (P = 0.021). Conclusions: among patients with severe aortic stenosis undergoing TAVI, a reduced pre-implant RVFWSL is able to predict long-term outcome.
Deformation analysis in post-hospitalised patients with moderate SARS-CoV-2 infection
Authors: Valatsou A , Tsartsalis D , Dimitroglou Y , Tolis E , Banos A , Sfendouraki E , Fragoulis C , Patsourakos D , Koukos M , Kalompatsou A , Chrysochoou C , Pirounaki M , Aggeli C , Vassilopoulos D , Tsioufis K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
SARS-CoV-2 infection is associated with multiple cardiac manifestations (1,2). Global longitudinal strain (GLS) by speckle tracking echocardiography (STE) is a novel transthoracic echocardiography (TTE) measure of myocardial deformation, which could early recognize subclinical cardiac injury in COVID-19 patients (3,4).

Purpose
We aimed to explore GLS profiles in post-hospitalized COVID-19 patients to identify features of eventual subclinical cardiac injury and to investigate the possible correlation with the severity of infection.

Methods
We enrolled 33 patients (mean age 59.2 ± 13, 64% men) with positive SARS-CoV-2 RT-PCR, hospitalized for moderate COVID-19 disease, with no admission to intensive care unit. Patients were submitted to TTE 1-2 months after discharge. Images were anonymised and analysed offline by two accredited cardiologists. Clinical parameters and laboratory findings from hospitalization were also collected. Acute myocardial infarction and pulmonary embolism were exclusion criteria.

Results
Mean duration of hospitalization was 12.9 ± 8.0 days. Study population had normal systolic function with a mean LV ejection fraction 58.6% (±3.6) while the majority of patients had relative low values of LV global longitudinal strain, mean 15.2% (±2.3). Arterial hypertension was present in 51.5% of patients and a history of previous myocardial infarction was referred in 6.1% of the population. Only 24.2% of patients had elevated troponin levels during the previous in-hospital period (mean maximal value of hs-troponin was 18.1 ±16.6 pg/mL) whereas 81.8% had abnormal D-Dimers values (mean 2424 μg /L, range ±2825) and 93.1% had high hs-CRP values (138.2 ±92.0 mg/L) . Duration of hospitalization had strong significant correlation with D-Dimers (rho: 0.708, p: &lt;0.001) and hs CRP (rho:0383, p:0.028) and marginal association with troponin ( rho: 0.335, p:0.056). Moreover, global longitudinal strain showed significant association with duration of hospitalization (rho:-0.545, p: 0.007). Traditional systolic indices as LVEF and the various diastolic parameters showed no significant association with severity of disease reflected by the duration of hospitalization and the other clinical and laboratory biomarkers.

Conclusion
Cardiac manifestations of SARS-CoV-2 infections could be present in mild to moderate disease and seems to associate with the severity of infection. The novel echocardiographic parameters such as GLS could add valuable information and identify possible subclinical cardiac injury often unrecognized by traditional TTE examination.
The effect of urgent blood pressure lowering on left atrial mechanics in patients with hypertensive episode in emergency setting
Authors: Dinc Asarcikli L , Sert S , Can F , Osken A , Unal S 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left atrial (LA) dilatation and dysfunction are early manifestation of hypertension and represent end-organ damage. Hypertension is a well-known risk factor for atrial fibrillation. Long term effect of hypertension on the left ventricle and left atrium was well-studied before. In this study, we aimed to investigate the acute effect of urgent blood pressure reduction on the left atrial strain.

Methods
We prospectively enrolled 52 consecutive patients (age: 67.5 ± 8.9 years, 48.1% male) (Fig1) admitted to our emergency department with a hypertensive attack. All patients underwent baseline standard echocardiographic evaluation. 2D images from apical 4-chamber view were recorded for offline analysis. Reservoir (PALS) and contractile (PACS) left atrial strain measurements were performed by automated software using the onset of QRS as a reference point. Patients with systolic dysfunction, acute coronary syndrome and any rhythym other than sinus or with poor echogeneicity were excluded. All measurements were repeated after achieving target blood pressure reduction and analyzed.

Results
Urgent blood pressure reduction result in improvement in LA contractile strain (PACS) and LVEF and increase in heart rate and RV systolic function while LV dimensions, LA volumes and LAVI were decreased. There is a statistically significant negative moderate relationship between absolute change of DBP and absolute change of PALS (r=-0.423; p = 0.002). There is a statistically significant negative and weak correlation between the absolute change in SBP and the absolute change in PACS (r=-0.280; p = 0.044).

Conclusion
Assessment of LA strain by 2D speckle tracking echocardiography is easy to apply and noninasive method to quantify LA function even in emergency setting. This study showed that LA contractile strain (PACS) rather than LA reservoir strain (PALS) was significantly affected from LV end diastolic pressure. Abstract Figure 1 Abstract Figure 2
Long term left ventricular impairment after SARS-COV2 infection
Authors: Brito J , Silva P , Valente Silva B , Pereira S , Silverio Antonio P , Morais P , Rigueira J , Placido R , David C , Silva D , Fernandes S , Ribeiro J , Pinto FJ , Almeida A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The impact of acute infection by SARS-COV2 on the cardiovascular system has been previously reported in the literature, with a higher propensity in patients with more serious pattern of disease and pro-inflammatory status. Nevertheless, the long-term burden and sequels of COVID-19 on the cardiovascular system is still unknown.

Purpose
To evaluate the long-term impact of COVID-19 on left ventricular function in patients with severe clinical presentation requiring intensive care hospitalization.

Methods

This was a single-center observational, prospective study which included patients requiring admission to the Intensive Care Unit (ICU) due to COVID-19 infection from January to November 2020. All discharged patients were contacted to perform a clinical, electrocardiographic and echocardiographic evaluation and those who accepted were included on the protocol. Baseline and clinical characteristics were collected from clinical reports. For the global longitudinal strain (GLS) analysis all patients with significant wall motion abnormalities and valvular cardiopathy were excluded. Statistical analysis was performed with Mann-Whitney and a safety cut-off was established with ROC curve analysis.

Results

A total of 43 patients were included (mean age 64 ± 12, 67.4% males). During SARS-COV2 infection 49% presented with severe ARDS and 51% with moderate, 35% required invasive mechanical ventilation, 14% noninvasive mechanical ventilation and 52% with high nasal flow cannula. On the follow-up analysis, fatigue was the most reported in symptom (52% patients) and the majority did not present other signs or symptoms suggestive of heart failure, with the mean NT-proBNP of 49 ± 389 pg/dL. The standard ECG and echocardiogram did not show significant changes with a mean LVEF of 58 ± 7.8 and mean TAPSE of 21 ± 4. The strain analysis showed low value of GLS (mean GLS of -17.14 ± 2.36) for a reference cut-off of -18%, suggesting subclinical left ventricular dysfunction in this subset of patients with preserved ejection fraction. Maximum CPR values during ICU did not correlate either with the extent of disease evolvement in CT (p= NS) or ARDS severity (p= NS). Nevertheless, maximum CPR correlated significantly with GLS reduction (R = 0.44, p = 0.019). A CPR value higher than iger30mg/dL had 100% specificity for GLS reduction and a cut-off of 14gm/dL reported a sensitivity of 65% and specificity pf 75% for reduction in GLS.

Conclusion
In our study, we reported subclinical impairment in left ventricular function detected with global longitudinal strain after serious infection with SARS-COV2. The detected myocardial dysfunction was related with higher inflammatory as expressed by CPR values. Long-term monitoring of these patients should be undertaken in order to timely detect late complications. Abstract Figure.