bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right ventricular diastolic dysfunction in breast cancer patients undergoing chemotherapy
Authors: Sumin A , Slepynina YUA , Shcheglova AV , Ivanova AV , Borzyanitsa SM , Polikutina OM 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Right ventricular (RV) diastolic dysfunction has been recognized as an independent predictor of adverse events and mortality in a wide range of diseases (1,2). Experimental and clinical data indicate that pathophysiological factors induce the development of RV diastolic dysfunction first, and only later - systolic dysfunction (3). The aim of the study was to assess the right ventricle diastolic function in patients with breast cancer undergoing chemotherapy.

Material and methods
The study included 40 women receiving anthracycline-based chemotherapy for cancer, and 25 age-matched and comorbidity-matched women without cancer as a control group. RV systolic (s"t, Tei-index, and TAPSE) and diastolic (Et, At, Et/At, e"t, a"t, e"t/a"t) function parameters at baseline and after treatment were compared and evaluated.

Results
In cancer patients during anthracycline-based chemotherapy, no signs of cardiotoxicity were detected according to the indicators of the left ventricular ejection fraction and global longitudinal strain. Progressive decline in RV diastolic function was noted in patients receiving anticancer therapy. Et was 53.0 (46.0; 62.0) sm/sec in control, 50.0 (41.0; 53.0) sm/sec in cancer group before treatment, and 45.0 (41.0; 51.0) sm/sec after one-year treatment (p = 0.017 for trend). Et/At was 1.4 (1.28; 1.6), 1.34 (1.23; 1.58), and 1.12 (0.81; 1.35), respectively (p = 0.002 for trend). RV systolic function was without changes during treatment. TAPSE was 2.5 (2.2; 2.8) sm in control, 2.3 (2.2; 2.5) sm in cancer group before treatment, and 2.3 (2.0; 2.4) sm after one-year treatment (p = 0.091 for trend).

Conclusion
Patients undergoing chemotherapy experience a decline in right ventricular filling rates despite not showing clear signs of anthracycline-associated cardiotoxicity. More research is needed to indicate the clinical and prognostic significance of such changes.
High frame rate blood speckle tracking echocardiography: left ventricle vortex analyisis in healthy children and in congenital heart disease
Authors: Cantinotti M , Marchese P , Assanta N , Van Den Eynde J , Franchi E , Shelby K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
High-frame rate blood speckle tracking (BST) echocardiography is a new method, for the evaluation of intracardiac flow, independent of the insonation angle. Left ventricle, throughout cardiac cycle, creates a vortical flow still poorly analysed in children with congenital heart disease (CHD). Aim of this study is to evaluate the characteristics of left ventricular (LV) vortices in healthy children and in those with CHD.

Methods
Characteristics of LV vortices were acquired on standard 4-chamber view and BST images from 230 healthy children (median age 5.96 years, range 2.9-10.1 years) and 72 children with CHD (median age 1.33 years, IQR 0.2-7.12 years). Both groups were compared after propensity matching. Multiple linear regression was used to identify factors that independently influence vortex characteristics.

Results
Feasibility of vortex imaging was 97% for healthy children and 96.7% for CHD. After propensity matching, there were mild significant differences in vortex distance to apex, distance to interventricular septum, height, width, sphericity index. Indexed by BSA Vortex Area (VAi) was significantly higher on CHD patients than healthy subjects (p &lt; 0.0001). However, multiple regression analysis exposed significant associations of LV morphology with vortex characteristics: a VAi &gt;0.98 can predict an abnormal LV morphology (Sensibility 73%, Specificity 83%). Furthermore, CHD involving LV volume or pressure overload were both associated with vortices localized closer to the IVS.

Conclusions
LV vortex analysis using high-frame rate BST echocardiography is feasible in healthy children and in those with CHD. Since vortices are associated with LV morphology and are altered in some CHDs, vortices might yield diagnostic and prognostic value. Future studies are necessary to further establish applications of vortex imaging in the clinical setting. Abstract Figure. Vortex in healthy children and in CHD
Evaluation by ultrasound of the velocity time integral in carotid stenosis
Authors: Perea O , Corneli MC , Perez Pardo N 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atherosclerotic disease is one of the main causes of cerebrovascular accident. Doppler ultrasound is one of the most important tools in the diagnosis and quantification of such issues. The classics variables to assess through this method are peak systolic velocity (PSV) at the highest stenosis carotid level, diastolic velocity at such level and the PSV rate between the PSV at the stenosis level of the internal carotid artery (ICA) respect the PSV at the common carotid artery (CCA).

Objectives
Compare the correlation of the velocity time integral (VTI) and the ratio between VTI of ICA and CCA to identify carotid stenosis by carotid ultrasound.

Material and methods
We included patients that assist at the institution for a carotid ultrasound to identify a carotid stenosis, between 2017 and 2020. Correlation tests between continuous variables were applied according to the type of distribution. Pearson"s test for continuous variables with normal distribution and Spearman"s for those with abnormal distribution.Fig. 1

Results
Three hundred and forty two patients were included, 78% male, mean age 67 ± 8.
According to its distribution, the VTI ACI / CCA ratio obtained as the median is 5 cm (1.27-8). By dividing the VTI ratio by quartiles, we observe that the percentage of individuals with a higher degree of carotid obstruction, increase significantly as the quartile increase: 0%, 36.5%, 94.2%, 98.8 %. p: 0.0001.
Likewise, a high correlation value between the classical quantitative values and VTI and ratio of VTI at different grade of carotid stenosis was seen by carotid ultrasound (Table 1).

Conclusions
VTI and VTI ratio are parameters that show good correlation with the classical variables to assess a carotid stenosis by carotid ultrasound. In future investigations, the evaluation of these parameters could lead the estimation of the stenosis area, considering the principles of the continuity equation. Abstract Figure. Fig 1 Abstract Table. 1
Detection of a diastolic heart sound in children and young adults using high-frame-rate echocardiography
Authors: Mccrary AW , Moore C , Sturgeon G , Lefevre M , Kisslo JA , Von Ramm OT , Barker PCA 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Colin"s Kids, Inc. PO Box 93 Hopewell, NJ 08525

Introduction
The auscultatory finding of a fourth heart sound (S4) is clinically associated with a pathologic decrease in left ventricular compliance, but may be seen in healthy children by phonocardiography. High-frame-rate difference imaging (HFRDI) has demonstrated several propagating myocardial phenomena in the left ventricular (LV) lateral wall throughout the cardiac cycle, including during diastole. We hypothesize that these visualized wave phenomena correlate with physiologic and pathologic heart sounds.

Purpose
Using HFRDI, we sought to define the characteristics of a LV lateral wall late diastolic wave in healthy children and young adults.

Methods
HFRDI was obtained from the apical 4-chamber view with synchronized electrocardiogram (ECG) on the T5 system (Phased Array Research Scanner) acquiring images for this study between 587 and 1174 frames per second (depending on participant imaging characteristics). In addition, tissue Doppler images were acquired with synchronized ECG and phonocardiography (PCG) on a commercial ultrasound machine (Figure 1). Timing events were measured from the QRS onset on the ECG tracing. An S4 wave correlate was defined by meeting the following criteria: 1) occurring after the P wave on ECG; 2) at or after the onset of a’ on TDI; 3) occurring during the PCG S4; and 4) occurring prior to the S1 wave complex. The timing of the S4 wave in HFRDI was measured from the onset of QRS to the first appearance of the wave, and the wave velocity was calculated by measuring the length of the lateral wall and counting temporally calibrated image frames while the wave was visible.

Results
Nine healthy volunteers completed the imaging protocol with a median age of 20 years (range 6 – 22 years). A single, distinct late diastolic HFRDI wave was seen in all participants propagating from apex to base of the lateral LV free wall. This wave met the defined criteria to be a visual correlate of S4 in all participants. Measurements of correlated events are presented in Table 1. S4 propagating velocity was 2.96 ± 1.8 m/sec and occurred 25 ± 18 msec prior to the QRS onset. There is a strong positive correlation between age and S4 velocity [r(7) = 0.76, p = 0.019].

Conclusion
The S4 heart sound can be reliably visualized by high frame rate imaging and has similar characteristics in healthy children and young adults. Further definition of normal and abnormal S4 wave characteristics may lead to a novel tool in defining LV diastolic function. Abstract Table 1 Abstract Figure 1
Non-invasive left ventricular myocardial work in patients with chronic aortic regurgitation and preserved left ventricular ejection fraction
Authors: Meucci MC , Butcher SC , Van Der Velde ET , Ajmone Marsan N , Bax JJ , Delgado V 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left ventricular global longitudinal strain (LV GLS) has been proposed as sensitive marker of myocardial damage in patients with chronic severe aortic regurgitation (AR) and preserved left ventricular ejection fraction (LVEF). However, LV GLS does not take into account the afterload.
Non-invasive LV myocardial work is a novel parameter of LV myocardial performance, which integrates measurements of myocardial deformation and non-invasive blood pressure (afterload).

Purpose
The aims of this study were: 1) to assess non-invasive LV myocardial work in patients with chronic AR and preserved LVEF and its correlation with other echocardiographic parameters, 2) to evaluate changes of LV myocardial work after aortic valve replacement or repair (AVR) and 3) to assess the relationship between LV myocardial work and post-operative LV reverse remodeling.

Methods
This retrospective study included fifty patients (53 ± 16 years; 68% men) with moderate or severe chronic AR and preserved LVEF, who underwent AVR. Non-invasive LV myocardial work indices were measured at baseline and post-operatively (between 2 and 12 months after surgery) and compared with previously reported normal reference ranges.

Results
Based on normal reference values, patients with chronic AR and preserved LVEF had preserved or increased values of LV global work index (LV GWI) (84% and 16%, respectively) and LV global constructive work (LV GCW) (78% and 22%, respectively) (Figure 1). In addition, LV global work efficiency (LV GWE) was preserved in all patients, despite 16 (32%) subjects had impaired values of LV GLS (&lt;16.7.% in men and &lt;17.8% in women). LV GWI and GCW showed a positive correlation with markers of AR severity and parameters of LV systolic function. AVR results in a significant reduction of myocardial work indices (p &lt; 0.0001), with the exception of LV global wasted work, that did not change (p = 0.29). According to normal reference ranges, 15 (30%) patients had impaired values of LV GWI and LV GCW post-operatively, while LV GLS was impaired in 37 (74%) patients. The post-operative impairment of LV GWI demonstrated a stronger association with reduced LV reverse remodeling, as compared to the impairment of LV GLS (Figure 2).

Conclusions
Compared to afterload-dependent echocardiographic parameters, non-invasive LV myocardial work indices allow a better understanding of myocardial performance and energetics in the setting of chronic AR with preserved LVEF and could improve risk stratification. Abstract Figure. Abstract Figure.
Left atrial volumetric/mechanical coupling index in the general population: distribution and prediction of incident atrial fibrillation
Authors: Benfari G , Skaarup KG , Johansen ND , Jensen GB , Schnohr P , Mogelvang R , Nistri S , Biering-Sorensen T 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The Copenhagen City Heart Study was funded by the Danish Heart Foundation, and the echocardiographic substudy was further funded by the Lundbeck Foundation.

Background
Atrial fibrillation (AF) represent a global health burden. Identifying people at risk based on echocardiography has always been challenging. Hence, we aimed to assess the distribution of left atrial volumetric/mechanical coupling index (LACI) in the general population and test its potential to predict incident AF.

Methods
In a large community-based population study, LACI was calculated by dividing the left atrial (LA) maximal volume by the a’ peak velocity obtained by color Tissue-Doppler Imaging. Clinical endpoint was incident AF. The exclusion criteria were history of AF or previous heart failure.

Results
A total of 1021 patients formed the study cohort (mean age 52.8 ± 13.3, 45% (n = 459) were male); Median LACI was 2.84 [IQR: 2.14-3.82], rarely exceeding the value of 6. During a follow-up period of 16.1 years (IQR15.6-16.3), 8.9 % (n = 91) of patients developed AF. LACI independently predicted AF (HR 1.11 [1.04-1.17], p = 0.001 unadjusted and HR 1.20 (1.06-1.35), p = 0.003 after a comprehensive multivariable adjustment (including clinical, biochemical, and echocardiographic variables). The Figure illustrates the strong relationship between LACI and the incidence of AF, almost linear, with no plateau effect. In a sensitivity analysis, the association between LACI and incident AF persisted in both hypertensive (HR 1.12 (1.05-1.19) p = 0.001) and non-hypertensive participants (HR 1.18 (1.03-1.35) p = 0.02).

Conclusion
LACI is a measure of LA function which is routinely available and presents a skewed distribution towards low values in the general population. LACI independently predicts incident AF, irrespective the presence of systemic arterial hypertension. Abstract Figure
Echocardiographic-derived Pulmonary Artery Pulsatility Index: towards non-invasive evaluation of right ventricular function
Authors: Boretto P , Gravinese C , Frea S , Pidello S , De Ferrari GM 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Pulmonary artery pulsatility index (PAPi)(1) is a powerful predictor of right ventricular failure in patients with acute inferior myocardial infarction(2) and in patients with heart failure undergoing LVAD implantation(3). PAPi derivation requires invasive right heart catheterism (RHC), thus limiting availability and seriate assessment of right ventricular function.
Purpose. Aim of the study was to evaluate accuracy and agreement of echocardiographic derived PAPi (ePAPi) compared to right heart catheterism derived PAPi in heart failure with reduced ejection fraction (HFrEF) patients.
Methods. ePAPi was defined as the ratio of pulmonary artery pulse pressure (sPAP – dPAP) to right atrial pressure (RAP). Systolic pulmonary artery pressure (sPAP) was determined from tricuspid regurgitation (TR) velocity using the simplified Bernoulli equation(4): sPAP = 4 x (peak TR jet velocity)2 + RA pressure. Diastolic pulmonary artery pressure (dPAP) was calculated as: dPAP = 4 x (end-diastolic pulmonary regurgitant velocity)2 + RA pressure. Simplified ePAPi, defined as peak TR pressure to RA pressure ratio was also investigated. Pearson and Spearman correlation tests were performed. A Bland-Altman plot analysis was performed to assess agreement between ePAPi and invasive PAPi. ROC curves were made to assess ePAPi accuracy in identifying patients with low PAPi (defined as PAPi &lt; 2 and PAPi &lt; 3.65).
Results. 66 HFrEF patients (age 59 ± 10 years, 63% males, mean EF: 35 ± 9%) underwent RHC and blinded echocardiogram in a single center Cardiology Departement. Mean invasive derived PAPi was 4.4 ± 3.6, while ePAPi was 3.9 ± 2.3. ePAPi showed an excellent correlation with invasive PAPi (Pearson r: 0.80, p &lt; 0.001; Spearman rho: 0.83, p &lt; 0.001) and good agreement as shown in Bland Altman plot (figure 1). In ROC analysis, ePAPi accurately identified patients with low hemodynamic PAPi &lt; 2 (Sensibility: 100%; Specificity: 87.2%; AUC: 0.97; Youden criterion: ePAPi &lt; 2.3) and PAPi &lt; 3.65 (Sensibility: 81.8%; Specificity: 84%; AUC: 0.89; Youden criterion: ePAPi &lt; 3.6)(figure 2). Simplified ePAPi also showed good correlation and agreement (Pearson r: 0.58, p &lt; 0.001; Spearman rho: 0.81, p &lt; 0.001).
Conclusions. In patients with HFrEF, echocardiographic derived PAPi showed a good agreement and correlation with invasive derived PAPi. ePAPi was also accurate in identifying patients with low PAPi values associated with poor outcomes and may be of interest for non-invasive right ventricular function seriate assessment. Further studies are needed to investigate prognostic implications. Abstract Figure. Abstract Figure 2
Feasibility and role of echocontrast evaluation of patients with LVAD
Authors: Baroni G , Pergola V , Semeraro L , Mastro F , Dellino C , Aruta P , Cecchetto A , Previtero M , Florencis A , Tarzia V , Mele D , Gerosa G , Iliceto S 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
In patients with Advanced heart failure (AHF) long-term support with durable mechanical circulatory support (MCS) devices such as left ventricular assist device (LVAD) brings survival benefits and improvement in quality of life, compared with conventional medical treatments. Development of RVF in patients with LVAD has a direct effect on mortality and is associated with prolonged length of stay in intensive care unit and in-hospital stay and with poor quality of life. Purpose: the evaluation of clinical safety and feasibility of echocontrast (EC) in patients implanted with 3 different types of LVAD (HeartWAre HVAD, Jarvik 2000, HeartMate 3); the assessment of the improvement in the visualization of heart structures; the intra and inter-operator agreement of RV measurements (FAC, TAPSE, sPAP, TR, regional wall motion abnormalities) with and without contrast. Methods: Between 2014 and 2019, 43 patients were implanted with LVAD, in particular 7 (16%) patients were implanted with Jarvik 2000, 31 (72%) with HeartMAte 3, 5 (12%) pts with HeartWAre HVAD. Nine patients (21%) either had contraindication or refused contrast injection. In 3 (7%) patients, it was technically challenging to obtain apical images at all levels. Two (5%) patients lost their follow-up. Our final population was of 29 (67%) patients. We also assessed the reproducibility of these measurements between two different expert operators (blind analysis). Results: We observed no allergic reaction to EC. Total 329 (64%) of 516 RV wall segments were available for qualitative analysis without contrast vs 451 (87%) with contrast (p &lt; 0.001) with a significant improvement of the evaluability of regional contractility and FAC (41% vs 90%, p &lt; 0.001). Evaluation of TAPSE, TR and sPAP was similar with and without contrast (p = NS) All the RV parameters showed little inter-operator variability when measured with contrast. TAPSE, FAC, and RWMA showed an excellent reproducibility (ICC &gt;0.86) while it was good for 2D-baseline derived parameters (ICC = 0.74) showing improvement of inter operator reproducibility in the evaluation of regional contractility in the contrast echocardiography modality. Conclusion: EC is safe with all the types of LVAD we examined. Accurate and reproducible visualization of RV is imperative for reliability of information, a routine use of EC could play a pivotal role in interpreting RV features. EC improves RV morphologic and functional judgment; allowing greater accuracy and precision in the assessment of both global and regional RV functions. This finding may have important clinical improvement, especially in the future for analysis focused in RV prognostic role in LVAD patients
Prognostic value of Doppler coronary artery assessment in comparison with other echocardiographic prognostic parameters
Authors: Kalinina E , Guskova E , Popkova Y , Shmatov D , Zagatina A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Coronary artery Doppler assessment during routine echocardiography is an established diagnostic tool, that was proved by previous investigators. The prognostic value of impaired coronary flow in left coronary artery was also recently shown in pilot studies [1, 2]. A low feasibility and unknown prognostic value in comparison with other traditional echocardiographic parameters in non-selected population are considered as the main limitations of this method.

Aim
To evaluate feasibility and the prognostic value of coronary artery ultrasound assessment in a non-selected population in everyday clinical practice in comparison with other echocardiographic parameters. Methods: 581 non-selected patients were screened in prospective cohort study. Left coronary artery flow was scanned in addition to conventional echocardiography. Follow-up period was 12 months. All-cause mortality, myocardial infarction, revascularization, and hospitalization due to heart failure decompensation were defined as major adverse cardiac events (MACE). Results: Feasibility of coronary artery visualization and Doppler assessment was 89.8%. Follow-up was available in 92% of patients; during this period 22 deaths and 1 non-fatal MI occurred, 116 patients had MACE. In univariable analysis age, global longitudinal strain (GLS), left atrium index and maximal coronary velocity were predictors for all-cause death (p &lt; 0.006-0.0001), but ejection fraction was not (p &lt; 0.29). In multivariable analysis maximal coronary velocity (HR: 1.02, 95%, CI: 1.01-1.03, p &lt; 0.0006), age (HR: 1.06, 95%, CI: 1.01-1.11, p &lt; 0.02), and left atrium index (HR: 1.05, 95%, CI: 1.01-1.08, p &lt; 0.007) were independent predictors for all-cause death. Maximal coronary velocity (HR: 1.02, 95%, CI: 1.01-1.03, p &lt; 0.0001), age (HR: 1.03, 95%, CI: 1.01-1.05, p &lt; 0.006), GLS (HR: 0.90, 95%, CI: 0.85-0.96, p &lt; 0.0008) and left atrium index (HR: 1.02, 95%, CI: 1.01-1.04, p &lt; 0.009) were independent predictors for MACE.

Conclusion
Doppler coronary flow velocity scanning during routine echocardiography is a feasible and valuable tool for assessment of short-term prognosis in non-selected patients. Its short-term prognostic value is better than prognostic value of ejection fraction and global longitudinal strain for the same patients. Abstract Figure. Coronary flow velocity