bluuebunny/crossref_metadata_2025_split huggingface dataset:
777 TISSUE CHARACTERIZATION IN TAKOTSUBO SYNDROME
Authors: Garau Enrica , Francesca Marchetti Maria , Biddau Mattia , Licciardi Marco , Utzeri Elena , Santus Sara , Maiani Silvia , Aste Francesca , Mandas Martina , Montisci Roberta 
Published: December 2022

Abstract

Aims
Takotsubo Syndrome (TTS), also known as stress cardiomyopathy, is an important form of acute reversible myocardial damage characterized by a transient systolic dysfunction of the left ventricle, which generally occurs following intense emotional or physical stress.
The availability of new imaging techniques broadened knowledge about TTS and allowed for more accurate risk stratification and their use as a potential guide to clinical management.
The aims of our study was that of evaluating changes in myocardial tissue characterization on cardiac magnetic resonance imaging in patients diagnosed with TTS admitted to our center.

Methods and Results
From December 2018 to December 2021, 52 patients diagnosed with TTS according to the 2018 InterTAK diagnostic criteria were admitted to our ICU; only 27 patients who underwent cardiac magnetic resonance imaging were included in our study.
Cardiac magnetic resonance was performed after an average of 7 days from admission to the ward, therefore not in all patients the regional wall motion abnormalities of the left ventricle found on the first echocardiogram performed were then still evident.
Despite this, at the evaluation of the T2-STIR sequences, the presence of myocardial edema in the segments with previous regional dissynergies was highlighted in all patients included in the study, indicating a greater sensitivity of tissue characterization techniques.
Furthermore, the analysis of T2 mapping, for the quantification of edema, also showed a significant lengthening of the average values ​​of the global T2 mapping, compared to the reference values ​​at our center [65.9 +/- 7.7 msec, vn T2 mapping = 53 ± 3 msec; mean baseline T2 mapping value: 60.4 +/- 5.5 msec, mean T2 mapping value: 65 +/- 7.1 msec, apical T2 mapping: 71 +/- 7.7 msec], with evidence of a clear base-apex gradient on 19/23 patients (82.6%) compatible with the greater involvement of the mid-apical segments typical of the classic form of "apical ballooning" TTS.
Finally, the evaluation of the systolic strain also showed a significant reduction in the values ​​both in the radial component and in the circumferential and longitudinal components, especially in the mid-apical segments, even in the absence of significant regional wall motion abnormalities or with preserved left ventricular EF [mean values global radial strain (GRS) of 28.6 +/- 9.5; global circumferential strain (GCS) of 15.4 +/- 7.9; global longitudinal strain (GLS) of 12.6 +/- 3.2].

Conclusions
Our study confirms that tissue characterization and functional evaluation techniques using myocardial strain with cardiac magnetic resonance appear to be more accurate, compared to the evaluation of regional wall motion abnormalities and left ventricular EF alone, in identifying pathophysiological changes and in diagnostic framework of TTS patients.
737 CLINICAL AND PROGNOSTIC SIGNIFICANCE OF LEFT VENTRICULAR OUTFLOW TRACT VELOCITY TIME INTEGRAL (LVOT-VTI) IN PATIENTS WITH CHRONIC HEART FAILURE
Authors: Gentile Francesco , Buoncristiani Francesco , Chubuchny Vlad , Sciarrone Paolo , Panichella Giorgia , Bazan Lorenzo , Gasparini Simone , Fabiani Iacopo , Taddei Claudia , Poggianti Elisa , Petersen Christina , Pasanisi Emilio , Passino Claudio , Emdin Michele , Giannoni Alberto 
Published: December 2022

Abstract

Background
The echocardiographic evaluation of cardiac output relies on the product of the flow across the left ventricular outflow tract (LVOT), estimated through its velocity time integral (LVOT-VTI), and its cross-sectional area, estimated through the formula πr2. Considering the geometrical assumption behind such formula, LVOT-VTI may be a more reproducible surrogate of systolic function and showed prognostic value in the critical care setting. However, the role of this measure in patients with chronic heart failure (HF) remains unexplored.

Objective
To assess the clinical and prognostic significance of LVOT-VTI in a contemporary cohort of patients with chronic HF.

Methods
Outpatients with chronic HF with either reduced (≤40%) or mildly reduced (41-49%) LV ejection fraction (LVEF) were prospectively enrolled to undergo a clinical, echocardiographic, and biohumoral assessment, and were followed-up for the endpoint of cardiac death.

Results
Finally, 971 patients were enrolled (71±12 years, 72% men, 50% ischemic etiology, LVEF 35±9%, 74% HFrEF). Most patients showed a NYHA class I-II (74%) and were treated with ACE-inhibitors/ARBs or ARNI (81%), beta-blockers (95%), and mineralocorticoid receptor antagonists (71%). Patients were distinguished in three subgroups according to LVOT-VTI tertiles, i.e., ≤19 (n=324), 20-24 (n=324), or &gt;24 (n=323). Compared with the other two subgroups, patients with LVOT-VTI ≤19 showed worse NYHA class, lower LVEF and tricuspid annular plane systolic excursion (TAPSE), and higher E/e’, left atrial volume index (LAVi), estimated systolic pulmonary arterial pressure, and NT-proBNP concentration (all p&lt;0.001). No differences were observed as for patients’ age, HF etiology, and therapies (all p&gt;0.05). Over a median follow-up of 22 (9-34) months, 68 (7%) patients met the primary endpoint. LVOT-VTI significantly stratified the risk of cardiac death, observing 44 (13%), 15 (5%), and 9 (3%) events across the subgroups with values ≤19, 20-24, or &gt;24 (log-rank 25.9, p&lt;0.001). At multivariable regression analysis, LVOT-VTI ≤19 (HR 2.32 [95% 1.20-4.49], p=0.002), but not LVEF &lt;30% (p=0.614) was an independent predictor of cardiac death in a model adjusted for age, sex, ischemic etiology, renal function, hemoglobin, E/e’, LAVi, TAPSE, and NT-proBNP. Of note, this finding was consistent both in the HFrEF and HFmrEF subsets (p for interaction =0.899).

Conclusion
LVOT-VTI is associated with disease severity and is a strong predictor of all-cause death in patients with chronic HF.
860 TRICUSPID REGURGITATION RELATED TO CARDIAC IMPLANTABLE DEVICES: A NEW ENTITY?
Authors: Ghisletti Andrea , Sabusco Alexandra , Vecchi Simona De , Patti Giuseppe 
Published: December 2022

Abstract
Background. The incidence of cardiac implantable electronic device (CIED) implantation is currently growing. Patients who develop a moderate to severe CIED-induced tricuspid regurgitation (TR) are at higher risk of pulmonary hypertension, right heart failure (HR) and have higher mortality. Transthoracic echocardiography (TTE) is the most common method for TR grading, while transesophageal echocardiography (TOE) with three-dimensional (3D) imaging is nowadays gaining importance to reconstruct valve morphology and to determine the TR pathophysiology.
Case Summary. We present the case of an 83-year-old man with multiple comorbidities, affected by non-ischemic dilated cardiomyopathy, for which a biventricular defibrillator (ICD-CRT) was implanted in 2007 in primary prevention. Over the years, the patient has been a CRT-responder, with partial recovery of the ejection fraction (40% in 2022 versus 25%). In 2018 he had an episode of acute pulmonary oedema and ventricular fibrillation with ICD intervention; during that hospitalization, the right ventricular catheter (EC) was replaced due to dysfunction. In 2022, the patient presented to our hospital for anasarca due to right HF. TTE and TOE showed new onset of right heart dilation and dysfunction with severe TR, which was predominantly caused from lead impingement of the septal tricuspid valve (TV) leaflet and later from secondary dilation of the TV annulus. The patient responded well to medical therapy and was discharged.
Discussion. CIED-related TR is getting more relevant since its growing prevalence and its prognostic impact, even if little is known about why some patients develop moderate-to-severe CIED-related TR. Clinicians should be aware of this entity and follow the patients with TR over the time with periodic echocardiograms. TOE and 3D imaging should always be performed to understand the mechanism of the TR and to select the optimal treatment. Currently, no guidelines nor randomized data are available in order to guide treatment in these patients. Figure 1:4-chamber views with and without color Doppler showing the ventricular EC passing the TV through with the presence of peri-catheter TR.Figure 2:trans-gastric TOE xPlane views showing how the ventricular EC determines a restrictive movement of the septal TV leaflet, causing the severe TR to form.
930 FULL EVALUATION OF LEFT AND RIGHT ATRIAL FUNCTION AFTER TAVI IMPLANTATION
Authors: Giamundo Angelo , Aquila Iolanda , Sorrentino Sabato , Bellantoni Antonio , Panarello Alessandra , Bruno Federica , Spinali Martina , Sportelli Martina , Mascaro Giuseppina , Mongiardo Annalisa , Indolfi Ciro , Spaccarotella Carmen 
Published: December 2022

Abstract

Aims
patients with severe aortic stenosis (AS) experience an increase in left ventricular filling pressure. This leads to changes in the structure and a deterioration in the function of the left (LA) and right (RA) atrium. Patients undergoing TAVI usually experience a reduction in the filling pressure of the left ventricle, thereby decreasing the wall tension of the atria in a retrograde way. The aim of this study was to demonstrate that patients with severe AS, undergoing TAVI, experience a positive remodeling of left and right atrium, with an improvement of their function.

Methods and results
we enrolled 38 symptomatic patients with severe AS (mean age 84,75 ± 12 years, 60% male, and pre-TAVI aortic valve area 0.75 ± 0.25 cm2 and mean gradient 47,96 ± 23 mmHg). 2D transthoracic echocardiography and 2D speckle tracking echocardiography at baseline and 12 months of follow up were performed. The variation of continuous variables was evaluated using a Student's T test for paired data. P values &lt; 0.05 were considered significant. When compared to baseline, at 12 months a statistically significant improvement was observed for RA strain (p &lt; 0.001) and LA (biplane) strain reservoir, conduction and contraction (p &lt; 0.001, p &lt; 0.012 and p &lt; 0.001, respectively). The LA FE increased significantly (26.01 ± 9.16 vs 32.66 ± 10.95; p &lt; 0.001). After TAVI, the LA (biplane) strain reservoir/end systolic volume ratio increased by 0.33 ± 0.18 to 0.49 ± 0.26 (p &gt; 0.001). Left atrial end-systolic and end-diastolic volume decreased significantly (p &gt; 0.001).

Conclusion
within 12 months after TAVI, there was a reverse LA and RA remodeling and an improvement in strain reservoir, condunction and contraction function. Also, there was a significant improvement of LA (biplane) strain reservoir/end systolic volume ratio.
1038 RIGHT VENTRICULAR-PULMONARY ARTERIAL (UN)COUPLING ESTIMATION IN PATIENTS WITH TRICUSPID REGURGITATION
Authors: Iseppi Manuela , Niro Lorenzo , Tafciu Elvin , Maffeis Caterina , Benfari Giovanni , Bergamini Corinna , Rossi Andrea , Luciano Ribichini Flavio 
Published: December 2022

Abstract

Background
right-ventricular (RV)-pulmonary arterial (PA) uncoupling expressed by Tricuspid Annular Plane Systolic Excursion (TAPSE)/Pulmonary Artery Systolic Pressure (PAPs) ratio is associated with poor outcomes in patients with heart failure (HF). TAPSE/PAPs ratio has been poorly investigated in patients with tricuspid regurgitation (TR) with related volume overload and progressive right chambers remodeling.

Purpose
to assess the effectiveness of other estimation methods of RV-PA coupling in different TR severity groups compared to the classic TAPSE/PAPs ratio.

Material and Methods
116 stable patients with TR were enrolled at the time of echocardiography (43 men, 37%; mean age 74±13 years). TR severity was quantified by means of proximal isovelocity surface area (PISA) derived effective regurgitant orifice area (EROA) and regurgitant volume (RVol). RV function was assessed by RV Free Wall Longitudinal Strain (FWLS).
PAPs was obtained using the following formula: 4*(peak tricuspid regurgitation velocity)2 + right atrial pressure (RAP); meanPAP was estimated using TR continuous wave signal mean gradient (PAPmIT) and pulmonary artery regurgitation peak gradient (PAPmIP), adding RAP for both. RV-PA coupling was evaluated by TAPSE/PAPs ratio, TAPSE/PAPmIT and TAPSE/PAPmIP ratios.

Result
TR was quantified mild in 23 patients, moderate in 49, severe and torrential in 29 and 15 patients respectively. Mean RV-FWLS was -26.4±6.9% in mild, -21.8±7.4% in moderate, -18±7% and -18.3±4.2% in severe and torrential TR respectively (p&lt;0.0001).
Mean TAPSE/PAPs ratio was 0.6±0.23 mm/mmHg, 0.44±0.19, 0.38±0.19 and 0.37±0.12 mm/mmHg in mild, moderate, severe and torrential TR respectively, with a statistically significant difference between the 4 groups (p&lt;0.0001).
Mean TAPSE/PAPmIP ratio was 1.08±0.5 mm/mmHg in mild TR, 0.68±0.34 in moderate, 0.67±0.5 in severe TR and 0.47±0.13 mm/mmHg in torrential TR with a statistically significant difference between distinct TR grades (p=0.004).
Mean TAPSE/PAPmIT in mild TR was 0.92±0.5 mm/mmHg, 0.63±0.29 in moderate, 0.53±0.29 and 0.51±0.16 mm/mmHg in severe and torrential TR respectively with a statistically significant difference between the groups (p&lt;0.0001).
Finally, an analysis of covariance with RV-FWLS as potential confounder was performed: only the adjusted means of TAPSE/PAPmIP and TAPSE/PAPmIT ratios preserved a statistically significant difference between distinct TR groups (p=0.01 and p=0.019 respectively).

Conclusion
TAPSE/PAPmIP and TAPSE/PAPmIT ratios seem to preserve a stronger relation with increasing TR grade and worsening of RV disfunction, suggesting it as a more powerful index in this subset of patients. The progression of TR grade leading to a right chamber remodeling could influence the reliability of RV-PA uncoupling expressed by standard TAPSE/PAPs ratio.
921 GLOBAL AND SEGMENTAL LONGITUDINAL STRAIN OF THE LEFT VENTRICLE IN THE STRATIFICATION OF ARRHYTHMIC MITRAL VALVE PROLAPSE
Authors: Landi Irene , Eltayeb Abdalla , Anwar Kashif , Alenazy Ali , Alotaibi Anwar , Vriz Olga 
Published: December 2022

Abstract

Background and aim
Mitral valve prolapse (MVP) is a common benign valvular disease though with an incidence of 0.2-1.9%/year of sudden cardiac death (SCD) related to complex ventricular arrhythmias in the form of arrhythmic MVP (AMVP). In MVP, first diagnostic approach is transthoracic echocardiography (TTE) that should be used to described morphological and functional valvular features and also the presence of mitral annular disjunction (MAD) which seems associated with AMVP. The aim of our study is to describe the association between advanced TTE markers of myocardial stretching such as global and focal longitudinal strain (GLS) and ventricular arrhythmias in MVP patients with and without MAD.

Methods
88 patients with MVP were prospectively enrolled. All of them underwent 12-lead ECG and TTE including global and focal GLS of the left ventricle. In addiction, 40 had 24-hour Holter.

Results
MAD + patients were younger than MAD - (32.22±12.49 vs 41.64±15, p= 0.007) and mostly were females (30 females vs 9 males, p= 0.027). MAD + patients had higher burden of complex ventricular arrhythmias such as premature ventricular contractions (PVCs) with right bundle branch block (RBBB) morphology, bigeminy, non-sustained ventricular tachycardia (NSVT) and VT (Figure A). MAD + group had higher GLS (mean -21.5%±3% vs -20%±2.7%, p=0.0153) with notable difference in the inferior wall GLS (-19.4%±8% vs -16.4%±8%, p= 0.045), figure B.

Conclusions
Increased global and inferolateral GLS of left ventricle indicates longitudinal deformation in segments exposed to greater tension and mechanical stress by prolapsing leaflets and MAD which are associated with higher arrhythmogenic burden. Advanced echocardiographic techniques, such as global and segmental GLS could be considered as an advanced tool in the arrhythmic stratification of MVP patients.
898 ROLE OF 3D ECHOCARDIOGRAPHY IN AORTIC VALVE ABNORMALITIES: TWO CASES REPORT
Authors: Monaco Maria Lo , Stankowski Kamil , Oliva Angelo , Figliozzi Stefano , Fazzari Fabio , Mantovani Riccardo , Curzi Mirko , Cannata Francesco , Marconi Manuel , Fumero Andrea Davide , Stefanini Giulio Giuseppe , Torracca Lucia , Bragato Renato Maria , Volpe Massimo , Condorelli Gianluigi 
Published: December 2022

Abstract

Introduction
Aortic valves with a number of cusps different from two or three are infrequent congenital anomalies that might manifest with valvular disease in young patients. We present two cases of unicuspid and quadricuspid aortic valve diagnosed in our Center.

Clinical Cases
Case 1. A 23-year-old asymptomatic male was admitted to our Hospital because of the necessity of bone marrow transplantation for Hodgkin lymphoma. He had a previous diagnosis of bicuspid aortic valve and presented a 5/6 mid-systolic harsh murmur, heard best at the right upper sternal border and radiating to the neck. ECG showed sinus rhythm with left ventricular hypertrophy. BNP was in normal range (31 pg/ml).
At trans-thoracic echocardiography, there was severe aortic stenosis [peak/mean gradient of 100/67 mmHg with an aortic valve area of 1.04 cm2 (0.54 cm2/m2); V max was 5 m/s] without regurgitation and dilation of the ascending aorta (39 mm), however the morphology of the aortic valve remained undefined. Left ventricle showed hypertrophy (maximum wall thickness = 13 mm) with normal volumes and systolic function. Thus, the patient underwent to 3D-Transesophageal echocardiography, which demonstrated unicuspid aortic valve with a lone commissure between L-NC and anterior calcification. After multidisciplinary discussion, the patient underwent close follow-up and aortic valve replacement was planned after the bone marrow transplantation.
Case 2. A 21-year-old male was referred by general practitioner to our outpatient clinic for palpitations. Cardiovascular physical examination and ECG were normal with no evidence of arrhyhtmia or cardiac murmurs.
Transthoracic echocardiography revealed central mild aortic valve regurgitation in a suspected quadricuspid aortic valve (i.e., an X-shaped commissure pattern during diastole and a rectangular appearance during systole in the parasternal short-axis view). Left ventricular size and function and ascending aorta dimensions were normal. There was no associated congenital cardiovascular abnormality. 3D-Transesophageal echocardiography confirmed the evidence of a quadricuspid aortic valve. The cusps appeared to be of different size: two equal larger cusps and two equal smaller cusps (Type C, Hurwitz and Robert's classification), thin and mobile. The patient was advised to echocardiographic follow-up at intervals of 12 months.

Conclusions
We describe two cases of aortic valve congenital anomalies in two coetaneous patients with completely different impacts on hemodynamics. Severe aortic stenosis complicated unicuspid aortic valve whereas quadricuspid aortic valve was associated with mild aortic regurgitation. 3D-Transesophageal echocardiography was essential for accurate morphological characterization of the aortic valves.
785 ACCURATE ASSESSMENT OF RIGHT VENTRICULAR FUNCTION BECOMES MORE CHALLENGING IN PATIENTS WITH SEGNIFICANT TRICUSPID REGURGITATION: A CASE REPORT OF RIGHT VENTRICULAR DYSFUNCTION AFTER TRICLIP IMPLANTATION
Authors: Lucchino Alessandro , Aquila Iolanda , Calvelli Pierangelo , Romano Letizia , Augusto Florinda , Mascaro Giuseppina , Mongiardo Annalisa , Indolfi Ciro 
Published: December 2022

Abstract

Introduction
anatomically and functionally different from the left ventricle, the right ventricle (RV) plays an increasingly recognized role in determining symptoms and outcomes in multiple conditions. Due to RV complex anatomy and mechanics, the evaluation of its size and function is challenging. The ideal imaging technique should be capable of comprehensive, accurate and reproducible assessment of RV morphology and contraction. In the absence of a single reliable 2DE measure of the RV systolic function, several surrogate echocardiographic parameters have been proposed for clinical use, from one-dimensional (TAPSE) to 3D techniques.

Clinical Case
we report a case of an 82-year-old female patient who was admitted to our hospital because of dyspnoea, with a history of atrial fibrillation, hypertension, diabetes mellitus, chronic kidney disease, and a last year hospitalization for heart failure. A transthoracic echocardiography (TTE) was performed, showing a high-grade tricuspid valve regurgitation. Further investigation using transoesophageal echocardiography (TEE) showed, in four chambers view, dilatation of right sections and confirm TR was significant, so screening for TriClip implantation was performed. The exam was diagnostic for massive TR, moderate Mitral Regurgitation, and the estimated PAPs about 50 mmHg, so, in the absence of anatomical exclusion elements, severe pulmonary hypertension and poor RV function, transcatheter treatment with TriClip was offered. We had evaluated RV function, obtaining a FAC about normal limit (which should be corrected by valvular regurgitation), and a reduced Strain value. The patient received an edge-to-edge reparation of the tricuspid valve using the TriClip XTR (Clip) system with 2 clips placed. The post-interventional echocardiographic results were an optimal correction of valvular regurgitation, with, however, a clear right ventricular disfunction. Those finding were confirmed by further echocardiographic follow up exams, even during inotropic treatment by low dobutamine dose.

Conclusion
estimating RV function remains challenging because of the complex geometry of the RV. In the presence of significant TR, the accurate assessment of RV function becomes even more challenging because of the load and angle dependency of TAPSE, RVFAC and RVEF. Significant TR result in a reduction in RV afterload, which may preserve the markers of TV function even when contractility is impaired. 2d-STE in less angle and load dependent than traditional RV function indices and less confounded by RV geometry and passive motion.