bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility of blood speckle imaging parameters as predictors of intracavitary thrombus in apical aneurysm
Authors: Montes A , Cecconi A , Martinez Vives P , De Rueda C , Gamarra A , Perich J , Roquero P , Martinez Avial M , Rojas AM , Lopez Melgar B , Diego G , Benedicto A , Dominguez L , Jimenez Borreguero LJ , Alfonso F 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
In patients with apical aneurysm, left ventricular thrombus (LVT) is a major complication associated with systemic embolism. Likely, abnormalities in apical wall contraction produce stagnant flow which leads to the thrombus formation. Currently, there is a lack of knowledge about predictors of thrombus in such patients. However, new imaging techniques might be able to identify flow properties useful for risk stratification. Specifically, blood speckle imaging (BSI), a technology based on high-frame rate ultrasound, is a promising pattern-matching technique that could allow a comprehensive assessment of blood flow in patients with apical aneurysms (1,2).

Purpose
The aim of the study was to demonstrate the feasibility of obtaining quantitative and qualitative measurements with BSI in patients with apical aneurysms and to explore which parameters may be associated with LVT.

Methods
We examined cases of patients with apical aneurysm and LVT studied in our tertiary center. In order to exclude from our analysis the pro-inflammatory effects of the acute event, patients with thrombus formation within the first month after the ischemic event were excluded. Patients with current presence of thrombus were also discarded. A control group of patients with apical aneurysm but without history of LVT was included.
A basic 2-dimensional echocardiography study was obtained, along with BSI images. BSI acquisitions were performed with a 29 cm/s (2.5 mHz) scale. Data regarding vortex flow were collected, including its presence, area, length, besides area without BSI vectors (Image 1). All measures were indexed by telediastolic left ventricular volume.

Results
Eight patients with apical aneurysms were enrolled in the study, four of them with history of LVT. Although in patients with history of thrombus a larger vortex area was found (Table 1), none of the differences in the BSI parameters was statistically significant.

Conclusion
This study shows for the first time the feasibility of BSI for characterizing complex flow patterns such as vortex in patients with apical aneurysms. Explorations in larger cohorts of patients are needed to prove significant findings with this technology in the future. Abstract Figure. Image 1 Abstract TABLE 1
Left ventricular strain analysis-the importance of being expert
Authors: Cvijic M , Ambrozic J , Bervar M , Podlesnikar T , Toplisek J 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
-

Background
Myocardial strain imaging using speckle-tracking echocardiography is widely used in both research and clinics. Left ventricular global longitudinal strain (GLS) has proven to be a reproducible and useful tool in clinical practice. However, data about the variability in global and segmental strain among novice are limited.

Purpose
The aim of this study was to evaluate how the variability of strain measurements depends on the experience of the physician performing the analysis. Furthermore, we tried to assess how image quality and presence of pathology influence the diagnostic performance of the analysis.

Methods
Twenty novice (no or limited experiences with strain analysis) and 5 experts analysed offline 3 cases: a healthy adult and a patient with ischemic cardiomyopathy, both with high image quality, and a healthy adult with suboptimal image quality (insufficient tracking in two segments). Frame rates were 65, 51, and 70 fps, respectively. Left ventricular GLS and segmental longitudinal peak systolic strain were quantified using the automated function imaging protocol from vendor-specific offline analysis software. The absolute difference in GLS and segmental strain between each novice readers and experts was calculated. Mean strain measurements from the experts were used as a comparator.

Results
Absolute values of GLS ranged from -13.6% to -20.1% in the novice group, while GLS ranged from -15.6% to -18.8% in the expert group. The absolute difference in GLS was significantly higher in the novice group compared to the expert group (P &lt; 0.001). Absolute differences in GLS varied significantly among cases, with low variability in healthy adult with high image quality (Panel A) and with significantly higher variability between novices and experts in case with suboptimal image quality and ischemic cardiomyopathy (Panel B-C). The absolute differences in segmental longitudinal peak systolic strain were up to 11.9% strain unit in novice group and up to 6,8% strain unit in experts (P &lt; 0.001 between groups). In novice group, highest absolute differences in segmental strain were observed in the region with suboptimal tracking and in infarct region in patient with ischemic cardiomyopathy (Panel D-E).

Conclusion
Left ventricular strain analysis by a reader with no or limited experiences severely affects the diagnostic potential of this method. Significant variability in strain measurements should be considered especially in cases with suboptimal image quality and in cases with regional left ventricular pathology. Abstract Figure.
Early predictors of systolic right ventricular dysfunction in the diagnostic algorithm in young patients with pulmonary sarcoidosis
Authors: Naiden TV , Bartosh-Zelenaya SJ , Evsikova IA , Mamaeva OP 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Sarcoidosis can affect not only the lungs, but also the heart, particularly, the right ventricle (RV), by both primary (5-25% of patients) or secondary mechanism due to PH. People of young, working age are at higher risk.

Purpose
to study global longitudinal strain (GLS), RV ejection fraction in 3D mode (EF-3D), TAPSE and S", pulmonary artery systolic pressure (SPAP) at rest and at peak of exercise in patients with sarcoidosis and to determine the role of these parameters in diagnostic algorithm.
Methods. The main group consisted of 66 patients with histologically confirmed stage I-II pulmonary sarcoidosis: 42 men (63.6%) and 24 women (36.4%); mean aged 31.9 ± 5.59 years. The control group included 33 healthy, nonsmoking people: 24 men (72.7%) and 9 women (27.3%); mean aged 30.18 ± 5.3 years.
Results. There were no deviations from the normal values of S’and TAPSE at rest, as well as at rest at the peak of exercise in both groups (p&gt; 0.05). EF-3D RV was within the normal values and didn’t differ significantly at rest and at the peak of exercise (p &gt; 0.05). RV GLS in both groups at rest and at the peak of exercise, were also normal. RV GLS in patients with sarcoidosis during exercise didn"t increase, but decreased (p = 0.004): from -22.8 ± 3.4% at rest to -21.2 ± 4.7% at the peak of exercise, by 7% (in control group: -24.1 ± 2.7 to -25.1 ± 3, p = 0.002).
Values of SPAP at rest in patients with sarcoidosis was slightly higher than in healthy individuals (28.5 ± 8.3 and 24.8 ± 5.21 mm Hg; p = 0.03), in normal ranges. At the peak of exercise SPAP in patients with sarcoidosis increased greater than in the control group (32.9 ± 10.1 and 48.36 ± 14.4 mm Hg; p = 0.000001).
In the control group at rest, the upper quartile of the SPAP was 29 mm Hg, at the peak of exercise - 38 mm Hg. In the main group, these indicators were significantly higher: 35 and 62 mm Hg. In the main group, at the peak of exercise, the SPAP value exceeded the upper quartile of the control group (38 mm Hg) in 79% of cases. These data may indicate the presence of subclinical pulmonary hypertension in the main group.
To determine the border of normal and pathology in study groups, the threshold values of the RV GLS were obtained at the peak of exercise by the method of constructing classification trees. For RV GLS at the peak of exercise, this value turned out to be -21.6%. This means that when RV GLS is less than -21.6% in young patients with pulmonary sarcoidosis, the likelihood of subclinical RV dysfunction is 90%. In combination with an increase in SPAP at the peak of exercise more than 39.5 mm Hg these patients have an even higher rank of the significance of RV dysfunction, namely 100%.
So, we propose to complete the diagnostic algorithm in patients with pulmonary sarcoidosis by RV GLS SPAP at the peak of exercise for defining the early RV systolic disfunction.
Hemodynamic responses associated with post-exercise hypotension in hypertensive patients with ischemic heart disease: concurrent circuit exercise versus high intensity interval exercise
Authors: Caminiti G , Iellamo F , D"antoni V , Catena M , Perrone M , Morsella V , Volterrani M 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Concurrent aerobic plus resistance exercise (RAE) and high intensive interval exercise (HIIE) are both effective on inducing post-exercise hypotension (PEH) in patients with hypertension. However central hemodynamic changes asssociated to PEH in hypertensive subjects with underlying ischemic heart disease (IHD) have been poorly investigated. Aim: to compare the acute effects produced by these two exercise modalities on left ventricular diastolic function and left atrial function .
Methods. Twenty untrained male patients with history of hypertension and IHD under stable pharmacological therapy were enrolled. Each patient underwent 3 exercise sessions: RAE, HIIE and a control session without exercise each lasting 45 minutes. Echocardiography examination was performed before and between 30 minutes and 40 minutes from the end of the exercise sessions.
Results. In the first hour post exercise BP values decreased in a similar way in RAE and HIIE and were unchanged after control. Compared to pre-session, E/E1 ratio increased after
HIIE and remained unchanged after both RAE snd control sessions (between-sessions p 0.002). PALS increased sligthly after RAE (+1.4 ± 1.1%), decreased after HIIE (-4.6 ± 2.4%) . and was unchanged after control. (between-sessions p 0.03). PACS was mildly increased after RAE, was reduced after HIIE. and was unchanged after control. Atrial volume was unchanged after both sessions. Left ventricular and left atrial stiffness increased significantly after HIEE while remained unchanged after RAE and control. Stroke volume and cardiac output increased after RAE, decreased after HIIE, anùd were unchanged after control.
Conclusion. Single sessions of RAE and HIIE determined similar PEHs in hypertensive subjects with IHD, while they evoked different central hemodinamyc adjustements. Given its neutral effects of on diastolic and atrial functions, RAE seems more suitable for reducing blood pressure in hypertensive patients with IHD .
Prognostic impact of right ventricular function in advanced heart failure
Authors: Dias Ferreira Reis JP , Bras P , Goncalves A , Pereira Da Silva T , Soares R , Galrinho A , Timoteo AT , Branco L , Ferreira R 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction
In patients with heart failure with reduced ejection fraction (HFrEF), the presence of coexistent right ventricular (RV) systolic dysfunction is associated with a worse functional capacity and outcome. However, the measurement of RV function is often overshadowed by its left counterpart.
Purpose
To assess the prognostic impact of RV dysfunction in a population of advanced HF patients.
Methods
Prospective evaluation of adult patients with advanced HFrEF referred to our Institution for evaluation with HF team for possible indication for urgent heart transplantation (HT) or MCS. Patients were followed up for 1 year for the primary endpoint of cardiac death and HT. RV systolic dysfunction was defined by a tricuspid annular plane systolic excursion (TAPSE) &lt; 17 mm and/ or fractional area change (FAC) &lt; 35%. A survival analysis was performed to evaluate the prognostic impact of RV dysfunction and survival curves were compared using the log-rank test.
Results
A total of 450 HFrEF patients (mean age of 56 ± 12 years, 80% male, mean LVEF of 29 ± 4%, mean TAPSE of 19 ± 3 mm and RV FAC of 37 ± 6%), of which 30.4% had RV dysfunction. Thirty patients (6.7%) met the primary endpoint. Patients with RV dysfunction had a higher NT-proBNP value (3278.9 ± 296.7 pg/mL, p = 0.005) and a lower LVEF (26.7 ± 6.4 vs 31.4 ± 5.1, p &lt; 0.001), as well as a worse cardiopulmonary fitness (CPET duration: 7.2 ± 3.8 vs 8.6 ± 4.1, p = 0.019; pVO2: 13.6 ± 4.9 vs 16.2 ± 6.1 ml/kg/min, p = 0.006; VE/VCO2 slope: 41.8 ± 11.9 vs 37.0 ± 10.6, p = 0.015; cardiorespiratory optimal point: 33.0 ± 8.9 vs 28.4 ± 6.2, p &lt; 0.001). RV dysfunction was associated with a lower survival free of events during the first follow-up year (log-rank p = 0.046).

Conclusion
RV is associated with a poor survival in advanced HF patients and it may improve risk stratification in this population. Abstract Figure.
Relationship between oxidative stress and three-dimensional echocardiographic changes in myxomatous mitral valves with severe regurgitation - a pilot study
Authors: Sosdean R , Ionica LN , Pescariu SA , Goanta FS , Lazar MA , Mornos C , Ionac A , Sturza A , Muntean DM , Luca CT , Feier H 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background. Reactive oxygen species (ROS) have been reported to contribute to the molecular pathogenesis of severe mitral regurgitation induced by myxomatous degeneration. Data about oxidative stress and the possible relationship with the extent of prolapsing and/or flail elements is scarce in the literature. The pathogenic mechanism may prompt the development of therapeutic approaches aimed at delaying extensive valvular alteration.
Purpose. The aim of the study is to investigate the possible correlation between ROS expression in myxomatous mitral valves with severe regurgitation and the extent of valvular alteration.
Material and methods. Samples from myxomatous mitral valves with ruptured chordae and severe regurgitation were harvested during surgical intervention for valve repair/replacement from 9 patients. Besides transthoracic echocardiography, all patients were evaluated before surgery by transesophageal echocardiography (TEE) with three-dimensional (3D) reconstruction of the mitral valve, using 3D zoom mode acquisition with qualitative and quantitative analysis through the 4D Auto MVQ technology. Tissue from the valvular samples was further analysed for the assessment of ROS by 2 methods: spectrophotometry (ferrous oxidation xylenol orange - FOX assay) and confocal microscopy (dihydroethidium staining).
Results. Patients had a mean age of 51.88 ± 13.54 years, with a left ventricular ejection fraction of 62.55 ± 7.33%, left ventricular end-diastolic diameter of 5.4 ± 0.72cm and end-diastolic volume of 168.55 ± 62.57ml, a mitral annulus area of 17.91 ± 5.74 cm2 and a number of prolapsing/flail scallops varying between 1 and 5 (average of 2 ± 1 scallops). All patients had diffuse thickening of the mitral leaflets with at least one primary and one secondary ruptured chordae and flail of the P2 scallop. Two patients had significant prolapse of at least 2 anterior mitral leaflet scallops and three patients had supplemental significant prolapse and/or flail of at least 1 posterior scallop, besides flail of P2. The mean value for ROS in the valvular tissue was 9.46 ± 2.03nM H2O2/mg tissue/h at FOX assay. A significant positive correlation between the ROS values and the extent of prolapsing/flail segments was found (R = 0.67, p = 0.04).
Conclusion. Besides the diagnosis and accurate preoperatory valve description, 3D TEE along with molecular investigations contribute to the understanding of myxomatous mitral valves’ pathogenesis. Oxidative stress increased in the mitral valves with advanced myxomatous degeneration. Whether this occurs as a cause or a consequence contributing to the disease progression as well as the sources of ROS are worth further investigation.
The impact of valvular heart disease in patients referred for suspected coronary artery disease
Authors: Molenaar MA , Coerkamp CF , Man JP , Bouma BJ , Isgum I , Verouden NJ , Selder JL , Chamuleau SAJ , Schuuring MJ 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The most recent European Society of Cardiology guideline on coronary syndromes recommends echocardiography in all patients with suspected coronary artery disease (CAD). Whereas left ventricular function (LVF) is recognized as an important determinant of major adverse cardiovascular events (MACE) in these patients, little is known about the role of valvular heart disease (VHD).

Purpose
The aim of this study was to evaluate the prevalence and impact on the prognosis of VHD in patients referred for suspected CAD.

Method
Baseline, treatment and event in follow-up data of patients with suspected CAD who underwent transthoracic echocardiography (TTE) in a tertiary center between 2014 and 2021 were collected. MACE were defined as all-cause death, nonfatal stroke and nonfatal myocardial infarction (MI). VHD was defined as moderate-or-severe aortic stenosis (AS) or mitral regurgitation (MR). LV dysfunction was defined an ejection fraction less than 50%. Time-to-first-event analysis was performed with Kaplan-Meier survival curves and Cox proportional hazard analysis adjusting for significant covariates and time-dependent interventions.

Results
A total of 845 patients (57% men) with mean age of 65 years were identified. The median follow-up time was 2.8 years (1.1 – 4.8). In total 144 MACE (108 all-cause death, 14 nonfatal stroke, 22 nonfatal MI) occurred. VHD was prevalent in 132 (16%) patients of which 95 patients had moderate or severe AS and 44 had moderate or severe MR, see Figure 1. Independent determinants of MACE in VHD patients included moderate or severe VHD (HR 1.5, p = 0,05), LV dysfunction (HR 2.1, p &lt; 0.001), age older than 70 years (HR 1.7, p = 0.003) and diabetes (HR 2.0, p &lt; 0.001).

Conclusion
There is a high prevalence of VHD in patients referred for suspected CAD. Moderate to severe VHD strongly determines the prognosis. Future studies are needed to determine whether valvular interventions can improve the long-term outcome. Abstract Figure.
Cardiac deformation imaging in differentiation between patients with ischemic versus non-ischemic dilated cardiomyopathy presented with Left bundle branch block
Authors: Badran H , Faheem N , Gaber H , Yacoub MY 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Differentiation between ischemic (IDCM) and non-ischemic(NIDCM) cardiomyopathy using non-invasive image modalities is a clinical dilemma. Left bundle branch block (LBBB) imparts additional challenges into the etiologic diagnosis of DCM. This study employed 2D-strain imaging to characterize myocardial deformation and extent of mechanical discoordination in IDCM and NIDCM in presence of LBBB and their possible value for etiologic diagnosis.

Methods
We examined myocardial longitudinal& circumferential strain at segmental & global levels and LV twist [derived from basal and apical rotation] and electromechanical dyssynchrony in 36 DCM patients with LBBB. Of these patients, 16 were diagnosed with IDCM and 20 with NIDCM using coronary angiography, they were compared to 30 healthy controls.

Results
NIDCM were younger in age (45.7 ± 14 versus 61.5 ± 7.5, P&lt;.0001) had larger LV end systolic (P&lt;.03), end diastolic (P&lt;.02) dimensions, LAV (P&lt;.003), more mitral regurgitation(P&lt;.02) and lower EF (31% vs 39%, P&lt;.04). Compared with IDCM, patients with NIDCM had lower longitudinal strain of septal, lateral, inferior walls and global longitudinal strain (GLS), P&lt;.001 and lower LV twist (1.64 ± 1.4º vs. 3.25 ± 2.1º, p&lt; 0.01). IDCM had prevalent typical contraction activation (38% versus 5%) and higher electromechanical delay compared with NIDCM (P&lt;.01). However, there was no significant difference in circumferential strain between LBBB groups. Using ROC analysis value of GLS &lt;3.4% predicted NIDCM with 87.5% sensitivity and 78.9% specificity, area under curve is 0.836 and p &lt; 0.001.

Conclusion
In dilated cardiomyopathy with LBBB, deformation imaging is offering newer mechanistic insights and enables detailed characterization of ischemic and non-ischemic etiologies in heart failure patients.
Sex-specific echocardiographic phenotypes in left ventricular outflow tract obstruction
Authors: Hagen C , Lonnebakken MT , Davidsen ES 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Previous studies have reported major sex differences in prevalence, demographics, and timing of intervention in left ventricular outflow tract (LVOT) obstruction. Whether the observed differences are related to LVOT anatomy is less explored.

Purpose
The aim of this study was to assess the anatomic substrate for LVOT obstruction by echocardiography to identify sex-specific phenotypes.

Methods
We included 76 patients (37% women) with symptomatic LVOT obstruction referred to a tertiary care centre between 2005-2020 to be considered for septal ablation or myectomy. A standardized echocardiography was extended with systematic measurements of parasternal LVOT dimensions at 5, 10 and 15 mm below the aortic valve, proximal septal thickness at 10, 20 and 30 mm, subaortic septal bulge radius and aortoseptal angle in all patients prior to intervention (Image). Measurements were also adjusted for body surface area (BSA). A total of 3 patients had to be excluded from analysis due to poor image quality.

Results
Women were older (p &lt; 0.001, Table), while there were no differences in body mass index (27.6 v.s. 27.5, p = ns), systolic and diastolic blood pressure (133 v.s 133 mmHg, p = ns and 75 v.s 80 mmHg, p = ns, respectively), or prevalence of hypertension (24% v.s. 29%, p = n.s). Left ventricular end-diastolic diameter, LVOT diameters and septum thickness measured 30 mm from the aortic valve were lower in women (Table). However, in all these measurements the differences disappeared after adjusting for BSA. There were no sex differences in posterior wall thickness. Furthermore, the aortoseptal angle was steeper among women, and the septum bulge radius smaller, remaining so even after adjustment for BSA(Table).

Conclusion
In women with LVOT obstruction, the septum bulge radius adjusted for BSA was smaller, and the aortoseptal angle steeper. Our findings suggest that there may be important sex differences in the echocardiographic phenotype in LVOT obstruction. Abstract Table Abstract Figure. Image