bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subclinical myocardial dysfunction identified with speckle tracking echocardiography in young adults patients recovered from asymptomatic or mildly symptomatic SARS-CoV-2 infection
Authors: Barosi A , Bergamaschi L , Cusmano I , Colombo C , Gherbesi E 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Myocardial strain assessed with speckle tracking echocardiography is a sensitive marker of cardiac dysfunction, with long-term prognostic value in many cardiac conditions. Both left ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) were affected by severe SARS-CoV 2 infection but little is known about cardiac involvement in patients with asymptomatic/mild disease that did not require hospitalization.

Aim
To assess if subclinical myocardial dysfunction could be identified using LV-GLS and RV-LS in patients with previous asymptomatic/mild SARS-CoV 2 infection.

Methods
40 young adults patients (70% males, mean age 24.4 ± 8.4 years), who had a confirmed diagnosis of SARS-CoV-2 infection and were asymptomatic or only mildly symptomatic, without previous known comorbidities/cardiovascular risk factors, were retrospectively included. Patients underwent standard transthoracic echocardiogram and speckle tracking echocardiographic study at least 3 months after diagnosis. A total of 44 age, sex, and body surface area comparable healthy subjects were used as control group.

Results
LV-GLS was within normal limits but significantly lower in the cases group compared to controls (-22.7 ± 1.6% vs. -25.7 ± 2.3%; p &lt; 0.001). Left ventricular ejection fraction (63.3 ± 4.1% vs 63.9 ± 4.6%; p = 0.5), tricuspid annular plane systolic excursion (24.3 ± 3.7 vs. 23.7 ± 3.3; p = 0.5) and RV-LS (-23.2 ± 3 vs. -23.6 ± 2.7; p = 0.6) were comparable between the two groups.
Moreover, in the infection group, there were 25 subjects (30.1% vs 9.6% in the control group, p &lt; 0.001) with a regional peak systolic strain of the left ventricle below -16% in at least two segments. At multivariable logistic regression corrected for age, gender and body surface area, previous SARS-CoV-2 infection was an independent predictor of reduced LV-GLS values (p &lt; 0.001).

Conclusion
SARS-CoV-2 infection may affect left ventricular deformation in 30% of young adults patients despite an asymptomatic or only mildly symptomatic acute illness.
Speckle tracking echocardiography could help in early identification of patients with subclinical cardiac involvement. Since long-term complications of COVID-19 are not yet known, myocardial deformation imaging could be important for risk stratification, treatment and planning of long-term follow-up.
Left atrial mechanical dyssynchrony: an independent predictor of left ventricular reverse remodelling after cardiac resynchronization therapy
Authors: Hammersboen LER , Aalen JM , Puvrez A , Remme EW , Donal E , Duchenne J , Voigt JU , Galli E , Khan FH , Sletten OJ , Smiseth OA , Stugaard M 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Institute for Chirurgical Research - Oslo University Hospital

Introduction
Left bundle branch block (LBBB) leads to left ventricular (LV) mechanical dyssynchrony. Since the left atrium (LA) and the left ventricle (LV) are anatomically connected, dyssynchronous LV contractions may be transmitted to the LA causing LA dyssynchrony and disturbed LA function.

Purpose
To investigate if LA dyssynchrony induced by LBBB predicts LV reverse remodelling after cardiac resynchronization therapy (CRT).

Methods
In a prospective study, myocardial strain was measured by speckle-tracking echocardiography in 171 heart failure patients with LBBB, before and 6 months after CRT. LA dyssynchrony was measured as the time delay between onset systolic stretch of the interatrial septum and the LA lateral wall (white arrows in Figure), and LV dyssynchrony as the time from onset septal shortening to onset lateral wall shortening. Septal flash was assessed visually. Response to CRT was defined as at least 15 % reduction in LV end systolic volume at 6 months follow up.

Results
The figure shows a representative LBBB patient with LA and LV dyssynchrony which was abolished by CRT. For the whole study population, LA dyssynchrony was 104 ± 77 ms (mean ± SD) before CRT, and decreased to 43 ± 70 ms (p &lt; 0.0001) after CRT. There was a significant correlation between LA and LV dyssynchrony (r = 0.68, p &lt; 0.0001).
LA dyssynchrony correlated with LV reverse remodelling after CRT (p = 0.009), and multivariable analysis revealed that LA dyssynchrony was an independent predictor of CRT response (β=-0.046, p = 0.04) when combined with septal flash, QRS duration and QRS morphology (Table).

Conclusions
Patients with LBBB had marked LA dyssynchrony which was attributed to direct LV-LA mechanical interaction. Furthermore, LA dyssynchrony was an independent predictor of LV reverse remodelling after CRT. These findings suggest that assessment of LA dyssynchrony should be part of the echocardiographic evaluation in patients with dyssynchronous heart failure. Abstract Figure.
AI do it better. Reproducibility of fully automated versus manual analysis of left ventricle function using a new software
Authors: Di Candia A , Castaldi B , Cati A , Basso A , Fumanelli J , Sabatino J , Di Salvo G 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital of Padua
Background/Introduction: Ejection fraction (EF) is a parameter widely used in Echolab to evaluate left ventricular function. Recently, in parallel with the growing interest in artificial intelligence (AI), attemps have been made to create automated systems for EF assessment, in order to reduce time and improve the accuracy of the analysis.

Purpose
to compare results of different methods of EF assessment: visual estimation (visual EF), manual and fully automated analysis.

Methods
28 consecutive pediatric patients were enrolled. This cohort of previously healthy patients was screened at our Center for cardiac evaluation within 6 months after an asymptomatic or paucisymptomatic COVID19 infection. All they were in sinus rhythm. Optimized apical 4- and 2- chamber views were collected for each patient using Canon Aplio i900. Off-line EF assessment was first evaluated visually by pediatric cardiologists with experience in echocardiography, then performed by both fully automated analysis (AI) using two different methods (Automatic Simpson -AI Simpson- and Wall Motion Tracking -AI WMT-) and pediatric cardiologists through manual tracing of endocardial border (Manual Simpson and Manual WMT respectively).
Operators were blinded to the AI analysis. To measure intraobserver variability, evaluations of 16 patients’ datasets were performed twice by both operators and AI.

Results
Patients’ demographic data were: age 9,8+/-4,7 years; males 22 (78%); height 134,3+/- 34,9 cm; weight 41,8+/-28,7 kg; BSA 1,2+/-0,4 mq, HR 85+/-15/min.
The time taken for off-line analysis was 0.3-0.7 minutes, 1-1.5 minutes, 1-3 minutes and 3-4 minutes, respectively for AI WMT, AI Simpson, Manual WMT and Manual Simpson.
As expected, visual EF showed high intraobserver variability and a poor reproducibility (ICC 43%). AI analysis revealed a good to excellent reproducibility (ICC from 80% to 99%, depending on the method used). WMT methods had the best reproducibility both for manual tracing of endocardial border and fully automated analysis (Table 1).
The comparison between different methods (Table 2) showed a good agreement between AI Simpson and AI WMT (mean bias 2,9, from -3,2 to 9,0, ICC 86%). A moderate correlation was found between different methods of AI analysis while only poor correlation was found between manual Simpson and manual WMT (Table 2).
Conclusion(s): Automatic Simpson and Wall Motion Tracking are two different fully automated methods which can be used for left ventricular function assessment. AI reproducibility is high for both methods, higher for WMT. WMT method is also less time consuming and improves reproducibility of manual tracing of endocardial borderd analysis. Abstract Table 1. Echocardiographic measurements Abstract Table 2. Comparison between different me
Infective endocarditis in octogenarians: a retrospective study in a single surgical center
Authors: Scheggi V , Merilli I , Ceschia N , Vanni F , Alterini B , Stefano PL , Marchionni N 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Infective endocarditis (IE) is a severe disease associated with high morbidity and mortality. The EURO-ENDO registry reported a mean age of 59.25 ± 18.03 years; 46.3% of patients were over 65 and 12.0% over 80 years. Little is known about the best management of elderly patients with IE. In these patients, surgery may be challenging.

Purpose
We aimed to determine the clinical and echographic characteristics, the therapeutic strategy, and the outcome of IE in octogenarians.

Method
We retrospectively included in the analysis 457 consecutive patients with definite active IE in a single surgical centre. Descriptive statistics are reported as mean ± standard deviation (SD) or median ± interquartile range (IQR) for continuous variables with normal and non-normal distribution and as frequencies and percentages for categorical variables. Between-groups comparisons were assessed by Student’s t-test, Mann-Whitney U test, Kruskal-Wallis, or chi-square test, as appropriate. Univariate long-term survival was analysed by the Kaplan-Meier method.

Results
In our cohort, octogenarians were 17% of the whole population (N = 77). In patients under the age of eighty, males were mostly involved with a sex ratio exceeding 2:1. This ratio was inverted in older people, where the female gender represented 57% of the total (0.001). Staphylococcus aureus (10.4 vs 20.5%, p =0.038) and Enterococci (29.9 vs 16.3%, p =0.008) were significantly less and more frequent than in younger people, respectively. Comorbidities were more frequent in elderly patients, such as hypertension (80.5 vs 53.2%, p = 0.001), dyslipidaemia (42.7 vs 27.3%, p = 0.008), and history of cancer (29.9 vs 19.2%, p = 0.036). Consequently, EUROSCORE II was higher (median ± IQR 19.18 ± 19.0 vs 11.9 ± 5.7, p = 0.001). In octogenarians, IE was more frequently left-sided (98.7 vs 89.2, p = 0.009) and complicated less often with peripheral embolism (31.2 vs 43.9%, p = 0.038). We found no differences between the two groups for the type of infected valve (native or prosthetic), the severity of valve dysfunction, paravalvular extension, and vegetation length. Octogenarians were more often excluded from surgery despite indication (19.5 vs 7.7%, p = 0.016) and had higher thirty-day (11.7 vs 7.9%, p = 0.001) and three-year (45 vs 30%, p = 0.001) mortality than younger patients.

Conclusions
Octogenarians represent a considerable proportion of overall cases of IE, with specific clinical and microbiological characteristics. Older patients are more often excluded from surgery, and the overall prognosis is poor. Abstract Figure.
Left ventricular lobal longitudinal strain as a prognostic marker in low-risk patients undergoing TAVI
Authors: Byczkowska K , Gil RJ , Pawlak A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Left ventricular global longitudinal strain (LV GLS) correlate with the risk of symptoms, irreversible myocardial damage and progressive myocardial fibrosis. LV GLS detects subtle changes in LV function that precede those of LVEF and is associated to outcomes after TAVI.

Purpose
Evaluation of the LV GLS as the prognostic parameter in patients low-, intermediate and high-risk patients undergoing TAVI and its potential relationship with frailty syndrom.

Methods
The study included 105 patients (mean age 82.36 ± 4.5) with severe AS treated with TAVI at the Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior in Warsaw. Each patient had laboratory tests, ECG, echocardiography (LV GLS) and was assessed based on the STS scale and the Katz frailty scale. Follow-up observations were carried out at 1 month and 1 year.

Results
In the study population 46% were men, the mean age was 82.36 ± 4.5 years, the mean STS score was 7.03 ± 4.24. The mean pre-TAVI LVEF was 54.51 ± 6.44% (in 87 (82.8%) patients above 50%). The mean LV GLS before TAVI was -12.82 ± 1.94%. AVAI area was 0.38 ± 0.08 cm/m2, and the mean gradient through the stenotic aortic valve was 51.69 ± 10.66 mmHg.
LV GLS was significantly improved in patients after TAVI. LV GLS analysis showed change from -12.82% before TAVI, to -14.35% after 1-month follow-up and -14.47% at 1-year follow-up (p ≤ 0,05, p ≤ 0,05 respectively). LV GLS of -11% was a cut-off value determining the risk of death after 1 year post-TAVI (p &lt; 0,001). The area under the curve was 0,87, which was a statistically significant result that can be used as a significant prognostic factor. In low-risk patients there was a significant improvement of LV GLS in 1-year follow-up, compared to patients with STS 4-8% (p ≤ 0.01) and in patients with STS&gt; 8% (p ≤ 0, 05) (Tab. 1).
Logistic regression analysis showed that the change of LV GLS at 1 year significantly correlated with Katz frailty score at 1-month and 1-year follow-up ((p ≤ 0,01, p ≤ 0,01 respectively) (Tab. 2).

Conclusion
LV GLS of -11% was a cut-off value distinguishing patients with increased risk of death after TAVI. In low-risk patients the improvement in LV GLS indicates a favorable reverse myocardial remodeling after TAVI and better prognosis after TAVI, which was not observed in the intermediate- and high-risk patients. Abstract Figure. Abstract Figure.
Prospective study comparing simultaneous transthoracic and transesophageal echocardiography aortic stenosis assessment
Authors: Schwartzenberg S , Vaturi M , Kazum S , Monakier D , Ofek H , Sagie A , Kornowski R , Shapira Y 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Transthoracic echocardiography (TTE) is the gold-standard for aortic stenosis (AS) assessment. Transesophageal echocardiography (TEE) can be used alternatively, but measurement of hemodynamic components can be affected.

Purpose
We aimed to compare head-to-head TTE vs transesophageal echocardiography (TEE) assessment of AS.

Methods
We prospectively studied 56 patients with ≥moderate AS who underwent TTE (TTE1) and consecutive conscious sedation with simultaneous TEE and TTE (TTE2). Echocardiographic variables and AS types measured by TEE vs TTE2 and by TEE vs TTE1 were compared using paired tests and chi square tests. Based on conservative vs actionable implication, AS types were dichotomized into Group-A, comprising moderate and Normal-Flow Low-Gradient, and Group-B, comprising High-Gradient, Low Ejection-Fraction Low-Flow Low-Gradient, and Paradoxical Low-Flow Low-Gradient AS.

Results
TEE vs simultaneous TTE2 comparison demonstrated higher mean gradients (31.7 ± 10.5 vs 27.4 ± 10.5mmHg) and velocities (359 ± 60.6 vs 332 ± 63.1cm/sec) with TEE, but lower left ventricular outflow velocity-time-integral VTI1 (18.6 ± 5.1 vs 20.2 ± 6.1cm), all p &lt; 0.001. This resulted in lower aortic valve area AVA (0.8 ± 0.21 vs 0.87 ± 0.28cm2), p &lt; 0.001, and a net relative-risk of 1.86 of Group A to B upgrade. TEE vs (awake-state) TTE1 comparison revealed a larger decrease in VTI1 due to higher initial awake-state VTI1 (22 ± 5.6cm), resulting in similar Doppler-velocity-index (DVI) and AVA decrease with TEE, despite slight increase in mean gradients of 0.8mmHg (-1.44 to 3.04 CI) and in velocities of 10cm/sec (-1.5 to 23.4 CI). This translated into a net relative-risk of 1.92 of Group A to B upgrade vs TTE1.

Conclusions
TEE under conscious sedation overestimates AS severity compared with both awake state TTE and simultaneous sedation state TTE, accounted for by different Doppler insonation angle obtained in transapical vs transgastric position. The net result is a smaller DVI and AVA by TEE vs TTE. TEE carries a high sensitivity but a low specificity for severe AS compared with TTE during awake state. Abstract Figure. Spectral Doppler w/TTE vs simultan. TEE Abstract Figure. Cardiac CT planes simulating TTE vs TEE
The prevalence and significance of mitral annular disjunction on clinical outcomes in patients undergoing mitral valve surgery
Authors: Bennett S , Tafuro J , Duckett S , Heatlie G , Kwok CS 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Mitral annular disjunction (MAD) is a common structural abnormality involving a distinct separation of the left atrium/mitral valve annulus and myocardium continuum. MAD is commonly associated with altered mitral valve annular dynamics, increased left ventricular and mitral valve apparatus stress and potentially life threatening arrhythmias. At present there is limited data on the prevalence and significance of MAD in patients requiring mitral valve surgery.

Purpose
To ascertain the prevalence, extent and significance of MAD on a general cohort of patients with mitral valve disease who required mitral valve surgery. Primary outcomes included: duration of surgery, need for re-do operation (any cause), neurological and gastro-intestinal complications, cardiogenic shock and mortality. These were assessed during the surgical hospitalisation period.

Methods
The local cardiothoracic database within a large tertiary centre was used to identify all patients who underwent mitral valve surgery between 2013 and 2020. From this, patients who were found to have a transthoracic echocardiogram (TTE) pre and post mitral valve surgery were included. Two experienced sonographers retrospectively reviewed and analysed each TTE. The data collected included: presence, location and extent of MAD (pre and post-surgery). The local cardiothoracic database and electronic patient records were reviewed for primary outcomes.

Results
A total of 187 patients were included (age: 65.6 ± 13.7 years, 74.2% males). The most common reason for mitral valve surgery was mitral valve prolapse (31.6%), remaining aetiologies included functional MR, ischemic MR, infective endocarditis, rheumatic mitral stenosis and congenital abnormalities. Surgical intervention included: leaflet repair ± annuloplasty ring (57.2%), bio-prosthesis (19.8%) or mechanical prosthesis (23.0%). Pre surgery, MAD was present in 32.6% of all patients and was most commonly seen in patients with mitral valve prolapse (21.3%). In patients with MAD, the averaged MAD length was 8.4 ± 3.9mm (median 7 [IQR: 5-11]). Post-surgery, MAD was only identified in 2 patients, both of whom had mitral valve repair± annuloplasty ring. As seen in Table 1, there were no significant differences in clinical outcomes in patients with or without MAD.

Conclusion
MAD is common in a cohort of patients requiring mitral valve surgery. Surgical intervention is able to correct MAD in the vast majority of patients and its presence does not affect immediate post-surgical outcomes. Abstract Table 1.
Echocardiographic diagnosis of aortic valve strands: case series and literature review
Authors: Garcia Olea A , Ramirez-Escudero Ugalde G , Maeztu Rada M , Garcia Ibarrondo N , Codina Prat M , Manzanal Rey A , Asla Ormaza C , Ruiz Gomez L 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Introduction. Aortic valve Lambl’s excrescences (LE) were first described as histopathological findings in 1856. Since then, most research on these structures consist of case reports and studies conducted to elucidate their thrombogenic role. Indeed, their nomenclature has differed on time, receiving names such as fibrous bands or strands, so features of patients with these conformations remain imprecise.
Purpose. To elucidate the demographic characteristics of patients with aortic valve strands detected by echocardiography.
Methods. We conducted a literature review in MEDLINE database for studies on aortic valve fibrous bands, strands or LE on humans, with no date restrictions and full text filter. Papillary fibroelastoma was not included in the search according to the histological differences of this neoformation. We screened these articles and removed incorrect matches, studies that did not differentiate between mitral and aortic strands and those which lacked an echocardiographic diagnosis. We added the cases of patients with aortic valve strand label in our laboratory database. Demographic variables present in the studies were extracted, summarized in a table and analyzed with descriptive statistics.
Results. The literature review disclosed 97 studies, out of which 53 fulfilled the inclusion criteria. The most common exclusion reasons were histopathological instead of echocardiographic diagnosis and absence of information of the LE location. A case series of 3 patients from our laboratory was added. Among the 560 cases of strands, aortic native valves (278, 49.6%) were more affected than prosthetic ones (68, 12%), most without predisposing valvular disease. Reports in women were similar to those in men (272 vs 259), and most registries showed a balanced gender proportion. The weighted mean age was around 54 years old, although strands were also found in newborns and 80-year-old men. The etiological study of cryptogenic stroke was, in most cases, the reason for the diagnostic echocardiogram performance (149, 26.6%), followed by endocarditis suspicion (46, 8.2%), while the studies conducted to assess aortic regurgitation or stenosis causes were predominant in case reports. The terms "strands" and "LE" were equally used in the studies on aortic fibrous bands.
Conclusion. Current evidence suggests that aortic valve strands are predominant in middle-age men or women with healthy native valves, especially in those patients whose echocardiography is performed searching for thrombogenic causes or endocarditis. Further prospective studies with a selective focus on LE search would help to precisely define the demographic features of patients presenting these structures. Abstract Figure. Summary table of articles and features Abstract Figure. Case series image