European Journal of Echocardiography最新文献

{"title":"Valvular heart disease in autoimmune diseases in Mexico","authors":"J. Melgar, J. Fritche-Salazar, M. Soto-López","doi":"10.1093/EHJCI/JEAA356.071","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.071","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000  The autoimmune diseases (AD) have high morbidity and mortality due to their affection to the heart.\u0000 \u0000 \u0000 \u0000 Our objective was to describe the valvular heart disease (VHD) in patients with AD.\u0000 \u0000 \u0000 \u0000 Patients with systemic lupus erythematous (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SS) diagnosis were included, from January 1st 2008 to December 31th 2018. Prevalence rates of valve involvement were calculated.\u0000 \u0000 \u0000 \u0000 A total of 163 patients (57.6% with SLE, 23.3% with RA, 19.0% with SS) were included. The global prevalence of VHD was 5.4% in SLS, 23.6% en RA, and 15.9% in SS. The more affected valve in SLS was the tricuspid valve in 24% (12% with severe tricuspid regurgitation (STR), p = 0.028), in RA was the aortic valve in 26% (13% with severe aortic stenosis (SAS), p = 0.02), and with SS was the tricuspid valve in 48% (29% with moderate tricuspid regurgitation (MTR)). The calcium deposit was present in 66% in RA (37% in aortic valve, p < 0.001). The valve thickening (>5 mm) was higher in RA (50%, p < 0.001), with predominance in mitral valve (26%).\u0000 \u0000 \u0000 \u0000 We found significant higher rates of STR in SLE, SAS in RA, and MTR in SS compared with the literature. Moreover, calcification and valve thickening were found more often in RA. Early diagnosis of subclinical VHD is mandatory to improve the long-term prognosis of these patients.\u0000 Valvular heart disease. Autoimmune Disease (n = 163) P value* SLE (n = 94) RA (n = 38) ES (n = 31) Demographic characteristics Age, years. Gender, Male / Female, n Body Mass Index (kg/m2) Arterial hypertension, n (%) Diabetes Mellitus, n (%) 38.8 (12.6) 9/85 26.2 (5.9) 21(22.3%) 6 (6.3%) 62.45 (12.3) 7/31 26.6 (7.1) 14(36.8%) 4 (10.5%) 53.8 (13.3) 2/29 25.4 (4.7) 12 (38.7) 5 (16.1%) <0.001 NS NS NS NS Echocardiographic findings. Valve thickening Aortic Mitral 8 (9%) 1 (1%) 7 (7%) 19 (50%) 9 (24%) 10 (26%) 1 (3%) 0 1 (3%) <0.001 Calcium Deposit Aortic Mitral 4 (4%) 2 (2%) 2 (2%) 25 (66%) 14 (37%) 11 (29%) 8 (26%) 4 (12.8%) 4 (12.9%) <0.001 Aortic valve disease 4 (4%) 10 (26%) 0 Aortic stenosis Moderate Severe 0 0 0 7 (18%) 2 (5%) 5 (13%) 0 0 0 0,02 Moderate Aortic Regurgitation 4 (4%) 3 (8%) 0 NS Mitral valve disease 8 (9%) 2 (5%) 2 (6%) Mitral stenosis Moderate Severe 4 (4%) 2 (2%) 2 (2%) 1 (3%) 0 1 (3%) 1 (3%) 0 1 (3%) NS Mitral Regurgitation Moderate Severe 4 (4%) 2 (2%) 2 (2%) 1 (3%) 0 1 (3%) 1 (3%) 0 1 (3%) NS Tricuspid Regurgitation Moderate Severe 22 (24%) 11 (12%) 11 (12%) 8 (21%) 7 (18%) 1 (3%) 15 (48%) 9 (29%) 6 (19%) 0,028 Pulmonic valve disease Moderate Pulmonic Stenosis Moderate Pulmonic Regurgitation 6 (6%) 1 (1%) 5 (5%) 1 (3%) 0 1 (3%) 0 0 0 NS * Not Significant.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87953928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective validation of a non-invasive method to estimate myocardial work in aortic stenosis","authors":"A. Hubert, K. Owashi, V. Rolle, A. Hernandez, E. Galli, E. Donal","doi":"10.1093/EHJCI/JEAA356.059","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.059","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public hospital(s). Main funding source(s): ANR - Maestro project\u0000 \u0000 \u0000 \u0000 Stratification of aortic stenosis patients remains challenging and robust indices are required. Myocardial work assessment is a new afterload independent alternative to evaluate left ventricular function. Although, this method was developed in patients with normal aortic valve. We previously developed an integrated cardiovascular system simulated by a computational model to estimate non-invasively myocardial work in aortic stenosis patients* (figure 1A). In the present study, we tested our model in a prospective population of AS patients.\u0000 \u0000 \u0000 \u0000 9 patients with severe AS (aortic valve area < 1cm2) were included. A complete trans-thoracic echocardiography with a non-invasive blood pressure by brachial artery cuff were realized immediately before a left heart catheterization to have an invasive left ventricular pressure. Myocardial work is then calculated with non-invasive and invasive LV pressure combined to LV strain curves. For constructive and wasted work, root mean squared between invasive and estimated measures were respectively r2 = 0.92 and r2 = 0.94 (figure 1B)\u0000 \u0000 \u0000 \u0000 The proposed model is efficient to estimate non-invasively myocardial work indices in AS-patients. These afterload independent indices could permit in future to better stratify this population. \u0000 *Owashi KP, Hubert A and al. Model-based estimation of left ventricular pressure and myocardial work in aortic stenosis. PlosOne 2020. Mar 3;15(3):e0229609\u0000 Abstract Figure 1\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82228400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prediction of long-term survival in haemoglobinopathies: insights from cardiac imaging and ferritin","authors":"V. Kamperidis, M. Vlachou, Z. Pappa, D. Pantelidou, T. Karamitsos, Despoina Papadopoulou, A. Kartas, E. Vlachaki, G. Giannakoulas, H. Karvounis","doi":"10.1093/EHJCI/JEAA356.396","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.396","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 Aims.The data on echocardiography, cardiac magnetic resonance (CMR) and ferritin predicting long-term survival in haemoglobinopathies are scarce. The current study evaluated the association of these parameters with the 10-years survival in haemoglobinopathies.\u0000 Methods.This prospective study included stable consecutive haemoglobinopathy patients .Demographics, ferritin, echocardiography and CMR parameters were prospectively collected.\u0000 Results. In total, 83 patients (mean age 38.4 ± 12.0 years, 46% male) with haemoglobinopathies were included and dichotomized based on their survival status after a follow-up of 9.8 ± 1.4 years. Patients who died were older (45.3 ± 11.6 vs 37.1 ± 11.7 years, p = 0.025), had higher ferritin levels (2498 vs 754 ng/ml, p = 0.001), higher right ventricular systolic pressure (RVSP) (41 ± 10 vs 31 ± 11mmHg, p = 0.001), more frequently elevated left ventricular (LV) end-diastolic pressure (70 vs 35%, p = 0.039) and lower CMR T2* values (23 ± 12 vs 35 ± 12ms, p = 0.007). Older age (HR: 1.053, p = 0.018), ferritin >2000ng/ml (HR: 3.517, p = 0.03), and >950ng/ml (HR: 11,135, p = 0.02), elevated LV end-diastolic pressure (HR: 3.977, p = 0.046), RVSP >34mmHg(HR: 10,134, p = 0.003), CMR T2* <20msec (HR: 4.900, p = 0.018) and <36msec (HR: 9.376, p = 0.035) were associated with increased all-cause mortality. A baseline model including age was created andit became more predictive of worse survival by adding RVSP >34mmHg than elevated LV end-diastolic pressure (C index 0.777 vs. 0.757 respectively) or ferritin >950ng/ml than >2000ng/ml (C index 0.805 vs. 0.770 respectively) or CMR T2*<36msec than <20msec (C index 0.825 vs. 0.810 respectively).\u0000 Conclusions. In haemoglobinopathy patients, RVSP >34mmHg, ferritin >2000ng/ml and CMR T2* <20ms were associated with worse long term survival.In the current era of advanced chelation therapy, aiming for ferritin <950ng/ml and CMR T2* >36ms appears to improve their prognosis.\u0000 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82643880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ventricular tachyarrhythmias prediction in patients with coronary artery disease and left ventricular dysfunction","authors":"T. Atabekov, R. Batalov, S. Krivolapov, M. Khlynin, S. Sazonova, S. Popov","doi":"10.1093/EHJCI/JEAA356.336","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.336","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 Introduction. The cardioverter-defibrillator (ICD) implantation is the most effective method for the sudden cardiac death (SCD) prevention. However, about 25% patients didn\"t have an incidence of ICD shocks during first battery life. Most of them are mainly represented by patients who had the ICD implanted for the primary prevention of the SCD. It us known, reduced left ventricular ejection fraction (LVEF) is an independent predictor of the SCD. So, it’s necessary to find out new predictors of the SCD and ventricular arrhythmias (VTA) incidence, which will help to optimize the selection of patients who really need a ICD implantation.\u0000 Purpose. To identify predicting methods of the VTA in patients with coronary artery disease and LVEF 35% or less.\u0000 Materials and methods. The study included 40 patients (males – 36, mean age – 63,4 ± 7,8 years) with coronary artery disease (CAD), LVEF 35% or less and ICD implantation indications (primary prevention of the SCD). Patients before ICD implantation underwent 6-minute walk test, echocardiography, heart rate variability analysis and cardiac single-photon emission computed tomography with 123I-meta-iodobenzylguanidine (123I-MIBG). All patients after ICD implantation were followed-up during two years and divided into two groups.\u0000 Results. The 1-st group consisted of 36 (90,0%) patients with VTA events. The 2-nd group consisted of 4 (10,0%) patients without VTA events. The univariate ROC-analysis showed that the low values of the average NN intervals (AUC = 0,986, p = 0,0001, t ≤ 1211 ms), standard deviation of NN intervals (AUC = 0,986, p = 0,0001, t ≤ 119 ms), standard deviation of the average NN intervals (AUC = 0,861, p = 0,0001, t ≤ 94 ms), average standard deviation of NN intervals (AUC = 0,792, p = 0,004, t ≤ 48 ms), root mean square of successive differences (AUC = 0,847, p = 0,0003, t ≤ 18 ms), very low frequency domain (AUC = 0,792, p = 0,02, t ≤ 2411 ms), low frequency domain (LFD) (AUC = 0,903, p = 0,0001, t ≤ 1046 ms), high frequency domain (AUC = 0,875, p = 0,0001, t ≤ 743 ms), total frequency domains (AUC = 0,847, p = 0,0003, t ≤ 2785 ms), heart/mediastinum ratio on early (AUC = 0,889, p = 0,0001, t ≤ 2,29) and delayed (AUC = 0,806, p = 0,001, t ≤ 1,65) scintigrams, as well as high values of the end-diastolic index (AUC = 0,944, p = 0,0001, t > 65,9 ml/m2), end-systolic index (AUC = 1,000, p = 0,0001, t > 23,6 мл/м2), 123I-MIBG accumulation defect on early (AUC = 0,958, p = 0,0001, t > 15,0%) and delayed (AUC = 0,958, p = 0,0001, t > 18,0%) scintigrams leaded to frequent occurrences of the VTA. The multivariate ROC-analysis demonstrated that the LFD (p = 0,0136) is independent predictor of the VTA. Also, increase of the VTA predictive ratio, calculated according to this predictive model, more than 0,8936 leaded to frequent occurrences of the VTA (AUC = 0,903, p = 0,0001). Conclusion. A decrease in the LFD can be a predictor of the VTA in patients with CAD. ","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89659471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitral annulus disjunction is associated with adverse outcome in patients with Marfan syndrome and Loeys-Dietz syndrome","authors":"M. Chivulescu, K. Krohg‐Sørensen, E. Scheirlynk, B. Lindberg, L. Dejgaard, Øyvind H. Lie, T. Helle-Valle, E. Skjølsvik, E. Aabel, T. Hunt, M. Estensen, T. Edvardsen, P. S. Lingaas, K. Haugaa","doi":"10.1093/EHJCI/JEAA356.419","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.419","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public Institution(s). Main funding source(s): South-Eastern Norway Regional Health Authority\u0000 \u0000 \u0000 \u0000 Mitral valve prolapse is a common finding in patients with Marfan (MFS) and Loeys-Dietz syndromes (LDS). Mitral annulus disjunction (MAD) is an atrial displacement of the hinge point of the mitral valve that frequently coexists with mitral valve prolapse, but its clinical relevance in connective tissue disorders is unknown.\u0000 \u0000 \u0000 \u0000 To explore the association between MAD and severity of mitral valve and aortic disease in patients with MFS and LDS.\u0000 \u0000 \u0000 \u0000 We included consecutive MFS patients and LDS patients fulfilling established diagnostic criteria. MAD was identified by echocardiography and defined as the distance from the ventricular myocardium to the hinge point of the posterior mitral leaflet (Figure, panel A). Aortic surgery was defined as emergency surgery for aortic dissection or prophylactic aortic surgery for aortic aneurysm. We recorded the need of mitral valve surgery including mitral valve repair or replacement.\u0000 \u0000 \u0000 \u0000 We included 168 patients of whom 103 (61%) had MFS and 65 (39%) had LDS. We identified MAD in 69 (41%) patients. Aortic surgery was performed in 112 (67%) patients (27 dissections and 85 prophylactic interventions). Patients with MAD were younger at the time of aortic surgery than those without MAD (p log rank = 0.02) (Figure, panel B). Patients needing aortic surgery had greater MAD distance (8 [7-10] mm vs. 7 [6-8] mm, p = 0.04). Mitral valve surgery was performed in 12 (7%) patients, more frequently in patients with MAD than in those without (16% vs. 1%, p < 0.001, p log rank < 0.001) (Figure, panel C).\u0000 \u0000 \u0000 \u0000 MAD was frequent and detected in 41% of patients with MFS and LDS. MAD was associated with a more severe disease phenotype including aortic surgery at younger age and frequent need for mitral valve surgery. Screening patients with MFS and LDS for MAD may provide prognostic information and may be relevant in planning surgical interventions.\u0000 Abstract Figure\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73221110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of imaging strategies to diagnose and select patients with non-obstructive coronary artery disease for statin treatment in the United Kingdom","authors":"A. Peultier, W. Redekop, S. Boccalini, B. Clayton, J. Severens","doi":"10.1093/EHJCI/JEAA356.428","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.428","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The project leading to this publication has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 668142.\u0000 \u0000 \u0000 \u0000 Patients with non-obstructive coronary artery disease (NOCAD) are at a higher risk of cardiovascular events compared to those with normal arteries. Plaque rupture is associated with increased adverse events and statin therapy seems to be beneficial for plaque stabilisation. Coronary Computed Tomography Angiography (CCTA) is currently the non-invasive imaging modality of choice for the morphological evaluation of NOCAD in the United Kingdom (UK). However, CCTA provides limited information regarding the vulnerability of plaques to rupture and the selection of patients for preventive statin treatment. Currently being tested on patients, Spectral Photon-Counting CT (SPCCT) may provide increased accuracy for vulnerable plaque detection and, in turn, improved selection of patients for statin treatment.\u0000 \u0000 \u0000 \u0000 We investigated the potential cost-effectiveness of SPCCT (compared to a set of CCTA-based strategies) in identifying NOCAD patients with rupture-prone plaques for preventive statin treatment.\u0000 \u0000 \u0000 \u0000 A decision tree and a Markov trace were developed to model the expected outcomes (costs and quality-adjusted life-years (QALYs)) for a hypothetical UK cohort of 50-year-old male patients with stable chest pain and no history of CAD. Input data were obtained from the literature. Deterministic and probabilistic sensitivity analyses were performed. The impact of a pairwise variation of SPCCT sensitivity and specificity was analysed. Furthermore, five competing imaging strategies were compared in terms of their lifetime costs and effects: 1) CCTA and treat NOCAD based on imaging results, 2) CCTA and treat all NOCAD, 3) CCTA and do not treat NOCAD, 4) SPCCT with high specificity and treat NOCAD based on imaging results, and 5) SPCCT with high sensitivity and treat NOCAD based on imaging results.\u0000 \u0000 \u0000 \u0000 Our deterministic and probabilistic results showed that an improved imaging test would add value compared to CCTA. While increased specificity (to 95%) is favorable at a lower willingness to pay (WTP) (up to ∼£9,000 per QALY), increased sensitivity (to 95%) is more likely to be favorable at a higher WTP (∼£9,000 to £120,000 per QALY). The role of a CCTA-treat-none strategy and a CCTA-treat-all strategy is minimal and potential only at really low (<£2,000 per QALY) and high (>£120,000 per QALY) WTP, respectively. The uncertainty around these results is highly correlated to the uncertainty around the long-term risk for NOCAD patients to experience myocardial infarction or stroke.\u0000 \u0000 \u0000 \u0000 An improved imaging test based on higher sensitivity in identifying rupture-prone coronary plaques in NOCAD patients seems to have value in guiding the decision of preventive statin treatment in the UK. However, additional ","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81020201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive value of left atrial expansion index and left atrial contractile strain in younger hypertensive patients with atrial fibrillation","authors":"N. Georgieva, E. Kinova, A. B. Petkova, B. Krastev, A. Goudev","doi":"10.1093/EHJCI/JEAA356.132","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.132","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000   Arterial hypertension (HTN) is the most prevalent risk factor for Atrial fibrillation (AF) through structural and functional changes of the left atrium. Paroxysmal AF is mainly asymptomatic and silent forms in patients with HTN are associated with thromboembolic complications. However, prompt identification of HTN patients at risk for AF may be strategic for preventing purposes. \u0000 \u0000 \u0000 \u0000 To assess sensitive and  predictive parameters for AF onset in HTN patients using two-dimensional (2D) conventional and speckle tracking echocardiography of the left atrium (LA) and left ventricle (LV). \u0000 \u0000 \u0000 \u0000 A total of 165 consecutive patients were screened for participation in the study.  Only 80 patients met the inclusion criteria ( age below 60 years; with well controlled HTN or HTN with AF; without concomitant disease or other risk factors for AF).They were separated in two groups: 43 with HTN and 37 patients with AF and HTN. All patients underwent standard 2D echocardiography with volumetric and Speckle tracking analysis for assessment of: LV global longitudinal strain; LA total ( LATEF), passive ( LAPEF), active (LAAEF) emptying fractions; LA stiffness and expansion index; LA - reservoir (LASr), conduit (LAScd) and contractile (LASct) strain. \u0000 \u0000 \u0000 \u0000 There were statistically significant differences between patents with HTN and  HTN with AF group in: LASr (30.88 ± 3.99% vs. 27.89 ± 8.21 %, p= 0.049), LASct (-17.64 ± 2.04% vs. -14.4 ± 6.74 %, p= 0.007) and LA expansion index (122 ± 42% vs. 174 ± 115%; p = 0.014). There were no significant differences in other LV and LA structural and functional indices. Multiple regression analysis demonstrated that  LASct ( B= - 0.043’ p= 0.001; 95%CI -0.063- -0.023) and expansion index (B= 0.023; p= 0.001, 95%CI 0.117- 0.349)  are independent predictors of AF in hypertensive patients. \u0000 \u0000 \u0000 \u0000 Preserved LA compliance and contractile function are essential for maintenance of sinus rhythm in younger HTN patients. These findings could be used for  prediction of cardiovascular events and preventing AF onset in younger hypertensive population with a huge social impact.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81275614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and prognostication of the substrate of ventricular arrhythmia with cardiac magnetic resonance (CMR) imaging in patients with normal echocardiography","authors":"S. Younus, H. Maqsood, A. Gulraiz, Khan, R. Awais","doi":"10.1093/EHJCI/JEAA356.372","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.372","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Other. Main funding source(s): Self\u0000 \u0000 \u0000 \u0000 Malignant ventricular arrhythmia contributes to approximately half of the sudden cardiac deaths. In common practice, echocardiography is used to identify structural heart diseases that are the most frequent substrate of VA. Identification and prognostication of structural heart diseases are very important as they are the main determinant of poor prognosis of ventricular arrhythmia.\u0000 Purpose :\u0000 The objective of this study is to determine whether cardiac magnetic resonance (CMR) may identify structural heart disease (SHD) in patients with ventricular arrhythmia who had no pathology observed on echocardiography.\u0000 Methods :\u0000 A total of 864 consecutive patients were enrolled in this single-center prospective study with significant ventricular arrhythmia. VA was characterized as >1000 ventricular ectopic beats per 24 hours, non-sustained ventricular arrhythmia, sustained ventricular arrhythmia, and no pathological lesion on echocardiography. The primary endpoint was the detection of SHD with CMR. Secondary endpoints were a composite of CMR detection of SHD and abnormal findings not specific for a definite SHD diagnosis.\u0000 Results :\u0000 CMR studies were used to diagnose SHD in 212 patients (24.5%) and abnormal findings not specific for a definite SHD diagnosis in 153 patients (17.7%). Myocarditis (n = 84) was the more frequent disease, followed by arrhythmogenic cardiomyopathy (n = 51), ischemic heart disease (n = 32), dilated cardiomyopathy (n = 17), hypertrophic cardiomyopathy (n = 12), congenital cardiac disease (n = 08), left ventricle noncompaction (n = 5), and pericarditis (n = 3). The strongest univariate and multivariate predictors of SHD on CMR images were chest pain (odds ratios [OR]: 2.5 and 2.33, respectively) and sustained ventricular tachycardia (ORs: 2.62 and 2.21, respectively).\u0000 Conclusion : Our study concludes that SHD was able to be identified on CMR imaging in a significant number of patients with malignant VA and completely normal echocardiography. Chest pain and sustained ventricular tachycardia were the two strongest predictors of positive CMR imaging results.\u0000 Abstract Figure. Distribution of different SHD\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"120 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73519409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac computed tomography for therapy targeting in surgical repair of anteroapical left ventricular aneurysms: assessment of aneurysm volume and of anticipated residual left ventricular volume","authors":"N. Solowjowa, O. Nemchyna, Y. Hrytsyna, A. Meyer, M. Pasic, V. Falk, C. Knosalla","doi":"10.1093/EHJCI/JEAA356.222","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.222","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Surgical ventricular repair (SVR) is an established treatment option in patients with heart failure (HF) due to left ventricular (LV) aneurysms, whereby LV volume reduction is the principal therapeutic target. Precise planning therefore is essential for postoperative improvement of HF symptoms.\u0000 \u0000 \u0000 \u0000 In this study we evaluated the potential of cardiac computed tomography (CCT) to estimate the aneurysm volume and to predict the achievable residual LV volume.\u0000 \u0000 \u0000 \u0000  205 patients (11/2005-01/2016, m:w = 151:54, median 63.4 years; mean NYHA class 3.03) with anteroapical LV aneurysm underwent SVR combined with coronary artery bypass grafting (77%), mitral valve repair/replacement (19%), and LV thrombectomy (19%). CCT was performed before and 7 days after surgery. Volumetric assessment was made using dedicated software (syngo.via Cardiac Function, Siemens AG).  Preoperative CCT data of 48 consecutive patients were analyzed and then matched with effectively achieved postoperative volumes. To separate the aneurysm volume in the systole and diastole a plane determined by three landmarks on borders of scared to intact LV myocardium (antero-septal, lateral and inferior) was used. In this way ensued the retrospective estimation of the aneurysm volume (AnV/AnVI) and anticipated LV end diastolic and end systolic volume (LVEDVI, LVESVI).\u0000 \u0000 \u0000 \u0000 Mean diastolic and systolic estimated AnV were 92 ± 56.6 ml and 83.5 ± 61.6 ml respectively. Relation of AnV to LVEDV and to LVESV was 29.2% and 38.2%, correspondingly. There was significant correlation between anticipated and effectively achieved LVEDV and LVESV (r = 0.87 and r = 0.88, respectively, p < 0.0001), and their indexed values (r = 0.83 and r = 0.83, respectively, p < 0.0001). Anticipated LVEDVI was only 10.3 ± 22.5 ml/m2 greater than achieved LVEDVI (p = 0.003), and anticipated LVESVI was only 2.4 ± 20.3 ml/m2 greater than achieved LVESVI (p = 0.433).\u0000 \u0000 \u0000 \u0000 Estimation of aneurysm volume and anticipated postoperative LV volume allows to predict if the therapeutic targets can be successfully achieved in individual patients. Based on the CCT assessment we propose an approach for surgical planning in anterior LV aneurysms.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84836314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preload stress echocardiography by using dynamic postural alteration can identify high risk patients with heart failure with reduced ejection fraction","authors":"Nao Shibata, Kensuke Matsumoto, H. Shiraki, Yuki Yamauchi, Y. Yoshigai, Ayu Shono, Keiko Sumimoto, Makiko Suzuki, Yusuke Tanaka, Kentarou Yamashita, S. Yokota, Makiko Suto, Kumiko Dokuni, Hiroshi Tanaka, K. Hirata","doi":"10.1093/EHJCI/JEAA356.209","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.209","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Haemodynamic assessment during stress testing is not commonly performed for patients with heart failure with reduced ejection fraction (HFrEF) due to its invasiveness, less feasibility, and safety concerns. Passive leg-lifting (PLL) manoeuvres have been introduced as a simple alternative for non-invasive preload stress testing; however, the haemodynamic load imposed on the cardiovascular system is unsatisfactory, which precludes the accurate assessment of the preload reserve for patients with HF.\u0000 \u0000 \u0000 \u0000 The purpose of this study was to assess the haemodynamic characteristics of patients with HFrEF in response to a preload stress during dynamic postural alterations by combining the semi-sitting position (SSP) and PLL. We also evaluated whether combined postural stress could be used for risk stratification for these patients.\u0000 \u0000 \u0000 \u0000 For this study, 101 patients with HFrEF and 35 age- and sex-matched normal controls were prospectively recruited. At each postural position (i.e., baseline, SSP, and PLL), all standard echocardiographic and Doppler variables were obtained. Adverse cardiac events were prespecified as the combined endpoints of death from or hospitalisation for deteriorated HF, or sudden cardiac death. Clinical follow-up was conducted for a median of 7 months.\u0000 \u0000 \u0000 \u0000 During PLL stress, the stroke volume index (SVi) significantly increased in both controls (from 40 ± 6 to 43 ± 6 mL/m², P = 0.03) and HFrEF patients (from 31 ± 9 to 34 ± 10 mL/m², P = 0.03). Conversely, during SSP stress, the SVi significantly decreased for both controls (from 40 ± 6 to 37 ± 6 mL/m², P = 0.03) and HFrEF patients (31 ± 9 to 28 ± 8 mL/m², P = 0.03). During the follow-up period, 16 patients developed cardiac events. In patients without events, the Frank-Starling mechanism was well preserved (Fig. A). Namely, the SVi significantly increased from 31 ± 9 to 35 ± 10 mL/m² (P = 0.02) during PLL stress, while the SVi significantly decreased from 31 ± 8 to 28 ± 8 mL/m² (P = 0.02) during SSP stress. In contrast, for patients with cardiac events, the SVi did not change during postural alterations (n.s), which indicated that the failing heart operates on the flat portion of the Frank-Starling curve (Fig. A). When patients were divided into three equal sub-groups based on the total difference in the SVi during dynamic postural stress, patients with impaired preload reserve (third trimester, ΔSVi ≤ 3.0 mL/m²) showed significantly worse event-free survival than the other two sub-groups (Fig. B; P < 0.001). In a Cox proportional-hazard analysis, baseline LVEF (hazard ratio 0.93; P = 0.04), and ΔSVi during postural stress (hazard ratio 0.76; P = 0.004) were predictors of future cardiac events.\u0000 \u0000 \u0000 \u0000 The combined assessment of dynamic postural stress during PLL and SPP is a simple, time-saving, and easy-to-use clinical tool for the assessment of preload reserve for patients with HFrEF. Moreover, postural stress echocardiography proved","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89264662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}