Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.166
K Katogiannis, I Ikonomidis, A Kountouri, A Mitrakou, J Thymis, E Korakas, G Pavlidis, I Andreadou, C Chania, K Thomas, A Antoniadou, V Lambadiari, G Filippatos
Abstract Funding Acknowledgements Type of funding sources: None. Introduction COVID-19 patients present impaired subclinical markers of cardiovascular and endothelial function. Subclinical myocardial and vascular dysfunction during COVID-19 disease have been associated with worse outcomes and higher mortality risk. Purpose We investigated the effect of COVID-19 infection on markers of endothelial, vascular and myocardial function at four and twelve months after the infection Methods We recruited 70 patients who were examined in a dedicated post-COVID-19 outpatient clinic during a scheduled follow-up visit at four and twelve months after a confirmed COVID-19 infection and 70 healthy individuals with similar clinical characteristics. At four and twelve months we measured (i) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), (ii) flow-mediated dilatation (FMD), (iii) coronary flow reserve (CFR) by Doppler echocardiography, (iv) pulse wave velocity (PWV) and central systolic blood pressure (cSBP), (v) global left and right ventricular longitudinal strain (GLS), (vi) myocardial global work index (GWI) global constructive work (GCW), global wasted work (GWW) and the myocardial global work efficiency (GWE) and v) malondialdehyde (MDA), an oxidative stress marker. Results At four months, COVID-19 patients displayed higher values of PBR5–25 compared to control group (p<0.001) which increased at twelve months (p<0.001). FMD, PWV and cSBP values were similar between 4 and 12 months (p>0.05 for all the comparisons) and higher than those in controls (p<0.001, p = 0.057, p = 0.003 respectively). At four months, COVID-19 patients presented impaired CFR and LVGLS values which were improved at twelve months (p = 0.002, p = 0.069 respectively), though remained impaired compared to controls (p = 0.003 for all the comparisons). At four months, COVID-19 patients had impaired RVGLS values which were significantly improved at twelve months (p = 0.001) and showed no statistically significant difference compared to controls (p>0.05). COVID-19 patients at four months display higher myocardial wasted work and decreased myocardial efficiency compared to controls (p = 0.01, p = 0.006, respectively). There was a modest improvement in GWW and GWE at twelve months, (p = 0.043, p = 0.001, respectively); however, these markers remained impaired compared to controls (p>0.05). At four months, MDA was higher in COVID-19 patients compared to control group and significantly decreased at twelve months (p<0.001); however, these values remain higher than in controls (p = 0.002). Conclusions SARS-CoV-2 causes endothelial and cardiovascular dysfunction which are partially restored at twelve months after the infection.
资金来源类型:无。新冠肺炎患者存在心血管和内皮功能亚临床指标受损。COVID-19疾病期间的亚临床心肌和血管功能障碍与较差的结局和较高的死亡风险相关。目的研究COVID-19感染对感染后4个月和12个月内皮、血管和心肌功能标志物的影响方法我们招募了70名患者，他们在确诊COVID-19感染后4个月和12个月的定期随访期间在专门的COVID-19后门诊诊所接受检查，以及70名具有相似临床特征的健康个体。在4个月和12个月时，我们测量了(i)舌下动脉微血管的灌注边界区(PBR) (PBR增加表明内皮糖萼厚度减少)，(ii)血流介导的扩张(FMD)， (iii)多普勒超声心动图冠状动脉血流储备(CFR)， (iv)脉搏波速度(PWV)和中央收缩压(cSBP)， (v)左右心室纵向应变(GLS)， (vi)心肌总功指数(GWI)总构建功(GCW)，总耗功(GWW)、心肌总功效率(GWE)和氧化应激标志物丙二醛(MDA)。结果4个月时，COVID-19患者的PBR5-25值高于对照组(p<0.001)， 12个月时PBR5-25值升高(p<0.001)。FMD、PWV和cSBP值在4个月和12个月之间相似(所有比较p amp;gt;0.05)，高于对照组(p amp;lt;0.001, p = 0.057, p = 0.003)。在4个月时，COVID-19患者出现CFR和LVGLS值受损，在12个月时有所改善(p = 0.002, p = 0.069)，但与对照组相比仍然受损(所有比较p = 0.003)。在4个月时，COVID-19患者的RVGLS值受损，在12个月时显著改善(p = 0.001)，与对照组相比无统计学差异(p>0.05)。与对照组相比，4个月时COVID-19患者心肌浪费功更高，心肌效率下降(p = 0.01, p = 0.006)。GWW和GWE在12个月时有适度改善(p = 0.043, p = 0.001);然而，与对照组相比，这些标记仍然受损(p>0.05)。在4个月时，与对照组相比，COVID-19患者的MDA较高，在12个月时显著降低(p<0.001);然而，这些值仍然高于对照组(p = 0.002)。结论SARS-CoV-2可引起内皮和心血管功能障碍，并在感染后12个月部分恢复。
{"title":"Impaired endothelial glycocalyx, vascular dysfunction and myocardial deformation four months after Covid-19 infection are partially improved at twelve months","authors":"K Katogiannis, I Ikonomidis, A Kountouri, A Mitrakou, J Thymis, E Korakas, G Pavlidis, I Andreadou, C Chania, K Thomas, A Antoniadou, V Lambadiari, G Filippatos","doi":"10.1093/ehjci/jead119.166","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.166","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Introduction COVID-19 patients present impaired subclinical markers of cardiovascular and endothelial function. Subclinical myocardial and vascular dysfunction during COVID-19 disease have been associated with worse outcomes and higher mortality risk. Purpose We investigated the effect of COVID-19 infection on markers of endothelial, vascular and myocardial function at four and twelve months after the infection Methods We recruited 70 patients who were examined in a dedicated post-COVID-19 outpatient clinic during a scheduled follow-up visit at four and twelve months after a confirmed COVID-19 infection and 70 healthy individuals with similar clinical characteristics. At four and twelve months we measured (i) perfused boundary region (PBR) of the sublingual arterial microvessels (increased PBR indicates reduced endothelial glycocalyx thickness), (ii) flow-mediated dilatation (FMD), (iii) coronary flow reserve (CFR) by Doppler echocardiography, (iv) pulse wave velocity (PWV) and central systolic blood pressure (cSBP), (v) global left and right ventricular longitudinal strain (GLS), (vi) myocardial global work index (GWI) global constructive work (GCW), global wasted work (GWW) and the myocardial global work efficiency (GWE) and v) malondialdehyde (MDA), an oxidative stress marker. Results At four months, COVID-19 patients displayed higher values of PBR5–25 compared to control group (p&lt;0.001) which increased at twelve months (p&lt;0.001). FMD, PWV and cSBP values were similar between 4 and 12 months (p&gt;0.05 for all the comparisons) and higher than those in controls (p&lt;0.001, p = 0.057, p = 0.003 respectively). At four months, COVID-19 patients presented impaired CFR and LVGLS values which were improved at twelve months (p = 0.002, p = 0.069 respectively), though remained impaired compared to controls (p = 0.003 for all the comparisons). At four months, COVID-19 patients had impaired RVGLS values which were significantly improved at twelve months (p = 0.001) and showed no statistically significant difference compared to controls (p&gt;0.05). COVID-19 patients at four months display higher myocardial wasted work and decreased myocardial efficiency compared to controls (p = 0.01, p = 0.006, respectively). There was a modest improvement in GWW and GWE at twelve months, (p = 0.043, p = 0.001, respectively); however, these markers remained impaired compared to controls (p&gt;0.05). At four months, MDA was higher in COVID-19 patients compared to control group and significantly decreased at twelve months (p&lt;0.001); however, these values remain higher than in controls (p = 0.002). Conclusions SARS-CoV-2 causes endothelial and cardiovascular dysfunction which are partially restored at twelve months after the infection.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161688","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}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.314
T Pezel, T Hovasse, S Toupin, F Sanguineti, P Garot, S Champagne, T Chitiboi, A Jacob, P Sharma, T Unterseeh, J Garot
Abstract Funding Acknowledgements Type of funding sources: None. Background Several studies described the independent prognostic value of left ventricular global longitudinal strain (GLS) using cardiovascular magnetic resonance (CMR) to predict cardiovascular events. However, the potential interest of GLS using a fully automatic method assessed at rest during a stress CMR exam was not well established. Aim To assess the prognostic value of GLS to predict all-cause death using a fully automatic machine learning algorithm without human correction in consecutive patients referred for stress CMR. Methods Between 2016 and 2018, all consecutive patients referred for stress CMR were included and followed for the occurrence of all-cause death. A fully automatic machine learning algorithm was trained and validated unseen CMR studies (MAGNETOM Aera and Skyra, Siemens Healthcare, Erlangen, Germany) to assess the GLS from long-axis cine images acquired at rest. The algorithm combines multiple deep learning networks for detection and segmentation with an active contours approach. Cox regressions were performed to determine the prognostic value of GLS. Results Among 9,883 consecutive patients who underwent stress CMR between 2016 and 2018 retrospectively included, the automatic GLS was successfully computed in 9,638 (97.5%) patients (67% male, mean age 66±12 years). A total of 510 (5.3%) deaths were observed during a median (IQR) follow-up period of 4.5 (3.7–5.2) years. GLS, the presence of inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of death (hazard ratio, HR: 1.22 [95% CI, 1.17–1.26]; HR: 2.23 [95% CI, 1.61–3.10]; and HR: 2.04 [95% CI, 1.41–2.95], respectively, all p<0.001). After adjustment for traditional risk factors, inducible ischemia and LGE, GLS was an independent predictor of a higher incidence of death (adjusted HR: 1.14 [95% CI, 1.08–1.20]). Automatic GLS showed an incremental prognostic value to predict death compared to traditional risk factors, inducible ischemia and LGE (C-statistic improvement: 0.05; NRI=0.146; IDI=0.244; all p<0.001). Conclusions Automatic GLS measured at rest has an incremental prognostic value to predict all-cause death above traditional risk factors, and other stress CMR parameters.
{"title":"Additional prognostic value of fully-automatic Global Longitudinal Strain using machine learning","authors":"T Pezel, T Hovasse, S Toupin, F Sanguineti, P Garot, S Champagne, T Chitiboi, A Jacob, P Sharma, T Unterseeh, J Garot","doi":"10.1093/ehjci/jead119.314","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.314","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Several studies described the independent prognostic value of left ventricular global longitudinal strain (GLS) using cardiovascular magnetic resonance (CMR) to predict cardiovascular events. However, the potential interest of GLS using a fully automatic method assessed at rest during a stress CMR exam was not well established. Aim To assess the prognostic value of GLS to predict all-cause death using a fully automatic machine learning algorithm without human correction in consecutive patients referred for stress CMR. Methods Between 2016 and 2018, all consecutive patients referred for stress CMR were included and followed for the occurrence of all-cause death. A fully automatic machine learning algorithm was trained and validated unseen CMR studies (MAGNETOM Aera and Skyra, Siemens Healthcare, Erlangen, Germany) to assess the GLS from long-axis cine images acquired at rest. The algorithm combines multiple deep learning networks for detection and segmentation with an active contours approach. Cox regressions were performed to determine the prognostic value of GLS. Results Among 9,883 consecutive patients who underwent stress CMR between 2016 and 2018 retrospectively included, the automatic GLS was successfully computed in 9,638 (97.5%) patients (67% male, mean age 66±12 years). A total of 510 (5.3%) deaths were observed during a median (IQR) follow-up period of 4.5 (3.7–5.2) years. GLS, the presence of inducible ischemia and late gadolinium enhancement (LGE) were significantly associated with the occurrence of death (hazard ratio, HR: 1.22 [95% CI, 1.17–1.26]; HR: 2.23 [95% CI, 1.61–3.10]; and HR: 2.04 [95% CI, 1.41–2.95], respectively, all p&lt;0.001). After adjustment for traditional risk factors, inducible ischemia and LGE, GLS was an independent predictor of a higher incidence of death (adjusted HR: 1.14 [95% CI, 1.08–1.20]). Automatic GLS showed an incremental prognostic value to predict death compared to traditional risk factors, inducible ischemia and LGE (C-statistic improvement: 0.05; NRI=0.146; IDI=0.244; all p&lt;0.001). Conclusions Automatic GLS measured at rest has an incremental prognostic value to predict all-cause death above traditional risk factors, and other stress CMR parameters.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"35 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161840","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}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.001
G Fazio, V Manfre
Abstract Funding Acknowledgements Type of funding sources: None. Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also referred to as COVID-19, was declared a pandemic by the World Health Organization in March 2020. The manifestations of COVID-19 are widely variable and range from asymptomatic infection to multi-organ failure and death. Like other viral illnesses, acute myocarditis and/or pericarditis has been reported to be associated with COVID-19 infection. The guidelines for the diagnosis of COVID-19 introduced the echocardiogram for diagnosis of carditis in these patients Pourpose In our study we investigated the incidences of myocarditis and/or pericarditis in a consecutive series of 1540 Athletes undergo to agonistic certification. Methods From march 2020 to October 2022 we enrolled 1540 consecutive patients that was affected by COVID. Every patients was admitted to ambulatory of sport medicine of 2 Italian centers to perform a return to play agonistic certificate. All patients perfomed an echocardiogram during the evaluation. We subdivided the incidence of carditis depend on the period and the variant of the covid (alpha, beta, gamma, delta, epsilon). Overall, 69% males and 31%. females were enrolled with a mean age of 24.3 years (12–67 years). None presented note risk factor of a cardiac disease. Results The incidence of Echocardiographic abnormality was 3,2% in all period. By the echocardiogram we recognize 8 dilated cardiomiopathy (0,4%), 8 regional kinetic dysfunction (0,4%), 30 pericardial effusion (1,9%), 4 non-specific alterations (0,2%). Also we evaluated the incidence of the echocardiographic disease during the quarters and in correlation of COVID Variant. The results was showed in figure 1. Conclusions Based on our evaluation the incidence of echocardiographic findings in COVID was 3,2%, with a progressive reduction long the time, from alpha to omicron variants.
{"title":"Echocardiographic findings in COVID: incidence of carditis and correlations with COVID variants","authors":"G Fazio, V Manfre","doi":"10.1093/ehjci/jead119.001","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.001","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also referred to as COVID-19, was declared a pandemic by the World Health Organization in March 2020. The manifestations of COVID-19 are widely variable and range from asymptomatic infection to multi-organ failure and death. Like other viral illnesses, acute myocarditis and/or pericarditis has been reported to be associated with COVID-19 infection. The guidelines for the diagnosis of COVID-19 introduced the echocardiogram for diagnosis of carditis in these patients Pourpose In our study we investigated the incidences of myocarditis and/or pericarditis in a consecutive series of 1540 Athletes undergo to agonistic certification. Methods From march 2020 to October 2022 we enrolled 1540 consecutive patients that was affected by COVID. Every patients was admitted to ambulatory of sport medicine of 2 Italian centers to perform a return to play agonistic certificate. All patients perfomed an echocardiogram during the evaluation. We subdivided the incidence of carditis depend on the period and the variant of the covid (alpha, beta, gamma, delta, epsilon). Overall, 69% males and 31%. females were enrolled with a mean age of 24.3 years (12–67 years). None presented note risk factor of a cardiac disease. Results The incidence of Echocardiographic abnormality was 3,2% in all period. By the echocardiogram we recognize 8 dilated cardiomiopathy (0,4%), 8 regional kinetic dysfunction (0,4%), 30 pericardial effusion (1,9%), 4 non-specific alterations (0,2%). Also we evaluated the incidence of the echocardiographic disease during the quarters and in correlation of COVID Variant. The results was showed in figure 1. Conclusions Based on our evaluation the incidence of echocardiographic findings in COVID was 3,2%, with a progressive reduction long the time, from alpha to omicron variants.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161891","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}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.419
G Bisaccia, F Ricci, M Y Khanji, S Gallina, S E Petersen, C Bucciarelli-Ducci
Abstract Funding Acknowledgements Type of funding sources: None. Background Assessment of inducible ischemia with stress cardiovascular magnetic resonance (CMR) is recommended in patients with chest pain and intermediate or high pre-test probability of coronary artery disease (CAD). We aimed to provide a contemporary quantitative data synthesis on diagnostic accuracy and prognostic value of stress CMR in patients with stable chest pain syndromes. Methods We performed a prespecified systematic review and meta-analysis of studies published over the last twenty years on the diagnostic and prognostic value of stress CMR (PROSPERO: CRD42022299275). We measured pooled diagnostic indicators, including diagnostic odds ratio (DOR), sensitivity, specificity, area under the curve (AUC), and summary effect size indicators, including odds ratios (ORs) and cumulative annualized event rates (AERs) for all-cause death, cardiovascular death and major adverse cardiac events (MACE). Results We identified 33 diagnostic studies pooling 7,815 individuals (mean age, 62 years, 62% males) and 31 prognostic studies pooling 67,080 patients (mean age, 62 years; 57% males; mean follow-up 3.5 years for a total of 381,357 person-years). Stress CMR yielded a pooled DOR of 26.4 (95%CI:10.6–65.9), a sensitivity of 81% (95%CI:68–89%), a specificity of 86% (95%CI:75–93%), and an AUC of 0.84 (95%CI:0.77–0.89) for the detection of functionally obstructive CAD with fractional flow reserve as the reference test. In subgroup analysis, 3 Tesla imaging yielded higher diagnostic accuracy achieving a DOR of 33.2. Presence of stress-inducible ischemia was associated with higher all-cause mortality (OR:2.0; 95%CI:1.7–2.3), cardiovascular mortality (OR:6.4; 95%CI:4.5–9.1), and increased risk of MACE (OR:5.3; 95%CI:4.0–7.0). AERs for cardiovascular death and MACE were < 1% in patients without stress-inducible ischemia. Conclusion Stress CMR yields high diagnostic accuracy and delivers robust prognostication in patients with stable chest pain and known or suspected CAD, particularly with 3 Tesla imaging. While inducible ischemia portends excess mortality and increased risk of MACE, a negative stress CMR indicates a very low risk of future cardiovascular events, with a warranty period of at least 3.5 years.
{"title":"Diagnostic and prognostic value of stress CMR imaging to evaluate stable chest pain: a twenty-year meta-analysis","authors":"G Bisaccia, F Ricci, M Y Khanji, S Gallina, S E Petersen, C Bucciarelli-Ducci","doi":"10.1093/ehjci/jead119.419","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.419","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Assessment of inducible ischemia with stress cardiovascular magnetic resonance (CMR) is recommended in patients with chest pain and intermediate or high pre-test probability of coronary artery disease (CAD). We aimed to provide a contemporary quantitative data synthesis on diagnostic accuracy and prognostic value of stress CMR in patients with stable chest pain syndromes. Methods We performed a prespecified systematic review and meta-analysis of studies published over the last twenty years on the diagnostic and prognostic value of stress CMR (PROSPERO: CRD42022299275). We measured pooled diagnostic indicators, including diagnostic odds ratio (DOR), sensitivity, specificity, area under the curve (AUC), and summary effect size indicators, including odds ratios (ORs) and cumulative annualized event rates (AERs) for all-cause death, cardiovascular death and major adverse cardiac events (MACE). Results We identified 33 diagnostic studies pooling 7,815 individuals (mean age, 62 years, 62% males) and 31 prognostic studies pooling 67,080 patients (mean age, 62 years; 57% males; mean follow-up 3.5 years for a total of 381,357 person-years). Stress CMR yielded a pooled DOR of 26.4 (95%CI:10.6–65.9), a sensitivity of 81% (95%CI:68–89%), a specificity of 86% (95%CI:75–93%), and an AUC of 0.84 (95%CI:0.77–0.89) for the detection of functionally obstructive CAD with fractional flow reserve as the reference test. In subgroup analysis, 3 Tesla imaging yielded higher diagnostic accuracy achieving a DOR of 33.2. Presence of stress-inducible ischemia was associated with higher all-cause mortality (OR:2.0; 95%CI:1.7–2.3), cardiovascular mortality (OR:6.4; 95%CI:4.5–9.1), and increased risk of MACE (OR:5.3; 95%CI:4.0–7.0). AERs for cardiovascular death and MACE were &lt; 1% in patients without stress-inducible ischemia. Conclusion Stress CMR yields high diagnostic accuracy and delivers robust prognostication in patients with stable chest pain and known or suspected CAD, particularly with 3 Tesla imaging. While inducible ischemia portends excess mortality and increased risk of MACE, a negative stress CMR indicates a very low risk of future cardiovascular events, with a warranty period of at least 3.5 years.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161415","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}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.333
M Widmann, R Nerla, F Castriota, A Squeri
Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Clinically relevant tricuspid regurgitation is a prevalent valvular disease that has a significant impact on survival. The remarkable progress made in cardiac imaging and in interventional cardiology in the last decades, permits today a better understanding of tricuspid valve and right ventricle morphology and pathophysiology. This allowed to develop multiple transcatheter devices for tricuspid valve interventions. Structural valve interventions are considered nowadays valuable treatment options in anatomically eligible patient at high surgical risk. Transcatheter tricuspid valve interventions are directed to increasing leaflet coaptation either directly by bringing the leaflets together (leaflet approximation devices) or indirectly by reducing the dilated annulus (annuloplasty devices). Efficacy and clinical outcome are promising, but the effect on right ventricle and tricuspid annular reverse remodelling is still under evaluation. Purpose Aim of the study is to evaluate the acute tricuspid annulus remodelling after percutaneous leaflet repair, using a leaflet approximation device for reduction of tricuspid regurgitation. Methods This is a retrospective dual-center cohort study that includes 22 consecutive patients, treated with TriClip in our Hospital. Tricuspid annulus geometry was evaluated using three-dimensional transoesophageal echocardiography examinations conducted during the procedure before and after Triclip implantation. The 3D data sets were analysed using the multiplanar reformatting method. Results The mean age of the study cohort was 80 years, and 90,9% were female. Tricuspid regurgitation was graded severe or greater at pre-operative examination in all patients, mostly due to annular dilation. Procedure was successfully in all patients, with at least 1-grade reduction of tricuspid regurgitation before hospital dismissal. A significative reduction of mean septal-lateral diameter (4,09 ± 0,45 cm vs 3,55 ± 0,57 cm, p = < 0,0001), mean major diameter (4,60 ± 0,56 cm vs 4,24 ± 0,58 cm, p = 0,0011), planimetric area (13,70 ± 2,68 cm2 vs 11,00 ± 2,49 cm2, p = <0,0001) and perimeter (13,50 ± 1,36 cm vs 12,40 ± 1,49 cm, p = 0,0001) of the tricuspid annulus was observed. The eccentricity index (obtained dividing septal-lateral by antero-posterior diameter) was 0,99±0,17 before TriClip implantation and 0,91± 0,19 after (p = 0,0336). Conclusions In this small real-world population, edge-to-edge repair using TriClip was found to be effective and safe. Tricuspid transcatheter repair with a leaflet approximation device lead also to a reduction in the tricuspidal annular dimensions. This is to date the first study that shows positive changes in tricuspid annular geometry, that could have potentially relevant therapeutic implications.
资金来源类型:无。临床相关的三尖瓣反流是一种常见的瓣膜疾病，对患者的生存有重要影响。在过去的几十年里，心脏成像和介入心脏病学取得了显著的进展，使得今天对三尖瓣和右心室的形态学和病理生理学有了更好的了解。这允许开发用于三尖瓣干预的多种经导管装置。结构瓣膜干预被认为是目前有价值的治疗选择，解剖符合条件的患者在高手术风险。经导管三尖瓣干预直接通过将小叶聚集在一起(小叶近似装置)或间接通过缩小扩张的环(环成形术装置)来增加小叶的适应。疗效和临床结果是有希望的，但对右心室和三尖瓣环反向重构的影响仍在评估中。目的探讨经皮小叶修复术后急性三尖瓣环重建，利用小叶近似装置减少三尖瓣反流的效果。方法回顾性双中心队列研究，纳入22例在我院接受TriClip治疗的连续患者。在Triclip植入前后，通过三维经食管超声心动图检查评估三尖瓣环的几何形状。采用多平面重格式化方法对三维数据集进行了分析。结果研究队列的平均年龄为80岁，其中女性占90.9%。所有患者术前检查时三尖瓣反流严重或加重，主要是由于环扩张。所有患者手术均成功，出院前三尖瓣返流至少降低1级。平均间隔外径显著减少(4.09±0.45 cm vs 3.55±0.57 cm)， p = <观察三尖瓣环的平均大直径(4,60±0.56 cm vs 4,24±0.58 cm, p = 0.0011)、平面面积(13,70±2,68 cm2 vs 11,000±2,49 cm2, p = < 0.0001)和周长(13,50±1,36 cm vs 12,40±1,49 cm, p = 0.0001)。偏心率指数(以前后径划分中隔外侧)在TriClip植入前为0,99±0,17，植入后为0,91±0,19 (p = 0,0336)。结论:在这个小的现实世界人群中，使用TriClip进行边缘到边缘修复是有效和安全的。三尖瓣经导管修复与叶近似装置也导致减少三尖瓣环尺寸。这是迄今为止第一个显示三尖瓣环几何形状积极变化的研究，这可能具有潜在的相关治疗意义。
{"title":"Tricuspid annulus remodelling after transcatheter edge-to-edge repair for reduction of tricuspid regurgitation","authors":"M Widmann, R Nerla, F Castriota, A Squeri","doi":"10.1093/ehjci/jead119.333","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.333","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Clinically relevant tricuspid regurgitation is a prevalent valvular disease that has a significant impact on survival. The remarkable progress made in cardiac imaging and in interventional cardiology in the last decades, permits today a better understanding of tricuspid valve and right ventricle morphology and pathophysiology. This allowed to develop multiple transcatheter devices for tricuspid valve interventions. Structural valve interventions are considered nowadays valuable treatment options in anatomically eligible patient at high surgical risk. Transcatheter tricuspid valve interventions are directed to increasing leaflet coaptation either directly by bringing the leaflets together (leaflet approximation devices) or indirectly by reducing the dilated annulus (annuloplasty devices). Efficacy and clinical outcome are promising, but the effect on right ventricle and tricuspid annular reverse remodelling is still under evaluation. Purpose Aim of the study is to evaluate the acute tricuspid annulus remodelling after percutaneous leaflet repair, using a leaflet approximation device for reduction of tricuspid regurgitation. Methods This is a retrospective dual-center cohort study that includes 22 consecutive patients, treated with TriClip in our Hospital. Tricuspid annulus geometry was evaluated using three-dimensional transoesophageal echocardiography examinations conducted during the procedure before and after Triclip implantation. The 3D data sets were analysed using the multiplanar reformatting method. Results The mean age of the study cohort was 80 years, and 90,9% were female. Tricuspid regurgitation was graded severe or greater at pre-operative examination in all patients, mostly due to annular dilation. Procedure was successfully in all patients, with at least 1-grade reduction of tricuspid regurgitation before hospital dismissal. A significative reduction of mean septal-lateral diameter (4,09 ± 0,45 cm vs 3,55 ± 0,57 cm, p = &lt; 0,0001), mean major diameter (4,60 ± 0,56 cm vs 4,24 ± 0,58 cm, p = 0,0011), planimetric area (13,70 ± 2,68 cm2 vs 11,00 ± 2,49 cm2, p = &lt;0,0001) and perimeter (13,50 ± 1,36 cm vs 12,40 ± 1,49 cm, p = 0,0001) of the tricuspid annulus was observed. The eccentricity index (obtained dividing septal-lateral by antero-posterior diameter) was 0,99±0,17 before TriClip implantation and 0,91± 0,19 after (p = 0,0336). Conclusions In this small real-world population, edge-to-edge repair using TriClip was found to be effective and safe. Tricuspid transcatheter repair with a leaflet approximation device lead also to a reduction in the tricuspidal annular dimensions. This is to date the first study that shows positive changes in tricuspid annular geometry, that could have potentially relevant therapeutic implications.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161577","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}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.009
Y Bohbot, L Tordjman, J Dreyfus, T Le Tourneau, Y Lavie Badie, C Selto, B Elegamandji, G L'official, A Fraix, S Aghezzaf, P Y Turgeon, M Enriquez Sarano, A Coisne, E Donal, C Tribouilloy
Abstract Funding Acknowledgements Type of funding sources: None. Background Various definitions of very severe (VS) tricuspid regurgitation (TR) have been proposed based on the effective regurgitant orifice area (EROA) or tricuspid coaptation gap (TCG). Because of the inherent limitations associated with the EROA, we hypothesized that the TCG would be more suitable for defining VSTR and predicting outcomes. Purpose To compare EROA and TCG for outcome prediction in patients with severe TR Methods In this French multicentre retrospective study, we included 606 patients with ≥ moderate-to-severe isolated TR (without structural valve disease or an overt cardiac cause) according to the recommendations of the European Association of Cardiovascular Imaging. Patients were further stratified into VSTR according to the EROA (≥60 mm²) and then according to the TCG (≥10 mm). The primary endpoint was all-cause mortality and the secondary endpoint was cardiovascular mortality. Results The relationship between the EROA and TCG was poor (R²=0.21), especially when the size of the defect was large. Four-year survival was comparable between patients with an EROA <60 mm² vs. ≥ 60 mm² (67±3% vs. 64±4%, p = 0.64), even after adjustment, for all-cause (p = 0.72) and cardiovascular mortality (p = 0.18). A TCG ≥10 mm was associated with lower four-year survival than a TCG <10 mm (53±7% vs. 69±3%, p<0.001). After adjustment for covariates, including age, comorbidity, right heart failure, dose of diuretics, and right ventricular dysfunction, a TCG ≥10 mm remained independently associated with higher all-cause mortality (adjusted HR[95%CI]=1.46[1.15–2.18], p = 0.015) and cardiovascular mortality (adjusted HR[95%CI]=1.95[1.22–3.14], p <0.001), whereas an EROA ≥60 mm² was not associated with all-cause or cardiovascular mortality (adjusted HR[95%CI]:1.07[0.75–1.51], p = 0.720, and adjusted HR[95%CI]:1.35[0.87–2.09], p = 0.176, respectively) Conclusion The correlation between the TCG and EROA is weak and decreases with increasing defect size. A TCG ≥10mm is associated with increased all-cause and cardiovascular mortality and should be used to define VSTR in isolated TR.
资金来源类型:无。基于有效反流孔面积(EROA)或三尖瓣适应间隙(TCG)，对非常严重(VS)三尖瓣反流(TR)有不同的定义。由于与EROA相关的固有局限性，我们假设TCG更适合定义VSTR和预测结果。目的比较EROA和TCG对严重TR患者预后的预测方法在这项法国多中心回顾性研究中，根据欧洲心血管影像学协会的建议，我们纳入了606例≥中度至重度孤立TR(无结构性瓣膜疾病或明显心脏原因)的患者。再根据EROA(≥60 mm²)和TCG(≥10 mm)将患者分为VSTR组。主要终点是全因死亡率，次要终点是心血管死亡率。结果EROA与TCG的相关性较差(R²=0.21)，尤其是当缺损较大时。即使在调整后，EROA≤60 mm²和≥60 mm²患者的4年生存率(67±3%对64±4%，p = 0.64)与全因(p = 0.72)和心血管死亡率(p = 0.18)相当。TCG≥10mm与TCG≤10mm相比，四年生存率较低(53±7% vs 69±3%，p<0.001)。校正协变量后，包括年龄、合共病、右心衰、利尿剂剂量和右室功能障碍，TCG≥10 mm仍然与较高的全因死亡率(校正HR[95%CI]=1.46[1.15-2.18]， p = 0.015)和心血管死亡率(校正HR[95%CI]=1.95[1.22-3.14]， p <0.001)独立相关，而EROA≥60 mm²与全因或心血管死亡率无关(校正HR[95%CI]:1.07[0.75-1.51]， p = 0.720)。校正HR[95%CI]:1.35[0.87-2.09]， p = 0.176)结论TCG与EROA的相关性较弱，随缺损尺寸的增大而降低。TCG≥10mm与全因死亡率和心血管死亡率增加相关，应用于确定孤立性TR的VSTR。
{"title":"Comparison of effective regurgitant orifice area by the PISA method and tricuspid coaptation gap measurement to identify very severe tricuspid regurgitation and stratify mortality risk","authors":"Y Bohbot, L Tordjman, J Dreyfus, T Le Tourneau, Y Lavie Badie, C Selto, B Elegamandji, G L'official, A Fraix, S Aghezzaf, P Y Turgeon, M Enriquez Sarano, A Coisne, E Donal, C Tribouilloy","doi":"10.1093/ehjci/jead119.009","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.009","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Various definitions of very severe (VS) tricuspid regurgitation (TR) have been proposed based on the effective regurgitant orifice area (EROA) or tricuspid coaptation gap (TCG). Because of the inherent limitations associated with the EROA, we hypothesized that the TCG would be more suitable for defining VSTR and predicting outcomes. Purpose To compare EROA and TCG for outcome prediction in patients with severe TR Methods In this French multicentre retrospective study, we included 606 patients with ≥ moderate-to-severe isolated TR (without structural valve disease or an overt cardiac cause) according to the recommendations of the European Association of Cardiovascular Imaging. Patients were further stratified into VSTR according to the EROA (≥60 mm²) and then according to the TCG (≥10 mm). The primary endpoint was all-cause mortality and the secondary endpoint was cardiovascular mortality. Results The relationship between the EROA and TCG was poor (R²=0.21), especially when the size of the defect was large. Four-year survival was comparable between patients with an EROA &lt;60 mm² vs. ≥ 60 mm² (67±3% vs. 64±4%, p = 0.64), even after adjustment, for all-cause (p = 0.72) and cardiovascular mortality (p = 0.18). A TCG ≥10 mm was associated with lower four-year survival than a TCG &lt;10 mm (53±7% vs. 69±3%, p&lt;0.001). After adjustment for covariates, including age, comorbidity, right heart failure, dose of diuretics, and right ventricular dysfunction, a TCG ≥10 mm remained independently associated with higher all-cause mortality (adjusted HR[95%CI]=1.46[1.15–2.18], p = 0.015) and cardiovascular mortality (adjusted HR[95%CI]=1.95[1.22–3.14], p &lt;0.001), whereas an EROA ≥60 mm² was not associated with all-cause or cardiovascular mortality (adjusted HR[95%CI]:1.07[0.75–1.51], p = 0.720, and adjusted HR[95%CI]:1.35[0.87–2.09], p = 0.176, respectively) Conclusion The correlation between the TCG and EROA is weak and decreases with increasing defect size. A TCG ≥10mm is associated with increased all-cause and cardiovascular mortality and should be used to define VSTR in isolated TR.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161836","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}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.328
P Bhagirath, F O Campos, S H Zaidi, Z Chen, M Eliott, J Gould, A J Prassl, A Neic, G Plank, C A Rinaldi, M J Bishop
Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): EACVI, Netherlands Heart Institute. Background Implantable cardiac defibrillator (ICD) implantation can protect against sudden cardiac death (SCD) after a myocardial infarction. However, relatively few patients with an ICD experience a life-threatening arrhythmic event. Imaging studies have proposed metrics based on 2D analysis of late gadolinium enhancement (LGE) characteristics to predict post-infarct malignant arrhythmias and improve SCD risk assessment. However, given the intrinsic 3D nature of the electrical pathways through the infarcted regions, 3D reconstructions of the scar substrate from LGE imaging may be required to fully characterize the pro-arrhythmic nature of the scar substrate. Aim To evaluate the accuracy of LGE based 3D metrics such as conduction corridors (regions of borderzone (BZ) surrounded by scar core) and 3D interface surfaces (boundaries between scar and myocardium) towards predicting ICD therapy. Methods ADAS LV and custom-made software was used to generate 3D patient-specific ventricular models in a prospective cohort of post-infarct patients (n=40) having undergone LGE imaging pre-ICD implantation. The extent of variation in scar-characteristics was evaluated in ADAS by quantifying the BZ, scar core, the number and weight of conduction corridors i.e. BZ surrounded by scar core. Custom-written scripts were used to calculate metrics describing the 3D topology of the scar substrate, specifically the interface area between myocardium and total enhancement (BZ+core), and the interface between BZ and core. These metrics were compared with ICD therapy during follow-up. Results Total corridors were comparable between both groups (6.53 ± 7.9 vs. 4.6 ± 4, p = .38). Corridor weight demonstrated a trend towards higher mass in the event group (2.7 ± 2.1g vs. 1.6 ± 1.4g, p = .06). Patients with an event (n=17) had higher myocardium-total enhancement interface (103.8±35.1cm2 vs. 77.4±33.7cm2, p = .021) and BZ-core interface (76±27.5cm2 vs. 55.2±27.6cm2, p = .024). Cox-regression demonstrated a significant independent association of myocardium-total enhancement interface with an event (HR 2.79; 1.44–5.44, p < .01). Kaplan-Meier analysis (Figure 1) showed a significantly higher event rate in patients with an interface area between myocardium-total enhancement of more than 72cm2 and BZ-core more than 42.3cm2. Conclusion These results demonstrate that patients with appropriate device therapy had larger myocardium-total enhancement and BZ-core surface interface areas. Conceptually, the BZ-core interface could be considered to be related to the reentrant circuit path-length whilst the myocardium-total enhancement interface reflects the surfaces most-likely to initiate unidirectional block, both of which can be consider pro-arrhythmic substrates. These findings emphasize the importance of visualizing and thereby characterizing substrate a
资金来源类型:基金会。主要资金来源:EACVI，荷兰心脏研究所。背景植入式心脏除颤器(ICD)植入术可预防心肌梗死后心脏性猝死(SCD)。然而，相对较少的ICD患者经历危及生命的心律失常事件。影像学研究提出了基于晚期钆增强(LGE)特征二维分析的指标，以预测梗死后恶性心律失常并改善SCD风险评估。然而，考虑到通过梗死区域的电通路的固有3D性质，可能需要通过LGE成像对疤痕基底进行3D重建，以充分表征疤痕基底的促心律失常性质。目的评价基于LGE的三维指标，如传导走廊(疤痕核心包围的边界区区域)和三维界面(疤痕与心肌之间的边界)对预测ICD治疗的准确性。方法采用ADAS LV和定制软件对40例接受LGE成像预icd植入的梗死后患者进行前瞻性队列研究，生成患者特异性三维心室模型。在ADAS中，通过量化BZ、疤痕核、被疤痕核包围的传导走廊(即BZ)的数量和权重来评估疤痕特征的变化程度。使用自定义编写的脚本计算描述疤痕基底的三维拓扑的指标，特别是心肌和总增强(BZ+核心)之间的界面面积，以及BZ和核心之间的界面。在随访期间将这些指标与ICD治疗进行比较。结果两组间总廊道具有可比性(6.53±7.9 vs. 4.6±4,p = 0.38)。事件组的走廊重量有增大的趋势(2.7±2.1g vs. 1.6±1.4g, p = 0.06)。事件组(n=17)患者心肌-总增强界面(103.8±35.1cm2 vs. 77.4±33.7cm2, p = 0.021)和BZ-core界面(76±27.5cm2 vs. 55.2±27.6cm2, p = 0.024)较高。cox回归显示心肌-总增强界面与事件有显著的独立关联(HR 2.79;1.44-5.44, p <. 01)。Kaplan-Meier分析(图1)显示，心肌总增强大于72cm2与BZ-core界面面积大于42cm2的患者，事件发生率明显更高。结论经适当器械治疗的患者心肌总增强和bz核表面界面面积增大。从概念上讲，BZ-core界面可以被认为与可重入回路路径长度有关，而心肌-全增强界面反映了最可能引发单向阻滞的表面，两者都可以被认为是促心律失常的底物。这些发现强调了可视化的重要性，从而将底物表征为3D实体，而不是目前应用的2D方法，以促进早期识别高风险患者。
{"title":"3D substrate complexity analysis using cardiac MRI predicts ICD therapy in post-infarct ventricular tachycardia","authors":"P Bhagirath, F O Campos, S H Zaidi, Z Chen, M Eliott, J Gould, A J Prassl, A Neic, G Plank, C A Rinaldi, M J Bishop","doi":"10.1093/ehjci/jead119.328","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.328","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): EACVI, Netherlands Heart Institute. Background Implantable cardiac defibrillator (ICD) implantation can protect against sudden cardiac death (SCD) after a myocardial infarction. However, relatively few patients with an ICD experience a life-threatening arrhythmic event. Imaging studies have proposed metrics based on 2D analysis of late gadolinium enhancement (LGE) characteristics to predict post-infarct malignant arrhythmias and improve SCD risk assessment. However, given the intrinsic 3D nature of the electrical pathways through the infarcted regions, 3D reconstructions of the scar substrate from LGE imaging may be required to fully characterize the pro-arrhythmic nature of the scar substrate. Aim To evaluate the accuracy of LGE based 3D metrics such as conduction corridors (regions of borderzone (BZ) surrounded by scar core) and 3D interface surfaces (boundaries between scar and myocardium) towards predicting ICD therapy. Methods ADAS LV and custom-made software was used to generate 3D patient-specific ventricular models in a prospective cohort of post-infarct patients (n=40) having undergone LGE imaging pre-ICD implantation. The extent of variation in scar-characteristics was evaluated in ADAS by quantifying the BZ, scar core, the number and weight of conduction corridors i.e. BZ surrounded by scar core. Custom-written scripts were used to calculate metrics describing the 3D topology of the scar substrate, specifically the interface area between myocardium and total enhancement (BZ+core), and the interface between BZ and core. These metrics were compared with ICD therapy during follow-up. Results Total corridors were comparable between both groups (6.53 ± 7.9 vs. 4.6 ± 4, p = .38). Corridor weight demonstrated a trend towards higher mass in the event group (2.7 ± 2.1g vs. 1.6 ± 1.4g, p = .06). Patients with an event (n=17) had higher myocardium-total enhancement interface (103.8±35.1cm2 vs. 77.4±33.7cm2, p = .021) and BZ-core interface (76±27.5cm2 vs. 55.2±27.6cm2, p = .024). Cox-regression demonstrated a significant independent association of myocardium-total enhancement interface with an event (HR 2.79; 1.44–5.44, p &lt; .01). Kaplan-Meier analysis (Figure 1) showed a significantly higher event rate in patients with an interface area between myocardium-total enhancement of more than 72cm2 and BZ-core more than 42.3cm2. Conclusion These results demonstrate that patients with appropriate device therapy had larger myocardium-total enhancement and BZ-core surface interface areas. Conceptually, the BZ-core interface could be considered to be related to the reentrant circuit path-length whilst the myocardium-total enhancement interface reflects the surfaces most-likely to initiate unidirectional block, both of which can be consider pro-arrhythmic substrates. These findings emphasize the importance of visualizing and thereby characterizing substrate a","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161578","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}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.320
R Licordari, C De Gori, U Ianni, L Restivo, G Grilli, A Barison, G Todiere, C Grigoratos, A De Luca, G Sinagra, G Di Bella, E Neri, G D Aquaro
Abstract Funding Acknowledgements Type of funding sources: None. Background the prognostic role of left ventricular (LV) papillary muscle abnormalities in patients with preserved LV systolic ejection fraction (LVEF) is unknown. Aim to evaluate the prevalence and the clinical and prognostic impact of papillary muscle abnormalities by CMR in patients with ventricular arrhythmias, preserved LVEF with no cardiac disease. Methods 391 patients with >500/24h premature ventricular complexes and/or with non-sustained ventricular tachycardia (NSVT), preserved LVEF and no cardiac disease, were enrolled. Different features of LV papillary muscles were considered: supernumerary muscles, papillary thickness, the attachment, late gadolinium enhancement (LGE). The end-systolic hypointensity was defined when its measured signal intensity (SI) was lower than the SI of the septum in early post-contrast cine CMR images. Dark-Paps was defined when both the main papillary muscles had systolic hypointensity. Mitral valve prolapse, mitral annular disjunction (MAD), myocardial LGE were considered. The outcome of hard cardiac events was define as a composite of cardiac death, resuscitated cardiac arrest, and appropriate implantable cardioverter defibrillator (ICD) shock, sustained ventricular tachycardia (lasting ≥30 s at ≥100 beats/min). Results Dark-Paps was found in 79 (20%) patients and was more frequent in females. It was associated with higher prevalence of mitral valve prolapse and MAD. During a median follow-up of 2534 days, 22 hard cardiac events occurred. At Kaplan-Meier curve (Figure) analysis patients with Dark-Paps were at higher risk of events than those without (p<0.0001). Dark-Paps was significantly associated with hard cardiac events in all the multivariate models performed. Dark-Paps improved prognostic estimation when added to NSVT (p = 0.0006), to LGE (p = 0.005) and to a model including NSVT+LGE (p = 0.014). Dark-Paps allowed a significant net reclassification when added to NSVT (NRI 0.30, p =0.03), to LGE (NRI 0.25, p =0.04), and to NSVT + LGE (NRI 0.32, p =0.02). Conclusions Dark-Paps sign could be considered a novel imaging prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction.
{"title":"Dark papillary muscles sign: a novel prognostic marker for cardiac magnetic resonance","authors":"R Licordari, C De Gori, U Ianni, L Restivo, G Grilli, A Barison, G Todiere, C Grigoratos, A De Luca, G Sinagra, G Di Bella, E Neri, G D Aquaro","doi":"10.1093/ehjci/jead119.320","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.320","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background the prognostic role of left ventricular (LV) papillary muscle abnormalities in patients with preserved LV systolic ejection fraction (LVEF) is unknown. Aim to evaluate the prevalence and the clinical and prognostic impact of papillary muscle abnormalities by CMR in patients with ventricular arrhythmias, preserved LVEF with no cardiac disease. Methods 391 patients with &gt;500/24h premature ventricular complexes and/or with non-sustained ventricular tachycardia (NSVT), preserved LVEF and no cardiac disease, were enrolled. Different features of LV papillary muscles were considered: supernumerary muscles, papillary thickness, the attachment, late gadolinium enhancement (LGE). The end-systolic hypointensity was defined when its measured signal intensity (SI) was lower than the SI of the septum in early post-contrast cine CMR images. Dark-Paps was defined when both the main papillary muscles had systolic hypointensity. Mitral valve prolapse, mitral annular disjunction (MAD), myocardial LGE were considered. The outcome of hard cardiac events was define as a composite of cardiac death, resuscitated cardiac arrest, and appropriate implantable cardioverter defibrillator (ICD) shock, sustained ventricular tachycardia (lasting ≥30 s at ≥100 beats/min). Results Dark-Paps was found in 79 (20%) patients and was more frequent in females. It was associated with higher prevalence of mitral valve prolapse and MAD. During a median follow-up of 2534 days, 22 hard cardiac events occurred. At Kaplan-Meier curve (Figure) analysis patients with Dark-Paps were at higher risk of events than those without (p&lt;0.0001). Dark-Paps was significantly associated with hard cardiac events in all the multivariate models performed. Dark-Paps improved prognostic estimation when added to NSVT (p = 0.0006), to LGE (p = 0.005) and to a model including NSVT+LGE (p = 0.014). Dark-Paps allowed a significant net reclassification when added to NSVT (NRI 0.30, p =0.03), to LGE (NRI 0.25, p =0.04), and to NSVT + LGE (NRI 0.32, p =0.02). Conclusions Dark-Paps sign could be considered a novel imaging prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161889","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}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.313
T Pezel, S Toupin, T Hovasse, F Sanguineti, S Champagne, T Unterseeh, T Chitiboi, A Jacob, I Borgohain, P Sharma, P Garot, J Garot
Abstract Funding Acknowledgements Type of funding sources: None. Background Although some recent reports showed that fully automated artificial intelligence (AI)-based left ventricular ejection fraction (LVEF) measured at stress has good performance, its prognostic value during a stress CMR exam to predict outcomes is not well established. Aim To determine in patients undergoing stress CMR whether fully automated AI-based LVEF (LVEF-AI) measured at stress can provide incremental prognostic value to predict death. Methods Between 2016 and 2018, we conducted a longitudinal study including all consecutive patients referred for vasodilator stress CMR. LVEF-AI was assessed using AI-algorithm combines multiple deep learning networks for LV segmentation. The primary outcome was all-cause death defined by the French National Registry of Death. Cox regression was used to evaluate the association of stress LVEF-AI with death after adjustment for traditional risk factors. Results In 9,712 patients (66±15 years, 67% men), there was an excellent correlation between stress LVEF-AI measurement and LVEF measured by expert (LVEF-expert) (r=0.94, p<0.001). Using Bland–Altman analysis, we found that the difference between the mean LVEF-expert and the LVEF-AI group was −0.1% (−0.066–0.067), that was not statistically significant (p = 0.46). Stress LVEF-AI was associated with death (median [IQR] follow-up 4.5 [3.7–5.2] years) before and after adjustment for risk factors (adjusted hazard ratio [HR], 0.84 [95% CI, 0.82–0.87] per 5% increment, p<0.001). Stress LVEF-AI had similar significant association with death occurrence compared with LVEF-expert. After adjustment, a lower stress LVEF-AI showed the greatest improvement in model discrimination and reclassification over and above traditional risk factors and stress CMR findings (C-statistic improvement: 0.11; NRI=0.250; IDI=0.049, all p<0.001; LR-test p<0.001), with a superior additional prognostic value than the LVEF-AI measured at rest. Conclusion AI-based fully automated LVEF measured at stress is independently associated with the occurrence of death in patients undergoing stress CMR, with an additional prognostic value above traditional risk factors, inducible ischemia and LGE.
{"title":"Incremental prognostic value of fully-automatic LVEF by stress CMR using machine learning","authors":"T Pezel, S Toupin, T Hovasse, F Sanguineti, S Champagne, T Unterseeh, T Chitiboi, A Jacob, I Borgohain, P Sharma, P Garot, J Garot","doi":"10.1093/ehjci/jead119.313","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.313","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Although some recent reports showed that fully automated artificial intelligence (AI)-based left ventricular ejection fraction (LVEF) measured at stress has good performance, its prognostic value during a stress CMR exam to predict outcomes is not well established. Aim To determine in patients undergoing stress CMR whether fully automated AI-based LVEF (LVEF-AI) measured at stress can provide incremental prognostic value to predict death. Methods Between 2016 and 2018, we conducted a longitudinal study including all consecutive patients referred for vasodilator stress CMR. LVEF-AI was assessed using AI-algorithm combines multiple deep learning networks for LV segmentation. The primary outcome was all-cause death defined by the French National Registry of Death. Cox regression was used to evaluate the association of stress LVEF-AI with death after adjustment for traditional risk factors. Results In 9,712 patients (66±15 years, 67% men), there was an excellent correlation between stress LVEF-AI measurement and LVEF measured by expert (LVEF-expert) (r=0.94, p&lt;0.001). Using Bland–Altman analysis, we found that the difference between the mean LVEF-expert and the LVEF-AI group was −0.1% (−0.066–0.067), that was not statistically significant (p = 0.46). Stress LVEF-AI was associated with death (median [IQR] follow-up 4.5 [3.7–5.2] years) before and after adjustment for risk factors (adjusted hazard ratio [HR], 0.84 [95% CI, 0.82–0.87] per 5% increment, p&lt;0.001). Stress LVEF-AI had similar significant association with death occurrence compared with LVEF-expert. After adjustment, a lower stress LVEF-AI showed the greatest improvement in model discrimination and reclassification over and above traditional risk factors and stress CMR findings (C-statistic improvement: 0.11; NRI=0.250; IDI=0.049, all p&lt;0.001; LR-test p&lt;0.001), with a superior additional prognostic value than the LVEF-AI measured at rest. Conclusion AI-based fully automated LVEF measured at stress is independently associated with the occurrence of death in patients undergoing stress CMR, with an additional prognostic value above traditional risk factors, inducible ischemia and LGE.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161888","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}
Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.267
L Quinio, E Galli, A Hubert, M Taconne, V Le Rolle, E Donal
Abstract Funding Acknowledgements Type of funding sources: None. Introduction Guidelines recommend replacement in patients with severe aortic stenosis (AS) who present with symptoms or left ventricular ejection fraction (LVEF) < 50%, both conditions representing a late stage of the disease. While global longitudinal strain (GLS) is load dependant but interesting for assessing prognosis, myocardial work has emerged. We aim to evaluate acute changes in myocardial work occurring in patients undergoing transcatheter aortic valve implantation (TAVI). Methods Patients who underwent TAVI were evaluated before and after by echocardiography. Complete echocardiographies were considered. Myocardial work indices (global work index (GWI), Global constructive work (GCW), Global work efficiency (GWE), Global wasted work (GWW)) were calculated integrating mean transaortic pressure-gradient and brachial-cuff systolic pressure. Results 125 patients underwent successful TAVI with significant decrease of the transaortic mean gradient (52.5 ± 16.1 to 12.2 ± 5.0, P<.0001). There was no significant change in LVEF post-TAVI. Myocardial work data post-TAVR showed a significant reduction of GWI (1389 ± 537 vs. 2014 ± 714, P<.0001), GCW (1693 ± 543 vs. 2379 ± 761, P<.0001) and GWE (85,0 ± 7,06 vs. 87,1 ± 5,98, P=0,0034). Decrease of GWI and GCW after TAVI was homogeneous among different sub-groups based on their GLS, LVEF of NYHA status before TAVI. We observed a significant association between GWI and GCW before TAVI and a GLS degradation after TAVI. Conclusion Myocardial work parameters show promising potential in best understanding the LV-myocardial consequences of AS and its correction. By their ability to discriminate NYHA status and GLS evolution, we can hypothesize on their clinical value.
资金来源类型:无。指南推荐对出现症状或左心室射血分数(LVEF)的严重主动脉瓣狭窄(AS)患者进行替代治疗。50%，这两种情况都代表了疾病的晚期。虽然整体纵向应变(GLS)是负荷依赖的，但对评估预后很有意义，心肌工作已经出现。我们的目的是评估经导管主动脉瓣植入术(TAVI)患者心肌功的急性变化。方法对TAVI患者行术前、术后超声心动图评价。考虑完全性超声心动图。计算心肌功指数(总功指数(GWI)、总建设性功(GCW)、总功效率(GWE)、总浪费功(GWW))，积分平均经主动脉压梯度和臂袖收缩压。结果125例患者TAVI成功，经主动脉平均梯度显著降低(52.5±16.1 ~ 12.2±5.0,P< 0.0001)。tavi后LVEF无明显变化。tavr后心肌功数据显示GWI(1389±537 vs. 2014±714,P< 0.0001)、GCW(1693±543 vs. 2379±761,P< 0.0001)和GWE(85,0±7,06 vs. 87,1±5,98,P= 0.0034)显著降低。不同亚组间的GLS、LVEF、NYHA状态在TAVI后GWI和GCW的下降呈均匀性。我们观察到TAVI前GWI和GCW与TAVI后GLS退化之间存在显著关联。结论心肌功参数对了解AS的左室心肌影响及其纠正具有重要意义。通过它们区分NYHA状态和GLS演变的能力，我们可以推测它们的临床价值。
{"title":"Evolution of non-invasive myocardial work parameters after transcatheter aortic valve implantation in patients with severe aortic stenosis","authors":"L Quinio, E Galli, A Hubert, M Taconne, V Le Rolle, E Donal","doi":"10.1093/ehjci/jead119.267","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.267","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Introduction Guidelines recommend replacement in patients with severe aortic stenosis (AS) who present with symptoms or left ventricular ejection fraction (LVEF) &lt; 50%, both conditions representing a late stage of the disease. While global longitudinal strain (GLS) is load dependant but interesting for assessing prognosis, myocardial work has emerged. We aim to evaluate acute changes in myocardial work occurring in patients undergoing transcatheter aortic valve implantation (TAVI). Methods Patients who underwent TAVI were evaluated before and after by echocardiography. Complete echocardiographies were considered. Myocardial work indices (global work index (GWI), Global constructive work (GCW), Global work efficiency (GWE), Global wasted work (GWW)) were calculated integrating mean transaortic pressure-gradient and brachial-cuff systolic pressure. Results 125 patients underwent successful TAVI with significant decrease of the transaortic mean gradient (52.5 ± 16.1 to 12.2 ± 5.0, P&lt;.0001). There was no significant change in LVEF post-TAVI. Myocardial work data post-TAVR showed a significant reduction of GWI (1389 ± 537 vs. 2014 ± 714, P&lt;.0001), GCW (1693 ± 543 vs. 2379 ± 761, P&lt;.0001) and GWE (85,0 ± 7,06 vs. 87,1 ± 5,98, P=0,0034). Decrease of GWI and GCW after TAVI was homogeneous among different sub-groups based on their GLS, LVEF of NYHA status before TAVI. We observed a significant association between GWI and GCW before TAVI and a GLS degradation after TAVI. Conclusion Myocardial work parameters show promising potential in best understanding the LV-myocardial consequences of AS and its correction. By their ability to discriminate NYHA status and GLS evolution, we can hypothesize on their clinical value.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136161575","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}
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