Pub Date : 2023-06-01DOI: 10.1093/ehjci/jead119.040
M Leitman, S Fuchs, V Tyomkin, A Hadanny, S Zilberman-Itskovich, S Efrati
Abstract Funding Acknowledgements Type of funding sources: None. Background Post-COVID-19 condition refers to a range of persisting physical and neurocognitive symptoms following SARS-CoV-2 infection. Recent evidence revealed that post-COVID syndrome patients may suffer from cardiac dysfunction and are at increased risk for a broad range of cardiovascular disorders. This randomized, sham-control, double-blind trial evaluated the effect of hyperbaric oxygen therapy (HBOT) on the cardiac function of post-COVID-19 patients with ongoing symptoms for at least three months after confirmed infection. Methods Sixty patients were randomized to receive 40 daily HBOT or sham sessions. They underwent echocardiography at baseline and 1-3 weeks after the last protocol session. Results Twenty-nine (48.3%) patients had reduced global longitudinal strain (GLS) at baseline. Of them, 13 (43.3%) and 16 (53.3%) were allocated to the sham and HBOT groups, respectively. Compared to the sham group, GLS significantly increased following HBOT (−17.8±1.1 to −20.2±1.0, p = 0.0001), with a significant group-by-time interaction (p = 0.041). Conclusion Post-COVID syndrome patients despite normal EF often have subclinical left ventricular dysfunction that is characterized by mildly reduced GLS. HBOT promotes left ventricular systolic function recovery in patients suffering from post COVID-19 condition. Further studies are needed to optimize patient selection and evaluate long-term outcomes.
{"title":"The effect of hyperbaric oxygen therapy on myocardial function in post- covid syndrome patients: a randomized controlled trial","authors":"M Leitman, S Fuchs, V Tyomkin, A Hadanny, S Zilberman-Itskovich, S Efrati","doi":"10.1093/ehjci/jead119.040","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.040","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Post-COVID-19 condition refers to a range of persisting physical and neurocognitive symptoms following SARS-CoV-2 infection. Recent evidence revealed that post-COVID syndrome patients may suffer from cardiac dysfunction and are at increased risk for a broad range of cardiovascular disorders. This randomized, sham-control, double-blind trial evaluated the effect of hyperbaric oxygen therapy (HBOT) on the cardiac function of post-COVID-19 patients with ongoing symptoms for at least three months after confirmed infection. Methods Sixty patients were randomized to receive 40 daily HBOT or sham sessions. They underwent echocardiography at baseline and 1-3 weeks after the last protocol session. Results Twenty-nine (48.3%) patients had reduced global longitudinal strain (GLS) at baseline. Of them, 13 (43.3%) and 16 (53.3%) were allocated to the sham and HBOT groups, respectively. Compared to the sham group, GLS significantly increased following HBOT (−17.8±1.1 to −20.2±1.0, p = 0.0001), with a significant group-by-time interaction (p = 0.041). Conclusion Post-COVID syndrome patients despite normal EF often have subclinical left ventricular dysfunction that is characterized by mildly reduced GLS. HBOT promotes left ventricular systolic function recovery in patients suffering from post COVID-19 condition. Further studies are needed to optimize patient selection and evaluate long-term outcomes.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"15 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":"136161744","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/jead119.264
I Kujala, W Nammas, T Maaniitty, I Stenstrom, R Klen, J J Bax, J Knuuti, A Saraste
Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): State Research Funding for Turku University Hospital. Background Combined anatomical and functional imaging enables detection of non-obstructive and obstructive coronary artery disease (CAD) as well as myocardial ischemia, and also provides prognostic information. Purpose We evaluated sex differences in disease phenotype and adverse outcomes by using non-invasive combined anatomical and functional imaging in symptomatic patients with suspected CAD. Methods We retrospectively evaluated patients undergone coronary computed tomography angiography (CTA) for suspected CAD. According to local routine, patients with suspected obstructive stenosis on CTA were referred to downstream 15O-water positron emission tomography (PET) myocardial perfusion imaging to assess stress myocardial blood flow (MBF; ≤2.3 mL/g/min considered abnormal). A composite adverse endpoint was recorded, including all-cause death, myocardial infarction, and unstable angina pectoris. Results A total of 1948 patients (59% women) underwent coronary CTA of whom 657 (34%) patients underwent downstream PET perfusion imaging. During a mean follow-up of 6.8 years, 182 adverse events occurred. Women more often had normal coronary arteries (42% vs. 22%, p<0.001) and less often abnormal stress MBF (9% vs. 28%, p<0.001), as compared with men. The annual adverse event rate was lower in women versus men (1.2% vs. 1.7%, p = 0.02). Both in women and men, coronary calcification, non-obstructive CAD, and abnormal stress MBF were independent predictors of events. Abnormal stress MBF was associated with 5.0 and 5.6-fold adverse event rates in women and men, respectively. There was no statistical interaction between sex and coronary calcification, non-obstructive CAD, or abnormal stress MBF in terms of predicting adverse outcome. Conclusion Among patients evaluated for chronic chest pain, women have lower prevalence of ischemic CAD and lower rate of future adverse events. Combined coronary CTA and PET myocardial perfusion imaging predicts outcomes equally in women and men.
{"title":"Prognostic value of combined coronary CT angiography and myocardial perfusion imaging in women and men","authors":"I Kujala, W Nammas, T Maaniitty, I Stenstrom, R Klen, J J Bax, J Knuuti, A Saraste","doi":"10.1093/ehjci/jead119.264","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.264","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): State Research Funding for Turku University Hospital. Background Combined anatomical and functional imaging enables detection of non-obstructive and obstructive coronary artery disease (CAD) as well as myocardial ischemia, and also provides prognostic information. Purpose We evaluated sex differences in disease phenotype and adverse outcomes by using non-invasive combined anatomical and functional imaging in symptomatic patients with suspected CAD. Methods We retrospectively evaluated patients undergone coronary computed tomography angiography (CTA) for suspected CAD. According to local routine, patients with suspected obstructive stenosis on CTA were referred to downstream 15O-water positron emission tomography (PET) myocardial perfusion imaging to assess stress myocardial blood flow (MBF; ≤2.3 mL/g/min considered abnormal). A composite adverse endpoint was recorded, including all-cause death, myocardial infarction, and unstable angina pectoris. Results A total of 1948 patients (59% women) underwent coronary CTA of whom 657 (34%) patients underwent downstream PET perfusion imaging. During a mean follow-up of 6.8 years, 182 adverse events occurred. Women more often had normal coronary arteries (42% vs. 22%, p&lt;0.001) and less often abnormal stress MBF (9% vs. 28%, p&lt;0.001), as compared with men. The annual adverse event rate was lower in women versus men (1.2% vs. 1.7%, p = 0.02). Both in women and men, coronary calcification, non-obstructive CAD, and abnormal stress MBF were independent predictors of events. Abnormal stress MBF was associated with 5.0 and 5.6-fold adverse event rates in women and men, respectively. There was no statistical interaction between sex and coronary calcification, non-obstructive CAD, or abnormal stress MBF in terms of predicting adverse outcome. Conclusion Among patients evaluated for chronic chest pain, women have lower prevalence of ischemic CAD and lower rate of future adverse events. Combined coronary CTA and PET myocardial perfusion imaging predicts outcomes equally in women and men.","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":"136161745","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/jead119.070
C Dellino, S Continisio, C Montonati, G Mattesi, E Cozza, M Savo, D Galzerano, G Tarantini, G De Conti, R Motta, S Iliceto, V Pergola
Abstract Funding Acknowledgements Type of funding sources: None. Background Spontaneous coronary artery dissection (SCAD) is one of the causes of acute coronary syndrome (ACS), myocardial infarction (MI) and sudden death (SD). Diagnosis is done with coronary angiography (CA); nevertheless, coronary computed tomography angiography (CCTA) is a new useful tool in the acute diagnosis and at follow-up. Treatment could involve a conservative approach or an invasive approach with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Purpose 1) analyze the clinical and CCTA features at baseline of patients with a SCAD diagnosis; 2) evaluate the clinical and anatomic outcome at follow-up of patients with a SCAD diagnosis treated with a conservative or invasive approach; 3) evaluate in the conservative approach treated patients the clinical and anatomic outcome of those dismissed with single or double antiplatelet therapy. Methods A retrospective analysis of 57 patients affected by SCAD followed up with Coronary CT angiography (CCTA) between 2010 and 2022. Clinical and anatomic data were collected at baseline and at the follow-up (FU). The clinical endpoints evaluated were: all cause mortality, hospitalization for cardiovascular cause, SCAD or PCI ex-novo and MI; the anatomic endpoints were: patency of coronary artery and/or stents and length dissection changing from baseline. Results 57 patients were divided in 2 groups: 46 (80,7%) patients underwent a conservative treatment and 11 (19,3%) patients a PCI treatment. Patients treated with PCI has a significative incidence of smokers (45,5% vs 15,2%; p = 0,042), peripherical arteriopathy (18,2% vs 0%; p = 0,034), higher troponin peak (40425,8 vs 13436; p = 0,011) and lower ejection fraction (51,4±11,0 vs 57,1±7,6; p = 0,050). Moreover the PCI population has a significant involvement of more than one coronary artery (72,7% vs 6,5%; p<0,001), of the proximal tracts of the coronary arteries (22,8% vs 13 %; p = 0,001) and of the truncus communis (45,4% vs 0%; p<0,001). At the follow up, there were no statistical differences for the clinical and anatomic endpoints between the conservative and invasive treated patients (p>0,05). Among patients treated with conservative therapy, there were a significant recurrence of SCAD in those treated with DAPT than in those treated with SAPT (33,3% vs 5,9%; p = 0,033). Conclusions patients with SCAD managed with PCI have more cardiovascular risk factors, a major myocardial infarction extension and a more complex coronary arteries involvement; conservative management is comparable to the PCI treatment for the clinical and anatomic endpoints evaluated; DAPT at discharge was associated with a higher rate of SCAD recurrence at follow-up.
资金来源类型:无。背景:自发性冠状动脉夹层(SCAD)是急性冠状动脉综合征(ACS)、心肌梗死(MI)和猝死(SD)的病因之一。诊断通过冠状动脉造影(CA)完成;然而，冠状动脉计算机断层血管造影(CCTA)在急性诊断和随访中是一种新的有用工具。治疗可包括保守入路或经皮冠状动脉介入治疗(PCI)或冠状动脉旁路移植术(CABG)。目的1)分析SCAD诊断患者的临床和CCTA基线特征;2)评价经保守或有创入路治疗的SCAD患者的临床和解剖随访结果;3)评价保守方法治疗的患者在接受单次或双次抗血小板治疗后的临床和解剖结果。方法回顾性分析2010 ~ 2022年57例SCAD患者行冠状动脉CT血管造影(CCTA)的临床资料。在基线和随访(FU)时收集临床和解剖数据。评估的临床终点为:全因死亡率、心血管原因住院、SCAD或PCI复发和心肌梗死;解剖终点为:冠状动脉和/或支架的通畅和长度剥离从基线变化。结果57例患者分为两组:46例(86.7%)行保守治疗，11例(19.3%)行PCI治疗。接受PCI治疗的患者吸烟者的发生率显著(45.5% vs 15.2%;P = 0,042)，外周动脉病变(18.2% vs 0%;P = 0.034)，肌钙蛋白峰值较高(40425,8 vs 13436;P = 0.011)和较低的射血分数(51,4±11,0 vs 57,1±7,6;P = 0.050)。此外，PCI患者明显累及不止一条冠状动脉(72.7% vs 6.5%;P< 001)，冠状动脉近端束(22.8% vs 13%;P = 0.001)和树干的比例(45.4% vs 0%;p&肝移植;0001)。随访时，保守治疗与有创治疗患者的临床和解剖终点无统计学差异(p> 0.05)。在接受保守治疗的患者中，DAPT治疗组的SCAD复发率明显高于SAPT治疗组(33.3% vs 5.9%;P = 0.033)。结论经PCI治疗的SCAD患者有更多心血管危险因素，主要心肌梗死扩展，冠状动脉受累更复杂;保守治疗的临床和解剖终点评估与PCI治疗相当;出院时的DAPT与随访时较高的SCAD复发率相关。
{"title":"Spontaneous coronary artery dissection: the role of Coronary CT angiography in the follow-up management","authors":"C Dellino, S Continisio, C Montonati, G Mattesi, E Cozza, M Savo, D Galzerano, G Tarantini, G De Conti, R Motta, S Iliceto, V Pergola","doi":"10.1093/ehjci/jead119.070","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.070","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Spontaneous coronary artery dissection (SCAD) is one of the causes of acute coronary syndrome (ACS), myocardial infarction (MI) and sudden death (SD). Diagnosis is done with coronary angiography (CA); nevertheless, coronary computed tomography angiography (CCTA) is a new useful tool in the acute diagnosis and at follow-up. Treatment could involve a conservative approach or an invasive approach with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Purpose 1) analyze the clinical and CCTA features at baseline of patients with a SCAD diagnosis; 2) evaluate the clinical and anatomic outcome at follow-up of patients with a SCAD diagnosis treated with a conservative or invasive approach; 3) evaluate in the conservative approach treated patients the clinical and anatomic outcome of those dismissed with single or double antiplatelet therapy. Methods A retrospective analysis of 57 patients affected by SCAD followed up with Coronary CT angiography (CCTA) between 2010 and 2022. Clinical and anatomic data were collected at baseline and at the follow-up (FU). The clinical endpoints evaluated were: all cause mortality, hospitalization for cardiovascular cause, SCAD or PCI ex-novo and MI; the anatomic endpoints were: patency of coronary artery and/or stents and length dissection changing from baseline. Results 57 patients were divided in 2 groups: 46 (80,7%) patients underwent a conservative treatment and 11 (19,3%) patients a PCI treatment. Patients treated with PCI has a significative incidence of smokers (45,5% vs 15,2%; p = 0,042), peripherical arteriopathy (18,2% vs 0%; p = 0,034), higher troponin peak (40425,8 vs 13436; p = 0,011) and lower ejection fraction (51,4±11,0 vs 57,1±7,6; p = 0,050). Moreover the PCI population has a significant involvement of more than one coronary artery (72,7% vs 6,5%; p&lt;0,001), of the proximal tracts of the coronary arteries (22,8% vs 13 %; p = 0,001) and of the truncus communis (45,4% vs 0%; p&lt;0,001). At the follow up, there were no statistical differences for the clinical and anatomic endpoints between the conservative and invasive treated patients (p&gt;0,05). Among patients treated with conservative therapy, there were a significant recurrence of SCAD in those treated with DAPT than in those treated with SAPT (33,3% vs 5,9%; p = 0,033). Conclusions patients with SCAD managed with PCI have more cardiovascular risk factors, a major myocardial infarction extension and a more complex coronary arteries involvement; conservative management is comparable to the PCI treatment for the clinical and anatomic endpoints evaluated; DAPT at discharge was associated with a higher rate of SCAD recurrence at follow-up.","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":"136161750","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/jead119.331
P Bhagirath, F O Campos, H A Zaidi, Z Chen, M Eliott, J Gould, M J B Kemme, A A M Wilde, M J W Gotte, 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 MRI late gadolinium enhancement (LGE) images can provide novel insights about critical pathways through scar but does not assess the vulnerability of these pathways for sustaining scar-mediated ventricular tachycardia (VT). Computational modelling can augment the insights from imaging derived metrics by providing the functional implications of structural anatomy of the substrate. However, current (monodomain) approaches are computationally expensive and may not, by design, extract all critical pathways. Aim This study evaluated the performance of a novel, reaction-Eikonal based, automated reentrant pathway finding algorithm (VITA) to assess the functional viability of critical circuits identified on LGE and non-invasively predict arrhythmic risk in both an ICD and post-ablation cohort recurrence. Methods ADAS LV and custom-made software was used to generate 3D patient-specific ventricular models in a prospective cohort of post-infarct ICD patients (cohort 1, n=40) and a retrospective cohort of 20 post-infarct VT-ablation patients (cohort 2). Our Virtual Induction and Treatment of Arrhythmias (VITA) framework was then applied to comprehensively probe the viability of the scar substrate to sustaining reentrant circuits. VITA metrics, related to the numbers of induced VTs and their corresponding round trip times (RTTs), were compared with appropriate ICD therapy (cohort 1) and VT-recurrence (cohort 2) during follow-up. Results Patients in both cohorts with an event had higher VITA metrics. In cohort 1 (ICD), VITA demonstrated significantly more inducible VTs (6.6±4.2 vs. 4.1±3.4, p = .044), longer mean RTT (116.2±50.9 ms vs. 76.9±42.6 ms, p = .012) and max RTT (194.4±105.1 ms vs. 109.6±78.7, p =.009) in the event group. In addition, Cox-regression demonstrated a significant independent association with an event: induced VTs (HR 1.67; CI 1.04–2.68, p = .03), mean RTT (HR 2.14; CI 1.11–4.12, p = .02), maximum RTT (HR 2.13; CI 1.19–3.81, p = .01). In cohort 2 (VT-ablation), total induced VTs (85±43 vs. 42±27, p = .01) and unique VTs (9±4 vs. 5±4, p = .04) were significantly higher in patients with- compared to patients without recurrence, and were predictive of recurrence with AUC of .820 and .770, respectively. Max RTT demonstrated a trend towards significance 293 ± 90 ms vs. 200 ± 114 ms (p = .06) for recurrence and non-recurrence, respectively. No differences were observed in mean RTT between the two groups. Conclusion VITA enabled quantitative assessment of pro-arrhythmic vulnerability of the substrate which related directly to patient outcomes. The number of induced VTs were the most robust measure of appropriate ICD therapy and post-ablation arrhythmia recurrence. The RTT metrics, related to viable circuit lengths through scar, demonstrated a significant independent association with appropriate ICD therapy.
资金来源类型:基金会。主要资金来源:EACVI，荷兰心脏研究所。MRI晚期钆增强(LGE)图像可以为通过疤痕的关键通路提供新的见解，但不能评估这些通路对维持疤痕介导的室性心动过速(VT)的脆弱性。通过提供基板结构解剖的功能含义，计算建模可以增强来自成像衍生度量的见解。然而，当前的(单域)方法在计算上是昂贵的，并且可能无法按照设计提取所有关键路径。目的:本研究评估了一种新的、基于反应的自动重入路径寻找算法(VITA)的性能，以评估在LGE上识别的关键回路的功能可行性，并无创地预测ICD和消融后队列复发的心律失常风险。方法使用ADAS LV和定制软件在梗死后ICD患者的前瞻性队列(队列1,n=40)和20例梗死后vt消融患者的回顾性队列(队列2)中生成3D患者特异性心室模型。然后应用我们的虚拟诱发和治疗心律失常(VITA)框架全面探索疤痕基质维持再入回路的可行性。VITA指标与诱发室性心动过境症的数量及其相应的往返时间(rtt)相关，在随访期间与适当的ICD治疗(队列1)和室性心动过境症复发(队列2)进行比较。结果两组患者均有较高的VITA指标。在队列1 (ICD)中，VITA显示出更多的诱导VTs(6.6±4.2 vs. 4.1±3.4,p = 0.044)，更长的平均RTT(116.2±50.9 ms vs. 76.9±42.6 ms, p = 0.012)和最大RTT(194.4±105.1 ms vs. 109.6±78.7,p = 0.009)。此外，cox -回归显示与诱发的VTs事件有显著的独立关联(HR 1.67;CI 1.04-2.68, p = .03)，平均RTT (HR 2.14;CI 1.11-4.12, p = 0.02)，最大RTT (HR 2.13;CI 1.19-3.81, p = 0.01)。在队列2 (vt消融)中，与无复发患者相比，有复发患者的总诱导vt(85±43 vs. 42±27,p = 0.01)和唯一vt(9±4 vs. 5±4,p = 0.04)显著高于无复发患者，并且预测复发的AUC分别为0.820和0.770。复发和未复发的最大RTT分别为293±90 ms和200±114 ms (p = 0.06)。两组的平均RTT无差异。结论VITA可以定量评估与患者预后直接相关的底物致心律失常易感性。诱发室性心动过速的次数是衡量适当的ICD治疗和消融后心律失常复发的最可靠指标。RTT指标与通过疤痕的可行电路长度相关，显示出与适当的ICD治疗有显著的独立关联。未来的研究应探讨vita指导的选择和治疗方法的临床应用。
{"title":"Predicting ICD therapy and post-ablation ventricular tachycardia recurrence using cardiac MRI-based advanced computational reentrant pathway analysis","authors":"P Bhagirath, F O Campos, H A Zaidi, Z Chen, M Eliott, J Gould, M J B Kemme, A A M Wilde, M J W Gotte, A J Prassl, A Neic, G Plank, C A Rinaldi, M J Bishop","doi":"10.1093/ehjci/jead119.331","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.331","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): EACVI, Netherlands Heart Institute. Background MRI late gadolinium enhancement (LGE) images can provide novel insights about critical pathways through scar but does not assess the vulnerability of these pathways for sustaining scar-mediated ventricular tachycardia (VT). Computational modelling can augment the insights from imaging derived metrics by providing the functional implications of structural anatomy of the substrate. However, current (monodomain) approaches are computationally expensive and may not, by design, extract all critical pathways. Aim This study evaluated the performance of a novel, reaction-Eikonal based, automated reentrant pathway finding algorithm (VITA) to assess the functional viability of critical circuits identified on LGE and non-invasively predict arrhythmic risk in both an ICD and post-ablation cohort recurrence. Methods ADAS LV and custom-made software was used to generate 3D patient-specific ventricular models in a prospective cohort of post-infarct ICD patients (cohort 1, n=40) and a retrospective cohort of 20 post-infarct VT-ablation patients (cohort 2). Our Virtual Induction and Treatment of Arrhythmias (VITA) framework was then applied to comprehensively probe the viability of the scar substrate to sustaining reentrant circuits. VITA metrics, related to the numbers of induced VTs and their corresponding round trip times (RTTs), were compared with appropriate ICD therapy (cohort 1) and VT-recurrence (cohort 2) during follow-up. Results Patients in both cohorts with an event had higher VITA metrics. In cohort 1 (ICD), VITA demonstrated significantly more inducible VTs (6.6±4.2 vs. 4.1±3.4, p = .044), longer mean RTT (116.2±50.9 ms vs. 76.9±42.6 ms, p = .012) and max RTT (194.4±105.1 ms vs. 109.6±78.7, p =.009) in the event group. In addition, Cox-regression demonstrated a significant independent association with an event: induced VTs (HR 1.67; CI 1.04–2.68, p = .03), mean RTT (HR 2.14; CI 1.11–4.12, p = .02), maximum RTT (HR 2.13; CI 1.19–3.81, p = .01). In cohort 2 (VT-ablation), total induced VTs (85±43 vs. 42±27, p = .01) and unique VTs (9±4 vs. 5±4, p = .04) were significantly higher in patients with- compared to patients without recurrence, and were predictive of recurrence with AUC of .820 and .770, respectively. Max RTT demonstrated a trend towards significance 293 ± 90 ms vs. 200 ± 114 ms (p = .06) for recurrence and non-recurrence, respectively. No differences were observed in mean RTT between the two groups. Conclusion VITA enabled quantitative assessment of pro-arrhythmic vulnerability of the substrate which related directly to patient outcomes. The number of induced VTs were the most robust measure of appropriate ICD therapy and post-ablation arrhythmia recurrence. The RTT metrics, related to viable circuit lengths through scar, demonstrated a significant independent association with appropriate ICD therapy.","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":"136161576","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/jead119.100
E Curtis, L Lemarchand, G L'official, G Leurent, V Auffret, E Oger, E Donal
Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): New Zealand National Heart Foundation Background The role of speckle tracking echocardiography has been expanding thanks to its utility in detecting subtle changes in cardiac function, and has prognostic value(1). Right atrial (RA) strain has shown promise in prognostication amongst patients with pulmonary hypertension and heart failure. It is associated with RA size, RV function and IVC size. However, its clinical utility and application remain under investigation (2–5). We sought to evaluate the associations of right atrial strain with both invasive and non-invasive measure of RV function and the association of RA strain with heart failure hospitalisations and death across a heterogeneous cohort. Methods A single-centre retrospective analysis of data from 225 consecutive patients (age 72 ±11.6 years old; male 56%) with both right heart catheterization (RHC) and TTE. Data regarding unplanned heart failure hospitalisations and date of death were recorded. Statistical analysis was performed using SAS 15.1 to assess the association between right atrial strain and prespecified echo and haemodynamic measures of right and left heart function and prognosis defined by heart failure hospitalisations and death. Results Over a median follow up of 28±16 months, there were 59 events. RA strain was associated with the following non-invasive and invasive measures of right heart function and left heart systolic function : TAPSE; RA size, RA pressure, RV strain, PAPi, RVSWI, RV FAC, LAVi, RV PA coupling (TAPSE/systolic PAP), LVEF, cardiac index, diastolic function (E/e’) with a p value of <0.05. Increasing atrial size was associated with lower values of R strain. Despite the association of impaired RV strain with prognosis, HR 2.94 (1.14 – 7.60), RA strain did not appear to be associated independently with prognosis HR 0.98 (0.95–1.0) P value = 0.0676. Conclusions Right atrial strain is independently associated with both invasive and non-invasive measures of RV function and may be a useful tool to help us assess right heart function. It did not appear to be associated with prognosis despite being independently linked with RV strain, which was strongly associated with prognosis in our cohort.
{"title":"Right atrial strain: what does it tell us about cardiac function and prognosis?","authors":"E Curtis, L Lemarchand, G L'official, G Leurent, V Auffret, E Oger, E Donal","doi":"10.1093/ehjci/jead119.100","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.100","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): New Zealand National Heart Foundation Background The role of speckle tracking echocardiography has been expanding thanks to its utility in detecting subtle changes in cardiac function, and has prognostic value(1). Right atrial (RA) strain has shown promise in prognostication amongst patients with pulmonary hypertension and heart failure. It is associated with RA size, RV function and IVC size. However, its clinical utility and application remain under investigation (2–5). We sought to evaluate the associations of right atrial strain with both invasive and non-invasive measure of RV function and the association of RA strain with heart failure hospitalisations and death across a heterogeneous cohort. Methods A single-centre retrospective analysis of data from 225 consecutive patients (age 72 ±11.6 years old; male 56%) with both right heart catheterization (RHC) and TTE. Data regarding unplanned heart failure hospitalisations and date of death were recorded. Statistical analysis was performed using SAS 15.1 to assess the association between right atrial strain and prespecified echo and haemodynamic measures of right and left heart function and prognosis defined by heart failure hospitalisations and death. Results Over a median follow up of 28±16 months, there were 59 events. RA strain was associated with the following non-invasive and invasive measures of right heart function and left heart systolic function : TAPSE; RA size, RA pressure, RV strain, PAPi, RVSWI, RV FAC, LAVi, RV PA coupling (TAPSE/systolic PAP), LVEF, cardiac index, diastolic function (E/e’) with a p value of &lt;0.05. Increasing atrial size was associated with lower values of R strain. Despite the association of impaired RV strain with prognosis, HR 2.94 (1.14 – 7.60), RA strain did not appear to be associated independently with prognosis HR 0.98 (0.95–1.0) P value = 0.0676. Conclusions Right atrial strain is independently associated with both invasive and non-invasive measures of RV function and may be a useful tool to help us assess right heart function. It did not appear to be associated with prognosis despite being independently linked with RV strain, which was strongly associated with prognosis in our cohort.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"6 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":"136161752","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/jead119.168
A Althunayyan, S Alborikan, S Badiani, K Wong, R Uppal, P Patel, S Petersen, G Lloyd, S Bhattacharyya
Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Saudi Arabian Cultural Bureau. Background Current guidelines recommend intervention in severe degenerative mitral regurgitation (MR) in symptomatic patients or asymptomatic patients with left ventricular dilatation or dysfunction. The insidious onset of symptoms may mean patients do not report symptoms. The role of systematic exercise testing for symptoms in MR is not clearly defined. Methods 97 patients with moderate to severe, asymptomatic MR underwent exercise echocardiography combined with cardiopulmonary exercise testing. Predictors of exercise-induced dyspnoea, symptom-free survival and mitral valve intervention were identified. Results 18 (19%) patients developed limiting dyspnoea on exercise. Spontaneous symptom free survival at 24 months was significantly higher in those without exercise-induced symptoms compared to those with exercise-induced symptoms, p <0.0001. The only independent predictors of spontaneous symptoms at 2 years were effective regurgitant orifice area (odds ratio 27.45 (95% CI 1.43 – 528.40), p = 0.03) and exercise-induced symptoms (odds ratio 11.56 (95% CI 1.71 – 78.09), p = 0.01). The only independent predictor of surgery was indexed left ventricular systolic volumes (Odds ratio 1.17 (95% CI 1.04 – 1.30), p = 0.006). Where only patients undergoing surgery due to symptoms were included, the only independent predictor was exercise-induced symptoms (Odds ratio 13.94 (95% CI 1.39 – 140.27), p = 0.025). Conclusion In patients with primary asymptomatic degenerative MR, one fifth develop symptoms on exercise. This predicts subsequent development of spontaneous symptoms and mitral valve intervention due to symptoms.
资金来源类型:私人资助和/或赞助。主要资金来源:沙特阿拉伯文化局。背景目前的指南推荐对有症状的患者或无症状的左心室扩张或功能障碍患者进行严重退行性二尖瓣反流(MR)的干预。症状的潜伏发作可能意味着患者不报告症状。系统运动试验对MR症状的作用尚不明确。方法对97例中重度无症状MR患者行运动超声心动图联合心肺运动试验。确定运动引起的呼吸困难、无症状生存和二尖瓣干预的预测因素。结果18例(19%)患者在运动时出现限制性呼吸困难。无运动诱发症状的患者24个月自发性无症状生存率显著高于有运动诱发症状的患者，p <0.0001。2年自发性症状的唯一独立预测因子是有效反流口面积(优势比27.45 (95% CI 1.43 - 528.40)， p = 0.03)和运动引起的症状(优势比11.56 (95% CI 1.71 - 78.09)， p = 0.01)。手术的唯一独立预测因子是左心室收缩容积指数(优势比1.17 (95% CI 1.04 - 1.30)， p = 0.006)。当仅纳入因症状而接受手术的患者时，唯一的独立预测因子是运动引起的症状(优势比13.94 (95% CI 1.39 - 140.27)， p = 0.025)。结论原发性无症状退行性MR患者中，五分之一的患者在运动时出现症状。这可以预测随后自发性症状的发展和症状导致的二尖瓣干预。
{"title":"Clinical and prognostic implications of cardiopulmonary exercise stress echocardiography in asymptomatic degenerative mitral regurgitation","authors":"A Althunayyan, S Alborikan, S Badiani, K Wong, R Uppal, P Patel, S Petersen, G Lloyd, S Bhattacharyya","doi":"10.1093/ehjci/jead119.168","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.168","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Saudi Arabian Cultural Bureau. Background Current guidelines recommend intervention in severe degenerative mitral regurgitation (MR) in symptomatic patients or asymptomatic patients with left ventricular dilatation or dysfunction. The insidious onset of symptoms may mean patients do not report symptoms. The role of systematic exercise testing for symptoms in MR is not clearly defined. Methods 97 patients with moderate to severe, asymptomatic MR underwent exercise echocardiography combined with cardiopulmonary exercise testing. Predictors of exercise-induced dyspnoea, symptom-free survival and mitral valve intervention were identified. Results 18 (19%) patients developed limiting dyspnoea on exercise. Spontaneous symptom free survival at 24 months was significantly higher in those without exercise-induced symptoms compared to those with exercise-induced symptoms, p &lt;0.0001. The only independent predictors of spontaneous symptoms at 2 years were effective regurgitant orifice area (odds ratio 27.45 (95% CI 1.43 – 528.40), p = 0.03) and exercise-induced symptoms (odds ratio 11.56 (95% CI 1.71 – 78.09), p = 0.01). The only independent predictor of surgery was indexed left ventricular systolic volumes (Odds ratio 1.17 (95% CI 1.04 – 1.30), p = 0.006). Where only patients undergoing surgery due to symptoms were included, the only independent predictor was exercise-induced symptoms (Odds ratio 13.94 (95% CI 1.39 – 140.27), p = 0.025). Conclusion In patients with primary asymptomatic degenerative MR, one fifth develop symptoms on exercise. This predicts subsequent development of spontaneous symptoms and mitral valve intervention due to symptoms.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"59 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":"136161890","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/jead119.436
E Panaioli, V D Volodia Dangouloff-Ros, N B Nathalie Boddaert, D B Damien Bonnet, D K Diala Khraiche
Abstract Funding Acknowledgements Type of funding sources: None. Background Paediatric hypertrophic cardiomyopathy (HCM) is a leading cause of sudden death. The relationship between the genotype variation and phenotype expression has not been fully elucidated, with some studies showing association with an increased hypertrophy and MYH7 or multiple genetic variations. In HCM fibrosis and hypertrophy contribute to left ventricular (LV) mechanics’ alteration resulting in subendocardial dysfunction. The latter is associated with a decreased global longitudinal and radial strains (GLS, GRS), whereas epicardial thickening leads to preserved global circumferential strain (GCS) and LV twist. Children with HCM have reduced LA function, measurable by both volumetric and strain analysis and reduced LA mechanics are associated with poor exercise capacity. Feature tracking –cardiac magnetic resonance (FT-CMR) has enhanced the non-invasive assessment of myocardial deformation in HCM. The main aim of our study was to assess differences of LV and LA mechanics features on CMR between patients harbouring multiple pathogenic or likely pathogenic variants (MGv, n=16) or single genetic variations (SGv, n=35). Methods Our retrospective CMR study included 51 patients (1.7–18.8 years ago). CMR data were: LV and LA’s morphological values, late gadolinium enhancement (LGE) of LA and LV walls, LV feature tracking (FT) derived strain and LV twist (LVT). LV twist was calculated as the difference between basal and apical rotation. The LA feature FT derived strain, LA conduit function, reservoir function and pump function were computed. Results In MGv group, the indexed LV mass 108.8 +/-53.0 vs 74.3+/- 22.2 in SGv (p = 0.03). LGE was present in 51% patients of the whole cohort, with LGE in 64 % of MGv group. LV FT derived strain values and LA function were not statistically significant different between groups (MGv vs SGv: GLS −15.8+/−5.3 vs −18.7+/−4.8, GCS −27.8+/8 vs −31.1+/−8.6, GRS 44.7+/−24.6 vs 62.3+/−32). LVT was reduced in MGv group (0.04+/−7.6) vs (7.4+/−7.4) in SGv (p = 0.003). LA contractile function did not differ between the groups (MGv vs SGv: GLS LA 25.1+/−14.2 vs 27.6+/−13.5). LA reservoir, conduction and pump function did not differ between the groups. LVT was significantly correlated with the LA contractile function. An increased of LVT was associated with an increased LA GLS and EF (p = 0.011; p = 0.004). Conclusions Patients with multiple genetic variants have a greater LV mass and altered LV mechanics with reduced LV twist. This study gives insights in phenotype- genotype correlation in paediatric HCM and warrants larger longitudinal studies to assess its clinical significance.
资金来源类型:无。背景:儿童肥厚性心肌病(HCM)是猝死的主要原因。基因型变异和表型表达之间的关系尚未完全阐明，一些研究显示与肥大和MYH7或多种遗传变异增加有关。在HCM中，纤维化和肥厚导致左心室(LV)力学改变，导致心内膜下功能障碍。后者与整体纵向和径向应变(GLS, GRS)减少有关，而心外膜增厚导致整体圆周应变(GCS)和左室扭转保留。HCM患儿的LA功能降低，可通过体积和应变分析测量，LA力学降低与运动能力差有关。特征跟踪-心脏磁共振(FT-CMR)增强了HCM心肌变形的无创评估。本研究的主要目的是评估具有多种致病或可能致病变异(MGv, n=16)或单一遗传变异(SGv, n=35)的患者在CMR时左室和左室力学特征的差异。方法回顾性CMR研究纳入51例患者(1.7 ~ 18.8岁)。CMR数据包括:左室和左室的形态学值、左室和左室壁的晚期钆增强(LGE)、左室特征跟踪(FT)衍生应变和左室扭转(LVT)。LV扭转被计算为基部和根尖旋转的差值。计算了LA特征FT衍生应变、LA导管函数、储层函数和泵函数。结果MGv组左室指数质量108.8 +/-53.0 vs SGv组74.3+/- 22.2 (p = 0.03)。整个队列中有51%的患者存在LGE, MGv组中有64%的患者存在LGE。各组间LV FT衍生应变值和LA功能差异无统计学意义(MGv vs SGv: GLS - 15.8+/−5.3 vs - 18.7+/−4.8,GCS - 27.8+/8 vs - 31.1+/−8.6,GRS 44.7+/−24.6 vs 62.3+/−32)。MGv组LVT降低(0.04+/ - 7.6)，SGv组LVT降低(7.4+/ - 7.4)(p = 0.003)。两组间LA收缩功能无差异(MGv vs SGv; GLS LA 25.1+/ - 14.2 vs 27.6+/ - 13.5)。两组间LA储层、传导和泵功能无显著差异。LVT与LA收缩功能显著相关。LVT升高与LA GLS和EF升高相关(p = 0.011;P = 0.004)。结论多基因变异患者左室质量增大，左室力学改变，左室扭转减小。这项研究提供了在儿童HCM的表型-基因型相关性的见解，并保证更大的纵向研究，以评估其临床意义。
{"title":"LV and LA mechanics in pediatric HCM : a CMR study of phenotype-genotype correlation","authors":"E Panaioli, V D Volodia Dangouloff-Ros, N B Nathalie Boddaert, D B Damien Bonnet, D K Diala Khraiche","doi":"10.1093/ehjci/jead119.436","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.436","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Paediatric hypertrophic cardiomyopathy (HCM) is a leading cause of sudden death. The relationship between the genotype variation and phenotype expression has not been fully elucidated, with some studies showing association with an increased hypertrophy and MYH7 or multiple genetic variations. In HCM fibrosis and hypertrophy contribute to left ventricular (LV) mechanics’ alteration resulting in subendocardial dysfunction. The latter is associated with a decreased global longitudinal and radial strains (GLS, GRS), whereas epicardial thickening leads to preserved global circumferential strain (GCS) and LV twist. Children with HCM have reduced LA function, measurable by both volumetric and strain analysis and reduced LA mechanics are associated with poor exercise capacity. Feature tracking –cardiac magnetic resonance (FT-CMR) has enhanced the non-invasive assessment of myocardial deformation in HCM. The main aim of our study was to assess differences of LV and LA mechanics features on CMR between patients harbouring multiple pathogenic or likely pathogenic variants (MGv, n=16) or single genetic variations (SGv, n=35). Methods Our retrospective CMR study included 51 patients (1.7–18.8 years ago). CMR data were: LV and LA’s morphological values, late gadolinium enhancement (LGE) of LA and LV walls, LV feature tracking (FT) derived strain and LV twist (LVT). LV twist was calculated as the difference between basal and apical rotation. The LA feature FT derived strain, LA conduit function, reservoir function and pump function were computed. Results In MGv group, the indexed LV mass 108.8 +/-53.0 vs 74.3+/- 22.2 in SGv (p = 0.03). LGE was present in 51% patients of the whole cohort, with LGE in 64 % of MGv group. LV FT derived strain values and LA function were not statistically significant different between groups (MGv vs SGv: GLS −15.8+/−5.3 vs −18.7+/−4.8, GCS −27.8+/8 vs −31.1+/−8.6, GRS 44.7+/−24.6 vs 62.3+/−32). LVT was reduced in MGv group (0.04+/−7.6) vs (7.4+/−7.4) in SGv (p = 0.003). LA contractile function did not differ between the groups (MGv vs SGv: GLS LA 25.1+/−14.2 vs 27.6+/−13.5). LA reservoir, conduction and pump function did not differ between the groups. LVT was significantly correlated with the LA contractile function. An increased of LVT was associated with an increased LA GLS and EF (p = 0.011; p = 0.004). Conclusions Patients with multiple genetic variants have a greater LV mass and altered LV mechanics with reduced LV twist. This study gives insights in phenotype- genotype correlation in paediatric HCM and warrants larger longitudinal studies to assess its clinical significance.","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"6 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":"136161894","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/jead119.312
T Pezel, P Garot, S Toupin, F Sanguineti, T Hovasse, T Unterseeh, T Chitiboi, A J Jacob, I Borgohain, P Sharma, S Champagne, J Garot
Abstract Funding Acknowledgements Type of funding sources: None. Background Left ventricular global circumferential strain using cardiovascular magnetic resonance (CMR) is an accurate indicator to predict cardiovascular events. Although several studies have shown the excellent prognostic value of stress CMR, the prognostic value of stress global circumferential strain (sGCS) remains unknown. Aim To investigate the prognostic value of sGCS for predicting cardiovascular events 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 major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction (MI). A fully automatic machine learning algorithm was trained and validated on unseen CMR studies (MAGNETOM Aera and Skyra, Siemens Healthcare, Erlangen, Germany) to assess the sGCS from short-axis cine images at stress. 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 sGCS. Results Among 2,906 consecutive patients who underwent stress CMR, the automatic sGCS was successfully computed in 2,859 (98.4%) patients (68% male, mean age 64±12 years). A total of 256 (8.8%) MACEs were observed during a median (IQR) follow-up period of 4.5 (3.7–5.3) years. Using Kaplan-Meier analysis, sGCS and the presence of inducible ischemia were significantly associated with the occurrence of MACE (hazard ratio, HR: 1.12 [95% CI, 1.08–1.17]; and HR: 8.48 [95% CI, 6.05–11.91], both p<0.001; respectively). After adjustment for traditional risk factors, inducible ischemia and late gadolinium enhancement (LGE), sGCS was an independent predictor of a higher incidence of MACE (adjusted HR: 1.12 [95% CI, 1.05–1.20]). Finally, sGCS showed an incremental prognostic value to predict MACE compared to a multivariable model including traditional risk factors, the presence of inducible ischemia and LGE (C-statistic improvement: 0.05, p = 0.007; NRI= 0.169; IDI= 0.097; both p<0.001). Conclusions Automatic sGCS has an incremental prognostic value to predict MACE above traditional risk factors, and other stress CMR parameters.
{"title":"Incremental prognostic value of fully-automatic machine-learning based global circumferential strain during a stress CMR exam","authors":"T Pezel, P Garot, S Toupin, F Sanguineti, T Hovasse, T Unterseeh, T Chitiboi, A J Jacob, I Borgohain, P Sharma, S Champagne, J Garot","doi":"10.1093/ehjci/jead119.312","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.312","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Left ventricular global circumferential strain using cardiovascular magnetic resonance (CMR) is an accurate indicator to predict cardiovascular events. Although several studies have shown the excellent prognostic value of stress CMR, the prognostic value of stress global circumferential strain (sGCS) remains unknown. Aim To investigate the prognostic value of sGCS for predicting cardiovascular events 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 major adverse cardiovascular events (MACE), defined by cardiovascular death or nonfatal myocardial infarction (MI). A fully automatic machine learning algorithm was trained and validated on unseen CMR studies (MAGNETOM Aera and Skyra, Siemens Healthcare, Erlangen, Germany) to assess the sGCS from short-axis cine images at stress. 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 sGCS. Results Among 2,906 consecutive patients who underwent stress CMR, the automatic sGCS was successfully computed in 2,859 (98.4%) patients (68% male, mean age 64±12 years). A total of 256 (8.8%) MACEs were observed during a median (IQR) follow-up period of 4.5 (3.7–5.3) years. Using Kaplan-Meier analysis, sGCS and the presence of inducible ischemia were significantly associated with the occurrence of MACE (hazard ratio, HR: 1.12 [95% CI, 1.08–1.17]; and HR: 8.48 [95% CI, 6.05–11.91], both p&lt;0.001; respectively). After adjustment for traditional risk factors, inducible ischemia and late gadolinium enhancement (LGE), sGCS was an independent predictor of a higher incidence of MACE (adjusted HR: 1.12 [95% CI, 1.05–1.20]). Finally, sGCS showed an incremental prognostic value to predict MACE compared to a multivariable model including traditional risk factors, the presence of inducible ischemia and LGE (C-statistic improvement: 0.05, p = 0.007; NRI= 0.169; IDI= 0.097; both p&lt;0.001). Conclusions Automatic sGCS has an incremental prognostic value to predict MACE 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":"136161682","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/jead119.427
I Leo, J Sabatino, A Strangio, G Canino, C Critelli, F Troilo, M Maglione, G Loliva, L R Romano, C Indolfi, S De Rosa
Abstract Funding Acknowledgements Type of funding sources: None. Background Assessment of intracardiac flows has acquired increasing significance in the past few years, due to the development and introduction of technologies for non-invasive cardiovascular imaging. Recent studies have demonstrated abnormalities in cardiac function, which are related to pathological intracardiac vortical flows. This study investigates the additional information provided by quantifying intracardiac flow dynamics for the evaluation of patients with aortic stenosis (AS), by using an advanced echocardiography vortex-based approach. Methods One hundred twenty patients with severe AS (65 females – 54%), 60 patients with concentric remodelling (VR) (7 females – 12%) and 100 healthy controls (CTRL) (32 females – 32%) were prospectively enrolled to undergo a non-invasive evaluation of intracardiac flow dynamics. Echocardiographic assessments were performed, and apical three chamber views were recorded by means of MyLab™ X8 Platform. The HyperDoppler software adapted to an Esaote echo-scanner without contrast injection was used to assess vortex properties in all the patients. Results Vortex depth, vortex length, vortex intensity and vortex area were all significantly increased in SAo compared to CTRL (p<0.001, p = 0.003, p<0.001 and p = 0,049, respectively). Only vortex depth and vortex intensity (p<0.001 and p = 0.013, respectively) were significantly increased in SAo compared with VR. The mean energy dissipation of SAo group was significantly increased compared to control group (p<0.001) and VR (p = 0.002). Finally, the ROC Curve, generated to assess the capability of vortex depth to discriminate patients with and without severe aortic stenosis, showed an AUC of 0.751 (cutoff value ≥ 0.354; sensitivity, 73%; specificity, 73%). Conclusions There is a significant change of vortex localization, vorticity and energy parameters in patients with Sao. In particular, vortex depth, vortex intensity and energy dissipation are all significantly increased in SAo compared to CTRL and vortex depth can independently differentiate patients with SAo to those with only concentric remodelling and to CTRLs with high accuracy. These findings indicate that the assessment of intracardiac flow dynamics may provide complementary information to standard echocardiography, helping to distinguish within the heterogeneous population of patients with severe AS.
资金来源类型:无。背景近年来，由于无创心血管成像技术的发展和引进，心内血流评估变得越来越重要。最近的研究表明，心功能异常与病理性心内旋流有关。本研究通过使用先进的超声心动图涡流方法，探讨了通过量化心内血流动力学来评估主动脉瓣狭窄(AS)患者所提供的额外信息。方法前瞻性纳入120例重度AS患者(女性65例，占54%)、60例同心重构(VR)患者(女性7例，占12%)和100例健康对照(CTRL)患者(女性32例，占32%)进行无创心内血流动力学评价。进行超声心动图评估，并通过MyLab™X8平台记录根尖三室视图。采用无需注射造影剂的Esaote超声扫描仪上的HyperDoppler软件评估所有患者的涡旋特性。结果与对照组相比，SAo组漩涡深度、漩涡长度、漩涡强度和漩涡面积均显著增加(p<0.001, p = 0.003, p<0.001, p = 0.049)。与VR相比，SAo只有漩涡深度和漩涡强度(p<0.001和p = 0.013)显著增加。与对照组(p<0.001)和VR组(p = 0.002)相比，SAo组的平均能量耗散显著增加。最后，为了评估漩涡深度区分严重主动脉狭窄患者和非严重主动脉狭窄患者的能力而生成的ROC曲线显示AUC为0.751(截止值≥0.354;敏感性,73%;特异性,73%)。结论Sao患者漩涡定位、涡量和能量参数发生显著变化。特别是在SAo中，漩涡深度、漩涡强度和能量耗散均较CTRL显著增加，漩涡深度可以独立区分SAo与仅同心圆重构患者和CTRL患者，准确度较高。这些发现表明，心内血流动力学的评估可能为标准超声心动图提供补充信息，有助于区分异质性的严重AS患者群体。
{"title":"Assessment of intracardiac flow dynamics for the evaluation of patients with aortic stenosis","authors":"I Leo, J Sabatino, A Strangio, G Canino, C Critelli, F Troilo, M Maglione, G Loliva, L R Romano, C Indolfi, S De Rosa","doi":"10.1093/ehjci/jead119.427","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.427","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Assessment of intracardiac flows has acquired increasing significance in the past few years, due to the development and introduction of technologies for non-invasive cardiovascular imaging. Recent studies have demonstrated abnormalities in cardiac function, which are related to pathological intracardiac vortical flows. This study investigates the additional information provided by quantifying intracardiac flow dynamics for the evaluation of patients with aortic stenosis (AS), by using an advanced echocardiography vortex-based approach. Methods One hundred twenty patients with severe AS (65 females – 54%), 60 patients with concentric remodelling (VR) (7 females – 12%) and 100 healthy controls (CTRL) (32 females – 32%) were prospectively enrolled to undergo a non-invasive evaluation of intracardiac flow dynamics. Echocardiographic assessments were performed, and apical three chamber views were recorded by means of MyLab™ X8 Platform. The HyperDoppler software adapted to an Esaote echo-scanner without contrast injection was used to assess vortex properties in all the patients. Results Vortex depth, vortex length, vortex intensity and vortex area were all significantly increased in SAo compared to CTRL (p&lt;0.001, p = 0.003, p&lt;0.001 and p = 0,049, respectively). Only vortex depth and vortex intensity (p&lt;0.001 and p = 0.013, respectively) were significantly increased in SAo compared with VR. The mean energy dissipation of SAo group was significantly increased compared to control group (p&lt;0.001) and VR (p = 0.002). Finally, the ROC Curve, generated to assess the capability of vortex depth to discriminate patients with and without severe aortic stenosis, showed an AUC of 0.751 (cutoff value ≥ 0.354; sensitivity, 73%; specificity, 73%). Conclusions There is a significant change of vortex localization, vorticity and energy parameters in patients with Sao. In particular, vortex depth, vortex intensity and energy dissipation are all significantly increased in SAo compared to CTRL and vortex depth can independently differentiate patients with SAo to those with only concentric remodelling and to CTRLs with high accuracy. These findings indicate that the assessment of intracardiac flow dynamics may provide complementary information to standard echocardiography, helping to distinguish within the heterogeneous population of patients with severe AS.","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":"136161838","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/jead119.004
A Ioannou, R K Patel, Y Razvi, A Martinez-Naharro, A Porcari, L Venneri, D Hutt, H Lachmann, A Wechalekar, H Lachmann, P N Hawkins, J D Gillmore, M Fontana
Abstract Funding Acknowledgements Type of funding sources: None. Background Systemic light-chain (AL) amyloidosis commonly involves the liver, spleen and heart. Cardiac magnetic resonance (CMR) with extracellular volume (ECV) mapping has demonstrated accuracy in measuring cardiac, hepatic and splenic amyloid infiltration. Purpose We sought to: (1) assess the association between baseline multi-organ ECVs and prognosis (2) assess the multi-organ response to treatment using ECV mapping, and (3) assess the association between multi-organ treatment response and prognosis. Methods We identified 351 patients with a confirmed diagnosis of systemic AL amyloidosis who underwent baseline serum amyloid P component (SAP) scintigraphy and CMR at diagnosis, of which 171 had follow-up imaging. We also recruited 20 healthy volunteers who underwent CMR with ECV mapping, without corresponding SAP scintigraphy, to allow calculation of the ECV normal ranges. Results At diagnosis, ECV mapping demonstrated that 304(86.7%) had cardiac involvement, 114(32.5%) significant hepatic involvement and 147(41.9%) significant splenic involvement. Baseline myocardial and liver ECV independently predict mortality (myocardial: HR=1.05,95CI%[1.03–1.07],P<0.001; liver: HR=1.03,95%CI[1.01–1.05],P<0.001). Liver and spleen ECV correlated with amyloid load assessed by SAP scintigraphy (R=0.751,P<0.001; R=0.765,P<0.001, respectively). Serial multi-organ ECV measurements accurately tracked treatment response as validated against serial SAP scintigraphy (the current reference standard). Multi-organ ECV regression was observed as early as 6-months in patients with a good haematological response (liver=15%, spleen=15%, heart=5%). The remaining patients with a good haematological response had stable liver and spleen ECVs, but 20% had cardiac progression. By 12-months more patients with a good haematological response demonstrated cardiac regression (liver=30%, spleen=36%, heart=32%), and this trend was maintained at 24-months. Multi-variable analysis adjusting for haematological response, change in myocardial, liver and spleen ECV demonstrated that haematological response, change in myocardial ECV (HR=1.11, 95%CI[1.02–1.19], P=0.011) and liver ECV (HR=1.06, 95%CI[1.01–1.11], P=0.015) remained independent predictors of prognosis at 6-months. Conclusions Multi-organ ECV quantification accurately tracks treatment response, and demonstrates different rates of organ regression, with the liver and spleen regressing more rapidly than the heart. A good haematological response alone is likely to induce visceral organ stabilisation/regression, but may not be sufficient to induce myocardial stabilisation/regression. Liver and myocardial ECV at diagnosis and changes in ECV at 6-months independently predict mortality. ECV mapping offers a comprehensive multi-organ assessment of treatment response and accurate prognostication.
资金来源类型:无。背景:系统性轻链淀粉样变性通常累及肝脏、脾脏和心脏。心脏磁共振(CMR)与细胞外体积(ECV)作图已证明准确测量心脏，肝脏和脾脏淀粉样蛋白浸润。我们试图:(1)评估基线多器官ECV与预后之间的关系;(2)评估使用ECV作图的多器官对治疗的反应;(3)评估多器官治疗反应与预后之间的关系。方法选取351例确诊为全身性AL淀粉样变性的患者，在诊断时进行基线血清淀粉样蛋白P成分(SAP)显像和CMR检查，其中171例进行了随访。我们还招募了20名健康志愿者，他们在没有相应的SAP显像的情况下进行了CMR的ECV测绘，以计算ECV的正常范围。结果诊断时，ECV显像显示304例(86.7%)有心脏受累，114例(32.5%)有肝脏受累，147例(41.9%)有脾脏受累。基线心肌和肝脏ECV独立预测死亡率(心肌:HR=1.05, 95% ci %[1.03-1.07]，P<0.001;肝脏:HR = 1.03, 95% ci (1.01 - -1.05), P&肝移植;0.001)。肝和脾ECV与SAP显像评估的淀粉样蛋白负荷相关(R=0.751, p < 0.01;R = 0.765, P&肝移植;分别为0.001)。系列多器官ECV测量准确地跟踪治疗反应，并根据系列SAP扫描图(当前参考标准)进行验证。血液学反应良好(肝脏=15%，脾脏=15%，心脏=5%)的患者早在6个月时就观察到多器官ECV消退。其余血液学反应良好的患者有稳定的肝脏和脾脏ecv，但20%有心脏进展。到12个月时，更多血液学反应良好的患者表现出心脏退化(肝脏=30%，脾脏=36%，心脏=32%)，这一趋势在24个月时保持不变。校正血液学反应、心肌、肝脏和脾脏ECV变化的多变量分析显示，血液学反应、心肌ECV变化(HR=1.11, 95%CI[1.02-1.19]， P=0.011)和肝脏ECV (HR=1.06, 95%CI[1.01-1.11]， P=0.015)仍然是6个月预后的独立预测因子。结论多脏器ECV定量能准确追踪治疗反应，显示出不同的脏器退化率，肝脏和脾脏的退化速度快于心脏。仅良好的血液学反应可能诱导内脏器官稳定/消退，但可能不足以诱导心肌稳定/消退。诊断时肝脏和心肌ECV以及6个月时ECV的变化独立预测死亡率。ECV制图提供了一个全面的多器官评估治疗反应和准确的预后。
{"title":"Tracking multi-organ treatment response in systemic AL amyloidosis with cardiac magnetic resonance derived extracellular volume mapping","authors":"A Ioannou, R K Patel, Y Razvi, A Martinez-Naharro, A Porcari, L Venneri, D Hutt, H Lachmann, A Wechalekar, H Lachmann, P N Hawkins, J D Gillmore, M Fontana","doi":"10.1093/ehjci/jead119.004","DOIUrl":"https://doi.org/10.1093/ehjci/jead119.004","url":null,"abstract":"Abstract Funding Acknowledgements Type of funding sources: None. Background Systemic light-chain (AL) amyloidosis commonly involves the liver, spleen and heart. Cardiac magnetic resonance (CMR) with extracellular volume (ECV) mapping has demonstrated accuracy in measuring cardiac, hepatic and splenic amyloid infiltration. Purpose We sought to: (1) assess the association between baseline multi-organ ECVs and prognosis (2) assess the multi-organ response to treatment using ECV mapping, and (3) assess the association between multi-organ treatment response and prognosis. Methods We identified 351 patients with a confirmed diagnosis of systemic AL amyloidosis who underwent baseline serum amyloid P component (SAP) scintigraphy and CMR at diagnosis, of which 171 had follow-up imaging. We also recruited 20 healthy volunteers who underwent CMR with ECV mapping, without corresponding SAP scintigraphy, to allow calculation of the ECV normal ranges. Results At diagnosis, ECV mapping demonstrated that 304(86.7%) had cardiac involvement, 114(32.5%) significant hepatic involvement and 147(41.9%) significant splenic involvement. Baseline myocardial and liver ECV independently predict mortality (myocardial: HR=1.05,95CI%[1.03–1.07],P&lt;0.001; liver: HR=1.03,95%CI[1.01–1.05],P&lt;0.001). Liver and spleen ECV correlated with amyloid load assessed by SAP scintigraphy (R=0.751,P&lt;0.001; R=0.765,P&lt;0.001, respectively). Serial multi-organ ECV measurements accurately tracked treatment response as validated against serial SAP scintigraphy (the current reference standard). Multi-organ ECV regression was observed as early as 6-months in patients with a good haematological response (liver=15%, spleen=15%, heart=5%). The remaining patients with a good haematological response had stable liver and spleen ECVs, but 20% had cardiac progression. By 12-months more patients with a good haematological response demonstrated cardiac regression (liver=30%, spleen=36%, heart=32%), and this trend was maintained at 24-months. Multi-variable analysis adjusting for haematological response, change in myocardial, liver and spleen ECV demonstrated that haematological response, change in myocardial ECV (HR=1.11, 95%CI[1.02–1.19], P=0.011) and liver ECV (HR=1.06, 95%CI[1.01–1.11], P=0.015) remained independent predictors of prognosis at 6-months. Conclusions Multi-organ ECV quantification accurately tracks treatment response, and demonstrates different rates of organ regression, with the liver and spleen regressing more rapidly than the heart. A good haematological response alone is likely to induce visceral organ stabilisation/regression, but may not be sufficient to induce myocardial stabilisation/regression. Liver and myocardial ECV at diagnosis and changes in ECV at 6-months independently predict mortality. ECV mapping offers a comprehensive multi-organ assessment of treatment response and accurate prognostication.","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":"136161841","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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