Pub Date : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.430
M. Porumb, A. Mumith, S. Gao, A. Parker, A. Beqiri, R. Sarwar, R. Upton, P. Leeson, G. Woodward
Type of funding sources: None. Segmentation of cardiac structures in echocardiography is a pre-requisite for accurately assessing cardiac morphology and function. Manual or semi-automated segmentation are both routinely used in clinical practice, although these can be time-consuming, and can introduce high inter- and intra- operator variability resulting in decreased reproducibility. Effective contouring with no manual input has proven to be challenging due to variations in image quality, image noise, motion during the acquisition and the lack of a well-defined geometry. This work proposes a coordinate regression method for automated left ventricle (LV) segmentation, presented in Figure 1 (a). The proposed method is based on a modified U-net architecture that outputs the likelihood of coordinates of landmark points. The obtained likelihood heatmaps are converted to 2D coordinates using a differentiable spatial to numerical transform. The model was trained and validated on UK multisite data (1383 subjects) comprising apical 2 and 4 chamber views for both contrast and non-contrast echocardiographic images. The Cardiac Acquisitions for Multi-structure Ultrasound Segmentation (CAMUS) echocardiographic image segmentation database was used to assess the performance of the proposed method acting as data from a new clinical site. The CAMUS dataset comprises apical 2 and 4 chamber views acquired from 500 patients with manually annotated cardiac structures for end-diastole and end-systole frames. The original CAMUS dataset was split into training (450 patients) and testing (50 patients), with manual contours being available only for the training dataset. Therefore, we used the CAMUS training dataset to both test and improve our model, by using a random sample of 100 studies as an independent testing dataset and the remaining 350 studies were used for retraining the initial model to improve performance for this dataset. The results obtained on the testing images are presented in Figure 1 (b). When the model was trained using no CAMUS data for the LV segmentation, a mean Dice coefficient of 0.890 and a median of 0.911 was obtained. Including 350 studies with the original 1383 UK dataset and retraining the same model improved the average Dice coefficient to 0.930 and the median to 0.939. The CAMUS dataset authors reported the best average Dice coefficient of 0.924 on the 50 CAMUS testing images, therefore the proposed points regression method introduces a promising alternative to mask-based segmentation models. In conclusion, the auto-contouring framework has proven to be effective in terms of its performance and ability to generalise to new data. Furthermore, this work highlights the importance of both evaluating model performance on data from new clinical sites and also enhancing model performance. Abstract Figure.
{"title":"Site-specific automated contouring model generalisibiliy enhancement","authors":"M. Porumb, A. Mumith, S. Gao, A. Parker, A. Beqiri, R. Sarwar, R. Upton, P. Leeson, G. Woodward","doi":"10.1093/EHJCI/JEAA356.430","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.430","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Segmentation of cardiac structures in echocardiography is a pre-requisite for accurately assessing cardiac morphology and function. Manual or semi-automated segmentation are both routinely used in clinical practice, although these can be time-consuming, and can introduce high inter- and intra- operator variability resulting in decreased reproducibility. Effective contouring with no manual input has proven to be challenging due to variations in image quality, image noise, motion during the acquisition and the lack of a well-defined geometry.\u0000 \u0000 \u0000 \u0000 This work proposes a coordinate regression method for automated left ventricle (LV) segmentation, presented in Figure 1 (a). The proposed method is based on a modified U-net architecture that outputs the likelihood of coordinates of landmark points. The obtained likelihood heatmaps are converted to 2D coordinates using a differentiable spatial to numerical transform. The model was trained and validated on UK multisite data (1383 subjects) comprising apical 2 and 4 chamber views for both contrast and non-contrast echocardiographic images.\u0000 The Cardiac Acquisitions for Multi-structure Ultrasound Segmentation (CAMUS) echocardiographic image segmentation database was used to assess the performance of the proposed method acting as data from a new clinical site. The CAMUS dataset comprises apical 2 and 4 chamber views acquired from 500 patients with manually annotated cardiac structures for end-diastole and end-systole frames. The original CAMUS dataset was split into training (450 patients) and testing (50 patients), with manual contours being available only for the training dataset. Therefore, we used the CAMUS training dataset to both test and improve our model, by using a random sample of 100 studies as an independent testing dataset and the remaining 350 studies were used for retraining the initial model to improve performance for this dataset.\u0000 \u0000 \u0000 \u0000 The results obtained on the testing images are presented in Figure 1 (b). When the model was trained using no CAMUS data for the LV segmentation, a mean Dice coefficient of 0.890 and a median of 0.911 was obtained. Including 350 studies with the original 1383 UK dataset and retraining the same model improved the average Dice coefficient to 0.930 and the median to 0.939. The CAMUS dataset authors reported the best average Dice coefficient of 0.924 on the 50 CAMUS testing images, therefore the proposed points regression method introduces a promising alternative to mask-based segmentation models.\u0000 \u0000 \u0000 \u0000 In conclusion, the auto-contouring framework has proven to be effective in terms of its performance and ability to generalise to new data. Furthermore, this work highlights the importance of both evaluating model performance on data from new clinical sites and also enhancing model performance.\u0000 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82141583","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 : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.332
E. Conte, G. Lauri, C. Agalbato, A. D. Cia, S. Mushtaq, M. Mapelli, G. Teruzzi, M. Biondi, G. Pontone, M. Pepi, D. Andreini
Type of funding sources: None. Recurrent pericarditis complicates 30% of acute pericarditis cases. Aim of the present study is to evaluate the role of cardiac MRI in the identification of patients subgroup at higher risk of recurrent pericarditis. Material and methods From a registry of consecutive patients who underwent cardiac MRI from January 2014 to January 2019 we retrospectively selected a subgroup of patients with clinical diagnosis of pericarditis according ESC guidelines on pericardial disease, for which a recent (less the 2 months before cardiac MRI) transthoracic echocardiography was available. CMR protocol included bSSFP images, T2w images and LGE in all patients. Transthoracic echocardiography was considered to be positive for pericardial disease if pericardial effusion and/or sign of pericardial constriction were present; cardiac MRI was considered to be positive for pericardial disease if pericardial effusion and pericardial hyperintensity signal were detected on T2w or LGE images. Clinical follow-up was recorded for a composite end-point including new episodes of recurrent pericarditis and subsequent diagnosis of chronic constrictive pericarditis A total of 25 patients were included in this preliminary analysis of the study. Pericarditis etiology was unknow (idiopathic) in 17 (68%), related to systemic autoimmune disease in 5 patients (20%) and related to cancer in 3 patients (12%). In 6 patients (24%) a myopericarditis was diagnosed. According to predefined criteria 10 patients had echocardiography positive for pericardial disease (40%), while in 9 patients cardiac MRI was positive for pericardial inflammation (36%). Both echocardiography and cardiac MRI were positive in 5 patients (20%). At a mean follow-up of 35.4 ± 12.2 months a total of 9 recurrent pericarditis events were recorded. At multivariate analysis MRI positive for pericardial inflammation [HR (95%CI) 15.9 (2.7-95.5)] but not echocardiography positive for pericardial disease [HR (95%CI) 0.33 (0.1-1.5)] resulted to be associated to recurrent pericarditis at follow-up. Cardiac MRI positive for pericardial inflammation could identify patients that may merit more aggressive anti-inflammatory therapy to prevent recurrent pericarditis.
{"title":"Prognostic role of cardiac MRI in the evaluation of patients with pericarditis: a long-term follow-up study","authors":"E. Conte, G. Lauri, C. Agalbato, A. D. Cia, S. Mushtaq, M. Mapelli, G. Teruzzi, M. Biondi, G. Pontone, M. Pepi, D. Andreini","doi":"10.1093/EHJCI/JEAA356.332","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.332","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Recurrent pericarditis complicates 30% of acute pericarditis cases. Aim of the present study is to evaluate the role of cardiac MRI in the identification of patients subgroup at higher risk of recurrent pericarditis.\u0000 Material and methods\u0000 From a registry of consecutive patients who underwent cardiac MRI from January 2014 to January 2019 we retrospectively selected a subgroup of patients with clinical diagnosis of pericarditis according ESC guidelines on pericardial disease, for which a recent (less the 2 months before cardiac MRI) transthoracic echocardiography was available. CMR protocol included bSSFP images, T2w images and LGE in all patients. Transthoracic echocardiography was considered to be positive for pericardial disease if pericardial effusion and/or sign of pericardial constriction were present; cardiac MRI was considered to be positive for pericardial disease if pericardial effusion and pericardial hyperintensity signal were detected on T2w or LGE images. Clinical follow-up was recorded for a composite end-point including new episodes of recurrent pericarditis and subsequent diagnosis of chronic constrictive pericarditis\u0000 \u0000 \u0000 \u0000 A total of 25 patients were included in this preliminary analysis of the study. Pericarditis etiology was unknow (idiopathic) in 17 (68%), related to systemic autoimmune disease in 5 patients (20%) and related to cancer in 3 patients (12%). In 6 patients (24%) a myopericarditis was diagnosed. According to predefined criteria 10 patients had echocardiography positive for pericardial disease (40%), while in 9 patients cardiac MRI was positive for pericardial inflammation (36%). Both echocardiography and cardiac MRI were positive in 5 patients (20%). At a mean follow-up of 35.4 ± 12.2 months a total of 9 recurrent pericarditis events were recorded. At multivariate analysis MRI positive for pericardial inflammation [HR (95%CI) 15.9 (2.7-95.5)] but not echocardiography positive for pericardial disease [HR (95%CI) 0.33 (0.1-1.5)] resulted to be associated to recurrent pericarditis at follow-up.\u0000 \u0000 \u0000 \u0000 Cardiac MRI positive for pericardial inflammation could identify patients that may merit more aggressive anti-inflammatory therapy to prevent recurrent pericarditis.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83722713","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}
Type of funding sources: None. The haemodynamic effect of atrial septal defect (ASD) is a chronic volume overload of the right heart and pulmonary vasculature. Pulmonary overcirculation is generally compensated for by the right ventricular (RV) and pulmonary arterial (PA) reserve. However, in a subset of patients, prolonged pulmonary overcirculation insidiously induces obstructive pulmonary vasculopathy, which results in postoperative residual pulmonary arterial hypertension (PAH) after ASD closure. Postoperative PAH is a major concern because it is closely associated with poor outcomes and impaired quality of life. However, to date, no clinically robust predictors of postoperative residual PAH have been clearly identified. This study sought to assess the haemodynamic characteristics of ASD patients in terms of mechano-energetic parameters and to identify the predictors of postoperative residual PAH in these patients. A total of 120 ASD patients (age: 58 ± 17 years) and 46 normal controls were recruited. As previously reported, the simplified RV contraction pressure index (sRVCPI) was calculated as an index of RV external work by multiplying the tricuspid annular plane systolic excursion (TAPSE) by the pressure gradient between the RV and right atrium. RV- PA coupling was evaluated using TAPSE divided by PA systolic pressure as an index of the RV length-force relationship. These parameters were measured both at baseline and 6 months after ASD closure. As expected, baseline sRVCPI was significantly greater in patients with ASD than in controls (775 ± 298 vs. 335 ± 180 mm Hg • mm, P < 0.01), which indicated significant "RV overwork". As a result, RV-PA coupling in ASD patients was significantly impaired compared to that in controls (0.9 ± 0.8 vs. 3.5 ± 1.7 mm/mm Hg, P < 0.01). All 120 ASD patients underwent transcatheter or surgical shunt closure; 15 of them had residual PAH after closure. After 6 months, RV-PA coupling index significantly improved in patients without residual PAH, from 0.96 ± 0.81 to 1.27 ± 1.24 mm/mm Hg (P = 0.02). Furthermore, RV load was markedly reduced, with sRVCPI falling from 691 ± 258 to 434 ± 217 mm Hg • mm, P < 0.01). However, in patients with residual PAH, RV-PA coupling index deteriorated from 0.64 ± 0.23 to 0.53 ± 0.12 mm/mm Hg (P < 0.01). As a result, RV overload was not significantly relieved (sRVCPI; from 971 ± 382 to 783 ± 166 mm Hg • mm, P = 0.22). In a multivariate analysis, baseline pulmonary vascular resistance (hazard ratio 1.009; P < 0.01) and preoperative sRVPCI (hazard ratio 1.003; P < 0.01) revealed to be independent predictors of residual PAH. In terms of mechano-energetic function, preoperative "RV overwork" can be used as a robust predictor of an impaired RV-PA relationship in ASD patients. Moreover, periodic assessment of sRVPCI may contribute to the better management for patients with unrepaired ASD. Abstract Figure.
资金来源类型:无。房间隔缺损(ASD)的血流动力学影响是右心和肺血管的慢性容量过载。肺过度循环通常由右心室(RV)和肺动脉(PA)储备来补偿。然而，在一部分患者中，延长的肺过度循环会隐性地诱发阻塞性肺血管病变，从而导致ASD闭合后的术后残余肺动脉高压(PAH)。术后PAH是一个主要的问题，因为它与预后不良和生活质量受损密切相关。然而，到目前为止，还没有明确确定术后残留多环芳烃的临床可靠预测因素。本研究旨在从力学-能量参数方面评估ASD患者的血流动力学特征，并确定这些患者术后残留多环芳烃的预测因素。共招募120例ASD患者(年龄:58±17岁)和46例正常对照。如前所述，简化后的右心室收缩压力指数(sRVCPI)是通过将三尖瓣环面收缩偏移(TAPSE)乘以右心室与右心房之间的压力梯度来计算的。使用TAPSE除以PA收缩压作为RV长度-力关系的指标来评估RV- PA耦合。这些参数分别在基线和ASD关闭后6个月进行测量。正如预期的那样，ASD患者的sRVCPI基线明显高于对照组(775±298 vs. 335±180 mm Hg•mm, P < 0.01)，这表明存在明显的“RV过度工作”。结果，与对照组相比，ASD患者的RV-PA耦合明显受损(0.9±0.8 vs. 3.5±1.7 mm/mm Hg, P < 0.01)。所有120例ASD患者均接受了经导管或手术分流关闭术;闭合后残留多环芳烃15例。6个月后，无PAH残留患者的RV-PA偶联指数明显改善，由0.96±0.81降至1.27±1.24 mm/mm Hg (P = 0.02)。RV负荷显著降低，sRVCPI由691±258降至434±217 mm Hg•mm, P < 0.01)。而残留PAH患者，RV-PA耦合指数由0.64±0.23下降至0.53±0.12 mm/mm Hg (P < 0.01)。结果，RV过载没有明显缓解(sRVCPI;971±382 ~ 783±166 mm Hg•mm, P = 0.22)。在多变量分析中，基线肺血管阻力(风险比1.009;P < 0.01)和术前sRVPCI(风险比1.003;P < 0.01)为PAH残留的独立预测因子。在机械-能量功能方面，术前“RV过度工作”可以作为ASD患者RV- pa关系受损的可靠预测因子。此外，定期评估sRVPCI可能有助于更好地管理未修复的ASD患者。抽象的图。
{"title":"preoperative right ventricular overwork is a major determinant of residual pulmonary arterial hypertension in patients with repaired arterial septal defect","authors":"Makiko Suzuki, Yusuke Tanaka, Kentarou Yamashita, Ayu Shono, Keiko Sumimoto, Nao Shibata, S. Yokota, Kumiko Dokuni, Makiko Suto, Eriko Hisamatsu, Kensuke Matsumoto, Hiroshi Tanaka, K. Hirata","doi":"10.1093/EHJCI/JEAA356.416","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.416","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 The haemodynamic effect of atrial septal defect (ASD) is a chronic volume overload of the right heart and pulmonary vasculature. Pulmonary overcirculation is generally compensated for by the right ventricular (RV) and pulmonary arterial (PA) reserve. However, in a subset of patients, prolonged pulmonary overcirculation insidiously induces obstructive pulmonary vasculopathy, which results in postoperative residual pulmonary arterial hypertension (PAH) after ASD closure. Postoperative PAH is a major concern because it is closely associated with poor outcomes and impaired quality of life. However, to date, no clinically robust predictors of postoperative residual PAH have been clearly identified.\u0000 \u0000 \u0000 \u0000 This study sought to assess the haemodynamic characteristics of ASD patients in terms of mechano-energetic parameters and to identify the predictors of postoperative residual PAH in these patients.\u0000 \u0000 \u0000 \u0000 A total of 120 ASD patients (age: 58 ± 17 years) and 46 normal controls were recruited. As previously reported, the simplified RV contraction pressure index (sRVCPI) was calculated as an index of RV external work by multiplying the tricuspid annular plane systolic excursion (TAPSE) by the pressure gradient between the RV and right atrium. RV- PA coupling was evaluated using TAPSE divided by PA systolic pressure as an index of the RV length-force relationship. These parameters were measured both at baseline and 6 months after ASD closure.\u0000 \u0000 \u0000 \u0000 As expected, baseline sRVCPI was significantly greater in patients with ASD than in controls (775 ± 298 vs. 335 ± 180 mm Hg • mm, P < 0.01), which indicated significant \"RV overwork\". As a result, RV-PA coupling in ASD patients was significantly impaired compared to that in controls (0.9 ± 0.8 vs. 3.5 ± 1.7 mm/mm Hg, P < 0.01). All 120 ASD patients underwent transcatheter or surgical shunt closure; 15 of them had residual PAH after closure. After 6 months, RV-PA coupling index significantly improved in patients without residual PAH, from 0.96 ± 0.81 to 1.27 ± 1.24 mm/mm Hg (P = 0.02). Furthermore, RV load was markedly reduced, with sRVCPI falling from 691 ± 258 to 434 ± 217 mm Hg • mm, P < 0.01). However, in patients with residual PAH, RV-PA coupling index deteriorated from 0.64 ± 0.23 to 0.53 ± 0.12 mm/mm Hg (P < 0.01). As a result, RV overload was not significantly relieved (sRVCPI; from 971 ± 382 to 783 ± 166 mm Hg • mm, P = 0.22). In a multivariate analysis, baseline pulmonary vascular resistance (hazard ratio 1.009; P < 0.01) and preoperative sRVPCI (hazard ratio 1.003; P < 0.01) revealed to be independent predictors of residual PAH.\u0000 \u0000 \u0000 \u0000 In terms of mechano-energetic function, preoperative \"RV overwork\" can be used as a robust predictor of an impaired RV-PA relationship in ASD patients. Moreover, periodic assessment of sRVPCI may contribute to the better management for patients with unrepaired ASD.\u0000 Abstract Figure.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"16 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80400575","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 : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.402
A. Quattrone, Øyvind H. Lie, E. Nestaas, C. Lange, Kirsti Try, H. Lindberg, H. Skulstad, G. Erikssen, T. Edvardsen, K. Haugaa, M. Estensen
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): South-Eastern Norway Regional Health Authority Patients with tetralogy of Fallot (TOF) have a high survival rate 30 years after surgical repair, and generally enjoy a satisfactory quality of life. Many female patients experience pregnancy during adulthood, however the effects of pregnancy on the long-term cardiovascular outcome in this group of patients are not well known. We aimed to investigate the association of pregnancy and cardiac function with occurrence of ventricular arrhythmia (VA) in women operated for TOF. We included 80 patients recruited from the national database for patients diagnosed for TOF. All were examined with echocardiography, including strain echocardiography. We assessed mechanical dispersion of right ventricle (RV) as measure of heterogeneous contraction. Holter monitoring or implanted devices detected ventricular arrhythmias (VA), defined as non-sustained or sustained ventricular tachycardia or aborted cardiac arrest. Blood tests included N-terminal pro-brain natriuretic peptide (NT-proBNP). In all, 55 (69%) women had experienced pregnancy (age 40 ± 9 years, parity median 1, range 1-4), while 25 (31%) women were nulliparous. The mean age was lower in nulliparous compared to those with children (30 ± 9 vs 40 ± 9, p < 0.01). VA was more prevalent in women who had experienced pregnancy (n = 16, 94%) compared to nulliparous (n = 1, 6%) (p = 0.02), and importantly also when adjusted for age [adjusted OR 9.8 (95% CI 1.2-79.1), p = 0.02]. RV mechanical dispersion was more pronounced in patients with VA [39.2 ± 14 ms vs. 49.6 ± 8 ms, p = 0.009, adjusted OR 2.1 (95% CI 1.3 - 7.5), p = 0.01 adjusted for age]. Higher NT-proBNP was also a marker of VA [211 ng/L (127-836) vs. 139 ng/L (30-465), p = 0.007, adjusted OR 1.4 (95% CI 1.1 - 1.8) p = 0.017 adjusted for age]. NT-proBNP >182 ng/L (normal values < 170 ng/L) optimally detected women with VA (p = 0.019), also independent of age [OR 7.2 (95% CI 1.7-30.1), p = 0.007]. History of pregnancy was associated with higher prevalence of VA among women with surgically corrected TOF. Right ventricular mechanical dispersion and NT-proBNP were age independent markers of VA. These findings may have importance for risk stratification and preconception counselling of these patients.
{"title":"Impact of pregnancy and risk factors for ventricular arrhythmias in women operated for tetralogy of Fallot","authors":"A. Quattrone, Øyvind H. Lie, E. Nestaas, C. Lange, Kirsti Try, H. Lindberg, H. Skulstad, G. Erikssen, T. Edvardsen, K. Haugaa, M. Estensen","doi":"10.1093/EHJCI/JEAA356.402","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.402","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): South-Eastern Norway Regional Health Authority\u0000 \u0000 \u0000 \u0000 Patients with tetralogy of Fallot (TOF) have a high survival rate 30 years after surgical repair, and generally enjoy a satisfactory quality of life. Many female patients experience pregnancy during adulthood, however the effects of pregnancy on the long-term cardiovascular outcome in this group of patients are not well known.\u0000 \u0000 \u0000 \u0000 We aimed to investigate the association of pregnancy and cardiac function with occurrence of ventricular arrhythmia (VA) in women operated for TOF.\u0000 \u0000 \u0000 \u0000 We included 80 patients recruited from the national database for patients diagnosed for TOF. All were examined with echocardiography, including strain echocardiography. We assessed mechanical dispersion of right ventricle (RV) as measure of heterogeneous contraction. Holter monitoring or implanted devices detected ventricular arrhythmias (VA), defined as non-sustained or sustained ventricular tachycardia or aborted cardiac arrest. Blood tests included N-terminal pro-brain natriuretic peptide (NT-proBNP).\u0000 \u0000 \u0000 \u0000 In all, 55 (69%) women had experienced pregnancy (age 40 ± 9 years, parity median 1, range 1-4), while 25 (31%) women were nulliparous. The mean age was lower in nulliparous compared to those with children (30 ± 9 vs 40 ± 9, p < 0.01).\u0000 VA was more prevalent in women who had experienced pregnancy (n = 16, 94%) compared to nulliparous (n = 1, 6%) (p = 0.02), and importantly also when adjusted for age [adjusted OR 9.8 (95% CI 1.2-79.1), p = 0.02].\u0000 RV mechanical dispersion was more pronounced in patients with VA [39.2 ± 14 ms vs. 49.6 ± 8 ms, p = 0.009, adjusted OR 2.1 (95% CI 1.3 - 7.5), p = 0.01 adjusted for age]. Higher NT-proBNP was also a marker of VA [211 ng/L (127-836) vs. 139 ng/L (30-465), p = 0.007, adjusted OR 1.4 (95% CI 1.1 - 1.8) p = 0.017 adjusted for age]. NT-proBNP >182 ng/L (normal values < 170 ng/L) optimally detected women with VA (p = 0.019), also independent of age [OR 7.2 (95% CI 1.7-30.1), p = 0.007].\u0000 \u0000 \u0000 \u0000 History of pregnancy was associated with higher prevalence of VA among women with surgically corrected TOF. Right ventricular mechanical dispersion and NT-proBNP were age independent markers of VA. These findings may have importance for risk stratification and preconception counselling of these patients.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90981366","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 : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.258
S. Backhaus, T. Lange, B. Beuthner, Rodi Topci, Xiaoqing Wang, J. Kowallick, J. Lotz, T. Seidler, K. Toischer, E. Zeisberg, M. Puls, C. Jacobshagen, M. Uecker, G. Hasenfuß, A. Schuster
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Research Foundation (DFG, CRC 1002, D1) Myocardial fibrosis is a major determinant of outcome in aortic stenosis (AS). Novel fast real-time (RT) cardiac magnetic resonance (CMR) mapping techniques allow comprehensive quantification of fibrosis but have not yet been compared against standard techniques and histology. Patients with severe AS underwent CMR before (n = 110) and left ventricular (LV) endomyocardial biopsy (n = 46) at transcatheter aortic valve replacement (TAVR). Midventricular short axis (SAX) native, post-contrast T1 and extracellular volume fraction (ECV) maps were generated using commercially available MOLLI (native: 5(3)3, post-contrast: 4(1)3(1)2) and RT single-shot inversion recovery fast low-angle shot (FLASH) with radial undersampling. Focal late gadolinium enhancement was excluded from T1 and ECV regions of interest. ECV and LV mass were used to calculate LV matrix volumes. Variability and agreements were assessed between RT, MOLLI and histology using intraclass correlation coefficients, coefficients of variation and Bland Altman analyses. RT and MOLLI derived ECV were similar for midventricular SAX slice coverage (26.2 vs. 26.5, p = 0.073) and septal region of interest (26.2 vs. 26.5, p = 0.216). MOLLI native T1 time was in median 20 ms longer compared to RT (p < 0.001). Agreement between RT and MOLLI was best for ECV (ICC >0.91), excellent for post-contrast T1 times (ICC >0.81) and good for native T1 times (ICC >0.62). Diffuse collagen volume fraction by biopsies was in median 7.8%. ECV (RT r = 0.345, p = 0.039; MOLLI r = 0.40, p = 0.010) and LV matrix volumes (RT r = 0.45, p = 0.005; MOLLI r = 0.43, p = 0.007) were the only parameters associated with histology. RT mapping offers fast and sufficient ECV and LV matrix volume calculation in AS. ECV and LV matrix volume represent robust and universally comparable parameters with associations to histologically assessed fibrosis and may emerge as potential targets for clinical decision making.
资金来源类型:公共拨款-仅限国家预算。主要资金来源:德国研究基金会(DFG, CRC 1002, D1)心肌纤维化是主动脉瓣狭窄(AS)预后的主要决定因素。新的快速实时(RT)心脏磁共振(CMR)制图技术可以全面量化纤维化，但尚未与标准技术和组织学进行比较。严重AS患者在经导管主动脉瓣置换术(TAVR)前接受CMR (n = 110)和左心室(LV)心肌内膜活检(n = 46)。使用市售的MOLLI(原生:5(3)3，对比后:4(1)3(1)2)和RT单次反转恢复快速低角度拍摄(FLASH)，径向欠采样，生成中心室短轴(SAX)原生、对比后T1和细胞外体积分数(ECV)图。T1和ECV相关区域排除局灶性晚期钆强化。用ECV和LV质量计算LV矩阵体积。使用类内相关系数、变异系数和Bland Altman分析评估RT、MOLLI和组织学之间的可变性和一致性。RT和MOLLI衍生的ECV在中脑室SAX片覆盖范围(26.2 vs. 26.5, p = 0.073)和室间隔区(26.2 vs. 26.5, p = 0.216)方面相似。与RT相比，MOLLI原生T1时间中位数长20 ms (p 0.91)，在对比后T1时间(ICC >0.81)和原生T1时间(ICC >0.62)方面表现优异。活检所得弥漫性胶原体积分数中位数为7.8%。ECV (RT r = 0.345, p = 0.039;MOLLI r = 0.40, p = 0.010)和LV矩阵体积(RT r = 0.45, p = 0.005;MOLLI r = 0.43, p = 0.007)是与组织学相关的唯一参数。RT映射在AS中提供了快速、充分的ECV和LV矩阵体积计算。ECV和LV基质体积是与组织学纤维化评估相关的可靠且普遍可比较的参数，可能成为临床决策的潜在目标。
{"title":"Real-time cardiovascular magnetic resonance tissue characterisation in patients undergoing transcatheter aortic valve replacement","authors":"S. Backhaus, T. Lange, B. Beuthner, Rodi Topci, Xiaoqing Wang, J. Kowallick, J. Lotz, T. Seidler, K. Toischer, E. Zeisberg, M. Puls, C. Jacobshagen, M. Uecker, G. Hasenfuß, A. Schuster","doi":"10.1093/EHJCI/JEAA356.258","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.258","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Research Foundation (DFG, CRC 1002, D1)\u0000 \u0000 \u0000 \u0000 Myocardial fibrosis is a major determinant of outcome in aortic stenosis (AS). Novel fast real-time (RT) cardiac magnetic resonance (CMR) mapping techniques allow comprehensive quantification of fibrosis but have not yet been compared against standard techniques and histology.\u0000 \u0000 \u0000 \u0000 Patients with severe AS underwent CMR before (n = 110) and left ventricular (LV) endomyocardial biopsy (n = 46) at transcatheter aortic valve replacement (TAVR). Midventricular short axis (SAX) native, post-contrast T1 and extracellular volume fraction (ECV) maps were generated using commercially available MOLLI (native: 5(3)3, post-contrast: 4(1)3(1)2) and RT single-shot inversion recovery fast low-angle shot (FLASH) with radial undersampling. Focal late gadolinium enhancement was excluded from T1 and ECV regions of interest. ECV and LV mass were used to calculate LV matrix volumes. Variability and agreements were assessed between RT, MOLLI and histology using intraclass correlation coefficients, coefficients of variation and Bland Altman analyses.\u0000 \u0000 \u0000 \u0000 RT and MOLLI derived ECV were similar for midventricular SAX slice coverage (26.2 vs. 26.5, p = 0.073) and septal region of interest (26.2 vs. 26.5, p = 0.216). MOLLI native T1 time was in median 20 ms longer compared to RT (p < 0.001). Agreement between RT and MOLLI was best for ECV (ICC >0.91), excellent for post-contrast T1 times (ICC >0.81) and good for native T1 times (ICC >0.62). Diffuse collagen volume fraction by biopsies was in median 7.8%. ECV (RT r = 0.345, p = 0.039; MOLLI r = 0.40, p = 0.010) and LV matrix volumes (RT r = 0.45, p = 0.005; MOLLI r = 0.43, p = 0.007) were the only parameters associated with histology.\u0000 \u0000 \u0000 \u0000 RT mapping offers fast and sufficient ECV and LV matrix volume calculation in AS. ECV and LV matrix volume represent robust and universally comparable parameters with associations to histologically assessed fibrosis and may emerge as potential targets for clinical decision making.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90184251","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 : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.328
M. Martinho, A. R. Pereira, A. Marques, I. Cruz, R. Calé, A. Almeida, L. Lopes, C. Lourenço, D. Sebaiti, A. Briosa, J. Santos, B. Ferreira, H. Pereira
Type of funding sources: None. Acute myocarditis (AM) is generally a self-limited and benign disease. However, a minority of patients (pts) present or develop adverse outcomes. It has been proposed that the presence of late gadolinium enhancement (LGE) in the septum is associated with worse prognosis. Also, the presence of LGE without oedema in follow-up cardiac magnetic resonance imaging (CMR) seems to reflect more permanent lesions. The aim of this study was to determine if the presence of septal LGE in acute-phase CMR was associated with higher extent of disease in follow-up CMR and if initial laboratory tests help to predict the evolution to more permanent lesions. Prospective single-centre study of pts admitted with AM diagnosed according to clinical findings, troponin T elevation and CMR criteria (Lake Louise), since 1/2013. Selection of those who underwent acute-phase (CMR-I) and follow-up CMR (CMR-II). Of 88 pts admitted with AM, 46 fulfilled our inclusion criteria: median age 31 ± 13 years, 85% males. CMR-I was performed at 6 ± 5days and LGE was present in 43 pts (93.5%). CMR-II was performed at 8 ± 4.3 months and 29 pts (63%) improved the number of LGE-positive segments, 10 pts (21.8%) had stable disease and 7 pts (15.2%) worsened CMR findings. Septal-LGE was detected in 10 pts (21.7%) in CMR-I and in 6 pts (13.0%) in CMR-II. Logistic regression analysis identified septal-LGE in CMR-I as a predictor of higher extent of LGE in CMR-II (OR 1.4, 95%CI 1.1-1.9, p = 0.020). Although median values of maximum high-sensitivity troponin and reactive-C protein (RCP) were not associated with septal LGE in CMR-I, increasing values of such tests were univariate predictors of a higher likelihood of septal involvement in CMR-II: maximum troponin (886 vs 1852ng/L; OR 1.00, 95%CI 1.00-1.00 p = 0.017) and RCP (4.2 vs 13.9mg/dL; OR 1.17, 95%CI 1.04-1.33, p = 0.012). After multivariate analysis, RCP was the independent predictor of septal LGE in CMR-II (AUC 80.8, 0.97-0.91, p = 0.012). RCP cut-off value >10.2mg/dL identified patients with septal LGE in CMR-II with a sensitivity and specificity of 83.3% and 85.0%, respectively. The presence of cardiovascular risk factors, clinical presentation and B-type natriuretic peptide values were not predictors of septal LGE in either CMR. In a mean clinical follow-up of 757 ± 476days, no patient died, 3 pts (6.5%) developed new-onset heart failure (NYHA class II functional symptoms) and 2 pts (4.3%) developed ventricular arrhythmias. Due to a small number of adverse events, neither laboratory tests nor LGE septal pattern predicted adverse outcomes. In this population, septal LGE pattern was able to predict higher extent of LGE in follow-up CMR. Increased cardiac biomarkers and inflammatory proteins in the acute setting were also associated with septal involvement in follow-up and can potentially help to establish the risk of adverse events for patients admitted with acute myoca
资金来源类型:无。急性心肌炎(AM)通常是一种自限性的良性疾病。然而，少数患者(患者)出现或发展不良后果。有人提出，中隔出现晚期钆增强(LGE)与较差的预后有关。此外，在随访的心脏磁共振成像(CMR)中，无水肿的LGE的存在似乎反映了更多的永久性病变。本研究的目的是确定急性期CMR中间隔LGE的存在是否与后续CMR中更高程度的疾病相关，以及最初的实验室检查是否有助于预测演变为更永久性的病变。2013年1月以来，根据临床表现、肌钙蛋白T升高和CMR标准(Lake Louise)诊断为AM的住院患者的前瞻性单中心研究。选择急性期(CMR- i)和随访期(CMR- ii)患者。88例AM患者中，46例符合纳入标准:中位年龄31±13岁，85%为男性。cmr - 1在6±5天进行，43例(93.5%)患者存在LGE。CMR- ii在8±4.3个月时进行，29例(63%)患者的lge阳性节段数量得到改善，10例(21.8%)患者病情稳定，7例(15.2%)患者的CMR结果恶化。在CMR-I和CMR-II中分别有10例(21.7%)和6例(13.0%)检测到间隔lge。Logistic回归分析发现，CMR-I的间隔期LGE是CMR-II中LGE程度较高的预测因子(OR 1.4, 95%CI 1.1-1.9, p = 0.020)。尽管在CMR-I中，最大高敏感性肌钙蛋白和反应- c蛋白(RCP)的中位数与室间隔LGE无关，但这些测试值的增加是CMR-II中较高的室间隔受损伤可能性的单变量预测因子:最大肌钙蛋白(886 vs 1852ng/L;OR 1.00, 95%CI 1.00-1.00 p = 0.017)和RCP (4.2 vs 13.9mg/dL;OR 1.17, 95%CI 1.04-1.33, p = 0.012)。经多因素分析，RCP是CMR-II中间隔LGE的独立预测因子(AUC 80.8, 0.97-0.91, p = 0.012)。RCP临界值>10.2mg/dL在CMR-II中识别室间隔LGE患者的敏感性和特异性分别为83.3%和85.0%。心血管危险因素的存在、临床表现和b型利钠肽值都不是CMR中室间隔LGE的预测因子。在平均757±476天的临床随访中，无患者死亡，3名患者(6.5%)出现新发心力衰竭(NYHA II类功能症状)，2名患者(4.3%)出现室性心律失常。由于少数不良事件，实验室检查和LGE间隔模式都不能预测不良结果。在该人群中，间隔LGE模式能够预测随访CMR中较高程度的LGE。在随访中，急性环境中心脏生物标志物和炎症蛋白的增加也与中隔受损伤有关，可能有助于确定急性心肌炎患者不良事件的风险。
{"title":"Predictors of the presence of septal late gadolinium enhancement in follow-up cardiac magnetic resonance imaging and its relation to acute myocarditis prognosis","authors":"M. Martinho, A. R. Pereira, A. Marques, I. Cruz, R. Calé, A. Almeida, L. Lopes, C. Lourenço, D. Sebaiti, A. Briosa, J. Santos, B. Ferreira, H. Pereira","doi":"10.1093/EHJCI/JEAA356.328","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.328","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Acute myocarditis (AM) is generally a self-limited and benign disease. However, a minority of patients (pts) present or develop adverse outcomes. It has been proposed that the presence of late gadolinium enhancement (LGE) in the septum is associated with worse prognosis. Also, the presence of LGE without oedema in follow-up cardiac magnetic resonance imaging (CMR) seems to reflect more permanent lesions.\u0000 \u0000 \u0000 \u0000 The aim of this study was to determine if the presence of septal LGE in acute-phase CMR was associated with higher extent of disease in follow-up CMR and if initial laboratory tests help to predict the evolution to more permanent lesions.\u0000 \u0000 \u0000 \u0000 Prospective single-centre study of pts admitted with AM diagnosed according to clinical findings, troponin T elevation and CMR criteria (Lake Louise), since 1/2013. Selection of those who underwent acute-phase (CMR-I) and follow-up CMR (CMR-II).\u0000 \u0000 \u0000 \u0000 Of 88 pts admitted with AM, 46 fulfilled our inclusion criteria: median age 31 ± 13 years, 85% males. CMR-I was performed at 6 ± 5days and LGE was present in 43 pts (93.5%). CMR-II was performed at 8 ± 4.3 months and 29 pts (63%) improved the number of LGE-positive segments, 10 pts (21.8%) had stable disease and 7 pts (15.2%) worsened CMR findings. Septal-LGE was detected in 10 pts (21.7%) in CMR-I and in 6 pts (13.0%) in CMR-II. Logistic regression analysis identified septal-LGE in CMR-I as a predictor of higher extent of LGE in CMR-II (OR 1.4, 95%CI 1.1-1.9, p = 0.020). Although median values of maximum high-sensitivity troponin and reactive-C protein (RCP) were not associated with septal LGE in CMR-I, increasing values of such tests were univariate predictors of a higher likelihood of septal involvement in CMR-II: maximum troponin (886 vs 1852ng/L; OR 1.00, 95%CI 1.00-1.00 p = 0.017) and RCP (4.2 vs 13.9mg/dL; OR 1.17, 95%CI 1.04-1.33, p = 0.012). After multivariate analysis, RCP was the independent predictor of septal LGE in CMR-II (AUC 80.8, 0.97-0.91, p = 0.012). RCP cut-off value >10.2mg/dL identified patients with septal LGE in CMR-II with a sensitivity and specificity of 83.3% and 85.0%, respectively. The presence of cardiovascular risk factors, clinical presentation and B-type natriuretic peptide values were not predictors of septal LGE in either CMR. In a mean clinical follow-up of 757 ± 476days, no patient died, 3 pts (6.5%) developed new-onset heart failure (NYHA class II functional symptoms) and 2 pts (4.3%) developed ventricular arrhythmias. Due to a small number of adverse events, neither laboratory tests nor LGE septal pattern predicted adverse outcomes.\u0000 \u0000 \u0000 \u0000 In this population, septal LGE pattern was able to predict higher extent of LGE in follow-up CMR. Increased cardiac biomarkers and inflammatory proteins in the acute setting were also associated with septal involvement in follow-up and can potentially help to establish the risk of adverse events for patients admitted with acute myoca","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79010012","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 : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.172
D. Lisi, G. Manno, F. A. Immordino, R. Intravaia, D. Calcullo, G. Alagna, M. Lunetta, A. Russo, G. Novo
Type of funding sources: None. The aim of our study was to assess subclinical cardiac effects of anthracyclines (ANTs) in women treated for breast cancer (BC). We enrolled 46 female patients with BC undergoing adjuvant treatment with anthracycline-containing chemotherapy (CT) followed by taxane (paclitaxel/docetaxel). Patients underwent physical examination, electrocardiogram (ECG) and standard transthoracic echocardiography (TTE) including evaluation of diastolic and systolic function, measured as left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (GLS) and myocardial work (MW) expressed as global work index (GWI), global constructive work (GCW), global work waste (GWW), and global work efficiency (GWE). The parameters were measured at baseline (T0) and at 3 months (T1) and 6 months (T2) follow up. All patients completed the chemotherapy cycles. No significant cardiovascular adverse events were observed during treatment. Neither 2D left ventricular ejection fraction (LVEF) nor E/e’ ratio evaluation at TDI were significantly changed after treatment. Conversely, GLS was significantly reduced at T1 and T2 since baseline (GLS - 19,99 % IQR -20,6 -19,3 % at T0 vs -17,88 % IQR -18,8 -16,9 % at T1, p< 0,00 1 and -16,71 % IQR 17,6 -15,7 % at T2, p< 0,001). Consensually, a significant reduction in myocardial work was also measured (GWI 2115 mmHg% IQR 1888 – 2342 mmHg% at T0 vs 1714 mmHg% IQR 1557 – 1870 mmHg% at T1, p< 0,0001 and 1694 mmHg% IQR 1482 – 1907 mmHg% at T2, p< 0,0001). Our study demonstrates that evaluation of myocardial work allows very early detection of subclinical cardiac damage induced by chemotherapy, consensually to the reduction of the GLS. A multiparametric assessment of the myocardial function, including myocardial work and GLS, could improve the accuracy of risk stratification of cardiotoxicity in patients undergoing ANTs treatment.
{"title":"Use of myocardial work for multiparametric detection of subclinical anthracycline cardiotoxicity in breast cancer patients","authors":"D. Lisi, G. Manno, F. A. Immordino, R. Intravaia, D. Calcullo, G. Alagna, M. Lunetta, A. Russo, G. Novo","doi":"10.1093/EHJCI/JEAA356.172","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.172","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 The aim of our study was to assess subclinical cardiac effects of anthracyclines (ANTs) in women treated for breast cancer (BC).\u0000 \u0000 \u0000 \u0000 We enrolled 46 female patients with BC undergoing adjuvant treatment with anthracycline-containing chemotherapy (CT) followed by taxane (paclitaxel/docetaxel). Patients underwent physical examination, electrocardiogram (ECG) and standard transthoracic echocardiography (TTE) including evaluation of diastolic and systolic function, measured as left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (GLS) and myocardial work (MW) expressed as global work index (GWI), global constructive work (GCW), global work waste (GWW), and global work efficiency (GWE). The parameters were measured at baseline (T0) and at 3 months (T1) and 6 months (T2) follow up.\u0000 \u0000 \u0000 \u0000 All patients completed the chemotherapy cycles. No significant cardiovascular adverse events were observed during treatment. Neither 2D left ventricular ejection fraction (LVEF) nor E/e’ ratio evaluation at TDI were significantly changed after treatment. Conversely, GLS was significantly reduced at T1 and T2 since baseline (GLS - 19,99 % IQR -20,6 -19,3 % at T0 vs -17,88 % IQR -18,8 -16,9 % at T1, p< 0,00 1 and -16,71 % IQR 17,6 -15,7 % at T2, p< 0,001). Consensually, a significant reduction in myocardial work was also measured (GWI 2115 mmHg% IQR 1888 – 2342 mmHg% at T0 vs 1714 mmHg% IQR 1557 – 1870 mmHg% at T1, p< 0,0001 and 1694 mmHg% IQR 1482 – 1907 mmHg% at T2, p< 0,0001).\u0000 \u0000 \u0000 \u0000 Our study demonstrates that evaluation of myocardial work allows very early detection of subclinical cardiac damage induced by chemotherapy, consensually to the reduction of the GLS. A multiparametric assessment of the myocardial function, including myocardial work and GLS, could improve the accuracy of risk stratification of cardiotoxicity in patients undergoing ANTs treatment.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"162 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77487289","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 : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.371
Y. Varlamova, K. Zavadovsky, I. Kisteneva, S. Sazonova, R. Batalov
Type of funding sources: Foundation. Main funding source(s): Russian Science Foundation To date, radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is a valuable treatment option. So far there are no clear predictors of the effectiveness of AF ablation. Nowadays, the association of cardiac sympathetic nervous system and the development and maintenance of AF has been showed. The association between сardiac sympathetic system impairment, assessed by 123I-MIBG scintigraphy and RFCA effectiveness was shown previously. However, the is lack of data concerning to prognostic value of MIBG scintigraphy in patients with different forms of AF – persistent (PAF) and long-standing persistent (LSPAF). To study the prognostic significance of 123I-MIBG scintigraphy in RFCA efficacy in patients with persistent and long-standing persistent AF. The study enrolled 36 patients with drug-resistant AF (both persistent (n = 20) and long-standing persistent (n = 16) forms). All patients had comorbidity as chronic coronary syndrome and hypertension. A comparison group (n = 10) was also enrolled in the study. It includes patients with chronic coronary syndrome and arterial hypertension (without arrhythmia). All patients underwent 123I-MIBG and 99mTc-MIBI scintigraphy to evaluate the cardiac sympathetic activity and myocardial perfusion, respectively. Patients with AF performed RFCA. After of 1 year follow-up patients were examined for AF recurrence. The AF recurrence was considered to be an AF of at least 30 sec duration on a 12-lead ECG or on the Holter monitoring. During the follow-up period, AF recurrences were reported in 7 (35%) PAF patients and in 8 (50%) LSPAF patients. According to multivariate analysis only a high pre-ablation washout rate of 123I-MIBG (WR) in PAF patients (OR: 1.668; 95% CI: 1.093–2.548) and large pre-ablation 123I-MIBG/99mTc-MIBI mismatch score in LSPAF patients (OR: 2.155; 95% CI: 1.192–3.897) were independent predictors of AF recurrence after RFCA. ROC analysis indicated that in PAF patients with higher WR ≥ 20.8% (AUC: 0.968; Sensitivity: 100 %; Specificity: 45%; p < 0.05) and LSPAF patients with larger 123I-MIBG/99mTc-MIBI mismatch score ≥ 12.5 % (AUC: 0.942; Sensitivity: 81 %; Specificity: 28 %; p < 0.05) had a higher risk of AF recurrence after RFCA. In AF patients the incidence of arrhythmia recurrence after RFCA is associated with impaired cardiac sympathetic nervous activity. In PAF patients the values of 123I-MIBG washout rate can predict AF recurrence. In LSPAF patients innervation/perfusion mismatch has prognostic value in terms of AF recurrence.
{"title":"Prognosis of atrial fibrillation radiofrequency ablation: Iodine-123-MIBG cardiac innervation imaging","authors":"Y. Varlamova, K. Zavadovsky, I. Kisteneva, S. Sazonova, R. Batalov","doi":"10.1093/EHJCI/JEAA356.371","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.371","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: Foundation. Main funding source(s): Russian Science Foundation\u0000 \u0000 \u0000 \u0000 To date, radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF) is a valuable treatment option. So far there are no clear predictors of the effectiveness of AF ablation. Nowadays, the association of cardiac sympathetic nervous system and the development and maintenance of AF has been showed. The association between сardiac sympathetic system impairment, assessed by 123I-MIBG scintigraphy and RFCA effectiveness was shown previously. However, the is lack of data concerning to prognostic value of MIBG scintigraphy in patients with different forms of AF – persistent (PAF) and long-standing persistent (LSPAF).\u0000 \u0000 \u0000 \u0000 To study the prognostic significance of 123I-MIBG scintigraphy in RFCA efficacy in patients with persistent and long-standing persistent AF.\u0000 \u0000 \u0000 \u0000 The study enrolled 36 patients with drug-resistant AF (both persistent (n = 20) and long-standing persistent (n = 16) forms). All patients had comorbidity as chronic coronary syndrome and hypertension. A comparison group (n = 10) was also enrolled in the study. It includes patients with chronic coronary syndrome and arterial hypertension (without arrhythmia). All patients underwent 123I-MIBG and 99mTc-MIBI scintigraphy to evaluate the cardiac sympathetic activity and myocardial perfusion, respectively. Patients with AF performed RFCA. After of 1 year follow-up patients were examined for AF recurrence. The AF recurrence was considered to be an AF of at least 30 sec duration on a 12-lead ECG or on the Holter monitoring.\u0000 \u0000 \u0000 \u0000 During the follow-up period, AF recurrences were reported in 7 (35%) PAF patients and in 8 (50%) LSPAF patients. According to multivariate analysis only a high pre-ablation washout rate of 123I-MIBG (WR) in PAF patients (OR: 1.668; 95% CI: 1.093–2.548) and large pre-ablation 123I-MIBG/99mTc-MIBI mismatch score in LSPAF patients (OR: 2.155; 95% CI: 1.192–3.897) were independent predictors of AF recurrence after RFCA. ROC analysis indicated that in PAF patients with higher WR ≥ 20.8% (AUC: 0.968; Sensitivity: 100 %; Specificity: 45%; p < 0.05) and LSPAF patients with larger 123I-MIBG/99mTc-MIBI mismatch score ≥ 12.5 % (AUC: 0.942; Sensitivity: 81 %; Specificity: 28 %; p < 0.05) had a higher risk of AF recurrence after RFCA.\u0000 \u0000 \u0000 \u0000 In AF patients the incidence of arrhythmia recurrence after RFCA is associated with impaired cardiac sympathetic nervous activity. In PAF patients the values of 123I-MIBG washout rate can predict AF recurrence. In LSPAF patients innervation/perfusion mismatch has prognostic value in terms of AF recurrence.\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88476185","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 : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.109
I. Jafaripour, Z. Aryanian, S. Hosseinzadeh, R. Pourkia, MM Ansari Ramandi, A Kebria Shirzadian, S. Tabari, M. Pourkia
Type of funding sources: None. Lichen planus (LP) which is a chronic inflammatory disease can cause impaired atrial electromechanical coupling, leading to increased risk of atrial fibrillation. The present study aimed to evaluate atrial electromechanical coupling in LP patients by using electrocardiography (ECG) and echocardiography. Forty-six LP patients were investigated in this cross-sectional case-control study. The control group comprised healthy individuals selected in age and gender-matched manner. Echocardiography and ECG were done for all patients to show inter and intra-atrial electromechanical delays and P wave dispersion respectively. The electromechanical delays were calculated by using the difference between the delays from the onset of the P wave on ECG to the onset of A wave on tissue Doppler recordings of the different areas. The baseline characteristics of the case and control group were similar and did not differ significantly. The P wave dispersion was 45.63 ± 3.48 milliseconds in the LP group in comparison to 36.56 ± 2.87 milliseconds in the control group (p < 0.001). As shown in the table, the intra and inter-atrial electromechanical delays were also significantly prolonged in LP patients when compared to the control group (p < 0.001). There was no significant difference between the left and right ventricular systolic function and diastolic function of the two groups. The results of the study indicate the presence of significant impaired atrial electromechanical coupling in patients with LP confirmed by both electrocardiographic and echocardiographic tools. Electromechanical delays Case N = 46 (mean ± SD) Control N = 46 (mean ± SD) P value Septal - PA (msec) 59.71 ± 13.24 44.39 ± 11.07 0.002 Lateral - PA (msec) 55.71 ± 13.26 48.89 ± 11.21 0.009 Tricuspid - PA (msec) 52.37 ± 13.12 43.28 ± 10.58 0.002 Inter-atrial delay (msec) (lateral PA−RV PA) 8.47 ± 1.62 6.37 ± 1.36 <0.001 Intra-atrial delay (msec) (LA) [lateral PA−septal PA] 4.80 ± 1.48 3.83 ± 0.82 <0.001 Intra-atrial delay (msec) (RA) [septal PA−RV PA] 3.91 ± 0.96 2.02 ± 0.71 <0.001 PA Delay from the onset of the P wave on ECG to the onset of A wave on tissue Doppler, N: number, SD: Standard Deviation, LA: Left Atrium, RA: Right Atrium, RV: Right Ventricle
{"title":"Impaired atrial electromechanical coupling in lichen planus patients","authors":"I. Jafaripour, Z. Aryanian, S. Hosseinzadeh, R. Pourkia, MM Ansari Ramandi, A Kebria Shirzadian, S. Tabari, M. Pourkia","doi":"10.1093/EHJCI/JEAA356.109","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.109","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Lichen planus (LP) which is a chronic inflammatory disease can cause impaired atrial electromechanical coupling, leading to increased risk of atrial fibrillation.\u0000 \u0000 \u0000 \u0000 The present study aimed to evaluate atrial electromechanical coupling in LP patients by using electrocardiography (ECG) and echocardiography.\u0000 \u0000 \u0000 \u0000 Forty-six LP patients were investigated in this cross-sectional case-control study. The control group comprised healthy individuals selected in age and gender-matched manner. Echocardiography and ECG were done for all patients to show inter and intra-atrial electromechanical delays and P wave dispersion respectively. The electromechanical delays were calculated by using the difference between the delays from the onset of the P wave on ECG to the onset of A wave on tissue Doppler recordings of the different areas.\u0000 \u0000 \u0000 \u0000 The baseline characteristics of the case and control group were similar and did not differ significantly. The P wave dispersion was 45.63 ± 3.48 milliseconds in the LP group in comparison to 36.56 ± 2.87 milliseconds in the control group (p < 0.001). As shown in the table, the intra and inter-atrial electromechanical delays were also significantly prolonged in LP patients when compared to the control group (p < 0.001). There was no significant difference between the left and right ventricular systolic function and diastolic function of the two groups.\u0000 \u0000 \u0000 \u0000 The results of the study indicate the presence of significant impaired atrial electromechanical coupling in patients with LP confirmed by both electrocardiographic and echocardiographic tools.\u0000 Electromechanical delays Case N = 46 (mean ± SD) Control N = 46 (mean ± SD) P value Septal - PA (msec) 59.71 ± 13.24 44.39 ± 11.07 0.002 Lateral - PA (msec) 55.71 ± 13.26 48.89 ± 11.21 0.009 Tricuspid - PA (msec) 52.37 ± 13.12 43.28 ± 10.58 0.002 Inter-atrial delay (msec) (lateral PA−RV PA) 8.47 ± 1.62 6.37 ± 1.36 <0.001 Intra-atrial delay (msec) (LA) [lateral PA−septal PA] 4.80 ± 1.48 3.83 ± 0.82 <0.001 Intra-atrial delay (msec) (RA) [septal PA−RV PA] 3.91 ± 0.96 2.02 ± 0.71 <0.001 PA Delay from the onset of the P wave on ECG to the onset of A wave on tissue Doppler, N: number, SD: Standard Deviation, LA: Left Atrium, RA: Right Atrium, RV: Right Ventricle\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74985780","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 : 2021-02-08DOI: 10.1093/EHJCI/JEAA356.198
L. Moderato, S. Binno, G. Rusticali, C. Dallospedale, D. Aschieri, G. Pastorini, M. Piepoli
Type of funding sources: None. Dipyridamole stress echocardiography (DSE) is an important tool for detecting reversible ischemia in patients with suspected coronary artery disease (CAD); nonetheless, the results of the test are related to wall motion abnormalities, moderately operator-dependent, and left anterior descending (LAD) artery reserve, resulting in a moderate sensibility and specificity. Aim Of our study was to evaluate whether an easy-to-use parameter like mitral annular plane systolic excursion (MAPSE) could be useful to identify CAD during DSE. We prospectively enrolled 512 patients that underwent DSE for suspected CAD; rest and peak MAPSE was acquired; 148 patients were referred to perform coronary angiography, with evidence of severe coronary stenosis in 91 patients. The mean age was 66.7 ±11 years, male gender was prevalent (64%). MAPSE at the peak was significantly different between patients with CAD and patient without (13,4mm vs 16,81 mm , p < 0.001); in fact, patients with CAD showed a blunted or no increase of MAPSE after dipyridamole infusion, with a significative difference in Delta Mapse (Mapse peak-Mapse rest) between groups ( -0.5mm vs 2.8mm) By using a Receiver Operating Curve, the Area under the curve was 0,764 (0.682-0.846), with the best cut-off value of +0.5mm (Sensibility 77%, Specificity 62% - Figure 1), comparabale with traditional methods like LAD reserve, FE reduction or Wall Motion Score Index. to our knowledge, this is the first study that compared the behavior of MAPSE during dipyridamole infusion in patients with and without coronary artery disease. MAPSE is a well-known surrogate of longitudinal systolic function and has increased sensitivity over traditional methods of systolic performance such as LV-EF: in this context, dipyridamole induced reversible ischemia could affect prematurely MAPSE then EF or wall motion abnormalities. In our study, in patients with evidence of reversible ischemia during DSE, a blunted or no increase of MAPSE was able to predict CAD. Incorporating this easy-to-use parameter could improve the specificity of DSE and strengthen the suspect of reversible ischemia when clear wall motion abnormalities are not found. Abstract Figure. Mean value of Mapse and ROC curve
资金来源类型:无。双嘧达莫应激超声心动图(DSE)是检测疑似冠状动脉疾病(CAD)患者可逆性缺血的重要工具;尽管如此，该测试结果与壁运动异常、中度依赖于操作者和左前降支(LAD)动脉储备有关，因此具有中等的敏感性和特异性。本研究的目的是评估二尖瓣环状平面收缩偏移(MAPSE)等易于使用的参数是否有助于识别DSE期间的CAD。我们前瞻性地招募了512例因疑似CAD而行DSE的患者;获得休息和峰值MAPSE;148例患者行冠状动脉造影，其中91例患者存在严重冠状动脉狭窄。平均年龄66.7±11岁，男性居多(64%)。冠心病患者与非冠心病患者的峰值MAPSE差异显著(13.4 mm vs 16.81 mm, p < 0.001);事实上，CAD患者在输注双吡达摩后，MAPSE表现为钝化或无增加，两组间Delta MAPSE (MAPSE峰- MAPSE息)差异显著(-0.5mm vs . 2.8mm)。通过Receiver Operating Curve，曲线下面积为0.764(0.682-0.846)，最佳截断值为+0.5mm(敏感性77%，特异性62% -图1)，与传统的LAD储备、FE还原或Wall Motion Score Index等方法相当。据我们所知，这是第一个比较有冠状动脉疾病和无冠状动脉疾病患者输注双嘧达莫期间MAPSE行为的研究。MAPSE是一种众所周知的纵向收缩功能替代物，与传统的收缩性能方法(如LV-EF)相比，它具有更高的敏感性:在这种情况下，双嘧达莫诱导的可逆性缺血可能会过早影响MAPSE，进而影响EF或壁运动异常。在我们的研究中，在DSE期间有可逆性缺血证据的患者中，MAPSE减弱或不增加能够预测CAD。结合这个易于使用的参数可以提高DSE的特异性，并在没有发现明显的壁运动异常时加强对可逆性缺血的怀疑。抽象的图。Mapse和ROC曲线的平均值
{"title":"Mitral anular plane excursion predicts coronary stenosis during stress echocardiography with dipyridamole","authors":"L. Moderato, S. Binno, G. Rusticali, C. Dallospedale, D. Aschieri, G. Pastorini, M. Piepoli","doi":"10.1093/EHJCI/JEAA356.198","DOIUrl":"https://doi.org/10.1093/EHJCI/JEAA356.198","url":null,"abstract":"\u0000 \u0000 \u0000 Type of funding sources: None.\u0000 \u0000 \u0000 \u0000 Dipyridamole stress echocardiography (DSE) is an important tool for detecting reversible ischemia in patients with suspected coronary artery disease (CAD); nonetheless, the results of the test are related to wall motion abnormalities, moderately operator-dependent, and left anterior descending (LAD) artery reserve, resulting in a moderate sensibility and specificity. \u0000 \u0000 \u0000 \u0000 Aim Of our study was to evaluate whether an easy-to-use parameter like mitral annular plane systolic excursion (MAPSE) could be useful to identify CAD during DSE. \u0000 \u0000 \u0000 \u0000 We prospectively enrolled 512 patients that underwent DSE for suspected CAD; rest and peak MAPSE was acquired; 148 patients were referred to perform coronary angiography, with evidence of severe coronary stenosis in 91 patients. \u0000 The mean age was 66.7 ±11 years, male gender was prevalent (64%). \u0000 MAPSE at the peak was significantly different between patients with CAD and patient without (13,4mm vs 16,81 mm , p < 0.001); in fact, patients with CAD showed a blunted or no increase of MAPSE after dipyridamole infusion, with a significative difference in Delta Mapse (Mapse peak-Mapse rest) between groups ( -0.5mm vs 2.8mm) By using a Receiver Operating Curve, the Area under the curve was 0,764 (0.682-0.846), with the best cut-off value of +0.5mm (Sensibility 77%, Specificity 62% - Figure 1), comparabale with traditional methods like LAD reserve, FE reduction or Wall Motion Score Index. \u0000 \u0000 \u0000 \u0000 to our knowledge, this is the first study that compared the behavior of MAPSE during dipyridamole infusion in patients with and without coronary artery disease. MAPSE is a well-known surrogate of longitudinal systolic function and has increased sensitivity over traditional methods of systolic performance such as LV-EF: in this context, dipyridamole induced reversible ischemia could affect prematurely MAPSE then EF or wall motion abnormalities.\u0000 In our study, in patients with evidence of reversible ischemia during DSE, a blunted or no increase of MAPSE was able to predict CAD. Incorporating this easy-to-use parameter could improve the specificity of DSE and strengthen the suspect of reversible ischemia when clear wall motion abnormalities are not found.\u0000 Abstract Figure. Mean value of Mapse and ROC curve\u0000","PeriodicalId":11963,"journal":{"name":"European Journal of Echocardiography","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76821567","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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