Assessment Of Ejection Fraction Research Articles

Association of anthropometric variables with therapy-induced cardiotoxicity in women with breast cancer: a pilot study for a randomized clinical trial

BackgroundDoxorubicin (DOX) has been widely used in the treatment of breast cancer, but it is directly associated with late-onset cardiovascular disease (CVD). Whether anthropometric, food intake or other risk factors together with DOX-based chemotherapy can increase the risk of developing cardiotoxicity remains uncertain. We examined the association between anthropometric variables with doxorubicin-induced cardiotoxicity in women with breast cancer.MethodsTwenty-six women (53.7 ± 9.6 y) undergoing DOX-based chemotherapy (408.3 ± 66.7 mg/m2) participated in the study. We collected data on body composition (bioimpedance), dietary intake (24 h) and cardiac function (echocardiographic assessment of left ventricular ejection fraction, LVEF). All measurements were taken at baseline, one month of treatment completion and one-year follow-up after start of treatment. DOX-induced cardiotoxicity was defined as ≥ 10% absolute decrease in LVEF. Thus, the participants were then grouped as DOX-induced (DIC) or non-DOX-induced (non-DIC) cardiotoxicity. Data are shown as mean ± SD (standard deviation). We performed comparisons between the two groups using Student’s t-test for independent samples or Generalized Estimating Equations (groups + 3 evaluation time points) with Bonferroni post-hoc test. Lastly, the correlations were analyzed using Pearson correlation; p < 0.05 for all tests.ResultsAt baseline the participants’ body mass index (BMI) was 29.9 ± 7.9 kg/m2 and LVEF was 67.4 ± 6.2%. Seven of them (26.9%) developed therapy-induced cardiotoxicity (ΔLVEF − 3.2 ± 2.6%; p < 0.001). Postmenopausal status and family history of CVD were more prevalent in the DIC group than non-DIC group. We found no consistent BMI changes in the groups over time. Interestingly, the non-DIC group showed a small increase in visceral fat at treatment completion and increased waist circumference at one-year follow-up compared to baseline. These same changes were not seen in the DIC group. We also observed a pattern of correlation of some anthropometric variables with LVEF: the more unfavorable the body composition the more pronounced the LVEF decrease at one-year follow-up, though not associated with cardiotoxicity.ConclusionsOur study did not provide sufficient evidence to support that anthropometric variables, food intake or other risk factors increase the risk of developing cardiotoxicity. However, there are apparent trends that need to be further investigated in larger samples.

Point-of-care ultrasound to assess left ventricular ejection fraction in heart failure in unselected patients in primary care: a systematic review.

Heart failure (HF) is the most frequent cardiovascular pathology in primary care. Echocardiography is the gold standard for diagnosis, follow-up, and prognosis of HF. Point-of-care ultrasound (POCUS) is of growing interest in daily practice. This study aimed to systematically review the literature to evaluate left ventricular ejection fraction (LVEF) assessment of unselected patients in primary care by non-expert physicians with cardiac POCUS (cPOCUS). We searched in Medline, Embase, and Pubmed up to January 2024 for interventional and non-interventional studies assessing LVEF with cPOCUS in unselected patients with suspected or diagnosed HF in hospital or outpatient settings, performed by non-expert physicians. Forty-two studies were included, involving 6598 patients, of whom 60.2% were outpatients. LVEF was assessed by 351 non-expert physicians after an initial ultrasound training course. The LVEF was mainly assessed by visual estimation (90.2%). The most frequent views were parasternal long/short axis, and apical 4-chamber. The median time of cPOCUS was 8 minutes. A strong agreement was found (κ = 0.72 [0.63; 0.83]) compared to experts when using different types of ultrasound devices (hand-held and standard), and agreement was excellent (κ = 0.84 [0.71; 0.89]) with the same device. Training course combined a median of 4.5 hours for theory and 25 cPOCUS for practice. The use of cPOCUS by non-expert physicians after a short training course appears to be an accurate complementary tool for LVEF assessment in daily practice. Its diffusion in primary care could optimize patient management, without replacing specialist assessment.

Evaluation of left ventricular ejection fraction by a new automatic tool on a pocket ultrasound device: Concordance study with cardiac magnetic resonance imaging.

Assessment of left ventricular ejection fraction (LVEF) is one of the primary objectives of echocardiography. The gold standard assessment technique in emergency medicine is eyeballing. A new tool is now available on pocket ultrasound devices (PUD): automatic LVEF. The primary aim of this study was to evaluate the concordance between LVEF values estimated by automatic LVEF with PUD and by cardiac magnetic resonance imaging (MRI). This was a prospective, monocentric, and observational study. All adult patients with an indication for cardiac MRI underwent a point-of-care ultrasound. Blinded to the MRI results, the emergency physician assessed LVEF using the automatic PUD tool and by visual evaluation. Sixty patients were included and analyzed. Visual estimation of LVEF was feasible for all patients and automatic evaluation for 52 (87%) patients. Lin's concordance correlation coefficient between automatic ejection fraction with PUD and by cardiac MRI was 0.23 (95% CI, 0.03-0.40). Concordance between LVEF estimated by the automatic ejection fraction with PUD and LVEF estimated by MRI was non-existent.

Multicenter validation study for automated left ventricular ejection fraction assessment using a handheld ultrasound with artificial intelligence

We sought to validate the ability of a novel handheld ultrasound device with an artificial intelligence program (AI-POCUS) that automatically assesses left ventricular ejection fraction (LVEF). AI-POCUS was used to prospectively scan 200 patients in two Japanese hospitals. Automatic LVEF by AI-POCUS was compared to the standard biplane disk method using high-end ultrasound machines. After excluding 18 patients due to infeasible images for AI-POCUS, 182 patients (63 ± 15 years old, 21% female) were analyzed. The intraclass correlation coefficient (ICC) between the LVEF by AI-POCUS and the standard methods was good (0.81, p < 0.001) without clinically meaningful systematic bias (mean bias -1.5%, p = 0.008, limits of agreement ± 15.0%). Reduced LVEF < 50% was detected with a sensitivity of 85% (95% confidence interval 76%–91%) and specificity of 81% (71%–89%). Although the correlations between LV volumes by standard-echo and those by AI-POCUS were good (ICC > 0.80), AI-POCUS tended to underestimate LV volumes for larger LV (overall bias 42.1 mL for end-diastolic volume). These trends were mitigated with a newer version of the software tuned using increased data involving larger LVs, showing similar correlations (ICC > 0.85). In this real-world multicenter study, AI-POCUS showed accurate LVEF assessment, but careful attention might be necessary for volume assessment. The newer version, trained with larger and more heterogeneous data, demonstrated improved performance, underscoring the importance of big data accumulation in the field.

Automated Assessment Of Global Left Ventricular Strain Versus Ejection Fraction Using Contrast-enhanced Cine Computed Tomography Angiography

Automated Assessment Of Global Left Ventricular Strain Versus Ejection Fraction Using Contrast-enhanced Cine Computed Tomography Angiography

Assessment of Right Ventricular Functions in Patients with Rheumatoid Arthritis by Tissue Doppler Imaging and 2D Speckle-Tracking Echocardiography

Abstract Background: Advanced echocardiographic techniques play a crucial role in evaluating right ventricular function and providing valuable information for the management of rheumatoid arthritis (RA)-related cardiovascular complications. Objectives: To investigate early signs of right ventricle dysfunction in patients with RA using tissue Doppler imaging and two- dimensional speckle-tracking echocardiography (GLS). Materials and Methods: This case–control study examined cardiac changes in 50 RA patients compared to 50 healthy controls. Echocardiography and anthropometric measurements were used to assess ejection fraction, ventricle systolic and diastolic function, and myocardial strain. Results: The study examined socio-demographic characteristics and echocardiographic parameters in RA patients (N = 50) compared to controls. RA patients had a mean age of 48.28 ± 11.06 years, with 74.0% females. No significant differences in age, BMI, and body surface area between RA patients and controls. There were no significant mean differences between the two study groups according to ejection fraction. There is a significant difference in right ventricular systolic function (TAPSE, S^ velocity, and MPI) observed in RA patients. There is a significant difference in right ventricular diastolic function (E/A ratio, IVRT) observed in RA patients. Global longitudinal strain (GLS) was also significantly reduced. The treatment strategy (single vs. combination therapy) did not significantly affect echocardiographic parameters. The findings emphasize the importance of monitoring cardiac health in RA patients. RA patients show cardiac function alterations, particularly in right ventricular systolic function (TAPSE, S^, and MPI), right ventricular diastolic function (E/A ratio, IVRT), and global function (GLS). Conclusion: Monitoring cardiovascular health in RA patients is crucial. Treatment regimens (combination or monotherapy) did not significantly affect the measured echocardiographic parameters.

Comparative Analysis of Left Ventricular Ejection Fraction Assessment: Visual Estimation via Echocardiography versus Quantitative Measurement Through Cardiovascular Magnetic Resonance Imaging

Objectives: This retrospective observational study aimed to evaluate the correlation between visually estimated left ventricular ejection fraction (LVEF) via 2D echocardiography (ECHO) and quantitatively measured LVEF via cardiovascular magnetic resonance imaging (CMR). Methodology: The study was conducted at Aga Khan University Hospital, involving patients who underwent both 2D ECHO and CMR within a maximum interval of three months between the two studies. LVEF was visually estimated by experienced cardiologists on 2D ECHO and quantitatively calculated on CMR. Results: Among 127 patients meeting inclusion criteria, comparisons between visually estimated LVEF ranges on ECHO and LVEF on CMR consistently showed highly significant differences (p &lt; 0.0001), with ECHO underestimating LVEF. The mean difference between visually estimated average LVEF by ECHO and calculated LVEF by CMR was 4.9 ± 7.0. Subgroup analysis revealed consistent findings across patients with coronary artery disease (CAD) and those with dilated or hypertrophic cardiomyopathy. Conclusion: Despite a significant difference, the observed discrepancy in LVEF values between visually estimated ECHO and quantitatively measured CMR remains small. Thus, visually estimated LVEF by experienced readers retains its reliability as a method for diagnosing and managing patients in routine clinical practice.

Correlation of Global Longitudinal Strain with Functional Status of Patients with Left Ventricular Systolic Dysfunction: Does Gender Difference Exist?

Objectives: Two-dimensional (2D) echocardiographic (echo) assessment of the left ventricular ejection fraction (LVEF) by Simpson’s biplane method is routinely used in clinical practice for patient management. The measurement of global longitudinal strain (GLS) using speckle tracking echocardiography is a new method for assessing left ventricular (LV) systolic function with several advantages. There are very few observations regarding the correlation of 2D GLS with the functional status of patients with the LV systolic dysfunction (LVSD). Therefore, we aimed to evaluate the superiority of GLS over Simpson’s method of LVEF in predicting the functional status of the patients with moderate-to-severe LVSD (ejection fraction &lt;40%) and to find out if any difference exists between male and female patients. Materials and Methods: Fifty patients aged 18–80 years satisfying the inclusion and exclusion criteria were studied over a period of 2 months. Simpson’s method was used to calculate 2D LVEF. 2D GLS was assessed using an automated function imaging technique. The Minnesota living with heart failure questionnaire was used to assess the functional status of patients. Results: Correlation of functional status of patients was better with 2D GLS than 2D LVEF, although both were found to be statistically significant and no statistically significant difference was found in observations between both genders. Conclusion: The correlation of functional status of patients with moderate-to-severe LVSD was better with 2D GLS than 2D LVEF. Further studies are needed to identify the gender differences in 2D GLS correlation with the functional status of patients with LVSD.

#1578 Left ventricular ejection fraction: association with risk of mortality and the incidence of AVF dysfunction

Abstract Background and Aims Ejection fraction (EF) and chronic heart failure (HF) are often considered as criteria for the possibility of arteriovenous fistula (AVF) creation in relation to an increased risk of death, without sufficient evidence for this. There is, however, rare but compelling evidence that low EF increases the risk of AVF dysfunction. Aims: to evaluate the association between EF at the time of AVF creation and the incidence of adverse cardiovascular events, all-cause mortality, as well as AVF dysfunction Method This retrospective cohort study included 962 adult patients who had a first-time created functioning AVF. Only patients with a more than three months period after AVF creation and within a five-year period were included. The mean follow-up period was 34 ± 13 months. Four groups were identified based on EF and the presence of HF at the time of AVF creation (transthoracic echocardiogram): HF with reduced EF (rEF) &amp;lt;40%, with mid-range (mrEF) of 40-49%, or with preserved EF (pEF) ≥50% + HF, and a “no HF” group with EF ≥50% and no HF. Results In the univariate analysis, a reduced EF was associated with an increased risk of mortality, with the hazard ratios (HRs) of 2.706 [95% CI 1.330; 5.507], p = 0.006 for mrEF and 8.250 [95% CI 2.621; 25.97], p &amp;lt; 0.001 for rEF, compared to the “no HF” group (here and thereafter)—Fig. 1. However, after adjusting for age, sex, and Charlson Comorbidity Index (CCI), the EF was not significantly associated with the risk of death. Only the CCI score remained a significant factor (HR = 1.748 [95% CI 1.482; 2.063], p &amp;lt; 0.001). A decreased EF was associated with the incidence of AVF dysfunction both in the univariate analysis and after adjustments. In the univariate analysis, the incidence rate ratios (IRRs) of 6.88 [95% CI 3.88; 12.1], p &amp;lt; 0.001 for mrEF, and 19.9 [95% CI 8. 64; 41.6], p &amp;lt; 0.001 for rEF, were shown. After adjusting for age, sex, and CCI, the IRR for mrEF was 8.96 [95% CI 5.81; 13.7], p &amp;lt; 0.001, and for rEF it was 23.4 [95% CI 13.8; 38.6], p &amp;lt; 0.001. Even in the presence of polycystic kidney disease and diabetes mellitus in the fully adjusted model, the association between EF and the incidence of AVF dysfunction remained statistically significant: the IRR was 8.61 [95% CI 5.61; 13.1], p &amp;lt; 0.001 for mrEF, and 33.4 [95% CI 19.5; 56.2], p &amp;lt; 0.001 for rEF. The findings were confirmed in a sensitivity analysis that included adjustments for unplanned onset of dialysis and competing risks survival analysis (death—outcome of interest, conversion of HD to PD or kidney transplantation and conversion of AVF to CVC—competing events). According to our results patients with EF&amp;lt;40% will inevitably lose AVF function for various reasons within 3.5 years—Fig. 2. Meanwhile, this approach will give the patient additional time of HD via AVF, but not CVC, without increasing the risk of death, subject to Qa monitoring. Conclusion In patients with CKD 5 who are initiating treatment with maintenance hemodialysis, a decreased EF is associated to a greater extent with a higher risk of AVF dysfunction than with an increased risk of mortality. The burden of comorbidities, rather than a standalone assessment of EF, is one of the major risk factors determining patient survival.

Obstructive sleep apnea and acute decompensated heart failure

Abstract Funding Acknowledgements None. Background Acute decompensated heart failure is a condition with a high frequency of hospitalizations and mortality. Screening and treatment for obstructive sleep apnea can be helpful in these patients. Purpose To determine the frequency of obstructive sleep apnea in patients with acute decompensated heart failure. To add CPAP home therapy to standard medical treatment for heart failure. To follow patients for 1 year. Methods We conducted a single-centre, prospective cohort study form 150 consecutive patients hospitalized for exacerbation heart failure in the cardiology department. 81 patients meet inclusion criteria – Apnea-Hypopnea index (AHI) &amp;gt; 5, Epworth Sleepiness Scale (ESS) &amp;gt; 8, NYHA class II/III and NTproBNP&amp;gt;900 pg/ml. Patients with OSA were offered to purchase a CPAP device for the home. They were divided into two groups with CPAP and no-CPAP. All patients receiving optimal medical treatment. The follow-up period was 1 year. At the end of the period, patients underwent a physical examination, an echocardiography, and ESS. In the non-CPAP group, 29 patients were followed up and 13 patients dropped out due to mortality. In the CPAP group, 16 patients were followed up, with 1 dropped out. Sleep apnea screening was performed with ApneaLinkTM. Echocardiographic assessment of left ventricular ejection fraction (LVEF) and the E/e‘m ratio. Results From 81 with sleep apnea 72.8% (n=59) has obstructive sleep apnea (OSA) and 27.2% (n=22) has central sleep apnea (CSA). Of the 59 patients with OSA, 17 patients (28.8%) purchased a device and continued therapy at home, while 42 patients (71.2%)on optimal drug therapy without CPAP. There is a statistically significant difference in BMI in the group with CPAP compared to the no-CPAP group at the beginning and at the end of the follow-up (CPAP group at the start 36.47±7.3 vs. the end 33.3±5.7, p=0.001 and no-CPAP group at the start 36.35±7.34 vs. the end 35.74±7.46 , p=0.356). A similar relationship is found in systolic blood pressure(SBP) and diastolic blood pressure(DBP). SBP in CPAP group at start 136.2±6.2 mmHg vs. end 123.1±5.9 mmHg; р&amp;lt;0.001. relative to no-CPAP group – start 131.2±9.8 mmHg vs. end 131.3±7.7 mmHg; р=0.965. DBP in CPAP group at start 85.9±6.7 mmHg vs. end 77.3±5.3 mmHg; р&amp;lt;0.001 and no-CPAP group start 82.1±7.4 mmHg vs. end 81.7±5.7 mmHg, р=0.644. There is a significant change in LVEF between the two groups at the beginning and at the end of the follow-up (in CPAP group at start 47.5±8.7, vs. at end 50.07±7.5; р=0.005, between no-CPAP at start 52.5±6.9 vs. at end 52.2±7.1; р=0.389). The CPAP group had a median survival of 11.7 months vs. 10.1 months in no CPAP group(Log Rank (Mental-Cox) p=0.044 ). Conclusion Obstructive sleep apnea is a common comorbidity in patients with acute decompensated heart failure. The addition of CPAP therapy in these patients improved BMI, SBP, DBP and increases LVEF. All this improves the prognosis for these patients.

Comparative analysis of left ventricle function and deformation imaging in short and long axis plane in cardiac magnetic resonance imaging.

Advancements in cardiac imaging have revolutionized our understanding of ventricular contraction. While ejection fraction (EF) is still the gold standard parameter to assess left ventricle (LV) function, strain imaging (SI) has provided valuable insights into ventricular mechanics. The lack of an integrative method including SI parameters in a single, validated formula may limit its use. Our aim was to compare different methods for evaluating global circumferential strain (GCS) and their relationship with global longitudinal strain (GLS) and EF in CMR and how the different evaluations fit in the theoretical relationship between EF and global strain. Retrospective monocenter study. Inclusion of every patient who underwent a CMR during a 15 months period with various clinical indication (congenital heart defect, myocarditis, cardiomyopathy). A minimum of three LV long-axis planes and a stack of short-axis slices covering the LV using classical steady-state free precession cine sequences. A single assessment of GLS on long axis (LAX) slices and a double assessment of GCS and EF with both short axis (SAX) and LAX slices were made by a single experienced CMR investigator. GCS-SAX and GCS-LAX were correlated (r = 0.77, P < 0.001) without being interchangeable with a high reproducibility for GCS, GLS and EF. EF calculated from LAX images showed an overestimation compared to EF derived from SAX images of 7%. The correlation between calculated EF and theoretical EF derived from SI was high (r = 0.88 with EF-SAX, 0.95 with EF-LAX). This study highlights the need to integrate strain imaging techniques into clinical by incorporating strain parameters into EF calculations, because it gives a deeper understanding of cardiac mechanics.

Abstract PO5-26-03: Evaluation of cardiotoxicity in Mexican patients with Breast Cancer under neoadjuvant treatment by two-dimension speckle echocardiography

Abstract Background Cardiotoxicity is a major concern in breast cancer patients treated with anthracyclines or anti-HER-2 therapy. The assessment of left ventricular ejection fraction (LVEF) by transthoracic echocardiogram (TTE) has been the most common method to evaluate cardiotoxicity. Different TTE parameters have been studied to assess cardiotoxicity, we aimed to evaluate left atrial strain (LAS) as a parameter of diastolic cardiotoxicity in Mexican patients under neoadjuvant treatment. Methods We prospectively recruited patients with breast cancer under neoadjuvant treatment with anthracyclines and/or anti-HER-2 from March 2022 to present. The evaluation includes TTE, and troponin measurements before chemotherapy, and respective follow-ups at 3 and 6 months from the baseline. We enrolled 187 patients, 172 and 131 had completed the three and six-month follow-ups, respectively. We limited the analysis to patients we could assess cardiotoxicity status, defined according to the ESC 2022 guidelines. Clinical and echocardiographic parameters were compared according to cardiotoxicity status using Chi-squared, two-tailed t-tests or Wilcoxon tests, as appropriate. Results The mean time of follow-up at second assessment was 213 days. The patients are divided into cardiotoxicity and no cardiotoxicity group. We reported 81 events of cardiotoxicity if we include troponin measurement or 36 events if we only evaluate TTE measurements. The incidence of cardiotoxicity in this study was not related with common risk factors as high BMI, presence of hypertension/diabetes or smoking status, but it was statistically associated with the presence of elevated LDL cholesterol (p 0.026). Fourteen percent (14%) were HR-/HER-2 (+), 44% HR+/HER-2 (-), 25% HR+/HER-2 (+), and 17% triple negative subtype. Eightyfive percent (85%) of patients received anthracyclines, 28% in combination with anti-HER-2 treatment, 12% received double anti-HER-2 blockade anthracycline free. The accumulated dose of anthracycline didn’t differ between groups. The use of anthracyclines and double anti/HER blockade was statically associated with development of CTRCD (p &amp;lt; 0.01 and p &amp;lt; 0.01), respectively, but not with a single anti-HER-2 treatment. In troponin-based cardiotoxicity definition, at the three-month follow-up, those who developed cancer therapy-related cardiac dysfunction (CTRCD) had only statically significant lower LVEF (Table 1) with respect to basal assessment. LASr baseline, three months and six months was similar between groups. In the cardiotoxicity group without troponin measurement, we observed statically significant decreased LVEF and LV GLS at 3 months and six months, and tendency to decreased LASr with respect to basal evaluation. Conclusions In our cohort the only modifiable risk factor with impact in the development of CTRCD was dyslipidemia, specifically high LDL. The traditional chemotherapy schemas as anthracyclines and doble anti HER-2 blockade correlate with the development of cardiotoxicity, but not the use of anti-HER-2 as single agent. The addition of troponin measurement to cardiotoxicity definition detected a greater number of events in this study, but doesn’t reflect changes in ETT parameters as LV- GLS and LVEF at this time of follow up, which means structural changes induced by treatment take time and serological measurement of troponin can enhance sensitivity and allows early detection. Further follow up and ETT assessment are needed. Table 1. Cardiotoxicity events including or not troponin levels and TTE parameters. Citation Format: Haydee Williams-Sanchez, Jose Rodrigo Espinosa-Fernandez, Sandy Ruiz-Cruz, Areli Velazquez-Martinez, Nilda Espinola-Zavaleta, Enrique C. Guerra, Alexis D Aparicio-Ortiz, Aldo Cabello-Ganem, Santiago Luna-Alcalá, Leonardo Proaño-Bernal, Neftali Eduardo Antonio-Villa. Evaluation of cardiotoxicity in Mexican patients with Breast Cancer under neoadjuvant treatment by two-dimension speckle echocardiography [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-26-03.

Mitral Annulus Pre-Systolic Excursion (MAPSE) Versus Modified Simpson’s Method for Ejection Fraction Estimation in Patients with Acute Coronary Syndrome

Objectives: Evaluating left ventricle (LV) systolic function is pivotal in cardiac assessment, primarily relying on the left ventricular ejection fraction (LVEF) calculated through the modified Simpson’s method. However, challenges arise in accurately determining LVEF, especially in patients with acute coronary syndrome, where difficulty in visualizing the blood tissue interface can lead to inaccuracies. Mitral annular plane systolic excursion (MAPSE), which evaluates longitudinal function of LV has shown promise in detecting subtle myocardial abnormalities, particularly in patients with preserved ejection fraction (EF). Materials and Methods: The study included three groups of patients based on EF measurement using modified Simpson’s method: Group A with EF &lt;50%, Group B with EF &gt;50%, and Group C as healthy controls. In each group, MAPSE and EF derived from MAPSE formula were calculated: 4.8 × MAPSE (mm) + 5.8 in males, 4.2 × MAPSE (mm) + 2.0 in females. Statistical analyses were conducted to assess the agreement and potential differences between the two methods within each group. Results: The mean age of study population was 55.63 ± 9.21 years in Group A, 54.79 ± 9.82 years in Group B, and 55.10 ± 8.79 years in Group C. In Group A, mean EF measured through modified Simpson’s formula was 37.79 ± 5.38, whereas mean EF measured through MAPSE was 37.95 ± 5.32. There was no statistical difference among EF calculation through Simpson’s method or MAPSE method. (P = 0.8293). In Group B, Mean EF calculated through Simpson method was 56.24 ± 3.12 whereas with MAPSE method was 52.31 ± 4.26. There was found to be a statistical difference in EF calculation by both of this method in patients with EF&gt;50% (P &lt; 0.0001). In Group C, mean EF calculated through Simpson’s method was 64.23 ± 5.21 and through MAPSE was 64.99 ± 4.85, respectively. There was no statistical difference between this two methods in terms of EF calculation (P = 0.2812). Conclusion: EF assessment using the traditional modified Simpson’s method and MAPSE demonstrated a strong correlation in patients with EF &lt;50% and controls. However, in patients with EF &gt;50%, MAPSE revealed subendocardial dysfunction undetected by the Simpson method, highlighting MAPSE’s value in identifying subtle myocardial abnormalities.

Harnessing the Power of AI: A Comprehensive Review of Left Ventricular Ejection Fraction Assessment With Echocardiography.

The quantification of left ventricular ejection fraction (LVEF) has important clinical utility in the assessment of cardiac function and is vital for the diagnosis of cardiovascular diseases. A transthoracic echocardiogram serves as the most commonly used tool for LVEF assessment for several reasons, including, its noninvasive nature, great safety profile, real-time image processing ability, portability, and cost-effectiveness. However, transthoracic echocardiogram is highly dependent on the clinical skill of the sonographer and interpreting physician. Moreover, even amongst well-trained clinicians, significant interobserver variability exists in the quantification of LVEF. In search of possible solutions, the usage of artificial intelligence (AI) has been increasingly tested in the clinical setting. While AI-derived ejection fraction is in the preliminary stages of development, it has shown promise in its ability to rapidly quantify LVEF, decrease variability, increase accuracy, and utilize higher-order processing capabilities. This review will delineate the latest advancements of AI in evaluating LVEF through echocardiography and explore the challenges and future trajectory of this emerging domain.

The Survival Benefit of Pegylated Liposomal Doxorubicin-Based Neoadjuvant Chemotherapy in the Management of Breast Cancer.

Purpose: This study aims to evaluate the short-term outcomes and prognosis and the cardiac safety of pegylated liposomal doxorubicin (PLD)-based neoadjuvant chemotherapy (NAC) compared with epirubicin-based therapy in breast cancer treatment. Methods: In total, 304 patients diagnosed with stages II and III breast cancer were enrolled that included 97 cases treated with PLD and 207 controls treated with epirubicin in NAC. The effectiveness of the antibreast cancer treatment was evaluated using overall survival (OS) and disease-free survival (DFS) metrics, whereas cardiac toxicity was measured through the left ventricular ejection fraction (LVEF) and electrocardiogram (ECG) assessments. Results: The 5-year DFS and OS rates in the PLD group were 84.5% and 88.7% (with 15 recurrences and 11 deaths), respectively, whereas in the control group, these rates were 72.9% and 79.2% (with 56 recurrences and 43 deaths). Regarding cardiac toxicity, there was no significant difference in ECG abnormalities or LVEF decline between the two groups. Conclusions: The study suggests that PLD-based NAC may provide substantial benefits in terms of DFS and OS, along with a safe cardiac toxicity profile, in patients with stage II-III breast cancer.

Clinical, electrical, and functional changes following CRT-P implantation: short-term results in patients with non-ischaemic cardiomyopathy

Aim. Assessment of the correlation between cardiac remodeling, functional status and electrical remodeling after cardiac resynchronisation therapy (CRT) in patients with non-ischaemic cardiomyopathy.Material and methods. A single center, prospective, observational study included 50 patients with non-ischaemic cardiomyopathy who were candidate for CRT implantation. All patients prior to CRT and then 3 months after implantation had standard 12-lead surface ECGs to assess QRSd for assessment electrical response, for assessment of left ventricular ejection fraction (LVEF) and volumes (left ventricular end diastolic and systolic volume, LVEDV and LVESV), mitral regurgitation (degree of mitral regurgitation), pulmonary artery systolic pressure (for diagnosis of pulmonary hypertension), NYHA class and 6 minute walk test (6MWT) to assess patient’s functional capacity.Results. 50 patients with CRT were included (35 males and 15 females, mean age 54.88±7.48 years). All patients were in sinus rhythm with QRS duration (QRSd) ≥120 ms, EF&lt;35% and left bundle branch block. After 3 months; there was significant improvement in QRSd in 82% of the cases (145.3±16.3 ms vs 133.3±17.2 ms, p&lt;0.001). NYHA class improved at least one class in 78% and 6 min walk test improved in 80% (168.5 [131.0; 181.0] m vs 280.0 [237.0; 297.0] m, p&lt;0.001). LVEF increased significantly in 74% of study cases (28.6±2.7 vs 34.5±3.1, p value 0.001) also there were statistically significant improvement in LVEDV (267.0±45.7 to 221.8±41.9 ml, p=0.002) and LVESV (137.43±47.19 to 105.03±42.7 ml, p=0.003). There was statistically significant correlation between QRSd and NYHA class (r=0.392, p=0.005), QRSd and 6MWT (r=0.323, p=0.022) and QRSd with LVEF (r=0.672 with p&lt;0.001). Only seven patients showed improvement in the 3 parameters: LVESV, QRS duration and 6 min walk test.Conclusion. The CRT-pacemaker implantation was associated with significant improvement in QRSd, NYHA class, 6MWT and LV volumes in the short-term period. QRSd improvement was significantly correlated with functional status and LV EF.

Assessment of left ventricular ejection fraction in artificial intelligence based on left ventricular opacification.

Left ventricular opacification (LVO) improves the accuracy of left ventricular ejection fraction (LVEF) by enhancing the visualization of the endocardium. Manual delineation of the endocardium by sonographers has observer variability. Artificial intelligence (AI) has the potential to improve the reproducibility of LVO to assess LVEF. The aim was to develop an AI model and evaluate the feasibility and reproducibility of LVO in the assessment of LVEF. This retrospective study included 1305 echocardiography of 797 patients who had LVO at the Department of Ultrasound Medicine, Union Hospital, Huazhong University of Science and Technology from 2013 to 2021. The AI model was developed by 5-fold cross validation. The validation datasets included 50 patients prospectively collected in our center and 42 patients retrospectively collected in the external institution. To evaluate the differences between LV function determined by AI and sonographers, the median absolute error (MAE), spearman correlation coefficient, and intraclass correlation coefficient (ICC) were calculated. In LVO, the MAE of LVEF between AI and manual measurements was 2.6% in the development cohort, 2.5% in the internal validation cohort, and 2.7% in the external validation cohort. Compared with two-dimensional echocardiography (2DE), the left ventricular (LV) volumes and LVEF of LVO measured by AI correlated significantly with manual measurements. AI model provided excellent reliability for the LV parameters of LVO (ICC > 0.95). AI-assisted LVO enables more accurate identification of the LV endocardium and reduces observer variability, providing a more reliable way for assessing LV function.

ИЗМЕНЕНИЕ ЛИПИДНОГО ПРОФИЛЯ ПЛАЗМЫ КРОВИ, ПАРАМЕТРОВ ХОЛТЕРОВСКОГО МОНИТОРИРОВАНИЯ И ЭХОКАРДИОГРАФИИ У ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА И ГИПОТИРЕОЗОМ

The article presents the results of a study of changes in the lipid spectrum of the blood plasma and certain indicators of Holter monitoring and echocardiography data in patients with coronary heart disease (CHD) and hypothyroidism who were in a cardiology hospital. The incidence of hypothyroidism in cardiac patients was 2.8 %. In patients with ischemic heart disease and hypothyroidism, no reliable correlation has been established between the presence of hypothyroidism and dyslipidemia, but a high incidence of hypercholesterolemia and increased levels of low-density lipoprotein cholesterol was found in patients with ischemic heart disease in combination with hypothyroidism, as in the control group. Extrasystole was determined in all patients with coronary artery disease, regardless of the presence of hypothyroidism. Only 2.7 % of patients with coronary artery disease and hypothyroidism had a decrease in myocardial contractile function according to the assessment of left ventricular ejection fraction (EF). The detection rate of left ventricular hypertrophy (LVH) in patients with coronary artery disease and hypothyroidism was 83.7 %. There was a significantly significant moderate correlation in the group of patients with coronary artery disease, regardless of the presence of hypothyroidism, between the number of premature atrial complexes (PAC) and the number of premature ventricular complexes (PVC). There was no effect of TSH level on EF values and the presence of LVH in patients with coronary artery disease in combination with hypothyroidism and in the absence of the latter.

Artificial Intelligence-Powered Left Ventricular Ejection Fraction Analysis Using the LVivoEF Tool for COVID-19 Patients.

We sought to prospectively investigate the accuracy of an artificial intelligence (AI)-based tool for left ventricular ejection fraction (LVEF) assessment using a hand-held ultrasound device (HUD) in COVID-19 patients and to examine whether reduced LVEF predicts the composite endpoint of in-hospital death, advanced ventilatory support, shock, myocardial injury, and acute decompensated heart failure. COVID-19 patients were evaluated with a real-time LVEF assessment using an HUD equipped with an AI-based tool vs. assessment by a blinded fellowship-trained echocardiographer. Among 42 patients, those with LVEF < 50% were older with more comorbidities and unfavorable exam characteristics. An excellent correlation was demonstrated between the AI and the echocardiographer LVEF assessment (0.774, p < 0.001). Substantial agreement was demonstrated between the two assessments (kappa = 0.797, p < 0.001). The sensitivity, specificity, PPV, and NPV of the HUD for this threshold were 72.7% 100%, 100%, and 91.2%, respectively. AI-based LVEF < 50% was associated with worse composite endpoints; unadjusted OR = 11.11 (95% CI 2.25-54.94), p = 0.003; adjusted OR = 6.40 (95% CI 1.07-38.09, p = 0.041). An AI-based algorithm incorporated into an HUD can be utilized reliably as a decision support tool for automatic real-time LVEF assessment among COVID-19 patients and may identify patients at risk for unfavorable outcomes. Future larger cohorts should verify the association with outcomes.

Empowering Medical Students: Harnessing Artificial Intelligence for Precision Point-of-Care Echocardiography Assessment of Left Ventricular Ejection Fraction

Introduction. Point-of-care ultrasound (POCUS) use is now universal among nonexperts. Artificial intelligence (AI) is currently employed by nonexperts in various imaging modalities to assist in diagnosis and decision making. Aim. To evaluate the diagnostic accuracy of POCUS, operated by medical students with the assistance of an AI-based tool for assessing the left ventricular ejection fraction (LVEF) of patients admitted to a cardiology department. Methods. Eight students underwent a 6-hour didactic and hands-on training session. Participants used a hand-held ultrasound device (HUD) equipped with an AI-based tool for the automatic evaluation of LVEF. The clips were assessed for LVEF by three methods: visually by the students, by students + the AI-based tool, and by the cardiologists. All LVEF measurements were compared to formal echocardiography completed within 24 hours and were evaluated for LVEF using the Simpson method and eyeballing assessment by expert echocardiographers. Results. The study included 88 patients (aged 58.3 ± 16.3 years). The AI-based tool measurement was unsuccessful in 6 cases. Comparing LVEF reported by students’ visual evaluation and students + AI vs. cardiologists revealed a correlation of 0.51 and 0.83, respectively. Comparing these three evaluation methods with the echocardiographers revealed a moderate/substantial agreement for the students + AI and cardiologists but only a fair agreement for the students’ visual evaluation. Conclusion. Medical students’ utilization of an AI-based tool with a HUD for LVEF assessment achieved a level of accuracy similar to that of cardiologists. Furthermore, the use of AI by the students achieved moderate to substantial inter-rater reliability with expert echocardiographers’ evaluation.