Global Index Research Articles

Fostering Regional Integration in Africa in the Wake of Military Takeovers in the Sahel: Recasting the Casablanca-Monrovia and Brazzaville Debate?

The resurgence of military coups in the Sahel region and the crisis surrounding the Economic Community of West African States (ECOWAS) has put back the question of regional integration and African unity to intense scholarly scrutiny. The Sahel has emerged as the epicentre of violent extremism in the world according to the Institute for Economic and Peace`s 2024 Global Terrorism Index. The resurgence of military coups in the region further adds to the political dynamics of the region. The intervention of ECOWAS and the AU to restore constitutional order and the counteraction of the military juntas have resulted to the formation of the Alliance of Sahel States in the Sahel which has implications for regional integration in Africa in general. This study adopts a qualitative research strategy and case study design to examine the resurgence of military coups in the Sahel. It is based on desk review, particularly data sources such as Google scholar. The findings reveal that the resurgence of military coups in the Sahel region has implications for regional integration and the objective of unity of the African Union. Military coups in the Sahel have raised the stakes and challenges for Africa unity via regional integration by complicating the role of the regional institution, ECOWAS and ultimately the African Union. It posits that revisiting the foundational discourse of African unity and integration that is the Casablanca-Monrovia and Brazzaville debates is essential to understanding the current political dynamics in the Sahel region.

Diagnostic, prognostic, and therapeutic potentials of gut microbiome profiling in human schistosomiasis: A comprehensive systematic review.

Several studies have highlighted alteration in the gut microbiome associated with the onset and progression of diseases. Recognizing the potential of gut microbiota as biomarkers, this systematic review seeks to synthesize current data on the intricate relationship between the host gut microbiome profiles and their usefulness for the development of diagnostic, prognostic and therapeutic approaches to control human schistosomiasis. A systematic literature review was carried out by searching for relevant studies published until date, that is May 2024, using Medline, Embase, Global Health, Web of Science, and Global Index Medicus databases. The keywords used to select articles were "Gut microbiome", "Gut Microbiota", "Schistosomiasis", "Bilharziasis ", and "Human". Extracted data were analysed qualitatively from the selected articles. Of the 885 articles retrieved and screened, only 13 (1.47%) met the inclusion criteria and were included in this review. Of the included studies, 6 (46.2%) explored alterations of gut microbiome in schistosome-infected patients, 4 (30.7%) in patients with liver pathologies, and 3 (23.1%) in patients treated with praziquantel. Bacteria from the genera Bacteroides, Faecalibacterium, Blautia and Megasphaera were associated with S. japonicum and S. haematobium infection in school-aged children, whereas infection with S. mansoni rather associated with Klebsiella and Enterobacter. The gut microbiota signature in patient with schistosomiasis-induced liver pathology was reported only for S. japonicum, and the genus Prevotella appeared as a non-invasive biomarker of S. japonicum-associated liver fibrosis. For S. mansoni-infected school-aged children, it further appeared that the treatment outcome following praziquantel administration associated with the abundance in the gut microbiome of bacteria from the classes Fusobacteriales, Rickettsiales and Neisseriales. The host gut microbiome appears to be a valuable, non-invasive, but still poorly utilized, source of host biomarkers potentially informative for better diagnosing, prognosing and treating schistosomiasis. Further studies are therefore needed to comprehensively define such gut microbial biomarkers of human schistosomiasis and catalyse the informed development of gut microbiome-based tools of schistosomiasis control.

The Impact of Gender Factors on Economic Development: A Global Comparative Analysis

The purpose of this study is to determine trends and the current state of the gender issue, as well as the impact of different gender factors, taking into account the period of COVID-19, on the level of Ukrainian GDP compared with the countries of the world in modern conditions and to propose appropriate recommendations for the activation and stimulation of women’s participation in business. The authors emphasize that women are disproportionately affected by various social crises: climate change, wars, conflicts and human rights violations etc. The authors analyze the Ukrainian Gender Inequality Index in and make a conclusion that it more than halved during the last decades. The reason for this, especially in recent years, was the COVID-19 pandemic and the subsequent full-scale Russian invasion of Ukraine that had a very negative impact on business. The authors note that Ukraine is situated in 35th place in the European ranking of countries concerning the value of the Gender Inequality Index. A large number of women are generally not involved in the labor market or other economic activities. At the same time, a continuing consequence of the Russian full-scale invasion of Ukraine was a noticeable lack of qualified personnel on the labor market. This is due to the involvement of exclusively men in certain sectors of the economy and their mobilization. The results of the regression analysis indicate that economic participation has the greatest impact on GDP among all the components of the Global Gender Gap Index in the USA, Canada and Poland. Educational attainment is situated on the second place. As for Ukraine, the authors show that as the level of participation of women in the labor force increases, Ukrainian GDP also increases. Taking into account the results of the calculations, the authors conclude that gender factors have a direct impact on the country's economy Keywords: gender factors, sustainable development, gender equality, Gender Inequality Index, Global Gender Gap Index, GDP, Ukraine, Poland, The USA, Canada.

Gender inequality, well-being, and ill-being: A macro analysis of human and societal flourishing.

Does gender equality exacerbate the women-versus-men conflict or enhance their well-being? Scholars argue women's well-being has deteriorated despite their socioeconomic empowerment due to exacerbated burdens and persistently gendered treatment in the workplace and home. Cross-sectional research, in contrast, shows people experience higher well-being in gender-egalitarian societies. Apart from these contradictory views, little is known about how mitigating different dimensions of gender inequality longitudinally affects well-being over time. In this article, we conduct fixed effects regressions with bootstrapping to examine the link between gender (in)equality and well-being/ill-being using an originally constructed macro-level panel dataset for 137 countries over 15 years, composed of the Global Gender Gap Index (GGGI), Gallup's well-being metrics, and other indices from the United Nations/European Union. Our analysis shows that more gender equality positively predicts both average life satisfaction and the proportion of thriving people, while it is negatively linked to the risk of facing ill-being for both genders. This favorable trend is confirmed significantly in the economic domain, such that women and men are likely to flourish as women's presence in the labor market advances (e.g., a unit increase of economic GGGI predicts 1.25-point/1.05-point higher life satisfaction in the 11-point Cantril ladder scale for women/men). These results suggest that mitigating gender gaps potentially helps enhance well-being among individuals and societies rather than exacerbating tradeoffs between gender groups, arguably by ensuring women's opportunities and liberating men from social norms for their breadwinner role. We argue that gender equality plays an important role in achieving human and societal flourishing.

Crossing borders to meet cardiac surgical needs: A scoping review on patients seeking cardiac surgery abroad.

Over 100 countries do not have a local cardiac surgeon, whereas capacity, coverage, or cultural constrains may limit access to cardiac surgical care in-country. This scoping review aims to summarize the current literature of patients seeking cardiac surgical care abroad and determine research gaps for this understudied aspect of global surgical care. A scoping review was conducted on patients seeking cardiac surgery outside of their home country using MEDLINE, EMBASE, CINAHL, SCOPUS, WHO Global Index Medicus, and PubMed databases. Relevant articles were descriptively and quantitatively summarized. Out of a total of 49 articles and 6351 patients, the most common procedures were coronary artery bypass grafts & valve procedures (N​=​3948; 62​%) and congenital heart disease repairs (N​=​2049; 32​%). The most prevalent countries of origin were Japan, Nigeria, and the United Arab Emirates. The United States, France, and the United Kingdom were the most common destination countries. Most patients (N​=​1483; 23​%) sought care abroad due to limited therapeutic options in the home country. Funding sources stemmed comparably from government funding, non-governmental organization funding, and out-of-pocket payments. The extent of and reasons for individuals traveling abroad for cardiac surgery are poorly described. Localizing cardiac care, while requiring significant resources, may lead to substantial cost savings and improved access to care. Until then, improving access to international travel for cardiac surgery remains an important strategy.

Effect of Human Immunodeficiency Virus on Lung Function and Structure: A Systematic Review and Meta-Analysis.

Rationale: Obstructive lung disease (OLD) pathogenesis includes inhalational (e.g., smoking) and noninhalational mechanisms (e.g., infections). Human immunodeficiency virus (HIV) has been suggested as a novel OLD risk factor. Substantial data have recently emerged about its effects on lung function and structure, especially in low- to middle-income countries and regarding longitudinal lung function. Objectives: To assess the association of HIV infection with OLD, impaired gas exchange, and emphysema. Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, and Global Index Medicus through April 2023 for controlled and observational studies of people living with and without HIV reporting pulmonary function and/or emphysema. Primary outcomes were OLD by spirometry, gas exchange impairment by diffusing capacity of the lung for carbon monoxide, and visual emphysema by computed tomography. We performed random-effects meta-analyses using odds ratios (ORs) with 95% confidence intervals (CIs). This study was registered in PROSPERO (CRD42021268498). Results: We included 95 publications pertaining to 43 unique studies. HIV was associated with OLD (OR, 1.29; 95% CI, 1.02-1.63), impaired gas exchange (OR, 2.63; 95% CI, 0.96-7.24), emphysema (OR, 1.46; 95% CI, 1.02-2.09), and faster lung function decline. OLD risk was greatest in Africans with HIV. There were no gas exchange or emphysema data from Africa. The certainty of evidence was low to very low, primarily because of studies' observational design. Conclusions: People living with HIV have increased risk for OLD, gas exchange impairment, faster lung function decline, and emphysema. OLD risk in HIV varies regionally. We recommend that both spirometry and diffusing capacity of the lung for carbon monoxide be measured in people living with HIV and respiratory symptoms. Future studies should develop and validate HIV-specific screening and case-finding strategies for chronic lung disease.

The regional ventilation distribution monitored by electrical impedance tomography during anesthesia induction with head-rotated mask ventilation

Objective.Abnormal regional lung ventilation can lead to undesirable outcomes during the induction of anesthesia. Head rotated ventilation has proven to change the airflow of upper airway tract and be effective in increasing the tidal volume. This study aimed to investigate the influence of head rotated mask ventilation on regional ventilation distribution during the induction phase of anesthesia.Approach.Ninety patients undergoing anesthesia induction were randomly assigned to receive either neutral head (neutral-head group) or rotated right side head (rotated-head group) mask ventilation. Pressure-controlled mode was used in all mechanical ventilation. The regional lung ventilation was monitored by electrical impedance tomography. The primary outcome was the ratio of left/right lung ventilation distribution. The secondary outcomes were global inhomogeneity index (GI), center of ventilation (CoV, 100% = entirely dorsal), and the regional lung distribution differences between spontaneous and mask ventilation.Main results.Forty-two patients with neutral-head and 38 with rotated-head mask ventilation were analyzed finally. Compared with spontaneous ventilation, mask positive-pressure ventilation caused significant changes in the ratio of left/right lung ventilation distribution [0.85 (0.27) versus 0.94 (0.30);P= 0.022]. However, there were no differences in the ratio of left/right lung ventilation distribution between neutral and rotated head groups (P= 0.128). When compared with spontaneous ventilation, mask ventilation caused regional distributions of ventilation shifts towards ventral lung areas (CoV: 45.7 ± 5.0% versus 39.2 ± 4.8%;P< 0.001), and significant lung ventilation inhomogeneity (GI: 0.40 ± 0.07 versus 0.49 ± 0.14;P< 0.001). Compared with neutral-head mask ventilation, rotated-head mask ventilation was associated with higher expiratory tidal volume (TVe) (575.1 ± 148.6 ml versus 654.2 ± 204.0 ml;P= 0.049).Significance.Mask positive ventilation caused regional lung ventilation changes. When compared with neutral-head mask ventilation, rotated-head mask ventilation did not improve the regional ventilation towards to left lung. However, rotated-head mask ventilation was associated with higher TVe, and has the potential for better oxygenation.Trial Registration.This study was registered on Chinese Clinical Trial Registry on 6 August, 2024 (ChiCTR2400087858).

Globalisation and Insurance Sector Penetration: Macro Evidence from Nigeria

The impact of globalisation on the penetration of the insurance industry in Nigeria from 1987 to 2021 was investigated in this study using the distributed lag long-run estimating technique. The results from the use of KOF Globalisation index showed that globalisation promotes penetration of the insurance sector (Coeff =0.1388; p. value0.01). It furthered revealed that Insurance penetration rate rises with increased GDP per capita, population, and financial sector development. However, inflation reduces insurance penetration rate. Globalisation greatly aids in the penetration of the insurance sector in Nigeria which suggests the opening up of the Nigerian insurance market to foreign competition, lowering costs and increasing the efficiency of insurance services. The government also need to formulate appropriate policies to encourage the mobility of insurance products, services, and capital. Asides the aforementioned, insurers in Nigeria are encouraged to continuously offer globalised products that adhere to international standards to attract foreign consumers. Meanwhile, the dark sides of globalisation should be mitigated while introducing these new insurance services and products.

Enhancing myocardial function assessment in hypertension patients through the integration of exercise stress echocardiography and pressure-strain loop technique.

Abstract Objective This study aims to investigate the characteristics of myocardial work(MW) and reserve function in left ventricular remodeling hypertension (LVRH) patients through exercise stress echocardiography (ESE) and pressure-strain loop (PSL) technique,and further to investigate the associations of MW parameters with the exercise capacity in this observational study. Methods One hundred and five hypertensive patients with left ventricular remodeling{Left ventricular mass index (LVMI) ≥115 g/m2 (male) and LVMI ≥95 g/m2 (female)} underwent ESE examination according to established guidelines, the test was terminated at 85% of the target heart rate. Additionally, 59 healthy subjects were included as a control group. Speckle tracking software was utilized for analysis, the myocardial work parameters were calculated by combining the longitudinal strain with the noninvasive left ventricular pressure curve.Exercise capacity and reserve function,global and segment work index were evaluated and analysed. Results Global work index (GWI) , global constructive work (GCW) and global wasted work (GWW) were significantly increased both at rest and peak in LVRH group, while global work efficincy(GWE) were decreased. The GWI from basal to apiex both at rest and peak showed increasing trend in the order of the control group. GWI-rest showed prominent relation with exercise metabolic equivalent(METs)(r=-0.502,p＜0.001),E/e-peak ( (r=0.612,p＜0.001), ΔGobal longitudinal strain (GLS) (r=0.421,p＜0.001).Further GWI-rest and ΔGWI as well as E/e-peak add increased predictive utility of exercise capacity, superior to the change in GLS .The myocardial work reserve function can be available for predicting patients with LVRH{ΔGWI，AUC: 0.869 (95%CI,0.815−0.924), providing incremental value for LVRH diagnostic performance. Conclusion MW parameters can reflect the contractile force under hemodynamic overload,provide a more comprehensive and compelling perspective for evaluating cardiac function. GWI is an important predictor of systolic and diastolic function and a variable closely related to exercise endurance in patients with LVRH. comparison rest and peak parameters ROC for identify LVH patients

The value of global longitudinal strain and myocardial work indices in the early detection of left ventricular systolic dysfunction in patients with acute myocarditis

Abstract Background/introduction Conventional transthoracic echocardiography (TTE) is found to have limited sensitivity in detecting myocardial damage in patients with acute myocarditis and preserved left ventricular ejection fraction (LVEF). Purpose This study aimed to investigate the role of global longitudinal strain (GLS) and myocardial work (MW) echocardiographic indices in the identification of subclinical left ventricular systolic dysfunction in patients with acute myocarditis. Methods The study retrospectively included all patients admitted to the cardiology clinic of a tertiary hospital between December 2019 and May 2024, with suspected myocarditis, preserved ejection fraction, negative findings for coronary artery disease on coronary angiography or coronary computed tomography angiography, and whose diagnosis of myocarditis was confirmed by cardiac magnetic resonance imaging (CMR) using the Lake-Louise criteria. Gender and age-matched healthy individuals were also enrolled. The echocardiographic parameters assessed included global longitudinal strain (GLS) and myocardial work indices, specifically Global Work Efficiency (GWE), Global Work Index (GWI), Global Wasted Work (GWW), and Global Constructive Work (GCW). Statistical analysis was performed using non-parametric tests (Mann-Whitney test) and the predetermined level of statistical significance was set at p&amp;lt;0.05. Results A total of 41 patients (34 males – 82.9%) and 32 healthy controls (25 males – 78%) were included in the study. The median age in the patient group was 28 years (range 16-46 years), and in the healthy controls group, it was 29 years (range 17-48 years). In the patient group, the median values were as follows: GLS -18%, GWE 96%, GWI 1636 mmHg%, GWW 66 mmHg%, and GCW 1842 mmHg%. In the healthy controls group, the median values were GLS -19.6%, GWE 96%, GWI 1856 mmHg%, GWW 76 mmHg%, and GCW 2095 mmHg%. Patients showed significantly lower absolute values of GLS (p=0.014), GWI (p=0.023), and GCW (p=0.005) compared to healthy individuals. There were no statistically significant differences found for GWE and GWW values between the two groups. Conclusion Our study suggests that GLS, GWI, and GCW indices may be valuable in the early detection of left ventricular dysfunction in patients with myocarditis and preserved ejection fraction. Larger epidemiological studies are needed to further validate these findings.

Myocardial work index in severe aortic stenosis and its relationship with staging classification of the associated cardiac damage: results of a large transcatheter valve replacement candidate cohort

Abstract Background With increasing life expectancy and aging of the population, aortic valve stenosis (AS) is now the most prevalent valvular disease in developed nations. Left ventricular (LV) functional assessment is challenging in this pressure-overloaded disease state, however, myocardial work analysis may overcome this issue by proving load-adjusted measures of LV function. Notably, long-standing severe AS results in progressive damage of the heart, starting from left ventricular (LV) remodeling to significant backward effects eventually leading to manifest right ventricular dysfunction. Myocardial work parameters, being less load-dependent markers of LV function may follow the extent of cardiac damage. However, the relationship of cardiac damage staging and myocardial work measures is scarcely investigated. Purpose Accordingly, we aimed to examine the relationship of myocardial work indices and AS staging in a transcatheter aortic valve replacement (TAVR) candidate AS cohort. Methods 296 patients (79±7 years, 41% female) with severe AS were enrolled. Medical history was obtained and we performed detailed echocardiography prior to TAVR. Aortic valve area (AVA) was calculated using the continuity equation. LVEDVi was measured using the biplane Simpson method. Based on the echocardiographic data, we determined the extent of cardiac damage caused by AS, patients were classified as Stage 0 (no cardiac damage), Stage 1 (LV damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (pulmonary artery vasculature or tricuspid valve damage), or Stage 4 (right ventricular damage). We determined the LV ejection fraction (EF) and via speckle-tracking echocardiography global longitudinal strain (GLS) was also measured. Then, utilizing left ventricular volume curves derived from systolic blood pressure and mean transaortic gradient, we calculated global myocardial work index (GWI). Results 14 (5%) patients were classified as Stage 0, 61 (21%) as Stage 1, 132 (45%) as Stage 2, 16 (5%) as Stage 3, and 73 (25%) as Stage 4. EF (from Stage 0-4: 61±6 vs. 48±12 vs. 48±11 vs. 45±14 vs. 40±15%, p≤0.01) and GLS (-16.9±3.4 vs.-13.2±3.3 vs. -12.6±3.8 vs. -11.8±4.8 vs. -9.8±4.4%, p≤0.01) only differed in Stages 3 and 4, while GWI values formed a more defined spectrum through the Stages (2481±543 vs. 1726±588 vs. 1717±686 vs. 1581±867 vs. 1185±692 mmHg%, p≤0.001). Using multivariate regression analysis, examining relevant clinical and echocardiographic parameters, age (β=0.15, p=0.02), cardiac damage stage (β=-0.19, p≤0.01), AVA (β=0.21, p≤0.01), LVEDVi (β=-0.33, p≤0.001) and having a pacemaker (β=-0.15, p=0.01) were independent predictors of GWI (R²= 0.41, p≤0.0001). Conculsions LV GWI show distinct changes throughout the spectrum of cardiac damage associated with severe AS. Beyond age, AVA, LVEDVi and having a pacemaker, cardiac damage stage is also an independent determinant of GWI in this population.

Myocardial work and left ventricular function in patients with heart failure with preserved ejection fraction

Abstract Background/Introduction Patients with Heart Failure with preserved Ejection Fraction (HFpEF) have impaired diastolic function that plays a major role in the syndrome΄s pathophysiology . Several studies imply that these patients also suffer from left ventricular systolic dysfunction as assessed by Global Longitudinal Strain (GLS) estimation . Other studies show that the estimation of General Myocardial Work (GMW) is associated with left ventricular systolic function. Purpose The aim of our study is the evaluation of these echocardiography indexes in HFpEF patients. Methods We enrolled 50 subjects in our study (25 patients with HFpEF and 25 control subjects). All patients undergone in clinical evaluation, electrocardiography (All subjects were in sinus rhythm) and transthoracic echocardiography, applying modern techniques (GLS , Global Work Index – GWI and Global Work Efficiency – GWE). Results Statistical analysis revealed a significant difference within patients with HFpEF and control group concerning GLS (median GLS LV (%) - 18.0 vs – 19.7, Wilcoxon rank-sum p-value = 0.001). In addition , HFpEF group had significant lower GWE (median GWE (%) 91 vs 95, Wilcoxon rank-sum p-value = 0.001) . There was no significant difference in GWI (median GWI (mmHg) 1806.0 vs 2006.0 , Wilcoxon rank-sum p-value = 0.16) within groups. (Table 1) Conclusion(s) The current study shows that patients with HFpEF have a significant impaired GLS and GWE, revealing primary underlying myocardial damage in these patients. Table1. Echocardiographic parameters

Sarcomere gene mutations leading to lower myocardial work values in hypertrophic cardiomyopathy

Abstract Background Sarcomere gene mutations is hypertrophic cardiomyopathy (HCM) can have prognostic value and role in risk assessment, according to numerous studies. In our previous investigations, we confirmed that echocardiographic parameters of left ventricular (LV) myocardial work (MW) derived from the non-invasive pressure-strain curve were reduced in patients with HCM, especially in the case of clinical features with advanced disease. The aim of our present work was to investigate the MW parameters in genotyped HCM patients. Patients and Methods We examined 75 genotyped HCM patients [48 men (64%), age 51±12 years], who underwent standard and 2D-speckle tracking echocardiography. The patients were divided into sarcomere mutation positive (P/LP+, n=32) and mutation negative (P/LP-, n=43) groups based on carrying a pathogenic/probably pathogenic (P/LP) sarcomere gene variant. Later we extended our examination to patients with variants of unknown significance (VUS). Results There was no significant difference between the demographic (age, gender, BMI, BSA) and laboratory (troponin T, NTproBNP) parameters of the P/LP+ and P/ LP- groups. Also, no significant difference was found in most echocardiographic parameters (LAV, LAVI, LVmax, EF, SV, SV index, TAPSE) between the two groups, except that the proportion of obstructive patients was higher in the P/LP group (p=0.026) and the resting (p= 0.004) and provoked (p=0.0082) LVOT gradients were higher. Despite of no difference in the GLS value in the two groups (p=0.850), the P/LP+ group had lower global work index [GWI: p=0.0035), global constructive work (GCW: p=0.0006), and global wasted work (GWW: p=0.0098), while global work efficiency (GWE: p=0.485) did not differ. The differences remained even when patients carrying variants of unknown significance (VUS+) were examined in a separate group (GWI: p=0.013; GCW: p=0.001; GWW: p=0.005). Summary These results indicate that the pathological gene mutation underlying HCM, leads to lower myocardial work values, even with a similar morphological or functional appearance. The latter observation further confirms the possible role of MW parameters in the prognosis of HCM.

Straining to predict mortality in low flow low gradient aortic stenosis patients undergoing TAVR: can GLS and myocardial work parameters improve outcomes?

Abstract Background Classic low flow low gradient aortic stenosis (LFLG-AS) represents 5-10% of the Aortic Stenosis (AS) population and is associated with poorer clinical outcomes when compared to other AS subtypes. The survival rate of these patients is low (40–60% at 2-yrs) with conservative management. The TOPAS study found a transfemoral Transcatheter Aortic Valve Replacement (TAVR) adjusted hazard ratio (HR) of 0.23 and Surgical Aortic Valve Repair adjusted HR of 0.36. However, mortality within 2-yrs of TAVR can still be as high as 30%-50%. Currently there are no pre-TAVR echocardiographic markers that reliably predict post-TAVR outcomes. Global longitudinal strain (GLS), a load-dependent measurement, in conjunction with the recently emerging load-independent measurements, global myocardial work index (GWI) and global myocardial work efficiency (GWE), have the potential to improve peri-procedural risk stratification. Purpose This study sought to establish the sensitivity and specificity of using GLS, GWI, GWE, Contractile Reserve, and Left Ventricle Ejection Fraction (LVEF) in predicting mortality for LFLG AS patients undergoing TAVR. Methods We measured baseline GLS, GWI, GWE, Contractile Reserve, and LVEF, using GE Echo Pac AFI software (ver. 203) in patients with LFLG AS (n=29, age 79 ± 8 yrs, 69% males) that underwent low dose Dobutamine Stress Echocardiography (DSE) pre-TAVR (2017 to 2023). Contractile flow reserve (defined as &amp;gt;20% increase in LV stroke volume (SV) during DSE was recorded. LVEF was re-measured by a single operator. Receiver operating curves (ROC) were created to predict mortality using SPSS. Results Baseline LVEF was 37.6 ± 9.3% with mean AV gradient of 30 ± 10 mmHg prior to TAVR. 59% (17) had contractile reserve (25 ± 19% increase in SV). There was -0.3 ± 15.7% change in LVEF and 24% (10) patients had ≥10% improvement in LVEF at 1-yr Total mortality was 21% (6) and heart failure admission was 34% (10) at 1-yr Post TAVR, GLS (AUC 0.82, p=0.017), GWI (AUC 0.688, p=0.209) and GWE (AUC 0.82, p=0.001) can predict 1-yr mortality compared to baseline LVEF (AUC 0.536, p=0.83), and contractile reserve (AUC 0.551, p=0.132) (Figure 1). Baseline GLS of ≥ -7.5% (83% sensitivity, 83% specificity), GWI ≤ 817 mmHg% (83% sensitivity, 67% specificity) and GWE ≤74% (83% sensitivity, 67% specificity) can predict 1-yr mortality. Conclusion This study demonstrates that GLS, GWI, and GWE possess superior predictive capabilities for predicting mortality within 1-yr post-TAVR compared to baseline LVEF and contractile reserve. A baseline GLS of ≥ -7.5%, GWI ≤ 817 mmHg%, and GWE ≤ 74% were identified as thresholds with high sensitivity and specificity. This study has notable limitations, being a single-center retrospective study with a small sample size, however, the findings justify replication of this study in a larger, multicenter cohort, in an effort to improve risk stratification in the patients with LFLG-AS being considered for TAVR.

Usefulness of echocardiographic parameters of myocardial work in the evaluation of left ventricular function in patients with severe aortic valve stenosis undergoing transcatheter aortic valve impla

Abstract Background Myocardial work (MW) is a new echocardiographic parameter used in the assessment of cardiac energy expenditure. Purpose The aim of the current study was to evaluate changes in left ventricular MW parameters in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Methods One hundred and thirty five consecutive patients who underwent TAVI at one center were evaluated before and after procedure by transthoracic echocardiography (TTE) with the assessment of MW indices: global constructive work (GCW), global wasted work (GWW), global work index (GWI) and global work efficiency (GWE). Results The comparison of MW parameters before and on average after 5.9 days after TAVI showed a significant increase in GCW: 1314,48± 487,53 vs 1438,22 ± 468,86 (p&amp;lt;0,001), GWW: 238,82 ± 160,67 vs 258,84 ± 145,09 (p= 0,045) and GWI: 966,45 ± 456,06 vs 1045,16 ± 428,68 and no significant change in GWE: 81,55 ± 10,46 vs 82,47 ± 7,75 (p=0,401). The increase in GCW and GWI parameters after TAVI strongly correlated with left ventricular ejection fraction (LVEF) and pressure aortic gradient (PGA) before the procedure. A significant increase in GWE was observed in patients with LVEF &amp;lt;30% (p=0,043). Conclusions Echocardiographic assessment of myocardial work parameters is a valuable method of documenting hemodynamic changes in patients with severe aortic stenosis before and after TAVI. Long-term left ventricular overload in patients with aortic stenosis results in a global decrease of myocardial work parameters, therefore, rapid decompression increases the effective work of the heart.

Ventilation-perfusion matching in early-stage of prone position ventilation: a prospective cohort study between COVID-19 ARDS and ARDS from other etiologies

Objective.Prone positioning has been established as a therapeutic strategy for severe acute respiratory distress syndrome (ARDS). In COVID-19-associated ARDS (CARDS), the application of prone position has shown varying responses, influenced by factors such as lung recruitability and SARS-CoV-2-induced pulmonary endothelial dysfunction. This study aimed to compare the early impact of pronation on lung ventilation-perfusion matching (VQmatch) in CARDS and non-COVID-19 ARDS patients (non-CARDS).Approach.This was a two-center, prospective study comparing between CARDS and non-CARDS. Electrical impedance tomography (EIT) was used to compare the VQmatch between supine and early-stage prone positions (∼2 h). The study identified the areas of Deadspace, shunt, and VQmatch. Within the defined VQmatch region, the global inhomogeneity index (VQmatch-GI) was computed to evaluate the degree of heterogeneity. Paired Wilcoxon signed-rank test and Chi-square test were used in statistical analysis.Main results.15 CARDS patients and 14 non-CARDS patients undergoing mechanical ventilation were included. In comparison to the non-CARDS group, the CARDS group exhibited a higher prevalence of diffuse lung disease (15 [100%] vs. 4 [28.6%], CARDS vs. Non-CARDS,p< 0.001), along with elevated SOFA score, PCO2, PEEP, and Ppeak. Among non-CARDS patients, 11/14 demonstrated improved oxygenation, whereas only 5/15 CARDS patients exhibited oxygenation improvement in prone ventilation. In 13/29 patients with oxygenation improvement (defined as above 20% increase in SpO2/FiO2), there was a significant decreased deadspace (21.3 [11.5, 33.1] vs. 9.7 [7.3, 16.9],p= 0.039), and VQmatch showed an upward trend. When comparing prone ventilation to supine ventilation, non-CARDS patients showed a significant improvement in overall VQmatch (Supine 65.7 [49.7, 68.5] vs. Prone 67.4 [60.8, 72.6],p= 0.019). CARDS patients had a notable decrease in ventral VQmatch (VQmatch_Ventral: Supine 35.0 [26.9, 42.0] vs. Prone 22.7 [12.4, 32.9],p= 0.003), and an improvement in dorsal VQmatch (VQmatch_Dorsal: Supine 33.4 [20.4, 39.4] vs. Prone 46.4 [37.4, 48.4],p= 0.031), leading to no significant improvement in overall VQmatch. Ten CARDS patients with no improvement in VQmatch had increased shunting and VQmatch-GI.Significance.In non-CARDS patients, the improvement in oxygenation and VQmatch following prone positioning exhibits a consistent pattern. Conversely, in CARDS patients, the impact of prone positioning reveals considerable individual variability. This study indicates that the response to short-time prone ventilation can vary in ARDS patients with different etiologies.Trial registration:NCT05816928, 04/17/2023, retrospectively registered. Ventilation-Perfusion Matching in Early-stage Prone Position Ventilation, NCT05816928. Registered 17 April 2023 - Retrospectively registered,https://clinicaltrials.gov/study/NCT05816928.

Pressure-strain-volume analysis-derived wasted work predicts clinical outcomes after transcatheter tricuspid valve intervention

Abstract Background The pressure-strain loop is a non-invasive alternative to the traditional pressure-volume analysis for calculating myocardial work. Incorporating volume into work calculations may be particularly beneficial in evaluating patients with tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve intervention (TTVI), who often present with highly varied load conditions. Purpose The study aimed to test the hypothesis that pressure-strain-volume analysis-derived right ventricular (RV) work will predict the composite clinical outcome of heart failure hospitalization (HFH) and death within 12 months after the TTVI. Methods Patients undergoing TTVI at two tertiary centers were included between June 2021 and November 2023. The pre-procedural three-dimensional echocardiographic acquisitions of the RV (to obtain RV volumes and global longitudinal strain) and RV pressures obtained from same day, pre-procedural right heart catheterization or calculated from TR maximal velocity and right atrial pressure were integrated into pressure-strain-volume loops using dedicated software (ReVISION, Argus Cognitive, USA). The pressure-strain-volume derived myocardial work was quantified as the volume under the three-dimensional curve and characterized by the following metrics: global work index (GWIV), global constructive work (GCWV), global wasted work (GWWV), and global work efficiency (GWEV). Conventional pressure-strain analysis-derived metrics were also calculated as previously described (1). The composite outcome was HFH or death within 12 months after TTVI. Cox regression analysis was performed to investigate the possible associations with the composite outcome and included all baseline clinical, echocardiographic, hemodynamic and RV work parameters. Variables were considered for multivariate analysis when they were related to composite endpoint on univariate analysis with a p value &amp;lt;0.05. Results Of 76 patients included, 52.6% were female. The mean age was 79.3 ± 7.5 years and median TRI-Score 5 [4-7] points. Transcatheter interventions included transcatheter tricuspid valve repair (61.8%) and tricuspid valve replacement (38.2%). TR at discharge was trace/mild, moderate, severe or massive in 60.6%, 26.3%, 13.2% and 0% cases respectively. At 12-month follow-up, 26 (34.2%) patients met the composite endpoint. After adjustment for number of HFH 12 months prior to TTVI, atrial fibrillation, glomerular filtration rate and NT-proBNP, GWWV remained the only baseline parameter significantly associated with increased risk of HFH and death at 12-month follow-up in the multivariate analysis with an adjusted OR of 1.079 (95% confidence interval 1.020 - 1.143; p = 0.009). Conclusion Results of this analysis show that baseline pressure-strain-volume analysis-derived wasted work identifies patients at higher risk for HFH or death following TTVI. Thus, the GWWV calculation may help identify individuals who are more likely to benefit from TTVI.

Myocardial work analysis of aortic stenosis parients with right ventricular pacing: interaction of afterload and mechanical dyssynchrony?

Abstract It is well known that left ventricular (LV) performance is substantially influenced by the corresponding loading conditions and LV synchrony. Notably, data are scarce about the interaction of these factors: previous studies suggest that patients with left bundle branch block (LBBB) has increased afterload sensitivity. This phenomenon may have special importance in certain clinical situations, such as aortic stenosis (AS) patients with concomitant right ventricular pacing (RVP). Accordingly, our aim was to investigate the effects of RVP on LV function in patients with severe AS before and after transcatheter aortic valve replacement (TAVR). Patients with a previously implanted pacemaker and significant AS undergoing TAVR in our Institute were screened. Only subjects with intrinsic non-LBBB QRS were enrolled (n=31). Detailed echocardiographic protocol suitable for speckle-tracking and myocardial work analysis was obtained. Myocardial work measures were calculated by estimating LV pressure as the sum of the systolic blood pressure and the mean aortic gradient. The patients underwent two sets of echocardiographic examinations: one with their narrow QRS rhythm and one with RVP. Those patients (n=19), who did not develop LBBB or complete AV-block also underwent a post-TAVI protocol. We measured LV ejection fraction (EF), global longitudinal strain (GLS) and also global work index (GWI) and global wasted work (GWW). Preoperatively, RVP resulted in significantly lower LV EF (55±9 vs. 49±10%, p≤0.001), GLS (-14.2±3.6 vs. -11.9±3.5%, p≤0.001) and GWI (1830±502 vs. 1322±546 mmHg%, p≤0.001) compared to narrow QRS rhythm, while GWW was markedly higher (222±129 vs. 344±146 mmHg%, p≤0.001). After TAVR, LV EF was comparable (55±9 vs. 52±8%, p=0.11), while GLS (-13.8±.3.8 vs. -11.4±3.8%, p≤0.001) and GWI (1360±403 vs. 1018±385 mmHg%, p≤0.01) was lower in RVP. Notably, the relative change in GWI in response to RVP was significantly lower after TAVR (-31±21 vs. -22±20%, p≤0.05). In patients with severe AS, LV dyssynchrony associated with RVP results in markedly lower LV functional measures. TAVR alleviates LV pressure overload, and the detrimental effect of RVP may dampen with the afterload reduction. Significant AS and RVP may have a highly unfavorable interaction raising the need for early interventions in this population.

Low myocardial work assessed by echocardiography is associated with prolonged ICU-Stay in CABG patients

Abstract Objectives The aim of this study was to investigate whether echocardiographic assessment of myocardial work is a predictor of outcome in patients undergoing operative revascularization. Background Global work index (GWI) is calculated by means of speckle tracking, blood pressure measurement at the moment of strain analysis, and a normalized reference curve. The prognostic value of GWI in patients who are scheduled for bypass surgery is unknown. Methods In this retrospective analysis, 193 patients scheduled for a bypass operation were tracked using echocardiographic strain measurement and calculation of the Global Longitudinal Strain (GLS), the GWI and ejection fraction concerning outcome parameters. The primary endpoint was the occurrence of intrahospital major cardiac events (MACE). As secondary endpoints, prolonged ICU stay (more than 24 hours), requirement for catecholamines (more than 12 hours) and duration of mechanical ventilation (mora than 12 hours) were defined as well as all-cause mortality within a year. Both GWI, EF, and Strain were examined for their validity with respect to the primary and secondary endpoints. Results The mean patient age was 63.41 years (SD 8.67). The median left ventricular ejection fraction was 53.78 % [IQR 48.30, 57.46] and the median global longitudinal strain -14.73 % [IQR-17.20, -11.87]. The median GWI was 1428.00mmHg% [IQR 1074.00, 1725.00]. Regarding the primary endpoint, no statistically significant differences were found between patients with a GWI of over 1000 mmHg% and those with a GWI of under 1000 mmHg% (p=0.281), which can be attributed to the low number of MACE events (n=13). For the secondary endpoints, there was no significant difference in terms of the duration of mechanical ventilation between patients with a GWI of under or over 1000 mmHg% (p= 0.879). However, there was a significantly higher risk for a longer stay in the ICU (OR 3.44, 95%CI [1.54, 8.33], p=0.004) among patients with a GWI of under 1000 mmHg%, and furthermore, a higher requirement for catecholamines was observed (p= 0.007). Conclusion GWI is associated with prolonged ICU Stay above 24 hours and requirement for catecholamines, but not for mace or ventilation time.

Prognostic significance of predischarge echocardiography in acute decompensated heart failure

Abstract Introduction Current guidelines do not specify the timing of echocardiography during acute decompensation of heart failure (HF). In particular, the question of the usefulness of an echocardiographic imaging immediately before discharge from the hospital, i.e. after achieving hemodynamic stabilization, remains unresolved. Aim To compare the prognostic value of echocardiography performed on admission and discharge in patients hospitalized due to acute HF decompensation, and to identify which echocardiographic markers may predict a poor early outcome after discharge. Methods A complete echocardiogram, comprising assessment of myocardial deformation and myocardial work: global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE) was performed twice- upon admission and upon discharge from the hospital in 130 patients (67±15 years of age, mean EF 35±15%) with decompensated HF (NYHA class III or IV). HFpEF was diagnosed in 26, HFmrEF in 19, and HFrEF in 85 enrollees. Participants were followed over 6 weeks after discharge for death and HF hospitalization (composite end-point). Results HF hospitalization or death occurred in 18 patients (13 and 5, respectively). Among echocardiographic parameters of left ventricular (LV), left atrial and right ventricular (RV) function, only E/e’ and GWW measured at pre-discharge were associated with the composite end-point, and the significance of these associations was retained when both predictors were included in the bivariable model. (Table). No associations with the study endpoint were found for any of the echo parameters measured at admission. Conclusions In patients with acute decompensated HF: 1) predischarge echocardiography after achieving hemodynamic stabilization can provide more short-term prognostic information than admission echocardiography during hemodynamic worsening; 2) in addition to LV filling pressure estimation (E/e’), measurement of LV myocardial work may improve the prediction of early mortality and HF readmission after hospital discharge. Table