Assessment Of Left Ventricular Function Research Articles

Clinical Utility of Systolic Left Ventricular Ejection Fraction in Atrial Fibrillation: Role of Prospective ECG-Triggered Cardiac CT.

The assessment of left ventricular (LV) systolic function and quantification of LV ejection fraction (EF) in patients with atrial fibrillation (AF) can be difficult. We previously demonstrated that LV volume changes over the 100 ms of systole (LVEF100ms) can be used as a measure of LV systolic function. We sought to evaluate the applicability of LVEF100ms in AF patients. We screened AF patients who underwent prospective systolic ECG-triggered cardiac computed tomography (CT) from January 2015 to June 2023. The correlation between LVEF100ms and echocardiography-derived LVEF was assessed. Patients were categorized into three groups based on echocardiographic LVEF (≤40%, 40-55%, ≥55%), and LVEF100ms was compared among these groups. Receiver operating characteristic curve analysis and Cox proportional hazards models were applied to determine the optimal LVEF100ms cut-off for predicting LVEF ≤40% and major adverse cardiovascular events (MACE), defined as a composite of cardiac death, myocardial infarction, heart failure hospitalization, and stroke. Of the total 123 patients, 62 (50.4%) patients had LVEF ≥55%, 40 (32.5%) had LVEF 40-50%, and 21 (17.1%) had LVEF ≤40%. LVEF100ms correlated with echocardiography-derived LVEF (p <0.001) and differed significantly among groups (p <0.001). LVEF100ms ≤3.3% predicted LVEF ≤40% (AUC 0.809, sensitivity 87%, specificity 67%). Patients with LVEF100ms ≤3.3% had higher rate of MACE compared to those without (p = 0.030), and LVEF100ms ≤3.3% was an independent predictor of MACE. LVEF100ms can provide a useful indicator of LV dysfunction in AF patients undergoing prospective ECG-triggered cardiac CT.

Quantitative assessment of left ventricular function by left ventricular pressure-strain loop in patients with end-stage renal disease.

A new and non-invasive technology of left ventricular pressure-strain loop (LV-PSL) has recently been used to provide information on myocardial work (MW) and identify subtle modifications in cardiac function. This study aimed to use LV-PSL for early identification of changes in LV structure and MW in patients with end-stage renal disease (ESRD). Methods： Seventy-two patients with ESRD were divided into two groups based on undergoing maintenance hemodialysis (MHD), namely the dialysis group (ESRD-D group) and non-dialysis group (ESRD-ND group). Thirty age- and sex-matched control participants were enrolled in the N group. Traditional echocardiography and LV-PSL measurements were conducted. The values of Global longitudinal strain (GLS), peak strain dispersion (PSD), global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE) were assessed. Results：The most prevalent anomaly in ESRD patients was left ventricular (LV) hypertrophy. The GLS value was significantly lower and PSD was higher in patients with ESRD than in controls. Furthermore, patients with ESRD had severely higher GWW values and lower GWE than the N group (p< 0.05). No significant differences were found in GWI and GCW between the three groups (p> 0.05). Correlation analysis showed that GCW, GWI and GWE were positively correlated with LV ejection fraction (EF) and negatively correlated with GLS. GWW was negatively correlated with LVEF and positively correlated with GLS and PSD. In addition, GWE was negatively correlated with PSD (all p< 0.05). Conclusions：Patients with ESRD have LV structural and functional abnormalities. LV-PSL measurement can be helpful in identifying these subclinical abnormalities. MHD did not change myocardial workload in patients with ESRD.

Assessment of Left Ventricular Function After Percutaneous Coronary Intervention for Chronic Total Occlusion

Assessment of Left Ventricular Function After Percutaneous Coronary Intervention for Chronic Total Occlusion

Relationship Between the Biomarkers of Collagen Regulation and Echocardiography Parameters in Patients With Heart Failure With Preserved Ejection Fraction.

To study the relationship between laboratory markers and echocardiography (EchoCG) parameters in heart failure with preserved ejection fraction (HFpEF) depending on the results of the diastolic stress test (DST). The diagnostic algorithm provided by the current guidelines for the assessment of left ventricular (LV) diastolic function was used to select patients. If there were not enough criteria to make a conclusion about increased LV filling pressure (FP) based on standard resting echocardiography data in patients with arterial hypertension and ischemic heart disease, DST was performed to detect HFpEF. 80 patients (50.0% men, mean age 66.3±5.4 years) were included. Group 1 consisted of 41 patients with a positive DST, and group 2 included 39 patients with a negative DST. Concentrations of the markers of immune inflammation, endothelial dysfunction, collagen homeostasis, and myocardial stress were measured. The DST showed significant differences in the E/e' ratio (15.1 [13.4; 15.9] in group 1 and 9.5 [7.9; 10.3] in group 2, respectively, p&lt;0.001) and the diastolic functional reserve index (DFRI) (9.8 [6.8; 14.0] and 21.0 [13.0; 29.0], p &lt; 0.001). Resting EchoCG revealed significant differences in the left atrial reservoir strain (LASr) (22.8 [19.6; 25.6]% and 28.0 [24.8; 30.2]%, p&lt;0.001) and the left atrial stiffness index (LASI) (0.50 [0.40; 0.57] and 0.34 [0.27; 0.41], p&lt;0.001). In patients with HFpEF, the laboratory parameters of collagen regulation had the greatest number of relationships. Correlations were found between the concentrations of matrix metalloproteinase-9 and other biomarkers, including interleukin-10 (IL-10) (r=0.311; p=0.048), myeloperoxidase (r=0.382; p=0.014), N-terminal propeptide of procollagen type I (procollagen I N-terminal propeptide, PINP) (r=0.722; p&lt;0.001) and type III (r=0.591; p&lt;0.001), C-terminal propeptide of procollagen type I (r=0.330; p=0.035), tissue inhibitor of metalloproteinases type 1 (r=0.410; p=0.008), EchoCG parameters, including left atrial volume index (LAVI) (r=0.414; p=0.007) and DFRI (r=0.354; p=0.025). In addition, correlations were found for the concentrations of PINP with IL-10 (r=0.401; p=0.009) and endothelin-1 (r= -0.337; p=0.031); PINP with LAVI (r=0.498; p=0.001) and DFRI (r=0.420; p=0.007). Patients with HFpEF have a greater number of relationships between markers of collagen homeostasis disorders and EchoCG parameters characterizing an increase in LV FP.

Characterization of Myocardial Recovery in Patients With Tachycardiomyopathy.

The degree and time course of improvement in left ventricular (LV) function with treatment in patients with tachycardiomyopathy (TCMP) is highly variable. This study aims to clinically characterize the recovery of TCMP based on the extent and course of improvement in LV function and identify predictors of complete myocardial recovery. In this prospective, single-center, observational study, patients with suspected TCMP who underwent successful tachyarrhythmia termination/control were included. Clinical and echocardiographic assessment of LV function was done at baseline, within 1 h after tachyarrhythmia termination, 24 h later, and at 12 weeks follow-up. Ninety-nine patients were enrolled in the study. Six patients had immediate normalization of LV ejection fraction (LVEF) with reversion to sinus rhythm and were labeled as "pseudo-TCMP"; the remaining 93 patients were included in the analysis. Based on complete versus partial normalization of LVEF at 12-week follow-up, 50 patients (53.8%) were labeled as completely recovered TCMP and 43 (46.2%) as partially recovered TCMP respectively. Causative arrhythmias included atrial fibrillation (38%), focal atrial tachycardia (28%), atrial flutter (22%), ventricular arrhythmias (11%), and orthodromic re-entrant tachycardia (2%). The LVEF at presentation was 0.25 ± 0.05 which improved to 0.36 ± 0.11 within 1 h after tachycardia termination (p < 0.0001), 0.41 ± 0.14 24 h later (p = 0.009) and to 0.52 ± 0.12 at 12 weeks follow-up (p < 0.0001). Male gender was the only differentiating statistically significant variable between completely recovered and partially recovered TCMP, 24 (48%) versus 30 (69.7%) respectively (p = 0.0339). Nearly half of the TCMP patients have complete recovery of LV function at 12 weeks follow-up, while the other half have a partial recovery only. There was no robust predictor of complete myocardial recovery.

Cardiac compressed sensing real-time cine for the assessment of left ventricular function: a large sample size analysis.

Segmented cine imaging using a balanced steady-state free precession sequence is the gold standard for accurately quantifying cardiac function and myocardial mass. However, this method suffers from inefficient K-space sampling, resulting in long scan times, and requires multiple breath holds that can be difficult for some patients. Real-time compressed sensing (CS) cine reduces image acquisition time through K-space undersampling and iterative reconstruction, enabling rapid magnetic resonance (MR) imaging. Further large-scale studies need to be conducted to validate its effectiveness. In this study, we assessed image quality and left ventricular (LV) function during the routine clinical use of CS imaging in cardiovascular MR (CMR) to determine the feasibility of using CS cine. From April 2022 to March 2023, 242 patients with various heart diseases, including arrhythmia, at outpatient, inpatient, and health examination centers, were consecutively enrolled in this prospective, cross-sectional study and underwent CMR. Two methods [real-time CS cine with free breathing (RTCSCineFB) and conventional breath-hold segmented cine (SegBH)] were used to acquire long- and short-axis cine images of the heart. The total scan time, image quality (Likert score; range, 1-5), LV function parameters, and image fidelity were evaluated for each method. The study cohort comprised 149 men and 75 women with a mean age of 56.2±15.1 years. The mean ± standard deviation (SD) total scan time was significantly shorter for RTCSCineFB than for SegBH (86.44±31.74 vs. 289.81±88.41 s, P<0.001). The overall image quality was slightly lower for RTCSCineFB than for SegBH (P<0.001). The correlations between cardiac function parameters were excellent (0.913-0.984), demonstrating good consistency between the two methods. Both methods were considered equivalent in evaluating LV function and image quality, and showed strong agreement in their diagnostic gradings of ejection fraction (EF) (κ=0.759) and high accuracy. CS cine assessed LV function with high diagnostic accuracy and enhanced image stability for individuals with arrhythmia while maintaining strong consistency in two methods for EF grading condition.

Assessment of left ventricular systolic function using a non-invasive index of myocardial work in amateur marathon runners.

For non-professionally trained athletes, the hyperphysiological stress response induced by marathon exercise may lead to heart fatigue and even cause organic changes such as abnormal ventricular septal thickening. Early detection of abnormal cardiac function in athletes can help prevent adverse cardiovascular events. The purpose of this study was to analyze the left ventricular systolic function (LVSF) of amateur marathon runners using a novel technique called the left ventricular (LV) pressure-strain loop (PSL). A total of 35 amateur marathon runners and 33 age-matched healthy controls from Hangzhou were enrolled in this cross-sectional study from October 2021 to August 2023. The LV myocardial work (MW) parameters were calculated as the area of the PSL by two-dimensional speckle-tracking echocardiography (2D-STE) and blood pressure. The differences between the structural and functional data of the two groups and the predictive efficacy of each of the MW parameters for LV systolic function were analyzed using receiver operating characteristic (ROC) curves. The correlations between the PSL parameters and conventional echocardiographic parameters were analyzed. Global wasted work (GWW) was higher and global work efficiency (GWE) was lower in the amateur marathon runner group than the control group (P<0.05). The ROC curve analysis showed that the maximum area under the curve (AUC) for GWE was 0.681 [95% confidence interval (CI): 0.551-0.812] with an optimal cut-off value of 96.14%, and a sensitivity and specificity of 75.8% and 62.9%, respectively. The correlation analysis results showed that GCW was associated with increased diastolic interventricular septal thickness (IVSTd) (P<0.05, r=0.379). GWE was related to all conventional echocardiography parameters (P<0.05, r=-0.416, -0.674, -0.393, 0.406, 0.502, and -0.424, respectively). While GWW was correlated with increased IVSTd, LV diastolic posterior wall thickness (LVPWTd), and decreased global longitudinal strain (GLS) (all P<0.05, r=0.352, 0.395, and -0.344, respectively). Amateur marathon runners show potential changes in cardiac structure and systolic function after a period of endurance exercise, which can be assessed using non-invasive MW to evaluate LVSF. LV MW, which incorporates the GLS and afterload conditions, is more sensitive than GLS, and has emerged as a promising parameter for LV systolic functional evaluation.

Assessment of Left Ventricular systolic Functions Using Dobutamine Stress Echocardiography in Patients with Myocardial Bridging Detected by Multidetector Coronary Computed Tomographic Angiography

Assessment of Left Ventricular systolic Functions Using Dobutamine Stress Echocardiography in Patients with Myocardial Bridging Detected by Multidetector Coronary Computed Tomographic Angiography

Reference intervals of two-dimensional speckle tracking–derived endocardial global longitudinal strain analysis in 132 healthy cats

IntroductionThe assessment of left ventricular myocardial deformation and function by two-dimensional speckle tracking–derived strain analysis is an established method in human cardiology. It also progressively gains recognition in veterinary cardiology in both dogs and cats. ObjectivesThe objectives of this study were to create reference intervals for two-dimensional speckle tracking echocardiography (STE)–derived endocardial global longitudinal strain (GLS) in a population of healthy adult cats of different breeds. Influences of heart rate, body weight, and age were investigated. AnimalsA total of 132 healthy, adult cats were included in this study. Materials and MethodsLeft apical two-, three-, and four-chamber views were obtained prospectively for GLS measurements using two-dimensional speckle tracking performed with cardiac performance analysis. Potential influence of body weight, heart rate, and age was analyzed, and the interobserver and intra-observer variability of the measurements was determined. ResultsEndocardial GLS values were not significantly influenced by body weight (P=0.102), heart rate (P=0.144), or age (P=0.075). A reference interval for GLS of −21.18% to −37.50% (±4.12) was determined. The interobserver and intra-observer variability showed excellent agreement. Discussion and ConclusionsTwo-dimensional STE is a feasible technique for the evaluation of cardiac myocardial deformation and systolic function in cats. Showing an excellent interobserver and intra-observer agreement, two-dimensional STE is a promising method for clinical analysis of cardiac deformation in cats.

A deep learning based method for left ventricular strain measurements: repeatability and accuracy compared to experienced echocardiographers

BackgroundSpeckle tracking echocardiography (STE) provides quantification of left ventricular (LV) deformation and is useful in the assessment of LV function. STE is increasingly being used clinically, and every effort to simplify and standardize STE is important. Manual outlining of regions of interest (ROIs) is labor intensive and may influence assessment of strain values.PurposeWe hypothesized that a deep learning (DL) model, trained on clinical echocardiographic exams, can be combined with a readily available echocardiographic analysis software, to automate strain calculation with comparable fidelity to trained cardiologists.MethodsData consisted of still frame echocardiographic images with cardiologist-defined ROIs from 672 clinical echocardiographic exams from a university hospital outpatient clinic. Exams included patients with ischemic heart disease, heart failure, valvular disease, and conduction abnormalities, and some healthy subjects. An EfficientNetB1-based architecture was employed, and different techniques and properties including data set size, data quality, augmentations, and transfer learning were evaluated. DL predicted ROIs were reintroduced into commercially available echocardiographic analysis software to automatically calculate strain values.ResultsDL-automated strain calculations had an average absolute difference of 0.75 (95% CI 0.58–0.92) for global longitudinal strain (GLS), and 1.16 (95% CI 1.03–1.29) for single-projection longitudinal strain (LS), compared to operators. A Bland–Altman plot revealed no obvious bias, though there were fewer outliers in the lower average LS ranges. Techniques and data properties yielded no significant increase/decrease in performance.ConclusionThe study demonstrates that DL-assisted, automated strain measurements are feasible, and provide results within interobserver variation. Employing DL in echocardiographic analyses could further facilitate adoption of STE parameters in clinical practice and research, and improve reproducibility.

Left atrial reservoir strain and global longitudinal strain associates with re-hospitalization and mortality in patients admitted for acute heart failure

Abstract Background Left atrial reservoir strain (LAr) and global longitudinal strain (GLS) have emerged as useful parameters for the assessment of left ventricular diastolic function and the estimation of left ventricular filling pressures. Yet, there remains a gap of knowledge regarding the possible association of LAr and GLS with re-hospitalization and mortality in patients with acute heart failure (HF). Aims This study aims to investigate the association between LAr and GLS with re-hospitalization and mortality in patients admitted for acute HF. Methods Out of 526 enrolled patients admitted for acute HF, 142 (mean age 71, 25% women) were systematically evaluated for LAr and GLS using speckle tracking echocardiography. Multivariable Cox regression analyses, adjusting age, sex, current smoking prevalent atrial fibrillation, hypertension, kidney disease and plasma glucose, were used to assess the associations between continuous values of LAr and GLS with all-cause mortality and HF-related re-hospitalization. Results The median follow-up time to death of any cause and HF rehospitalization was 39 (interquartile range 14-66) and 22 (4-51) months, respectively. During follow up, 63 (44%) patients died, and 63 (44%) were re-hospitalized due to HF. Lower values of LAr were significantly associated with higher risk of mortality (HR 0.93; 95%CI 0.89-0.98, p=0.008). Similarly, lower GLS was associated with higher risk of mortality (HR 0.94; 95%CI 0.89-0.99, p=0.045). Only lower values of LAr were associated with higher risk of HF re-hospitalization in the multivariable model (HR 0.93; 95%CI 0.88-0.98, p=0.004). Conclusion In this prospective, long-term follow-up study of patients with acute heart failure, lower values of LAr and GLS showed prognostic significance, with lower values being indicative of poorer outcomes. Notably, LAr was associated with higher risk of both death and rehospitalization for heart failure, whereas GLS was solely associated with higher mortality risk. These echocardiographic parameters could be further investigated for risk assessment of patients with heart failure in order to identify those at higher risk of rehospitalization and death, thereby facilitating targeted interventions to improve their prognosis.KM-curves for or the Quartiles of LAr

Myocardial work and aortic valve stenosis cardiac damage stages are predictors of all-cause mortality in patients undergoing transcatheter aortic valve replacement

Abstract In aortic stenosis (AS) patients, assessment of left ventricular (LV) systolic function is complicated due to the significant impact of increased afterload on conventional parameters. Myocardial work (MW) analysis, a novel echocardiographic method adjusts myocardial deformation to instantaneous LV pressure which may better reflect the LV contractile state. Importantly, long-term LV pressure overload has marked backward effects beyond the LV: classification of this extravalvular cardiac damage effectively represents the involvement of the cardiopulmonary system in AS. Both MW and cardiac damage staging could hold remarkable prognostic power in the clinically complex population of transcatheter aortic valve replacement (TAVR) candidates. Accordingly, our aim was to assess the prognostic value of MW analysis and cardiac damage staging in patients undergoing TAVR. We enrolled 289 patients (79±6 years, 41% female) prior to TAVR. Echocardiographic measurements were performed one day before the procedure. We calculated LV ejection fraction (EF) and by speckle-tracking echocardiography global longitudinal strain (GLS), as well. Global constructive work (GCW) was quantified with dedicated software and LV pressure was estimated using transaortic mean gradient and systolic blood pressure. Based on the echocardiographic data, we also determined the extent of cardiac damage associated with 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). Our primary outcome was all-cause mortality, reached by 68 patients (median follow-up: 26 months). In our cohort, preprocedural EF was 47±13 %, GLS was -12.3±4 %, while GCW was 2043±791 mmHg%. 14 (5%) patients were classified as Stage 0, 61 (21%) as Stage 1, 128 (44%) as Stage 2, 15 (5%) as Stage 3, and 71 (25%) as Stage 4. GCW showed a continuous decline through the AS Stages (from Stage 0-4: 2963±652 vs. 2154±652 vs. 2168±718 vs. 1988±969 vs. 1552±772 mmHg%; p&amp;lt;0.001). Using univariate Cox analysis GCW (HR 0.968 [95% CI 0.938-0.998] per 100 unit change; p=0.034) and AS Staging (HR 1.236 [95% CI 1.015-1.505]; p=0.035) were both associated with all-cause mortality, while EF (HR 0.984 [95% CI 0.966-1.002]; p=0.085) and GLS (HR 1.042 [95% CI 0.984-1.103]; p=0.160) were not. In multivariate Cox regression models, both GCW (HR 0.957 [95% CI 0.922-0.992] per 100 unit change; p=0.018) and AS cardiac damage staging (HR 1.263 [95% CI 1.029-1.549]; p=0.025) were proven to be significant independent predictors of all-cause mortality. In TAVR patients, preoperative GCW values exhibited a persistent decrease across AS Stages. As opposed to EF and GLS, GCW and AS Staging both showed strong association with all-cause mortality in our cohort. Moreover, GCW had higher prognostic value than any other conventional or advanced measure of LV function.

Global longitudinal strain measurement in the modern era - is artificial intelligence the answer ?

Abstract Background Global longitudinal strain (GLS) enhances the assessment of left ventricular (LV) function beyond ejection fraction (EF) in 2D echocardiography (Echo). However, manual GLS measurement, the most common technique, is operator dependent. A novel vendor-independent artificial intelligence (AI)-based software streamlines automated 2D-Echo exam evaluation and GLS calculation. Purpose We sought to evaluate the ability of the AI to automatically identify LV 4-, 2-, and 3-chamber views (CV) from 2D-Echo exams and to validate GLS against the conventional manual method. Methods 540 patients underwent standard 2D-Echo exams. The server-based AI recognized the optimal LV CVs from 2D-Echo exams and automatically calculated triplane GLS by endocardial delineation (n=489, 91%). Manual LV GLS was performed independently by accredited cardiologists. Pearson’s correlation (R) and Bland-Altman analysis were performed to assess bias and limits of agreement (LOA) for GLS. Multivariate between-method regression was performed using ordinary least squares to disclose possible sources of possible bias. Significance was defined as a 2-tailed P value &amp;lt; 0.05. Results Patients’ median age was 70 years [18-93], 59% were males. The 2D-Echo indications were coronary artery disease (36%), valvular heart disease (15%), non-ischemic heart failure (15%) and others (34%). The feasibility of the AI to calculate GLS was 91% (n=489) due to endocardial border delineation issues. AI correctly classified all CVs. An excellent correlation (r=0.92, p&amp;lt;0.001) was observed between AI and manual GLS, with low bias (0.5%) and narrow LOAs (-3.1 and +4.2%) (Figure 1, top row). We identified LV end-diastolic volume and EF as statistically significant confounders (p &amp;lt; 0.05) with only small effect as depicted in Figure 1 (bottom row). Neither sex, age, acoustic window, body mass index, nor heart rate, along with the interaction with sex, end-diastolic volume, or EF, were significant (p &amp;gt; 0.23). Conclusion AI-based LV GLS calculation in 2D-Echo shows promising feasibility and accuracy. Strong agreement between AI-derived GLS and manual measurements supports its reliability. The AI's ability to identify optimal LV views underscores its robustness. Further validation and refinement are warranted, highlighting the transformative potential of AI in advancing cardiovascular diagnostics.

Multi-vendor validation of automated left ventricular analysis from 3D echocardiography using artificial intelligence

Abstract Background Accurate echocardiographic assessment of left ventricular (LV) function is dependent on both image acquisition and analysis. Although 3D echocardiography (3DE) is increasingly recommended for volume quantification, manually derived volumes are limited by operator subjectivity, variable image quality, and the lengthy duration of analysis. Consequently, several automated approaches based on artificial intelligence (AI) have been proposed to segment the LV cavity from 3DE and have demonstrated better accuracy and reproducibility compared to human experts. While the utility of AI models in the clinic depends on their ability to generalise to different populations and ultrasound vendors, the external validation of developed models remains limited. Purpose This study evaluates the ability of an existing AI model trained using data from a single vendor to accurately estimate routine 3DE LV indices in an independent external dataset acquired using equipment from a different vendor. Methods A previously published and internally validated deep learning model for segmentation of the LV cavity and myocardium from 3DE was used to automatically derive LV indices including end-diastolic volume (EDV), end-systolic volume (ESV), LV mass, and ejection fraction (EF) [1]. A second independent dataset consisting of paired 3DE and CMR images from 65 marathon runners from a different centre (using equipment from a different vendor) was subsequently used for external validation. Images from both datasets were subjectively scored from 1 (poor) to 5 (excellent) as a measure of image quality. Agreement with CMR as the reference was assessed using a two-way mixed effects intraclass correlation coefficient (ICC), supplemented by Bland-Altman analysis, to determine the model bias (between 3DE and CMR) and 95% limits of agreement (LOA). To assess whether performance could be improved by inclusion of multi-vendor data during training, the initial model was fine-tuned using a small subset (n=9) of images from the second centre. Results The mean image quality score from the second dataset was 2.5 (± 1.1), which was significantly lower than the mean of 3.4 (± 1.0) from the first dataset. Despite vendor and image quality differences, the initial model produced good agreement with CMR in EDV, ESV, and LV mass but only poor agreement in EF (Fig 1). Fine tuning greatly improved agreement in EF with reduced bias and narrower 95% LOA (Fig 2). Conclusion With the addition of a small number of cases for fine-tuning, AI models for automated LV analysis can achieve good performance analysing 3DE images acquired from a different vendor and population. Advancing model generalisability through more sophisticated data augmentation strategies may enable truly vendor-agnostic automated LV analysis from 3DE.

Can examining shear wave elastography predict elevated filling pressures? - A comparative evaluation against the current guideline algorithm

Abstract Background The clinical assessment of left ventricular diastolic function is complex, as there is no single non-invasive parameter that provides a direct measurement of myocardial relaxation, myocardial compliance, or–as a surrogate-LV filling pressure. The estimation of diastolic function involves therefore a combination of various parameters. Shear wave (SW) elastography (SWE) is a novel method based on high frame rate echocardiography. SWs are generated following mechanical excitation of the myocardium, such as after mitral valve closure (MVC), and their propagation velocity is directly linked to myocardial stiffness (MS) and is therefore a potential marker of diastolic function. Purpose The aim of this study was to investigate if the propagation velocities of natural shear waves are related to invasively measured mid-(LVMDP) and end-diastolic LV filling pressures (LVEDP) and, thus, could be used as echocardiographic estimate of left ventricular diastolic function. Methods We prospectively enrolled 95 patients with a wide range of diastolic function, scheduled for heart catheterization so that LVMDP and LVEDP could be invasively measured. Patients with myocardial pathology or dysfunction of the anteroseptal wall, as well as severe aortic stenosis, and a more than moderate mitral regurgitation were excluded. Echocardiography was performed immediately after catheterization. SW elastography in parasternal long axis views of the left ventricle (LV) was performed using an experimental scanner (HD-PULSE) at 1040±200 frames per second. An anatomical M-mode was extracted from the midline of the LV septum and color coded for tissue acceleration. The SW propagation velocity at MVC was measured as slope on the M-mode (A). Standard echocardiographic parameters were obtained with a high-end ultrasound machine (Vivid 95, GE Vingmed Ultrasound). The algorithm for evaluating diastolic dysfunction as recommended by the European Association of Cardiovascular Imaging expert consensus 2021 was applied to categorize LV filling pressure as normal or elevated. Results SW velocities correlated significantly with both, LVMDP (r=0.47; p&amp;lt;0,001) and LVEDP (r=0.71, p&amp;lt;0.001). They could excellently detect elevated LVEDP (AUC=0.95, Sensitivity=0.92, Specificity=0.94) and detected elevated LVMDP with AUC=0.79, Sensitivity=0.87, Specificity= 0.65, similar to the guideline approach (AUC=0.78, Sensitivity=0.62, Specificity=0.94). Conclusions SW velocities, measured by high frame rate echocardiography, show a strong correlation with the end-diastolic and a good correlation with mid-diastolic filling pressures. The method could excellently distinguish normal and elevated LVEDP and could–through a single measurement-differentiate normal and elevated LVMDP as good as the current guideline algorithm with its combination of four parameters in a decision tree. Our data suggest a potential clinical value of the new method for the non-invasive assessment of diastolic function.

Predictors of Right vEntricular Failure aftER LVAD implantation: PREFER LVAD study

Abstract Introduction The use of left ventricular assist devices (LVAD) is increasing both as bridge-to-transplantation or destination therapy, considering the lack of heart donors for transplantation in advanced heart failure (AHF) population. Right ventricular post-implantation failure, major bleedings and infective events remain the principal adverse events in LVAD carriers, thus an accurate selection of candidates is needed. Purpose To identify between clinical, laboratory, standard and advanced (Speckle Tracking, STE) echocardiography, and right heart catheterization (RHC) indices, the best predictors of outcome after LVAD implantation. Materials and Methods We screened in our third-level center 30 patients with AHF, followed up from May 2013 to February 2022, for the assessment of LVAD implantation suitability. They all underwent a complete cardiological history collection, electrocardiography, standard and STE left ventricular (LV) and left atrial (LA) size and function assessment. Regarding the right ventricle, SIENA score parameters, including RV sphericity index, RV free wall longitudinal strain (LS), right ventricular fractional area change (RVFAC), and 3D ejection fraction were used for exclude RV disfunction. RHC was performed on the same day of echocardiography. Follow-up was conducted at 1, 3, 6, 9 and 12 months repeating all the assessments, for the occurrence of RV failure, all-causes mortality, hemorrhagic events and re-hospitalization for heart failure. With a univariate and multivariate statistical analysis, we went to test among all the parameters the possible predictors of outcome. Results The final population consists of 29 patients (93% male, mean age of 63±11 years), in NYHA class III or IV and a severe reduction of left ventricular (LV) ejection fraction (EF), in whom arterial hypertension and smoking, present or previous, were present in 58% and 65% of cases, respectively. The population was divided into two groups according to the occurrence of at least one cardiovascular event. 11 major events were recorded: including 4 hemorrhagic events, 3 all-causes mortality and 4 hospital admission for HF. No RV failure occurred in the first 12 months of follow-up. No differences were identified between the two groups in terms of echocardiographic indices and RV function, including RVFAC or RV-FWLS. At univariate analysis (see Table 1), the only parameter able to predict major CV events was central venous pressure (CVP)/pulmonary capillary wedge pressure (PCWP) ratio, obtained by RHC, an index of balance between right and left heart filling pressure. Conclusions A careful application of SIENA score indices before LVAD implantation can significantly reduce the incidence of post-operative RV failure, as in our small population. Our results also confirmed the paramount role of RHC in the diagnostic work up of AHF.

Left atrial reservoir strain as a prognostic indicator for cardiovascular events after mitral valvuloplasty

Abstract Background In patients after mitral valvuloplasty (MVP), assessing valve function and heart failure (HF) is crucial for prognostic predictions. Left ventricular diastolic function assessed by transthoracic echocardiography (TTE) plays an important role in the evaluation of HF in general practice. However, post-mitral valve surgery patients are excluded from the left ventricular diastolic function assessment guidelines proposed by the American Society of Echocardiography in 2016 due to their low correlation with left ventricular diastolic function indices. On the contrary, the left atrial reservoir strain (LARS) before MVP is considered as a prognostic factor, reflecting left atrial dysfunction caused by mitral regurgitation. Nevertheless, there are limited reports on the relationship between LARS and cardiovascular (CV) events after MVP. Purpose The study aims to investigate the utility of LARS in predicting CV events after MVP. Methods The study included 249 patients who underwent TTE between January 2011 and January 2023 after MVP at our hospital. Patient background data, including NYHA classification, medical history, medications, blood tests, and TTE data, were collected at the time of follow-up TTE. LARS, left ventricular global longitudinal strain (LV-GLS), and right ventricular free wall strain (RV-FWSL) analysis were performed using a vender-independent external strain analysis software for all patients in the cohort. The primary endpoints were cardiovascular death and HF rehospitalization. The predictor of cardiovascular events was assessed using the Cox proportional hazards model and Kaplan-Meier curve (KMC). Results The mean age was 61±14 years, and 159 patients (64%) were male. The median time from surgery to TTE was 4.8 (1.0-6.8) years, 32 patients (13%) had events within 8.5 (3.7-10.8) years after TTE. The event groups had higher age, NYHA classification, and NT-pro BNP compared to the non-event group. TTE parameters such as left ventricular mass index, left ventricular end-diastolic volume and end-systolic volume were larger, and LV-GLS and LARS were significantly lower in the event group. In multivariate Cox proportional hazards models showed that LARS was also a prognostic indicator even after adjustment for several variables (Table 1). The KMC showed that LARS was associated with events regardless of left atrial volume index (Log-rank p &amp;lt;0.001, chi-square:31.03) (Figure 1). Conclusion LARS was strongly associated with CV events after MVP. We consider LARS to be a useful prognostic indicator after MVP.

Incidence of left ventricular dysfunction in the general population of the Amazon Basin and diagnostic potential of lung ultrasound

Abstract Background B-lines by lung ultrasound (LUS) are associated with left ventricular (LV) dysfunction and may be useful for diagnostics in resource-limited settings. Purpose To assess the incidence of LV dysfunction in the general population of the Amazon Basin and to evaluate the diagnostic potential of LUS. We defined LV dysfunction as LV ejection fraction &amp;lt;45% and LUS was assessed across eight chest zones. B-lines were calculated as the sum of all zones. Methods and results We conducted echocardiography and LUS in 514 individuals from a population sample in the Amazon Basin (mean age 41 years, 40% men). No patients had known heart failure, renal insufficiency or lung disease. A total of 14 individuals (3%) had LV dysfunction, corresponding to an incidence of 27.2 per 1,000 individuals. The mean number of B-lines in the general population was 0.2 (range 0 to 17 B-lines). Individuals with LV dysfunction presented with a significantly higher number of B-lines (P=0.006) and more frequently had &amp;gt;=3 B-lines (8% vs 2%, P=0.018) compared to those with normal LV function. Identification of &amp;gt;=3 B-lines yielded a sensitivity of 58% and specificity of 93% (AUC 0.72, negative predictive value 99%, positive predictive value 19%) for detecting LV dysfunction. Per 1 unit increase in B-lines, LV ejection fraction decreased by 9% (95%CI: -15% to -3%, P=0.010) and the relationship persisted to be significant after adjusting for age, sex, body mass index, heart rate and creatinine (-8%, 95%CI: -15% to -2%, P=0.016). Conclusion The incidence of LV dysfunction in the Amazon Basin was 27.2/1,000 individuals and B-lines by LUS was able to detect LV dysfunction with reasonable diagnostic accuracy. Moreover, a higher number of B-lines was associated with decreasing LV ejection fraction. Our findings indicate that LUS may supplement conventional cardiac diagnostics for assessing LV function, especially in rural environments with restricted access to imaging tools.B-lines and LV ejection fraction

Assessment of left ventricular function in patient after ventricular septal defect closure using echocardiography

Assessment of left ventricular function in patient after ventricular septal defect closure using echocardiography

Assessment of Blood Pressure Levels and Left Ventricular Functions of American Football Players in Türkiye

Assessment of Blood Pressure Levels and Left Ventricular Functions of American Football Players in Türkiye