Stiffness Index Research Articles

CARDIOVASCULAR RESPONSES TO SINGLE- VS. MULTI-CHAMBERED BLOOD FLOW RESTRICTION CUFFS

https://youtu.be/PhZCG3KN3e8 BACKGROUND This study aimed to investigate the impact of the blood flow restriction bladder type (single- [SC-BFR] vs. multi-chambered [MC-BFR]) on cardiovascular responses with exercise sessions incorporating multiple sets to volitional failure in a randomized, crossover experimental design. METHODS Twenty-seven healthy, physically active participants (11 females; age: 22.6±5.7; BMI: 25.0±4.1 kg/m2; ~93% reported regular resistance training within 6 months) randomly performed wall squats to failure (4 x sets to failure, 20% 1RM, 60% limb occlusion pressure, 1 min rest between sets) in each of three conditions: SC-BFR (using the Delfi Personalized Tourniquet Device), MC-BFR (using the BStrong Cuffs), and N-BFR (no BFR control). Hemodynamic assessments and indices of arterial stiffness were monitored immediately before and after each exercise session. RESULTS SC-BFR blunted post-exercise increases in carotid-femoral pulse wave velocity (p = 0.328) whereas the other conditions showed elevations (p < 0.05). CONCLUSION The bladder design of a BFR cuff impacts the acute responses to exercise, as SC-BFR mitigates post-exercise arterial stiffness responses compared to MC-BFR and N-BFR. This was the first intervention to examine the acute effects of BFR bladder design on arterial stiffness during lower body exercise. SC-BFR appears to be a safe option for lower limb occlusion training.

The validity of carotid-femoral pulse wave velocity in the seated posture as an index of central arterial stiffness.

A previous study reported an increase in carotid-femoral pulse wave velocity (cfPWV) during an upright posture compared to the supine position, partly due to sympathetic activation. However, given that cfPWV is influenced by the transmural pressure (TMP) of the artery, which is elevated in the abdominal aorta in the seated posture due to the increased hydrostatic pressure. Thus, it remains unclear whether this increased cfPWV reflects a true rise in arterial stiffness or is simply a result of the elevated TMP. To assess the validity of cfPWV in the seated posture for arterial stiffness assessment, 20 young healthy subjects underwent arterial stiffness measurements in both the supine and seated positions. There were no significant differences in carotid artery compliance, β-stiffness index, and aortic characteristic impedance between the two positions (P = 0.209-0.380). However, cfPWV was higher in the seated posture than the supine posture (5.4 ± 0.6 vs. 6.2 ± 0.8 m/s, P < 0.0001), showing a high intraclass correlation coefficient (ICC) between positions (r = 0.841, P < 0.0001) and a parallel upward shift by 14% (y = 1.01x + 0.54). Moreover, cfPWV was correlated with TMP at the groin level (r = 0.532, P = 0.0004), and after adjusting for TMP at the groin level using analysis of covariance (ANCOVA), the posture-related difference in cfPWV was no longer significant (P = 0.867). These findings suggest that the increase in cfPWV observed in the seated posture is primarily due to elevated TMP caused by increased hydrostatic pressure, rather than a genuine rise in arterial stiffness. Consequently, cfPWV measurements taken in the seated posture may overestimate arterial stiffness unless they are appropriately adjusted for TMP.NEW & NOTEWORTHY This study demonstrated for the first time that the increase in carotid-femoral pulse wave velocity (cfPWV) observed in the seated posture is likely due to elevated transmural pressure (TMP) caused by increased hydrostatic pressure, rather than an actual rise in central arterial stiffness. Intraclass correlation analysis also showed a parallel upward shift in the regression line between supine and seated postures. This suggests that cfPWV values obtained in the seated position should be adjusted for hydrostatic pressure and TMP.

Evaluation of a machine learning-based metabolic marker for coronary artery disease in the UK Biobank.

An in silico quantitative score of coronary artery disease (ISCAD), built using machine learning and clinical data from electronic health records, has been shown to result in gradations of risk of subclinical atherosclerosis, coronary artery disease (CAD) sequelae, and mortality. Large-scale metabolite biomarker profiling provides increased portability and objectivity in machine learning for disease prediction and gradation. However, these models have not been fully leveraged. We evaluated a quantitative score of CAD derived from probabilities of a machine learning model trained on metabolomic data. We developed a CAD-predictive learning model using metabolic data from 93,642 individuals from the UK Biobank (median [IQR] age, 57 [14] years; 39,796 [42%] male; 5640 [6%] with diagnosed CAD), and assessed its probabilities as a quantitative metabolic risk score for CAD (M-CAD; range 0 [lowest probability] to 1 [highest probability]) in participants of the UK Biobank. The relationship of M-CAD with arterial stiffness index, ejection fraction, CAD sequelae, and mortality was assessed. The model predicted CAD with an area under the receiver-operating-characteristic curve of 0.712. Arterial Stiffness Index increased by 0.19 and ejection fraction decreased by 0.2% per 0.1 increase in M-CAD. Both incident and recurrent myocardial infarction increased stepwise over M-CAD quartiles (odds ratio (OR) 15.3 [4.2%] and 12.5 [0.2%]) in top quartiles as compared to the first quartile of incident and recurrent MI respectively). Likewise, the hazard ratio and prevalence of all-cause mortality, CVD-associated mortality, and CAD-associated mortality increased stepwise over M-CAD deciles (2.98 [14%], 9.34 [4.3%], 26.7 [2.7%] in the top deciles as compared to the first decile of all-cause, CVD, and CAD mortality respectively). Metabolic-based machine learning can be used to build a quantitative risk score for CAD that is associated with atherosclerotic burden, CAD sequelae and mortality.

Association of arterial structure and function with incident cardiovascular diseases and cognitive decline.

We examined the associations of carotid intima-media thickness (CIMT), arterial stiffness index (ASI), and pulse pressure (PP) with cerebrovascular disease, cognitive function and decline, and incident cardiovascular diseases (CVD) and dementia in the UK Biobank cohort. The study consisted of 42,711 participants (mean age 64.2 years) with brain magnetic resonance imaging (MRI), vascular assessments, and cognitive testing. Cerebrovascular disease markers included white matter hyperintensities (WMH) and brain volumes. CIMT, ASI, and PP were measured using carotid ultrasound, photoplethysmography, and blood pressure, respectively. General cognitive ability (g-score) was derived from various cognitive tests using principal components analysis (PCA). Elevated CIMT, ASI, and PP were associated with increased WMH volume (WMHV). Increased PP was independently associated with poorer numeric memory (ß=-0.028,p=0.002), fluid intelligence (IQ) (ß=-0.060,p<0.001), and g-score (ß=-0.028,p<0.001) in cross-sectional analysis, but not longitudinally. CIMT showed the strongest association with incident CVD and dementia. CIMT had the most robust associations with WMHV, incident CVD, and dementia, suggesting its utility as an alternative endpoint. Effects of arterial stiffness on cognition, dementia, and CVD.Structural vascular parameters included CIMT.Functional properties included ASI and PP.CIMT, ASI, and PP were positively associated with WMHV.CIMT had the greatest associations with incident CVD and dementia.

Standard b-value DWI-derived stiffness index analysis may provide a way to evaluate the development of intracerebral hematoma

Background and purposeThe development of intracerebral hemorrhage (ICH) is closely related to mechanical forces. However, noninvasively evaluating mechanical forces for ICH patients in the current clinical setting is challenging. In this study, we aimed to build an easily accessible stiffness index (STI) and evaluate the stiffness of the perihematomal edema (PHE) region in ICH patients.Materials and methodsIn this retrospective study, two cohorts of 57 patients were included. One cohort (the exploratory cohort) comprised patients with both standard b-value diffusion-weighted imaging (sDWI) (b-values of 0 and 1,000 s/mm2, b0 and b1000) and higher b-value diffusion-weighted imaging (hDWI) (b-values of 200 and 1,500 s/mm2). Another cohort (the hemorrhage cohort) consisted of patients who were diagnosed with ICH and who underwent sDWI within 48 h from onset. The hDWI-based virtual shear modulus (μdiff) was calculated and correlated with the sDWI data in the exploratory cohort. In the hemorrhage cohort, STI maps that were used to estimate μdiff were generated. The mean STI (mSTI) and coefficient of variation (COV) of the STI were computed on the basis of the STI maps in the whole and largest-slice PHE regions.ResultsThe STI could be calculated with the Equation 0.047697*S1000-0.022944*S0 + 5.359883, where S1000 and S0 represent the signal intensities of the b1000 and b0 images, respectively. In the whole and largest-slice PHE regions, both the mSTI and COV were correlated with the hematoma volume (p &amp;lt; 0.01), but neither were correlated with the time from onset.ConclusionThe standard b-value DWI-derived stiffness index analysis may provide a noninvasive and easily accessible way to evaluate the development of ICH.

Echocardiographic left atrial stiffness index predicts high left ventricular filling pressures in patients with acute heart failure: an observational prospective study

Abstract Introduction In acute heart failure (AHF) patients, non-invasive estimation of left ventricular filling pressures (LVFPs) appears crucial to guide management. Although poorly investigated, left atrial (LA) mechanics play a pivotal role in this setting. Interestingly, recent findings indicate that combining LARS with conventional diastolic echocardiographic parameters, such as E/e’, may yield even more reliable estimations of LVFPs. Purpose This report sought to assess the correlation of echocardiographic LA stiffness index with invasive LVFPs and its diagnostic accuracy as compared to other parameters used in clinical practice. Methods In this observational, prospective study, 104 patients with suspected acute coronary syndrome and signs/symptoms of AHF were enrolled. Available invasive estimation of LVFPs was required. Comprehensive echocardiography was performed for all patients, including LA reservoir strain (LARS). LA stiffness index was derived as early diastolic transmitral inflow velocity/mitral annulus early diastolic velocity [E/e']/LARS. Predictive models based on LA stiffness index and LARS were built and tested in independent populations by randomly assigning patients to a "training group" for model building and a "test group" for model evaluation, using simple random sampling. Sampling was carried out with the "sample" function of R, with a 4:1 group ratio. Models’ performances were evaluated in the independent population "test group" against the guideline-recommended echocardiographic flowchart for the assessment of diastolic dysfunction. Results Invasively measured LVFPs showed a strong correlation with LA stiffness index (Spearman ρ = 0.773, p &amp;lt; 0.0001), as well as with LARS and E/e’. Receiver operating characteristic (ROC) curve analysis was used to demonstrate better accuracy performed by LA stiffness index than other echocardiographic metrics in predicting high LVFPs. Guideline-recommended assessment of diastolic function was finally compared to LARS and LA stiffness index performances in an independent population group; we were hence able to obtain a LA stiffness threshold of 0.48 with a positive predictive value of 91.7% and a negative predictive value of 88.9% in identifying patients with high LVFPs. Conclusions For the first time, diagnostic performance of LA stiffness index has been investigated in a heterogeneous AHF population, providing correlations with invasively measured LVFPs and comparisons with established diastolic function metrics.

Left atrial stiffness index estimated by echocardiography is an independent predictor of mortality in non-ischemic dilated cardiomyopathy

Abstract Introduction and Objectives Left atrial function parameters have been shown to be important prognostic markers in different clinical settings. Our objective was to evaluate the prognostic role of a non-invasive estimation of left atrial stiffness index using echocardiography in patients with non-ischemic dilated cardiomyopathy (NIDCM). Methods Prospective cohort study of patients with NIDCM evaluated at a tertiary Spanish hospital between 2017 and 2022. Clinical and cardiac imaging variables were collected in a multipurpose registry, and the incidence of clinical events was recorded during follow-up. Left atrial stiffness index was estimated non-invasively as the ratio between E/e' and left atrial strain in the reservoir phase. Results Mean age of patients in our cohort (n=200) was 61 (14) years, and 68 (34%) were women. During a mean follow-up of 3.6 years, 33 (16.5%) patients died, and 54 (27%) were hospitalized for heart failure. Mean left ventricular ejection fraction (LVEF) was 31% (9.5), and mean left atrial stiffness index was 1.3 (0.9), with significant differences between patients with and without events (1.68 (1.1) vs 1.21 (0.8); p=0.005) (Figure). In a logistic regression analysis, the variables significantly associated with all-cause mortality during follow-up were LVEF, E/e' ratio, and left atrial stiffness index (Table). In a multivariable analysis, left atrial stiffness index emerged as an independent predictor of mortality (OR 1.79, 95% CI 1.19-2.69; p=0.005). Conclusions In our cohort of patients with NIDCM, the left atrial stiffness index, which combines information related to filling pressures with left atrial function, was an independent predictor of mortality and could be useful as an additional tool for risk stratification in this setting. Differences in LA stiffness index Logistic regression analysis (mortality)

Left atrial stiffness and its association to left ventricular geometry in resistance trained athletes using anabolic-androgenic steroids

Abstract Background Anabolic-Androgenic Steroids (AAS) are commonly used in resistance trained (RT) individuals despite the negative impact on left ventricular (LV) structure and function. Purpose Due to the inter-dependence of the left atrium (LA) and the LV, alongside the importance of the atria contributing to LV filling and cardiac output, this study aimed to assess the relationship between LV geometry and LA stiffness in young RT users of AAS. Methods Utilising a cross-sectional design, male (n=99) and female (n=19) RT individuals aged 29±6yrs were grouped based on self-reported AAS user status: current (CU; n=70), past (PU; n=22) and non-users (NU; n=27). All participants underwent transthoracic echocardiography with strain imaging. Left ventricular geometry was defined based on LV mass index and relative wall thickness as per European Association of Cardiovascular Imaging guidelines. Left atrial stiffness index (LASi) was calculated as the ratio of E/E’ to LA reservoir strain (LARes) and concentricity as the ratio of LV mass to end-diastolic volume^0.67. Ejection Fraction (EF) was calculated using Simpsons biplane method. All data was presented as mean ± standard deviation with group differences assessed using a one-way ANOVA with post-hoc Bonferroni adjustment and Kruskal-Wallis test for non-normally distributed indices. A Fishers exact test was used to compare geometry between groups. Relationships between LASi and concentricity were assessed using multi linear regression Results Current users presented greater LV remodelling compared to PU and NU (eccentric hypertrophy (45%, 9% and 0%), concentric remodelling (2%, 0% and 0%) and concentric hypertrophy (8%, 0% and 0% respectively; p&amp;lt;0.001). EF was lower in those with concentric (52±9, p=.006) and eccentric (53±5, p&amp;lt;.001) hypertrophy than with normal geometry (58±5), but no difference between concentric and eccentric hypertrophy. LARes was lower in CU (32.0±7.5) compared to PU (39.1±8.3, p=.001) and NU (40.2±7.7, p&amp;lt;.001). E/E’ and LASi were higher in CU than PU (p=.006, p=.001) and NU (p&amp;lt;.001, p&amp;lt;.001; E/E’: 6.7±1.8, 5.9±1.5, and 5.7±1.4; LA stiffness index: 0.21±0.08, 0.16±0.05, and 0.15±0.05). Concentricity was higher in CU than PU (p&amp;lt;.001) and NU (p&amp;lt;.001; 8.3±2.2; 6.4±1.4 and 5.7±2.2 respectively). Controlling for user status, concentricity predicted LASi (R²=0.23, F(2,109)=16.1, p&amp;lt;.001) with a 0.1 increase in LASi for each 10g.ml^-0.667 increase in concentricity. Conclusions Although current users of AAS presented with more eccentric hypertrophy, those with increased concentricity and concentric hypertrophy had higher LA stiffness index. These data highlight 1) the potential greater negative functional impact of concentric compared to eccentric hypertrophy in young RT individuals using AAS, 2) the added value of LASi above conventional indices such as EF and 3) the possible reversible nature of LV and LA remodelling following cessation of AAS use.

Left atrial function parameters in patients with a first episode of myocardial infarction: relationship with infarct size and serological inflammatory biomarkers

Abstract Aim Left atrial (LA) function is linked with clinical events in different cardiovascular scenarios. Our aim was to evaluate the associated between LA function and different imaging and serological biomarkers in a cohort of patients with a first episode of acute myocardial infarction (AMI). Methods Prospective cohort of patients with a first episode of AMI treated with percutaneous revascularization in a tertiary care hospital in 2016. All patients underwent echocardiography and cardiac magnetic resonance and blood samples were taken for serological biomarkers analysis. LA function was assessed by means of LA stiffness (E/e’ divided by LA reservoir strain) and LA volumetric-mechanical coupling index [LACI] (LA volume index divided by tissue Doppler a’). Results Mean age of patients in our cohort (n=41) was 57.5±10 years, and 38 (93%) were male. 64% of patients had single vessel coronary artery disease, and median LVEF eas 58% (55-62). Regarding LA function, median LACI was 2.47 (1.99-3.14) and median LA stiffness was 0.27 (0.21-0.44), with 11 (26.8%) patients fulfilling criteria for high LA stiffness. The correlation between these parameters and different imaging and serological biomarkers is shown in Figure 1. There was a significant correlation between LA stiffness and ventricular-arterial coupling, infarct size, and T1 native values. LACI was associated with pulmonary artery systolic pressure, interleukin-6 and soluble CD-14 antigen. Both LA parameters were also significantly associated with left ventricular (LV) ejection fraction and LV global longitudinal strain (Figure 2). Conclusions In our cohort of patients with a first episode of AMI, echocardiographic parameters of LA function were significantly associated with LV function, infarct size and serological biomarkers of inflammation. These parameters might serve as an additional tool for risk stratification in patients with ischemic cardiomyopathy. Figure 1 Figure 2

Left atrial stiffness index in patients with cryptogenic ischemic stroke: a clue of atrial fibrillation?

Abstract Introduction About 25% of cryptogenic ischemic stroke are due to undiagnosed atrial fibrillation. New echocardiographic markers derived from left atrial strain analysis could be useful to early identify patients candidates to oral anticoagulation. Purpose Aim of our study was to investigate the relationship between left atrial strain parameters assessed by speckle tracking echocardiography (STE) and the new documentation of atrial fibrillation at follow-up in patients admitted for acute cryptogenic ischemic stroke. Methods From 2020 to 2023 consecutive patients admitted to Stroke Unit of our Hospital for cryptogenic ischemic stroke undergoing loop-recorder implantation were retrospectively enrolled in our study. Main exclusion criteria were previous diagnosis of atrial fibrillation and poor image quality. All patients underwent full echocardiographic examination, including left atrial strain analysis with STE by dedicated software. Results Sixty-nine patients were finally selected, divided in patients with and without atrial fibrillation at follow-up (26 and 43 pts, respectively). No clinically significant differences were found between the two groups at baseline. Analysing echocardiographic parameters, significant differences were found in patients with and without diagnosis of atrial fibrillation at follow-up, respectively, with regard to left atrial volume index (LAVi, 44.26 ± 10.58 vs 34.54 ± 11.03 ml/m2, p 0.005), peak atrial longitudinal strain of reservoir phase (PALSr 19.50 ± 8.48 vs 26.22 ± 9.11%, p 0.01) and contraction phase (PALSct 5.70 (0; 20.92) vs 11.23 (5.98; 16), p 0.017). Left atrial stiffness index was defined as the ratio between E/E’ (expression of left ventricular filling pressures) and PALSr. Using a cut-point of 0.55, identified with ROC analysis, a significant difference was found between the two groups (10/26 (38.4%) vs 4/43 (9.3%), p 0.002). Among all these parameters, at the multivariate logistic regression analysis only left atrial stiffness index showed a trend to the significance (p 0.06). Conclusions Left atrial strain analysis can be useful to better select patients with cryptogenic stroke who need loop-recorder implantation and a closer follow-up to prompt recognize atrial fibrillation. In particular, Left atrial stiffness index seems to be the most useful parameter to stratify patients at higher risk of atrial fibrillation.

Reverse structural and functional left atrial remodeling after successful catheter ablation for paroxysmal atrial fibrillation.

Abstract Background Catheter ablation is considered the most effective method for restoring sinus rhythm in patients with atrial fibrillation (AF). However, data on the reverse structural and functional remodeling of the left atrium (LA) after a successful procedure are still inconclusive, especially in patients with sinus rhythm during catheter ablation. The aim of the present study was to investigate echocardiographic parameters indicating the presence of reverse LA remodeling, following a successful procedure and long-term follow-up of sinus rhythm maintenance. Methods Of the 106 patients who had undergone successful catheter ablation (between January 2021 and May 2023) for paroxysmal AF (with sinus rhythm on echocardiography during ablation), 49 patients were included in the study up to now. The absence of AF recurrence was assessed during a follow-up consisting of outpatient visits/televisits and 7-day Holter monitoring (at 6 and 12 months after ablation). All patients underwent conventional and 2D speckle tracking echocardiography on the day of ablation and after the long-term of follow-up period of maintanance of sinus rhythm. Results A total of 48 patients were included in the study. The mean age of the study population was 60±11 years, of which 62.5% were male. The follow-up period was 17 ± 4month. A significant increase in LA reservoir strain (LASr) (median 23 vs. 25%, p&amp;lt;0.001) and e’ average (median 7.5 vs. 8.5 cm/s, p=0.02) was noted from baseline to follow-up. LA stiffness index (defined as E/e’average/LASr ratio) (median 0.33 vs. 0.28, p=0.001), LA area (median 23.8 vs. 22.1cm2, p=0.003) and LA volume index (median 35.9 vs. 32.9ml/m2, p&amp;lt;0.001) showed significant reduction over the same time period. In addition, left ventricular (LV) end-diastolic diameter, indexed LV mass index and right atrial area, decreased significantly (51 vs. 49 mm, p&amp;lt;0.001; 123 vs. 109g/m2, p&amp;lt;0.001, 17.2 vs. 15.5cm2, p=0.02, respectively). Left ventricular function parameters, such as LV ejection fraction or global LV longitudinal strain, remained unchanged. Conclusions During the long-term follow-up period after restoration and maintenance of sinus rhythm following catheter ablation for AF, both structural and functional echocardiographic parameters of the LA improved. Our preliminary results also suggest the possibility of reverse structural LV and RA remodeling after successful AF treatment.

Left atrial stiffness index by three-dimensional speckle tracking echocardiography:association with exercise capacity in hypertension-related heart failure with preserved ejection fraction patients

Abstract Objective The purpose of this study was to analyze the characteristics of left atrial function and its utility compared with exercise E/e’(Ex-E/e’). To explore the diagnostic value of three dimensional left atrial stiffness index(3D-LASI) in predicting exercise ability in hypertension(HT) and hypertension-related heart failure with preserved ejection fraction (HT-HFpEF) patients. Methods The study population consisted of 62 healthy subjects and 163 patients with hypertension (112 patients in the simple HT group and 51 patients in the HT-HFpEF group) from July 1, 2022 to July 31, 2023. Standard two dimensional and three dimensional ultrasonic images were collected and analyzed, especially the 3D left atrial function were evaluated.Treadmill exercise stress test was performed, and hemodynamic parameters were recorded.To evaluate the diagnostic value of 3D-LASI (E/e’/LASr and E/e’/LASr-c) in HT and HT-HFpEF patients’ exercise capacity. Results Compared with the healthy subjects, the HT group’s left atrial volume of different phase increased and strain value decreased (p &amp;lt; 0.05). In HT-HFpEF group, the longitudinal strain of reserve phase(LASr),circumferential strain of reserve and contraction phase(LASr-c,LASct-c) furtherd decreased. The E/e’/LASr and E/e’/LASr-c were significantly correlated with METs (r=-0.498, p &amp;lt; 0.001;r=-0.412, p &amp;lt; 0.001) , through multiple regression model analysis, E/e’/LASr and E/e’/LASr-c remained independent predictors of metabolic equivalents(METs) .The E/e’/LASr and E/e’/LASr-c(AUC, 0.845;AUC,0.809) demonstrated great value for identify HT-HFpEF with reduced exercise capacity by receiver operating characteristic curves and E/e’/LASr had similar diagnostic efficacy compared with Ex-E/e’(AUC: 0.845 vs 0.876, p=0.239 dron test)). Conclusion The left atrial stiffness in HT-HFpEF patients can be evaluated by 3D speckle tracking technology, including rapid acquisition of different phase parameters.The E/e’/LASr and E/e’/LASr -c as indicators of atrioventricular compliance plays key role in maintaining left atrial function, and E/e’/LASr is an independent predictor of exercise ability and with similar diagnostic value to Ex-E/e’ in HT-HFpEF patients. correlation analysis heat map ROC for identify HT-HFpEF

Left atrial stiffness difference between beta thalassemia major and sickle cell disease patients

Abstract Introduction Diastolic dysfunction emerges as the earliest cardiac abnormality in individuals with hemoglobinopathies including sickle cell disease (SCD) and β-thalassemia major (β-ΤΜ). In symptomatic patients with hemoglobinopathies, Heart Failure with preserved Ejection Fraction (HFpEF) stands out as the predominant cardiac phenotype. Left Atrial Stiffness Index (LASI) has been established as a prognostic indicator in HFpEF patients. Purpose To investigate potential LASI differences between SCD and β-ΤΜ patients. Methods In this cross-sectional study, thirty-four SCD patients (mean age 46.6 ± 15.6 years, 44.2% males), sixty, age- and sex-matched, patients with β -ΤΜ, and twenty-nine, age- and sex-matched, controls were enrolled. Various echocardiographic parameters, including left ventricular ejection fraction (LVEF), early mitral inflow velocity to basal septal early diastolic velocity ratio (E/e’), left atrial volume index (LAVI), tricuspid valve regurgitation velocity (TVR), and left atrial deformation at reservoir phase (LASr), were calculated. LASI was derived as the [E/e’]/[LASr] ratio. Patients with LVEF &amp;lt;50% were systematically excluded. Diastolic dysfunction was established based on 2016 ASE/EACVI Guidelines and Standards. Results LASI was greater in β-ΤΜ patients compared to both SCD patients (0.30 ± 0.22 vs 0.22 ± 0.11, p = 0.006) and controls (0.30 ± 0.22 vs 0.18 ± 0.06, p = 0.002). No statistically significant difference was observed between SCD patients and controls. Among SCD patients, those with diastolic dysfunction (n = 12) demonstrated elevated LASI (0.31 ± 0.10 vs 0.16 ± 0.04, p = 0.001) and reduced LASr (24.50 ± 3.20 vs 51.50 ± 11.20, p = 0.001) compared to those without diastolic dysfunction. Moreover, SCD patients with diastolic dysfunction had a higher LASI value (0.31 ± 0.10 vs 0.16 ± 0.06, p = 0.001) compared to controls. Conclusions There is significant difference in terms of left atrial stiffness between β-ΤΜ and SCD. A possible explanation could be the regular blood transfusions in β-ΤΜ patient group that could contribute to the increased left atrial stiffness in these patients.

Prognostic utility of non-invasive left atrial stiffness index in patients with heart failure with preserved ejection fraction: insights from EASY-HFpEF study

Abstract Background It is known that an increase left atrial stiffness is associated with poor prognosis in patients with heart failure with preserved ejection fraction (HFpEF). Purpose We evaluated the predictive utility of non-invasive left atrial stiffness index (LASI) in HFpEF patients, comparing it to other clinical prognostic indicators. Methods Patients were recruited from the EASY-HFpEF study, a multicenter prospective observational cohort study in Japan involving patients hospitalized with acute decompensated heart failure and a left ventricular ejection fraction of &amp;gt;40%. Among the patients in the study, those with registered echocardiographic image data of sufficient quality were analyzed for left atrial strain. The LASI was calculated as the ratio of E/e’ to the left atrial reservoir strain. The primary endpoint was a composite outcome of all-cause death and readmission due to heart failure during the 2-year follow-up period. Results We analyzed 95 patients, with a median age of 75 years and including 41% female patients. LASI was associated with an increased risk of composite outcome (adjusted HR 1.10 [95%CI; 1.04-1.17, P=0.001] per 0.1 increase). LASI was non-inferior in predictive ability compared to predictors such as B-type natriuretic peptide (BNP) and H2FPEF score. (AUCLASI=0.79, AUCBNP=0.80 [vs.AUCLASI, P=0.775], AUCH2FPEF =0.75 [vs.AUCLASI, P=0.342]) (Figure 1). The addition of LASI significantly improved the prognostic power of a model containing BNP and H2FPEF score (model of BNP+H2FPEF score, χ2=29.3; model of BNP+H2FPEF+LASI, χ2=40.5, P=0.004) (Figure 2). Conclusion Non-invasive LASI in HFpEF patients is associated with increased risks of all-cause mortality and heart failure readmission, its potential utility in predicting these adverse events.

Right atrial remodelling in middle- aged patients with atrial fibrillation and without overt heart disease

Abstract Background Atrial fibrillation (AF) is the most common cardiac arrhythmia, where the focus of echocardiographic evaluation is the left atrium (LA), as a substrate for the arrhythmia(1). But AF is not only a disease of the LA, it also affects the right atrium (RA) (2). Available data on structural changes of RA in AF are scarce, and even more in relatively young patients without overt heart disease. Aim To assess RA structure and function with volumetric and speckle-tracking analysis in middle-aged symptomatic AF patients without overt heart disease , where conventional 2D echocardiography (2DE) demonstrated structurally normal hearts. Methods Prospective consecutive patients with AF (n=936), who had been admitted for sinus rhythm restoriation in our hospital for the period January 2016- December 2018, were screened for participation in the study. A total of 70 patients met the inclusion criteria- stable sinus rhythm, age between 40-60 years, without overt heart disease. They were separated in two groups:with new onset AF(n=33) and reccurent episode of AF(n=37); 30 healthy subjects were enrolled in the control group. All patients underwent 2DE assessment of RA structure and function with volumetric and speckle tracking analyses. Results There were significant differences between all groups in RA volumes- table 1. Furthermore, patients with AF had reduced reservoir strain and increased RA stiffness index in comparison to healthy controls. There were no differences between groups in emptying fractions, as well as in expansion index of RA. Conclusion In middle- aged AF patients without overt heart disease early structural and functional changes in RA were found. These findings supports the concept of bi-atrial remodelling in AF, where subclinical atrial disease progress to clinical one with first manifestation- AF (3,4)

Noninvasive left atrial stiffness is associated with atrial fibrillation recurrence after catheter ablation

Abstract Background Catheter ablation for atrial fibrillation (AF) improves quality of life and lowers cardiovascular adverse events. However, AF recurrence rates remain high - thus the need for better or improved predictors of AF recurrence. The role of left atrial (LA) stiffness remains unclear, as prior findings were controversial. Purpose To explore the relationship between a noninvasive LA stiffness index (LAstiffn) and AF recurrence after catheter ablation. Methods We analyzed a prospectively recruited cohort of patients who underwent catheter ablation for AF, were in sinus rhythm at 3 months post-ablation, had no significant (&amp;lt; moderate) valvular disease, and had LA volumes and LA diastolic function prospectively measured. LAStiffn was calculated as (E/e’)/LA emptying fraction (LAEF) ratio (abnormal defined as &amp;gt;15/45≈0.3). Outcome endpoint was the first documented AF/atrial flutter episode, lasting &amp;gt;30s, beyond 3 months post ablation (end of blanking period). Results A total of 589 patients were studied (mean age 60±10 years; 75% men; 50% with persistent AF; Table 1). At 3 months post-ablation, mean LAVI(Left atrial volume index) was 36±10 mL/m2 and LAstiffn 0.32±0.22. LAstiffn tended to be higher in older patients, in females, and patients with persistent AF and comorbidities (hypertension, congestive heart failure, coronary artery disease, CHA2DS2-VASc score ≥2, etc). At multivariable regression analysis, LAstiffn correlated with LV size and mass, degree of mitral/tricuspid regurgitation, and right ventricular systolic pressure. At 1 year, 3 years, and 8 years follow up, AF recurred in 118, 191, and 347 patients, respectively. At univariate Cox proportional hazards regression analysis, LAstiffn index &amp;gt;0.3 was significantly associated with AF recurrence at 1 year (log-rank P=.0005), 3 years (P=.0002), and 8 years follow up (P&amp;lt;.0001; Figure). In multivariate analysis including all clinical and laboratory factors with P&amp;lt;.10 in univariate analysis, LAstiffn &amp;gt;0.3 remained an independent factor for AF recurrence only at 3-years (adjusted HR 1.40 [1.03-1.91], P=.03) and 8 years follow up (adjusted HR 1.65 [1.29-2.13], P&amp;lt;.0001) after adjustment for age, sex, type of AF (persistent/paroxysmal), LA volume index (LAVi), obstructive sleep apnea, and prior pacemaker/ICD implantation (best independent factors); P=.14 at 1 year follow up. In ROC analysis, LAstiffn (AUC 0.61, P=.001) performed slightly better than LA deformation LAEF (AUC 0.59, P=.002) or E/e’ (AUC 0.58, P=.03), though with modest sensitivity/specificity (58%/62%). Conclusions LAstiffn may reflect LA myopathy that is likely due to the cumulative effects of comorbidities, diastolic dysfunction, and intrinsic LA tissue remodeling. LA stiffening may be a substrate facilitating redevelopment of AF, thus patients with increased LAstiffn may need more frequent monitoring to prevent/treat AF recurrence earlier.

Elevated left atrial stiffness index is a poor prognostic factor in heart failure with preserved ejection fraction undergoing transcatheter aortic valve replacement

Abstract Background Patients with severe aortic valve stenosis undergoing transcatheter aortic valve replacement (TAVR) present with a high prevalence of heart failure with preserved ejection fraction (HFpEF). An elevated left atrial stiffness index (LASI) has recently been recognized as a potential prognostic factor for worsened outcomes in HFpEF patients. Purpose This study investigates whether the LASI is a prognostic factor for outcomes following TAVR in HFpEF patients. Methods In this single-center retrospective study, patients with severe aortic valve stenosis who underwent TAVR at our center from February 2020 to May 2023 and had left ventricular ejection fraction &amp;gt;40% were included (Figure 1). The LASI was defined as the ratio of E/e’ to the left atrial reservoir strain from transthoracic echocardiography performed before and one week after TAVR. The primary endpoint was a composite outcome of all-cause mortality and cardiovascular events during the follow-up period. Results We analyzed 178 patients with a median age of 84 years, of whom 69% were female. During a median follow-up period of 549 days, 34 cases (19%) experienced the composite outcome. Multivariate Cox proportional hazards analysis using preoperative indices showed that LASI was independently associated with the occurrence of outcomes (HR 1.84 [95% CI; 1.15-2.95, P = 0.011] per 1.0 increase). A sub-analysis excluding cases had left bundle branch block postoperatively revealed a significant association between postoperative LASI and outcomes (HR 3.62 [95% CI; 2.01-6.51, P = &amp;lt;0.001] per 1.0 increase), particularly pronounced in patients with preoperative grade 2 left ventricular diastolic dysfunction (HR 4.38 [95%CI; 2.07-9.26, P=&amp;lt;0.001] per 1.0 increase) (Figure 2). Conclusion There is potential for LASI as a prognostic factor for outcomes following TAVR in HFpEF patients.

Spleen stiffness in a healthy pediatric population undergoing liver magnetic resonance elastography.

Splenic stiffness is a potential imaging marker of portal hypertension. Normative spleen stiffness values are needed to define diagnostic thresholds. To report stiffness measurements of the spleen in healthy children undergoing liver magnetic resonance (MR) elastography across MRI vendors and field strengths. This was a post-hoc analysis of data collected under a prospective multicenter cross-sectional study. Volunteers aged 7-17.9years without a known history of liver or spleen disease were recruited for a research MRI between February 2018 and October 2019. Gradient recalled echo (GRE) or spin-echo-echo-planar imaging (SE-EPI) MR elastography was performed on a total of three vendor platforms and at two field strengths (1.5T (T) and 3T) with standard right upper quadrant passive driver placement (frequency of 60Hz). Two independent reviewers measured spleen stiffness, length, and volume. Descriptive statistics, independent sample t-tests or Mann-Whitney test, and Pearson's or Spearman's correlation were used. From 101 study volunteers, 72 (34 female) had measurable splenic stiffness. Median age was 12years (interquartile range [IQR], 9.9-14.9years). Mean (± SD) spleen stiffness was 4.7 ± 0.9kPa (IQR, 3.8-5.4kPa) with 6.1kPa reflecting the 95th percentile. Strong correlation was observed between reviewers (ICC = 0.89 [95%CI, 0.71-0.93; P < 0.001]). Male volunteers had slightly higher splenic stiffness compared to females: 4.9 ± 0.9 vs. 4.3 ± 0.8kPa (P = 0.014). There was significant correlation between spleen stiffness and body mass index (r = 0.33 [95%CI, 0.06-0.56; P = 0.024]) but no other measure of patient size (r = 0.15-0.29). No significant difference in spleen stiffness was observed across vendors (P = 0.089) or field strengths (P = 0.236). MR elastography-based spleen stiffness, measured as part of a liver MR elastography acquisition, is < 6.1kPa in a healthy pediatric population and does not vary with MRI vendor or field strength.

Evaluation of hepatic steatosis in obese children and adolescents using immune-inflammatory markers and shear wave elastography.

To investigate the changes in liver stiffness and immune-inflammatory markers associated with obesity and the degree of hepatic steatosis in obese children and adolescents. A total of 76 obese children and adolescents aged 6-18 years, with body mass index percentiles >95th, were included in the study. Patients with metabolic syndrome, diabetes mellitus, and chronic liver disease were excluded. A control group of 44 patients of healthy and normal-weight children was included. Laboratory values from the past month were analyzed using patient records. Shear wave elastography and ultrasound examinations were performed on a single device by the same experienced radiologist. The systemic immune-inflammation index and pan-immune inflammation values were significantly higher in obese patients with hepatic steatosis compared to obese patients without hepatic steatosis (p <0.001). Liver stiffness values were significantly higher in steatotic patients compared to nonsteatotic patients (p <0.001). A significant difference was observed between hepatic steatosis grades in terms of immune-inflammation index and pan-immune inflammation value values (p <0.001). There was a strong, positive, statistically significant correlation between liver stiffness and immune-inflammation index and pan-immune inflammation value (p <0.05). Immune-inflammatory biomarkers and shear wave elastography may provide valuable insights into the diagnosis and follow-up of inflammation and fibrosis in the evaluation of hepatic steatosis in obese children and adolescents.

Features of comorbidity of chronic heart failure and chronic kidney disease in patients infected with the human immunodeficiency virus

THE AIM OF THE STUDY: to identify risk factors associated with the course of chronic kidney disease (CKD), as the main manifestation of damage to the target organ – the kidney, in patients with chronic heart failure (CHF) infected with the human immunodeficiency virus (HIV).PATIENTS AND METHODS. In a multidisciplinary hospital for 28 months in 2019-2022, a one-stage screening clinical study was conducted, which included 240 patients with HIV infection. Of these, 160 people were diagnosed with CHF. Depending on the presence of CKD with a glomerular filtration rate (GFR) &lt;60 mm/min/m2, patients with CHF were divided into 2 groups. The first group consisted of patients with CKD (46 people), and the second group – without signs of CKD (114 people). All patients within the framework of the study underwent the determination of cystatin C in blood serum, the Nterminal fragment of the brain natriuretic peptide (NT-proBNP) in blood plasma, C-reactive protein (CRP) in blood serum, and the quantitative determination of protein in urine.RESULTS. The prevalence of CKD among patients with CHF and HIV infection is 58.82 %, which is 4 times more common than in patients with HIV infection without CHF. Risk factors for the development of CKD in patients with CHF and HIV infection are smoking, alcohol and drug use, a history of chronic and acute forms of coronary artery disease, atrial fibrillation, ventricular arrhythmias, diabetes mellitus, chronic viral hepatitis C, anemia, and thrombocytopenia. Patients with CHF and CKD have a more rigid arterial wall – there is a significant excess of the stiffness indices of the aorta and peripheral arteries. Long-term use of antiplatelet agents and antiretroviral therapy aggravates the course of CHF in HIV-infected people with CKD manifestations. The concentration of NT-proBNP in the blood plasma of patients with CHF equal to or greater than 683.65 pg/ml can be considered as a diagnostic criterion for the development of CKD in HIV-infected people with a sensitivity of the method of 75.0 % and a specificity of 75.4 %, respectively. It has been proven that GFR depends on three main factors that reflect damage to the heart muscle – the concentration of NT-proBNP in blood plasma, the values of LVEF % and LVMI, which together, being included in the regression model, determine 42.2 % of the dispersion of GFR values and are decisive in the development of CKD in patients with CHF on the background of HIV infection.