Autonomic function and specific right atrial functions - Is there a relationship? Correlations from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study

INTRODUCTION

Similarly to the ventricles, the atria are under sympathetic/parasympathetic neural regulation. Accordingly, correlations were investigated between Ewing's standard cardiovascular reflex tests (SCRTs) and three-dimensional speckle-tracking echocardiography (3DSTE)-derived right atrial (RA) volumes and strains in healthy subjects.

MATERIALS AND METHODS

The study comprised 45 healthy adults, but 5 subjects were excluded due to inferior image quality for 3DSTE-derived RA assessments. The remaining 40 individuals being in sinus rhythm had a mean age of 35.1 ± 3.5 years (20 men). Two-dimensional, Doppler, 3DSTE and SCRTs were performed in all cases.

RESULTS

RA maximum volume and total and passive RA stroke volumes correlated with the Valsalva ratio. Active RA stroke volume and emptying fraction showed correlations with 30/15 ratio. Peak global and mean segmental RA circumferential (CS) and longitudinal strains (LS) showed correlation with the Valsalva ratio. At atrial contraction, global RA-LS and mean segmental RA-CS showed correlations with the Valsalva ratio. Moreover, mean segmental RA-CS correlated with 30/15 ratio and mean segmental RA radial strain showed correlations with systolic blood pressure in response to standing. Autonomic neuropathy score correlated with peak global RA-LS.

CONCLUSIONS

Autonomic function parameters have significant associations with specific RA functions in healthy adults, making the latter possible indicators of autonomic dysregulation.

Cardiac Mechanics and Valvular and Vascular Abnormalities in Hypereosinophilic Syndrome

Hypereosinophilic syndrome (HES) is considered to be a rare myeloproliferative disease that is characterized by persistent eosinophilia with associated multiple-organ damage. The heart is often involved in HES, representing a major cause of morbidity and mortality. HES is a heterogeneous group of disorders; the majority of the cases are idiopathic. Summarizing the findings regarding myocardial, valvular, and vascular abnormalities in a series of patients with HES, most studies found normal left ventricular (LV) volumes with reduced LV global longitudinal strain and LV apical rotation and twist in HES cases, accompanied by increased left atrial (LA) volumes and stroke volumes, reduced peak LA circumferential strain (representing systolic abnormalities), and mitral annular dilation and functional deterioration. Regarding the right heart, preserved right ventricular volumes and functional properties, increased right atrial volumes, mild RA functional abnormalities, and dilated tricuspid annular dimensions without functional impairment could be seen in these studies. Aortic and pulmonary valves showed no specific disease-related alterations. Vascular abnormalities included increased aortic stiffness without dilation of the aorta and pulmonary hypertension in some cases. These results suggest disease-specific but relatively mild myocardial, valvular, and vascular abnormalities in HES. The present review aimed to summarize the available clinical data about cardiac mechanics and valvular and vascular abnormalities in a series of patients with HES.

Correlations between vegetative autonomic function and specific left atrial functions in healthy adults: Insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study

INTRODUCTION

The functioning of the left atrium (LA) is partly controlled by the neural system. It was purposed to evaluate correlations between the result of Ewing's 5 standard cardiovascular reflex tests (SCRTs) characterizing autonomic function and LA volumetric and functional features as assessed by three-dimensional speckle-tracking echocardiography (3DSTE) in healthy individuals.

MATERIALS AND METHODS

The current study comprised 18 healthy volunteers being in sinus rhythm (mean age: 35 ± 12 years, 10 men). Measurement of blood pressure, ECG, 5 SCRTs, two-dimensional Doppler echocardiography and 3DSTE were performed. These parameters were in normal ranges in all cases.

RESULTS

From LA volumetric parameters, only systolic total atrial emptying fraction (r = 0.559, p = 0.037) and early diastolic passive atrial emptying fraction (r = 0.539, p = 0.047) correlated with systolic blood pressure response to standing representing sympathetic autonomic function. From LA strains, peak mean segmental LA radial strain (RS) (r = -0.532, p = 0.050), global and mean segmental LA circumferential strain (CS) (r = 0.662, p = 0.010 and r = 0.635, p = 0.015, respectively) representing systolic LA function correlated with Valsalva ratio representing parasympathetic autonomic function. Global LA-RS (r = -0.713, p = 0.040) and LA-CS (r = 0.657, p = 0.011) and mean segmental LA-CS (r = 0.723, p = 0.003) at atrial contraction representing end-diastolic atrial contraction showed correlations with Valsalva ratio, as well. Peak global and mean segmental LA-CS (r = 0.532, p = 0.050 and r = 0.530, p = 0.050) and the same strains at atrial contraction (r = 0.704, p = 0.005 and r = 0.690, p = 0.006) representing systolic function and end-diastolic atrial contraction correlated with systolic blood pressure response to standing representing both parasympathetic and sympathetic autonomic functions.

CONCLUSIONS

Significant correlations between features of vegetative autonomic function represented by Ewing's 5 SCRTs and specific LA functions represented by 3DSTE-derived LA volume-based functional properties and strains could be demonstrated in healthy adults.

Myocardial Mechanics and Associated Valvular and Vascular Abnormalities in Left Ventricular Noncompaction Cardiomyopathy

Left ventricular (LV) non-compaction (LVNC) is a rare genetic cardiomyopathy due to abnormal intra-uterine arrest of compaction of the myocardial fibers during endomyocardial embryogenesis. Due to the partial or complete absence of LV compaction, the structure of the LV wall shows characteristic abnormalities, including a thin compacted epicardium and a thick non-compacted endocardium with prominent trabeculations and deep intertrabecular recesses. LVNC is frequently associated with chronic heart failure, life-threatening ventricular arrhythmias, and systemic embolic events. According to recent findings, in the presence of LVNC, dysfunctional LV proved to be associated with left atrial volumetric and functional abnormalities and consequential dilated and functionally impaired mitral annulus, partly explaining the higher prevalence of regurgitation. Although the non-compaction process morphologically affects only the LV, signs of remodeling of the right heart were also detected. Moreover, dilation and stiffening of the aorta were present. The aim of the present detailed review was to summarize findings regarding changes in cardiac mechanics, valvular abnormalities, and vascular remodeling detected in patients with LVNC.

Similarities and Differences between Three-Dimensional Speckle-Tracking Echocardiography-Derived Left and Right Atrial Volumes and Volume-Based Functional Properties in the Same Healthy Adults-A Detailed Analysis from the MAGYAR-Healthy Study

Background and Objectives: It would be important to know what happens to the volume and volume-based functional properties of one atrium if the size of the other atrium is larger or smaller than the average. Therefore, the present study aimed to perform three-dimensional speckle-tracking echocardiography (3DSTE)-derived quantification of left atrial (LA) and right atrial (RA) volumes and volume-based functional properties to examine these associations in healthy adults with mean and lower or higher than mean atrial volumes. Materials and Methods: The present study consisted of 179 healthy volunteers with a mean age of 32.3 ± 12.3 years (92 males). Three-dimensional speckle-tracking echocardiography-derived LA and RA volumes and volume-based functional properties were determined in all cases. Results: When different LA or RA volume groups were evaluated, both LA and RA showed the same pattern of volume changes in all phases of atrial function with higher LA or RA volumes. In case of low and mean LA volumes, RA volumes were higher compared to their LA counterpart. In case of mean and high RA volumes, RA volumes proved to be higher as well. In case of mean LA or RA volumes, differences between LA and RA stroke volumes (SVs) could not be detected, but all atrial emptying fractions (EFs) were lower for RA than for LA. Some differences were detected in counterpart LA/RA total, passive, and active atrial SVs and EFs values in the presence of lower/higher than mean LA/RA volume. Conclusions: In case of mean LA or RA volumes, RA volumes are higher compared to their LA counterpart, LA-SVs and RA-SVs are similar, but atrial EFs are lower for RA than for LA. If lower/higher than mean LA or RA volumes are present, some differences in patterns of changes in counterpart atrial volumes-SVs and EFs-could be detected.

Myocardial, Valvular, and Vascular Structural and Functional Properties in Acromegaly

Acromegaly is an uncommon systematic endocrine disease caused by the hypersecretion of human growth hormone and, consequently, of insulin-like growth factor-1 during adulthood. Acromegaly could cause a typical cardiomyopathy characterized by left ventricular hypertrophy associated with diastolic dysfunction, which later could progress to systolic dysfunction. Moreover, some valvular and vascular abnormalities are also associated with acromegaly. This present review aims to summarize available information regarding acromegaly-associated abnormalities in myocardial, valvular, and vascular structural and functional properties and their relationship to disease activity and treatment options.

The Relationship between Tricuspid Annular Longitudinal and Sphincter-like Features of Its Function in Healthy Adults: Insights from the MAGYAR-Healthy Study

INTRODUCTION

The tricuspid valve is an atrioventricular valve located on the right side of the heart, which consists of the fibrous tricuspid annulus (TA), three valvular leaflets and a supporting apparatus, the papillary muscles and the tendinous chords. The TA is an oval-shaped three-dimensional (3D) fibrous structure with a complex spatial movement during the cardiac cycle. Three-dimensional echocardiography (3DE) could help during "en-face" assessment of TA dimensions and related functional properties featuring its "sphincter-like" function. TA plane systolic excursion (TAPSE) is a displacement of the lateral edge of the TA toward the apex in systole measured in apical long-axis using M-mode echocardiography (MME). The aim of this study was to determine potential relationships between TA size and its "sphincter-like" and "longitudinal" functions in healthy adults with no functional tricuspid regurgitation.

METHODS

The present study consisted of 119 healthy patients (age: 34.6 ± 11.5 years, 70 men) who underwent routine echocardiography with M-mode-derived TAPSE measurement and 3DE. Two subgroups of healthy subjects were compared with each other. A total of 29 subjects with TAPSE between 17 and 21 mm were compared with 90 cases with TAPSE ≥ 22 mm.

RESULTS

Subjects with TAPSE of 17-21 mm had tendentiously dilated TA dimensions compared with subjects with TAPSE ≥ 22 mm. Significant differences could be detected in the end-systolic TA area (5.85 ± 1.90 cm2 vs. 3.70 ± 1.22 cm2, p < 0.05), leading to impaired TAFAC (24.8 ± 9.0% vs. 35.1 ± 9.1%, p < 0.05) in subjects with lower TAPSE (17-21 mm) compared with subjects with TAPSE ≥ 22 mm. TAPSE did not show correlations with any TA size or "sphincter-like" functional parameters as determined using 3DE.

CONCLUSIONS

Three-dimensional echocardiography is capable of measuring TA dimensions and functional "sphincter-like" properties, which are associated with MME-derived TAPSE, suggesting a sensitive and harmonic TA function in healthy adults without functional tricuspid regurgitation.

Left ventricular deformation in patients with lymphedema before and after the use of medical compression stockings-detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

Background

Lymphedema (LE) is a chronic condition, which refers to tissue swelling due to excess interstitial fluid accumulation or impaired lymphatic conduit. Theoretically, lymphedema-related fluid retention could affect left ventricular (LV) mechanics, which could be detailed by recent three-dimensional speckle-tracking echocardiography. Therefore, it was purposed to examine LV strains in LE patients before and one hour after the use of medical compression stockings and to compare findings to those of matched normal subjects.

Methods

The study comprised 26 cases with lymphedema, however, 4 cases had to be excluded due to inferior quality of images. Their results were compared to 27 age- and gender-matched healthy controls.

Results

Global LV circumferential and area strains and mean segmental LV circumferential strain were increased in lymphedema patients before the use of medical compression stockings as compared to controls. One hour after the use of medical compression stockings, no global and mean segmental LV strain showed significant impairment or improvement, but tendentious reduction was seen in LV circumferential strain. With LV segmental analysis, midventricular LV radial, circumferential and area strains proved to be significantly increased, while basal LV longitudinal strain and midventricular LV three-dimensional strain were decreased as compared to controls. No changes in regional LV strains could be detected after one-hour medical compression stockings use as compared to data collected at rest.

Conclusions

Increased global LV circumferential strain is seen in lymphedema. With using medical compression stockings, LV deformation parameters change towards the normal range emphasizing their importance on cardiac function.

Left ventricular rotational mechanics and left ventricular volumes: is there a relationship in healthy adults?-three-dimensional speckle-tracking echocardiography-derived insights from the MAGYAR-Healthy Study

Background

Left ventricular (LV) rotational mechanics play a crucial role in LV pump function by strengthening and improving its efficacy. Dependence of LV rotational parameters on left atrial volumes has already been demonstrated. The evaluation of the effect of LV rotational mechanics on LV volumes was purposed in a population of healthy subjects by three-dimensional speckle-tracking echocardiography (STE).

Methods

The study comprised 175 healthy subjects with a mean age of 32.8±12.2 years (79 males). All subjects underwent a complete physical examination, laboratory assessments, standard 12-lead electrocardiography and two-dimensional Doppler and three-dimensional STE, the results of these examinations were within the normal range.

Results

Increased basal LV rotation was associated with increased LV volume measured in end-systole and impaired LV ejection fraction. Increased apical LV rotation was associated with reduced LV volumes assessed in end-diastole and in end-systole and increased ejection fraction of the LV. Elevated basal LV rotation showed associations with increased LV mass. In case of increasing basal LV rotation, apical LV rotation showed a decreasing tendency and LV twist showed a tendency of increasing. Similarly, lower basal LV rotation and increased LV twist were seen with increasing apical LV rotation. Increasing LV end-diastolic volume was associated with increasing LV volume measured in end-systole and preserved ejection fraction of the LV. Increasing LV end-systolic volume was associated with increasing LV end-diastolic volume and reduction of LV ejection fraction. Increasing LV volumes were associated with increasing LV mass. While increased LV volumes were associated with reduced apical LV rotation and twist, basal LV rotation did not show significant changes.

Conclusions

LV rotational mechanics are strongly associated with LV volumes in healthy adults suggesting its volume-dependence.

Tricuspid annular and right atrial volume changes are associated in healthy adults-insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study

Introduction

The tricuspid valve and its annulus (TA) and the right atrium (RA) play a significant role in regulating blood flow in the right heart. However, their effect on each other is not fully understood even in normal circumstances. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is able to simultaneously assess TA and RA at the same time in a non-invasive way. The present study aimed to examine associations between tricuspid annular (TA) dimensions and right atrial (RA) volumes in healthy adults by 3DSTE.

Methods

The present study comprised 144 healthy subjects (mean age: 34.4 ± 12.6 years, 72 males), who participated in this study on a voluntary basis for screening between 2011 and 2015. In all subjects, electrocardiography, two-dimensional Doppler echocardiography and 3DSTE have been performed.

Results

With increasing end-systolic maximum RA volume, all end-systolic and end-diastolic TA dimensions showed simultaneous increase, but in various degrees resulting in (non-significant) reduction of TA functional properties. Similarly, with increasing diastolic pre-atrial contraction and minimum RA volumes, TA dimensions increased simultaneously (except end-diastolic TA diameter), but in various degrees resulting in reduced TA fractional shortening and fractional area change. With increasing RA dimensions, end-systolic and end-diastolic TA dimensions showed simultaneous increase, but in different, sometimes not significant degrees. While RA stroke volumes showed increasing pattern with TA dilation, RA emptying fractions have not changed substantially.

Conclusions

3DSTE is suitable for non-invasive assessment of TA dimensions and RA volumes at the same time using the same 3D echocardiographic dataset. Significant associations between TA size and RA volumes exist in healthy circumstances. Strong associations in case of dilation of TA in the presence of higher RA volumes could partly explain functional tricuspid regurgitation later developing in subjects in sinus rhythm.

A three-month physical training program improves cardiovascular autonomic function in patients with metabolic syndrome with and without diabetes - a pilot study

Introduction

Vascular complications and neuropathy may develop in the presence of metabolic syndrome. The aim of our study was to measure the cardiovascular autonomic function following physical training in patients with metabolic syndrome with and without diabetes.

Subjects and methods

56 patients with metabolic syndrome (32 men/24 women, 40 non-diabetic patients (NDMetS)/16 diabetic patients (DMetS) [mean ± SD]: age: 50.35 ± 8.03 vs. 56.8 ± 9.30 years, p=0.023; baseline BMI: 32.2 ± 7.03 vs. 32.8 ± 5.94 kg/m2, p=0.739) were involved in our study. All tests and measurements were carried out before and following a 3-month physical training period. Autonomic function was assessed by means of five standard cardiovascular reflex tests. ECG repolarization parameters, including short-term QT variability and stress-ECG were also measured.

Results

In the whole population, Valsalva-ratio (VR) and the autonomic score (AS) improved following training (VR: 1.49 ± 0.24 vs. 1.64 ± 0.34, p=0.001; AS: 2.05 ± 1.73 vs. 1.41 ± 1.36, p=0.015) accompanied by the significant decrease of the systolic (150.3 ± 16.12 vs. 134.1 ± 16.67 mmHg, p<0.001) and diastolic (90.64 ± 12.8 vs. 82.79 ± 11.1 mmHg, p<0.001) blood pressure. An improvement in VR was detected in NDMetS patients following training (1.51 ± 0.24 vs. 1.67 ± 0.31, p= 0.002). No significant changes could be detected in autonomic tests' results in the DMetS patient group following training. The applied exercise training program did not lead to significant changes in ECG repolarization. The stress-ECG test in the whole study population yielded a significant increase in the test duration (12.9 ± 3.76 vs. 15.1 ± 2.96 min, p<0.001) and in the test load (10.5 ± 2.78 vs. 11.6 ± 2.39 MET, p<0.001). The load capability improved significantly in both subgroups: 11.1 ± 2.04 vs. 12.1 ± 1.82, (p<0.001) and 9.0 ± 3.64 vs. 10.4 ± 3.05, (p=0.033) in subpopulations of NDMetS and DMetS, respectively. The DMetS patients achieved a significantly lower MET score at baseline (p=0.039) and following training (p=0.044) in comparison to the NDMetS patients.

Conclusion

The three-month exercise program improved the Valsalva-ratio and the AN score in the MetS patients, that is potentially protective against cardiovascular events. The training had some beneficial effect on blood pressure and the results of the stress-ECG tests in both groups. The absence of significant change in the reflex tests in DMetS group reflects an impaired adaptation compared to the NDMestS group.

Complexity of left ventricular strains in response to elevated volumes in healthy adults - Detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study

Introduction

Cardiac haemodynamics is described by the Frank-Starling law, which states that the strength of the left ventricular (LV) systolic contraction is related to the LV diastolic filling, with other words LV stroke volume increases as LV volume increases due to the stretching of the myocyte. The purpose of the present study was to examine how the increasing LV volumes affect LV contractility represented by three-dimensional (3D) speckle-tracking echocardiography (3DSTE) -derived LV strains in healthy adults.

Methods

This is post-hoc analysis of the MAGYAR-Healthy Study employing a novel method for technical analysis of echocardiographic datasets. The present study consisted of 301 healthy adults. Due to inferior image quality, 127 subjects have been excluded, therefore the remaining population included 174 subjects (mean age: 32.9 ± 12.1 years, 80 males). All cases have undergone complete two-dimensional Doppler echocardiography extended with 3DSTE.

Results

LV global longitudinal (gLS) and area (gAS) strains were lowest in case of the highest LV end-diastolic volume (EDV). LV global radial (gRS) and 3D (g3DS) strains tendentiously increased with increasing LV-EDV. When segmental analysis was performed, increased LV-EDV was associated with increase of basal LV-RS and LV-3DS. Increased LV strains were associated with increased LV ejection fraction (EF) due to higher LV-EDV for LV-gRS (and LV-g3DS), lower LV-ESV for LV-gCS and lower LV-EDV and LV-ESV for LV-gLS (and LV-gAS). With increasing LV-gRS, LV-gCS and LV-g3DS, all LV strains increased except LV-gLS. With increasing LV-gLS, LV-gRS did not show any increase, LV-gCS and LV-g3DS were the highest when LV-gLS was the highest, while LV-gAS increased simultaneously. With increasing LV-gAS, all LV strains increased.

Conclusions

There is a complex contractility pattern of LV segments/regions in response to elevated LV volumes in healthy circumstances.

Three-Dimensional Speckle-Tracking Echocardiography-Derived Tricuspid Annular Dimensions and Right Atrial Strains in Healthy Adults-Is There a Relationship? (Insights from the MAGYAR-Healthy Study)

INTRODUCTION

The tricuspid valve and its annulus (TA) are thought to be integrally related to right atrial (RA) size and function. The present study aimed to assess associations between TA dimensions and RA strains, and quantitative features of its contractility were determined by 3DSTE in healthy adults.

METHODS

The study comprised 145 healthy volunteers with a mean age of 34.4 ± 12.5 years (73 males). Electrocardiographic, two-dimensional Doppler echocardiographic and 3DSTE parameters were in normal reference ranges in all subjects.

RESULTS

Enlarged TA areas, regardless of which phase of the cardiac cycle were measured, were not associated with the deterioration of peak RA strains in longitudinal (LS) and circumferential (CS) directions. Increased end-diastolic TA area was associated with reduced RA strain in the radial direction (RS). Dilation of end-diastolic and end-systolic TA areas was related to increased RA volumes. End-diastolic TA area was the smallest in case of increased peak global RA-RS, and other associations between increasing TA areas and peak global strains could not be detected. Peak global RA-CS and RA-LS were not related to TA areas. Increasing peak global RA-RS was not associated with peak global RA-LS and RA-CS, while increasing peak global RA-LS and RA-CS were not associated with peak global RA-RS. Increasing peak global RS did not show associations with RA volumes, V_min was the smallest in the case of highest peak global RA-CS and RA-LS. V_max increased with increasing peak global RA-LS.

CONCLUSIONS

3DSTE is suitable for simultaneous non-invasive determination of TA dimensions and RA volumes and strains using the same acquired 3D dataset, allowing physiologic studies. RA volumes are associated with end-diastolic and end-systolic TA areas. RA strains in radial direction (RS) show associations with end-diastolic TA area.

Simultaneously Assessed Three-Dimensional Speckle-Tracking Echocardiography-Derived Left Ventricular and Left Atrial Volumes Are Associated in Healthy Adults-Findings from the MAGYAR-Healthy Study

INTRODUCTION

The left atrium (LA) has a significant role in regulating blood flow from veins to the left ventricle (LV). LV performance is affected by several factors including preload, which is partly, but highly, dependent on LA volumes. The aim of the present study is to perform simultaneous assessment of LA and LV volume changes during the cardiac cycle in healthy circumstances. Therefore, LA and LV volumes and volume-based functional properties were determined in healthy adults, and the associations of these parameters were examined.

METHODS

The present study consists of 164 healthy adults (age: 33.0 ± 12.3 years, 82 males) being in sinus rhythm. All subjects have undergone complete two-dimensional Doppler echocardiography with three-dimensional speckle-tracking echocardiography (3DSTE).

RESULTS

Increased end-systolic maximum LA volume was associated with higher LV volumes and reduced LV ejection fraction. Very high early pre-atrial contraction and late diastolic LA volumes were associated with increased LV volumes, reduced LV ejection fraction and increased LV mass. Increased LA volumes were associated with increased LV mass. Higher LV volumes were associated with tendentiously higher LA volumes. Higher LV end-diastolic volume was associated with tendentiously higher all LA stroke volumes (SVs) and total and active LA emptying fractions (EFs). Higher LV end-systolic volume was associated with tendentiously higher all LA SVs but preserved all LA EFs.

CONCLUSIONS

3DSTE is capable of simultaneous assessment of LA and LV volumes and volume-based functional properties for (patho)physiologic studies. Moreover, 3DSTE-derived LV and LA volumes and functional properties show strong associations.

Correlation between Coronary Artery Disease with Other Arterial Systems: Similar, Albeit Separate, Underlying Pathophysiologic Mechanisms

Atherosclerosis is a multifactorial systemic disease that affects the entire arterial tree, although some areas are more prone to lipid deposits than others. Moreover, the histopathological composition of the plaques differs, and the clinical manifestations are also different, depending on the location and structure of the atherosclerotic plaque. Some arterial systems are correlated with each other more than in that they simply share a common atherosclerotic risk. The aim of this perspective review is to discuss this heterogeneity of atherosclerotic impairment in different arterial districts and to investigate the current evidence that resulted from studies of the topographical interrelations of atherosclerosis.

Left Ventricular Deformation and Rotational Mechanics in Various Pathologies-The Role of the Pattern of Abnormalities

Non-invasive assessment of myocardial mechanics using modern imaging techniques became a current topic due to the rapid developments in echocardiography and cardiac magnetic resonance imaging (cMRI) [...].

[Left ventricular deformation: similarities and dissimilarities in elite sport activity- and acromegaly-related abnormalities. Results from the three-dimensional speckle-tracking echocardiographic MAGYAR-Sport and MAGYAR-Path Studies]

INTRODUCTION

Acromegaly is a chronic endocrine disorder, which produces a significant amount of human growth hormone and consequently insulin-like growth factor in adulthood due to a tumor in the pituitary gland. If left untreated, it can have a significant effect on the cardiovascular system. It is also known that elite sport activity is also associated with physiologic cardiac transformation, the so-called athletes' heart, in which volumetric and functional adaptation of the heart cavities can be observed.

OBJECTIVE

In accordance with the above facts, the question may rightly arise as to what differences can be observed in left ventricular morphology and function in acromegaly, and what similarities and dissimilarities do the obtained results show compared to the values of healthy non-athlete adults compared to the values of the left ventricle of young elite athletes.

METHOD

The present study comprised 21 elite athletes playing high dynamic sports (mean age: 31.2 ± 6.4 years, 13 males) and 18 acromegaly patients (mean age: 47.9 ± 8.9 years, 9 males). Their results were compared to those of 22 negative controls (mean age: 47.7 ± 10.6 years, 13 males).

RESULTS

Left ventricle is dilated, but its function is preserved in both elite athletes and patients with acromegaly. While increased longitudinal and circumferential left ventricular strains could be seen in elite athletes primarily due to the more pronounced contractility of left ventricular apical segments, increased radial left ventricular strain was detected in acromegaly due to increased function of the left ventricular basal region. Left ventricular rotational mechanics show different patterns as well: while basal left ventricular rotation is decreased in elite athletes, apical left ventricular rotation showed a reduction leading to the significant deterioration of left ventricular twist in acromegaly.

CONCLUSION

Both elite athletes playing high dynamic sports and acromegaly patients have dilated left ventricle, more pronounced regional left ventricular contractility and left ventricular rotational abnormalities with differences in nature and extent of these alterations as compared to those of non-sporting healthy subjects. Orv Hetil. 2023; 164(8): 308-316.

Prognostic role of three-dimensional speckle-tracking echocardiography-derived left ventricular global longitudinal strain in cardiac amyloidosis: Insights from the MAGYAR-Path Study

INTRODUCTION

Systemic amyloidosis is an uncommon disorder in which amyloid fibrils deposit extracellularly. Three-dimensional speckle-tracking echocardiography (3DSTE) is a novel method able to assess left ventricular (LV) global longitudinal strain (GLS). Our aim was to evaluate the prognostic impact of 3DSTE-derived LV-GLS in patients with cardiac amyloidosis (CA).

MATERIALS AND METHODS

A total of 35 patients suffering from light-chain (AL) CA or transthyretin (TTR) CA were selected, but 7 patients had to be excluded due to insufficient image quality or were lost for follow-up. With AL-CA 23 cases, while for TTR-CA 5 patients were diagnosed. Complete two-dimensional Doppler and 3DSTE were performed in all subjects.

RESULTS

The median follow-up was 201 days (ranging from 36 to 632 days) during which cardiovascular event was detected in 17 CA patients, including 8 cardiac deaths. Six patients were diagnosed with acute heart failure, two patients needed invasive interventions (percutaneous coronary intervention with stent-implantation, implantable cardioverter defibrillator implantation) and in one patient new higher grade atrioventricular block was registered. Using ROC analysis, 3DSTE-derived LV-GLS ≥11.8% (absolute value) was found to be a significant predictor for cardiovascular event-free survival (sensitivity 65%, specificity 64%, area under the curve 0.71, p = .05). Lower LV ejection fraction was confirmed in patients with LV-GLS <11.8% as compared to cases with LV-GLS ≥11.8%. In case of a cardiovascular event, LV-GLS was lower as compared to that of subjects with no events. Multivariable regression analysis confirmed that LV-GLS and LV end-diastolic diameter were independent predictors of cardiovascular survival.

CONCLUSION

3DSTE-derived LV-GLS is an independent predictor for future cardiovascular events in CA patients.

[Congenital heart diseases in patients above the age of 60 years. Results from the CSONGRAD Registry]

INTRODUCTION

Development in paediatric and interventional cardiology and cardiac surgery resulted in an increase in the number and average age of adult congenital heart disease patients. Comorbidities may appear with increased age leading to new challenges in the diagnosis and treatment of this complex group of patients.

OBJECTIVE

The aim of this study is to compare clinical and echocardiographic parameters in adult congenital heart disease patients under our care below the age of 40 years, between 40 and 59 years and above the age of 60 years.

METHOD

Data of a total of 346 patients were analyzed; 154 patients were under 40 years of age, 133 patients were between 40 and 59 years of age, and 59 patients were 60 years old or older. All adult congenital heart disease patients who underwent an outpatient examination were included in the study. As part of the physical examination, the New York Heart Association (NYHA) clinical classification of heart failure was determined, electrocardiography, echocardiography and 6-minute walk test were performed.

RESULTS

Above the age of 40, the ratio of comorbidities increased, significantly more patients were classified into NYHA functional classes III-IV and the ratio of patients having a left ventricular ejection fraction below 55% significantly increased. The prevalence of arrhythmia was similar in all age groups, but an increasing tendency could be seen with age.

CONCLUSION

There is a growing number of elderly adult congenital heart disease patients with comorbidities that play an important role in the management and in the outcome of congenital heart disease. New protocols and recommendations are required in the follow-up of these patients to help determining the optimal time for reoperation, intervention or heart transplantation. Orv Hetil. 2023; 164(6): 219-226.

[Multimodality imaging of adult patients with surgically corrected tetralogy of Fallot. Results from the CSONGRAD Registry]

INTRODUCTION

There is an increasing ratio of surviving patients with congenital heart disease including tetralogy of Fallot.

OBJECTIVE

The aim of the present study was a comparative assessment of echocardiographic and cardiac magnetic resonance imaging-derived findings in patients with tetralogy of Fallot following early total reconstruction versus early palliation/late correction.

METHODS

The study comprised 17 patients with tetralogy of Fallot (mean age: 28.6 ± 10.4 years; 10 males). Early total reconstruction was performed in 10 cases (mean age: 25.0 ± 8.0 years; 8 males), while early palliation/late construction was done in 7 subjects (mean age: 33.7 ± 11.8 years; 2 males). Complete two-dimensional Doppler echocardiography and cardiac resonance imaging were performed in all patients.

RESULTS

During long-term follow-up, lower left ventricular end-systolic (40.50 ± 10.55 ml/m2 vs. 58.14 ± 19.07 ml/m2, p = 0.013) and end-diastolic volume indices (86.60 ± 12.62 ml/m2 vs. 116.70 ± 23.70 ml/m2, p = 0.002) and stroke volume index (46.00 ± 6.77 ml/m2 vs. 58.43 ± 7.11 ml/m2, p = 0.001) could be detected, which were associated with higher echocardiographic left ventricular ejection fraction (69.75 ± 6.80% vs. 61.67 ± 8.80%, p = 0.038) in patients with tetralogy of Fallot following early total reconstruction as compared to that of subjects late after early palliation/late correction. In regard with the right heart, larger right ventricular muscle mass (72.33 ± 21.03 g/m2 vs. 51.33 ± 22.33 g/m2, p = 0.044) could be seen in patients with tetralogy of Fallot following early total reconstruction.

CONCLUSION

Beneficial left ventricular morphological and functional parameters, but more pronounced right ventricular hypertrophy could be detected in patients with tetralogy of Fallot following early total reconstruction as compared to that of subjects late after early palliation/late correction. Orv Hetil. 2023; 164(5): 186-194.

Dependence of Left Ventricular Rotational Mechanics on Left Atrial Volumes in Non-Smoker Healthy Adults: Analysis Based on the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Healthy Study

Introduction: As has been established, the left ventricle (LV) and the left atrium (LA) form an organic unit of the left heart; however, little is known about the dependence of LV rotational parameters on LA volumes, even in healthy circumstances. Therefore, the present study aimed to assess the associations between basal and apical LV rotations and LA volumes and volume-based functional properties throughout the cardiac cycle in healthy adults by three-dimensional speckle-tracking echocardiography. Methods: The present study comprised 167 healthy adults (age: 33.4 ± 12.6 years, 77 males) with normally directed LV rotational mechanics. All subjects underwent complete two-dimensional Doppler echocardiography with three-dimensional speckle-tracking echocardiography (3DSTE)-derived data acquisition. The 3DSTE-derived LA volumes and LV rotational parameters were determined at a later date. Results: An increasing end-systolic maximum LA volume (Vmax) was associated with increasing pre-atrial-contraction early (VpreA) and minimum end-diastolic (Vmin) LA volumes, and all stroke volumes were increased as well. Systolic basal left ventricular rotation (LVrot) was highest in the case of the highest systolic Vmax and early-diastolic VpreA. Apical LVrot did not show obvious associations with any increasing LA volumes. The highest systolic basal LVrot was associated with significantly increased diastolic VpreA and Vmin. Reduced diastolic LA volumes (VpreA, Vmin) were seen in the case of increased apical LVrot. An increasing basal LVrot was associated with the tendentious lowering of the apical LVrot and the significant elevation of LV twist. Similarly, an increasing apical LVrot was associated with the tendentious lowering of basal LVrot and the significant elevation of LV twist. Conclusions: Strong associations and adaptations between 3DSTE-derived LA volumes throughout the cardiac cycle and LV rotational mechanics were evidenced, even in healthy circumstances.

Right atrial volumes and strains in healthy adults: is the Frank-Starling mechanism working?-detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Healthy Study

Background

With larger blood volume flowing into a cardiac chamber, by stretching muscle fibers, increased contraction force could be detected. This phenomenon is called Frank-Starling mechanism, allowing the output of a cardiac chamber to be synchronized without external regulation. The purpose of the present study was to investigate the Frank-Starling mechanism in the right atrium (RA) represented by its volumes, volume-based functional properties and strains respecting the cardiac cycle in healthy adults by three-dimensional (3D) speckle-tracking echocardiography (3DSTE).

Methods

The present single center retrospective cohort study comprised 179 healthy adult volunteers (mean age: 33.2±12.0 years, 92 males), in whom complete two-dimensional Doppler echocardiography with 3DSTE was performed. Subjects were divided into 3 groups according to the mean value of maximum RA volume (V_max) ± standard deviation: V_max <30 mL, 30 mL ≤ V_max <60 mL and V_max ≥60 mL.

Results

All RA volumes respecting the cardiac cycle of all subjects and calculated separately for females and males and their indexed equivalents increased with V_max. RA stroke volumes increased with V_max regardless of the phase it was measured in. While total atrial emptying fraction representing the reservoir phase remained unchanged with the increase of V_max, a significant increase in passive atrial emptying fraction representing the conduit phase could be detected, in case of V_max >60 mL (28.9%±15.1% vs. 32.5%±12.6%, P<0.05). Active atrial emptying fraction representing the booster pump function did not change with the increase of V_max. Most global and mean segmental peak RA strains did not show significant changes with increasing RA volumes except for the RA area strain, it was the largest when V_max was larger than 60 mL (64.7%±44.9% vs. 83.3%±49.4%, P<0.05). RA circumferential, longitudinal and area strains at atrial contraction decreased with increasing V_max, RA radial and 3D strains did not change significantly with increasing V_max.

Conclusions

Increasing RA volumes do not cause significant increase in RA contractility represented by strains, but reduction in strains in longitudinal and circumferential directions could be detected in end-diastolic booster pump function. In contrast to the left atrium, obvious signs of Frank-Starling mechanism could not be detected in case of the RA.

Survival of Myocardial Infarction Patients with Diabetes Mellitus at the Invasive Era (Results from the Városmajor Myocardial Infarction Registry)

Due to the lifelong nature of diabetes mellitus (DM), it has been demonstrated to have significant effects on patients' morbidity and mortality. The present study aimed to assess the effects of DM on the clinical outcome and survival in patients who underwent percutaneous coronary intervention (PCI) due to myocardial infarction (MI) and to examine the relationship of DM to the type of the MI and to left ventricular (LV) and renal functions. A total of 12,270 patients with ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) were revascularized at our Institution between 2005 and 2013. In this pool of patients, 4388 subjects had DM, while 7018 cases had no DM. In both STEMI and NSTEMI, the 30-day and 1-year survival were worse in diabetic patients as compared to non-diabetic cases. In the patients with DM, NSTEMI showed worse prognosis within 1-year than STEMI similarly to non-diabetic subjects. Regarding survival, the presence of DM seemed to be more important than the type of MI. Regardless of the presence of DM, reduced LV function was a maleficent prognostic sign and DM significantly reduced the prognosis both in case of reduced and normal LV function. Survival is primarily affected by LV function, rather than DM. Worse renal function is associated with worse 30-day and 1-year survival in both cases with and without DM. Considering different renal functions, the presence of DM worsens both short- and long-term survival. Survival is primarily affected by renal function, rather than DM. The results from a high-volume PCI center confirm significant the negative prognostic impact of DM on survival in MI patients. DM is a more important prognostic factor than the type of the MI. However, survival is primarily affected by LV and renal functions, rather than DM. These results could highlight our attention on the importance of recent DM treatment with new drugs including SGLT-2 inhibitors and GLP-1 antagonists with beneficial effects on survival.

Physiological and psychological effects of a 12-week home-based telemonitored training in metabolic syndrome

Background

Metabolic Syndrome (MetS) increases the risk of cardiovascular diseases (CVD) and affects around one fourth of the population worldwide. In the prevention and treatment regular exercise trainings are inevitable. Providing personal supervision in out/inpatient care settings for such a large target population challenges the healthcare systems, but using telemonitoring of the home-performed trainings could be a promising and widely available option.

Objectives

The aim of this study was to evaluate the physiological and psychological effects of a 12-week home-based physical training program, telemonitored by widely available fitness devices on parameters of MetS patients.

Methods

A total of 55 MetS patients (mean age 49.19 ± 7.93 years) were involved in the study. They were asked to perform 3-5 sessions of exercise activity (min. 150 min) each week for 12 weeks. Trainings were monitored off-line by heart rate sensors, a fitness application and a cloud-based data transfer system. Physiotherapists supervised, coached, and feedback the trainings through an online coach system. We investigated different anthropometric parameters, maximum exercise and functional capacity levels, laboratory parameters, the level of depression, insomnia, vital exhaustion, and wellbeing as well.

Results

The average weekly training time was 152.0 ± 116.2 min. Out of the 55 participants who completed the program, 22 patients (40%) performed the recommended 150 min or more weekly. Patients showed statistically significant changes in: all the measured waist and hip circumferences; 6-min walk distance (6MWD; from 539.69 ± 78.62 to 569.72 ± 79.96 m, p < 0.001); maximal exercise capacity (11.02 ± 2.6 to 12.14 ± 2 MET, p < 0.001), stress-electrocardiogram duration time (13.74 ± 3.29 to 15.66 ± 2.64 min, p < 0.001); body weight (98.72 ± 21.7 to 97.45 ± 21.76 kg, p = 0.004); high-density lipoprotein cholesterol (n = 45, 1.28 ± 0.31 to 1.68 ± 0.36 mmol/L, p < 0.001); fasting plasma glucose (FPG; n = 47, 6.16 ± 1.26 to 5.44 ± 1.31 mmol/L, p = 0.001); glycated hemoglobin A1c (HbA1c; n = 41, 6.22 ± 0.68 to 5.87 ± 0.78%, p = 0.01). Out of the 55 patients who finished the program 38 patients (70%) completed all the psychological questionnaires. We found statistically significant decrease of the overall scores of the Maastricht Vital Exhaustion Questionnaire, from 3.37 ± 2.97 points to 2.63 ± 2.70 points (p < 0.05) and a significant increase of the overall scores of the WHO Wellbeing Scale from 9.92 ± 2.59 points to 10.61 ± 2.76 points (p < 0.05). We have not found any statistically significant changes in the scores of the Beck Depression Inventory and the Athens Insomnia Scale.

Conclusion

A 12-week home-based telemonitored training supported by an affordable, commonly available device system produces positive, statistically significant changes in many core components in MetS patients. Telemonitoring is a cheap method for coaching and feeding back the home-based interventions.

Left ventricular deformation in athletes playing sports with high dynamics-insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Sport Study

Background

Earlier results suggest the role of speckle-tracking echocardiography (STE)-derived left ventricular (LV) strains in screening and could help better understanding of adaptation to exercise. The present retrospective cohort study aimed to investigate three-dimensional STE-derived LV strains representing its deformation in athletes playing sports with high dynamics with different grades of static components of their training.

Methods

The study consisted of 67 athletes (mean age: 23.6±6.4 years, 39 males). This group of athletes was further divided into the following groups: Group C.I. (high dynamic/low static) (n=12), Group C.II. (high dynamic/moderate static) (n=22) and Group C.III. (high dynamic/high static) (n=33). The control group comprised 83 age- and gender-matched non-athletic healthy volunteers (mean age: 23.6±3.2 years, 50 males).

Results

Global LV longitudinal strain (LS) representing LV lengthening or shortening (-18.5%±3.0% vs. -16.3%±2.3%, P<0.05), LV circumferential strain (CS) representing LV widening or narrowing (-29.9%±5.2% vs. -28.1%±4.8%, P<0.05) and LV area strain (AS; combination of LS and CS; -43.7%±5.4% vs. -40.9%±4.8%, P<0.05) were increased in elite athletes as compared to those of non-athlete controls. All apical LV strains proved to be increased in all athletes with enhanced basal radial strain (RS, representing LV thickening and thinning) and LS and midventricular LS, AS and 3D strain (3DS, combination of RS, LS and CS).

Conclusions

Increased LV-LS, LV-CS and LV-AS represents enhanced LV deformation in longitudinal and circumferential directions in athletes playing sports with high dynamics. This enhancement is not related to the grade of the static component of training. Some regional differences in LV strains could be detected.

Normal reference values of tricuspid annular dimensions and functional properties in healthy adults using three-dimensional speckle-tracking echocardiography (insights from the MAGYAR-Healthy Study)

Background

Three-dimensional speckle-tracking echocardiography (3DSTE) is a relatively new non-invasive imaging modality with ability for simultaneous chamber quantifications and determination of valvular dimensions. The aim of the present retrospective cohort study was to determine normal reference values of 3DSTE-derived tricuspid annular (TA) dimensions and functional properties and to evaluate their age- and gender dependency.

Methods

The present study comprised 156 healthy adult subjects, from which 28 cases were excluded due to inferior image quality, therefore the remaining group consisted of 128 cases with the mean age of 35.4±12.5 years (72 males). The subject population was further divided into the following categories: 18-29 years (n=57; mean age: 25.2±2.8 years, 51 males), 30-39 years (n=29; mean age: 34.1±2.5 years, 31 males), 40-49 years (n=17; mean age: 44.1±3.2 years, 11 males) and ≥50 years of age (n=25, mean age: 59.2±6.4 years, 14 males).

Results

End-diastolic TA diameter (2.2±0.3 vs. 2.5±0.3 cm, P<0.05), area (7.1±1.3 vs. 8.1±1.7 cm², P<0.05) and perimeter (10.3±0.9 vs. 11.0±1.2 cm, P<0.05) were lower in females than in males in the 18-29 year-old group and TA area (6.1±0.8 vs. 8.0±1.2 cm², P<0.05) and TA perimeter (9.7±0.8 vs. 11.0±0.9 cm, P<0.05) were lower in females than in males in the 40-49 year-old group. End-systolic TA diameter were lower in females than in males in the 18-29 year-old group (1.8±0.2 vs. 1.9±0.3 cm, P<0.05) and TA area (4.7±0.3 vs. 6.3±1.2 cm², P<0.05) and TA perimeter (8.6±0.4 vs. 9.5±0.9 cm, P<0.05) were lower in females than in males in the 40-49 year-old group. TA fractional area change was found to be reduced in the 40-49 year-old group as compared to the 30-39 year-old group (21.7%±8.7% vs. 29.2%±10.0%, P<0.05).

Conclusions

3DSTE is a novel method for non-invasive assessment of TA dimensions and functional properties. Results highlight the importance of age- and gender-specific reference values in case of TA diameter, area and perimeter and calculated functional features respecting the cardiac cycle.

Global meta-analysis of soil hydraulic properties on the same soils with differing land use

Global land use change has resulted in more pasture and cropland, largely at the expense of woodlands, over the last 300 years. How this change affects soil hydraulic function with regard to feedbacks to the hydrological cycle is unclear for earth system modelling (ESM). Pedotransfer functions (PTFs) used to predict soil hydraulic conductivity (K) take no account of land use. Here, we synthesize >800 measurements from around the globe from sites that measured near-saturated soil hydraulic conductivity, or infiltration, at the soil surface, on the same soil type at each location, but with differing land use, woodland (W), grassland (G) and cropland (C). We found that texture based PTFs predict K reasonably well for cropland giving unbiased results, but increasingly underestimate K in grassland and woodland. In native woodland and grassland differences in K can usually be accounted for by differences in bulk density. However, heavy grazing K responses can be much lower indicating compaction likely reduces connectivity. We show that the K response ratios (RR) between land uses vary with cropland (C/W = 0.45 [W/C = 2.2]) and grassland (G/W = 0.63 [W/G = 1.6]) having about half the K of woodland.

Distal Radial Artery Access for Recanalization of Radial Artery Occlusion and Repeat Intervention: A Single Center Experience

Background: Once occluded, the radial artery becomes unsuitable for repeat interventions and obligates the need for alternative vascular access, such as the femoral approach, which is not encouraged by current guidelines. With the dissemination of distal radial access (DRA), which allows the cannulation of the artery in its distal segment and which remains patent even in the case of radial artery occlusion (RAO), the option to perform angioplasty at this level becomes feasible. Methods: Thirty patients with RAO were enrolled in this pilot study. Recanalization was performed through DRA using hydrophilic guidewires. The feasibility endpoint was procedural success, namely the successful RAO recanalization, the efficacy endpoint was patency of the artery at 30 days, and the safety endpoint was the absence of periprocedural vascular major complications or major adverse cardiac and cerebrovascular events. Results: The mean age of the patients was 63 ± 11 years, and 15 patients (50%) were men. Most patients had asymptomatic RAO (n = 28, 93.3%), and only two (6.6%) reported numbness in their hands. The most common indication for the procedure was PCI (19, 63.2%). Total procedural time was 41 ± 22 min, while the amount of contrast used was 140 ± 28 mL. Procedural success was 100% (n = 30). Moreover, there were no major vascular complications (0%); only two small hematomas were described (10%) and one had an angiographically visible perforation (3%). One case of periprocedural stroke was reported (3%), with onset immediately after the procedure and recovering 24 h later. Twenty-seven radial arteries (90%) remained patent at the one-month follow-up. Conclusions: RAO recanalization is feasible and safe, and by using dedicated hydrophilic guidewires, the success rate is high without significantly increasing procedural time or the amount of used contrast.

Radial artery calcification in predicting coronary calcification and atherosclerosis burden

Background

Atherosclerosis is a systemic arterial disease with heterogeneous involvement in all vascular beds, however studies examining the relationship between coronary and radial artery calcification are lacking.

The purpose of this study was to assess the relationship between the two sites and the prognostic value of radial artery calcification (RC) for coronary artery disease.

Methods and results

This is a single-center, retrospective cross-sectional study based on doppler ultrasound of radial artery (RUS) and coronary artery angiography (CAG). We included a total of 202 patients undergoing RUS during distal radial access and CAG at the same procedure, between December 2020 and May 2021, from which 103 were found having RC during RUS (RC-group) and 99 without (NRC-group). Coronary calcifications were evaluated either by angiography examination (moderate and severe), positive CT (&gt;100 Agatson units) or intracoronary imaging (IVUS, OCT). A significant correlation was observed between radial calcification and coronary calcification variables (67.3%, vs 32.7% – p=0.001). The correlation between risk factors such as age, smoking, chronic kidney disease and diabetes mellitus was higher while sex did not play a role. The need of PCI and/or CABG was higher in the RC-group (60% vs 44%, p=0.02). RC therefore predicts the extent and severity of coronary artery disease.

Conclusion

RC may be frequently associated with calcific coronary plaques. These findings highlight the potential beneficial examination of radial arteries whenever CAD is suspected.

Funding Acknowledgement

Type of funding sources: None.

Left Atrial Volumetric and Functional Properties in Hemophilia - Insights from a Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Path Study

Introduction

Hemophilia is an inherited disorder due to deficiencies in factor VIII (type A) and factor IX (type B). Abnormalities in myocardial mechanics could be theorized due to hemophilia-associated hypocoagubility and related quantitative and qualitative changes of the blood. The present study aimed a detailed assessment of left atrial (LA) volumetric and functional properties in patients with hemophilia using three-dimensional speckle-tracking echocardiography (3DSTE).

Materials and Methods

The study consisted of 12 subjects with hemophilia type A and 2 cases with hemophilia type B (mean age: 40.8 ± 19.1 years, all males). Results of hemophilia patients were compared to that of 23 age-, gender- and risk factor-matched controls (42.4 ± 9.0 years, all males). Routine two-dimensional Doppler echocardiography and 3DSTE were performed in all subjects.

Results

LA volumes respecting cardiac cycle did not differ between controls and hemophilia patients. From LA volume-based functional properties, LA stroke volumes were similar between the groups examined in all phases of LA function. While total atrial emptying fraction featuring LA reservoir function was reduced in patients with hemophilia compared to that of controls, passive and active atrial emptying fraction characterizing LA conduit and booster pump functions were similar between the groups. From LA strains, peak mean segmental circumferential and longitudinal LA strains were impaired in patients with hemophilia, other peak LA strains were similar between the groups. LA strains at atrial contraction did not differ between groups of hemophilia patients and controls.

Conclusions

Hemophilia is not associated with LA volumetric changes, but mild LA functional abnormalities are present.

Evaluation of electrocardiographic repolarization parameters in patients with polycystic ovary syndrome

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office

Introduction

Polycystic ovary syndrome (PCOS) is a multifactorial, endocrine disease associated with metabolic disturbances (e.g. hyperinsulinemia, insulin resistance) and increased cardiovascular risk. Recent data strongly suggest that different QT variability parameters characterizing cardiac repolarization instability represent novel markers in proarrhythmic risk assessment.

Purpose

In the present study we investigated ECG repolarization parameters, including QT variability parameters in patients with polycystic ovary syndrome.

Methods

Fifty-five PCOS patients (age: 29±6 years) and 55 age-matched healthy volunteers (age: 29±10 years) were enrolled in the study. Five-minute 12-lead resting electrocardiograms were recorded, the ECGs were digitized and evaluated off-line using the Cardiosys-A01 system (Cardiosys-A01, MDE Heidelberg GMBH, Heidelberg, Germany). The following parameters were determined: the frequency corrected QT interval (QTc) using Bazett’s, Fridericia, Framingham and the Hodges formulas; QT dispersion (QTd) and T wave peak-to-end distance (Tpeak-Tend). Among QT variability parameters we analyzed the QT variance (QTv), the QT variability index (QTVI), the short-term beat-to-beat QT and RR interval variability (STV-QT, STV-RR) based on constructed Poincaré plots and the variability ratio (VR).

Results

The RR interval did not differ significantly in PCOS patients compared to controls (821±129 ms vs. 847±99 ms), however the QT interval (373±30 ms vs. 391±27 ms, p&lt;0.01), the QTc calculated with Bazett’s, Framingham, Fridericia and Hodges correction formulas (QTc Bazett’s: 413±18 ms vs. 426±21 ms, p&lt;0.01) and the Tpeak-Tend intervals were significantly shorter (76±10 ms vs. 83±12 ms, p&lt;0.01). The QTd, QTv, and STV-RR did not differ significantly. However, the VR (0.3±0.4 vs. 0.2±0.2, p&lt;0.05), the QTVI (-0,9±0.5 vs. -1,3±0.4, p&lt;0.001), and importantly, the STV-QT were significantly higher in PCOS patients compared to controls (4.0±0.9 ms vs. 3.2±0.9 ms, p&lt;0.0001).

Conclusion

Some of the alterations in repolarization parameters and the significant increase in the short-term beat-to-beat QT interval variability and the QT variability index may indicate increased repolarization instability in patients with polycystic ovary syndrome compared to age-matched controls, however, further studies are needed to establish the exact relation of this finding to increased arrhythmia propensity in this population.

The tricuspid annulus in amyloidosis with cardiac involvement: Detailed analysis from the three-dimensional speckle tracking echocardiographic MAGYAR-Path Study

Introduction

Amyloidosis is a rare condition due to extracellular deposition of excessive amount of protein in parenchymal tissues including the heart. The present study aimed to test whether cardiac amyloidosis (CA) is associated with morphological and functional abnormalities of the tricuspid annulus (TA). For this aim, the results of patients having CA were compared to age- and gender-matched healthy controls by three-dimensional speckle-tracking echocardiography (3DSTE). Moreover, differences in TA parameters between light-chain CA (AL-CA) and transthyretin CA (TTR-CA) were studies as well.

Materials and Methods

The study comprised 27 CA patients (mean age: 62.7 ± 9.1 years, 21 males), their results were compared to those of 20 age- and gender-matched healthy volunteers (59.3 ± 3.8 years, 13 males). Complete two-dimensional Doppler echocardiography and 3DSTE were performed in all CA patients and controls.

Results

Dilated end-diastolic and end-systolic TA diameter, area and perimeter could be detected in all CA patients and in the AL-CA and TTR-CA subgroups, as well. Although only a few TTR-CA patients were involved, morphologic TA parameters proved to be tendentiously higher as compared to those of AL-CA patients. Functional parameters of TA were found to be reduced in CA patients, which were more deteriorated in AL-CA patients.

Conclusions

Dilated TA is associated with its functional deterioration in CA.

Tricuspid Annular Abnormalities in Isolated Left Ventricular Non-compaction—Insights From the Three-dimensional Speckle-Tracking Echocardiographic MAGYAR-Path Study

Introduction

Prominent trabecular left ventricular (LV) meshwork and deep intertrabecular LV recesses are featuring LV non-compaction (LVNC). The aim of this study was to evaluate tricuspid annular (TA) morphological and functional abnormalities by three-dimensional speckle-tracking echocardiography (3DSTE) in patients with LVNC without right ventricular (RV) involvement.

Materials and Methods

This study consisted of 21 patients with isolated LVNC, from which 6 cases were excluded due to inferior image quality. The remaining patient group consisted of 15 subjects with a mean age of 52.1 ± 11.4 years (9 males). LVNC was defined according to the Jenni's criteria. Their results were compared to 21 age- and gender-matched healthy controls (mean age: 52.4 ± 3.9 years, 14 males). Complete routine 2-dimensional Doppler echocardiographic examination was performed in all the patients with isolated LVNC and healthy controls. End-systolic and end-diastolic TA dimensions were assessed on selected planes derived from full-volume 3D echocardiographic datasets during 3DSTE.

Results

Patients with isolated LVNC showed significantly dilated end-systolic and end-diastolic TA diameter and area, which were accompanied with preserved TA functional properties and associated with right atrial (RA) volumes. TA plane systolic excursion (TAPSE) showed mild correlations with TA fractional area change (TAFAC) and TA fractional shortening (TAFS). No correlations could be demonstrated between TAPSE and TA morphological features. Extent of LVNC did not correlate with any echocardiographic parameters.

Conclusion

TA is dilated with preserved sphincter-like function in patients with isolated LVNC. Longitudinal (TAPSE) and sphincter-like (TAFAC and TAFS) TA movements correlate with each other. TA dilation is associated with an increased RA volumes respecting cardiac cycle.

Evaluation of electrocardiographic repolarization parameters in patients with polycystic ovary syndrome

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Research, Development and Innovation Office

Introduction

Polycystic ovary syndrome (PCOS) is a multifactorial, endocrine disease associated with metabolic disturbances (e.g. hyperinsulinemia, insulin resistance) and increased cardiovascular risk. Recent data strongly suggest that different QT variability parameters characterizing cardiac repolarization instability represent novel markers in proarrhythmic risk assessment.

Purpose

In the present study we investigated ECG repolarization parameters, including QT variability parameters in patients with polycystic ovary syndrome.

Methods

Fifty-five PCOS patients (age: 29±6 years) and 55 age-matched healthy volunteers (age: 29±10 years) were enrolled in the study. Five-minute 12-lead resting electrocardiograms were recorded, the ECGs were digitized and evaluated off-line using the Cardiosys-A01 system (Cardiosys-A01). The following parameters were determined: the frequency corrected QT interval (QTc) using Bazett’s, Fridericia, Framingham and the Hodges formulas; QT dispersion (QTd) and T wave peak-to-end distance (Tpeak-Tend). Among QT variability parameters we analyzed the QT variance (QTv), the QT variability index (QTVI), the short-term beat-to-beat QT and RR interval variability (STV-QT, STV-RR) based on constructed Poincaré plots and the variability ratio (VR).

Results

The RR interval did not differ significantly in PCOS patients compared to controls (821±129 ms vs. 847±99 ms), however the QT interval (373±30 ms vs. 391±27 ms, p&lt;0.01), the QTc calculated with Bazett’s, Framingham, Fridericia and Hodges correction formulas (QTc Bazett’s: 413±18 ms vs. 426±21 ms, p&lt;0.01) and the Tpeak-Tend intervals were significantly shorter (76±10 ms vs. 83±12 ms, p&lt;0.01). The QTd, QTv, and STV-RR did not differ significantly. However, the VR (0.3±0.4 vs. 0.2±0.2, p&lt;0.05), the QTVI (-0,9±0.5 vs. -1,3±0.4, p&lt;0.001), and importantly, the STV-QT were significantly higher in PCOS patients compared to controls (4.0±0.9 ms vs. 3.2±0.9 ms, p&lt;0.0001).

Conclusion

Some of the alterations in repolarization parameters and the significant increase in the short-term beat-to-beat QT interval variability and the QT variability index may indicate increased repolarization instability in patients with polycystic ovary syndrome compared to age-matched controls, however, further studies are needed to establish the exact relation of this finding to increased arrhythmia propensity in this population.

A bal kamrai globális myocardialis munka echokardiográfiás vizsgálata

Összefoglaló. A bal kamra funkciójának megítélésére számos echokardiográfiás paraméter alkalmas. Bár a bal kamrai ejekciós frakció és a globális longitudinális strain széleskörűen alkalmazott paraméterek, használatuk során limitáló tényezők változatlanul fennállnak. A globális myocardialis munka noninvazív meghatározása ma már elérhető klinikai lehetőség, mely kombinálja a speckle-tracking echokardiográfiás strainanalízist a brachialis artériában mandzsettával systoléban mért vérnyomásértékkel. Az így számítható paraméterek töltéstől független lehetőséget nyújtanak a bal kamra funkciójának jellemzésére. A jelen összefoglaló mű célja ennek az új módszernek a rövid bemutatása a korai eredmények ismertetése mellett, irodalmi adatok alapján. Orv Hetil. 2022; 163(13): 495–499.

Summary. Several echocardiographic parameters are suitable for the evaluation of left ventricular function. Although left ventricular ejection fraction and global longitudinal strain are widely used parameters, limitations are still persisting. Non-invasive estimation of global myocardial work has become a new clinical opportunity, which combines speckle-tracking echocardiography-derived strain analysis with systolic blood pressure measured by brachial cuff. Calculated parameters make a load-independent choice for featuring left ventricular function. The present review aimed a short demonstration of this methodology together with early results based on literature. Orv Hetil. 2022; 163(13): 495–499.

Left ventricular rotational abnormalities in hemophilia-insights from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

BACKGROUND

Hemophilia is an X-linked inherited disorder primarily affecting males, its major types are type A (deficiency in factor VIII) and B (deficiency in factor IX), and is considered to be the most common severe congenital coagulation factor deficiency. The present study was designed to test whether any differences in left ventricular (LV) rotational mechanics could be demonstrated between male patients with hemophilia and healthy controls using three-dimensional speckle-tracking echocardiography (3DSTE)-derived virtual LV models.

METHODS

The present study consisted of 17 patients with hemophilia, however, 3 patients were excluded due to insufficient image quality. In the remaining patient population, 12 patients had hemophilia A and 2 patients had hemophilia B (mean age: 42.2±18.9 years, all males). The control group comprised 16 age-matched healthy subjects (46.0±5.9 years, all males).

RESULTS

None of the routine two-dimensional echocardiographic data differ between patients with hemophilia and controls. None of the patients and controls showed ≥ grade 1 valvular regurgitations and had valvular stenoses. In one subject, the near absence of LV twist called as LV "rigid body rotation" could be detected, data of which were managed separately. While 3DSTE-derived apical LV rotation was 3.65 degrees, basal LV rotation proved to be 3.57 degrees leading to 0.08-degree LV apico-basal gradient suggesting counterclockwise LV "rigid body rotation". In the remaining patients, both LV apical rotation (7.25±6.20 vs. 10.39±4.16 degrees, P<0.02) and LV twist (10.24±5.60 vs. 14.38±3.93 degrees, P<0.003) showed significant impairment in patients with hemophilia.

CONCLUSIONS

LV rotational abnormalities are present in hemophilia with reduced LV apical rotation and twist.

Is treated hypopituitarism associated with increased left ventricular strains?-detailed analysis from the three-dimensional speckle-tracking echocardiographic MAGYAR-Path Study

Reduced secretion of one or more of the hormones normally produced by the pituitary gland is called hypopituitarism, which is a rare and frequently underdiagnosed condition. Hypopituitarism can be present at birth called congenital or may develop due to acquired causes like tumor, infection, infiltration, vascular or other causes. Symptoms of hypopituitarism are highly dependent on which hormones are insufficient. The present prospective study was designed to test whether treated hypopituitarism is associated with changes in 3DSTE-derived LV strains in patients without known cardiovascular disorder. We investigated 38 patients with treated hypopituitarism who were in sinus rhythm (57.0±13.6 years, 19 males), 6 patients were excluded from the study due to inferior image quality. The remaining patient group consisted of 16 patients with congenital hypopituitarism and 16 patients with acquired form of hypopituitarism. Their results were compared to age- and gender-matched controls (mean age: 55.3±4.7 years, 14 males). Out of the 32 patients with hypopituitarism, 30 patients had growth hormone deficiency, 27 patients had central adrenal insufficiency, 12 patients had central hypothyroidism, 12 patients had hypogonadotropic hypogonadism and 5 patients had diabetes insipidus. Only LV longitudinal and area strains proved to be significantly increased in patients with hypopituitarism, other LV strains did not differ between patients and controls. No significant differences could be confirmed in LV strains between patients with congenital and acquired hypopituitarism. It could be concluded that longitudinal LV strains are increased in both congenital and acquired treated hypopituitarism.

The mitral annulus in transposition of the great arteries late after Senning- and Mustard-procedures (Insights from the CSONGRAD Registry and MAGYAR-Path Study)

Background

Dextro-transposition of the great arteries (dTGA) is a rare condition comprising 5–7% of all congenital heart diseases (CHD). Until 1990s, atrial switch operations were the method of choice for the treatment of dTGA. The aim of our present study was to evaluate the abnormalities of the mitral annulus (MA) by three-dimensional speckle-tracking echocardiography (3DSTE). Potential differences in MA dimensions and functional properties late after Senning- and Mustard-procedures were analyzed as well.

Methods

This retrospective cohort study comprised 19 dTGA patients late after atrial switch operation, from which 7 subjects were not involved due to inferior image quality. The remaining dTGA patient group comprised 12 subjects (age: 30.7±8.6 years, 7 males). For comparisons, 32 age- and gender-matched healthy controls were evaluated (age: 34.4±12.3 years, 18 males).

Results

End-systolic and end-diastolic MA diameter (MAD), area and perimeter proved to be increased, while MA functional parameters [MA fractional area change (MAFAC) and fractional shortening (MAFS)] were reduced in all dTGA patients as compared to matched controls regardless of the atrial switch procedure used. However, MA morphological parameters were tendentiously lower, while MA functional parameters were tendentiously favorable in case of Senning-procedure compared to Mustard-procedure.

Conclusions

dTGA is accompanied by MA dilation and its functional impairment late after Senning- and Mustard-procedures.

Medical treatment of pulmonary hypertension in adults with congenital heart disease: updated and extended results from the International COMPERA-CHD Registry

BACKGROUND

Pulmonary arterial hypertension (PAH) is common in congenital heart disease (CHD). Because clinical-trial data on PAH associated with CHD (PAH-CHD) remain limited, registry data on the long-term course are essential. This analysis aimed to update information from the COMPERA-CHD registry on management strategies based on real-world data.

METHODS

The prospective international pulmonary hypertension registry COMPERA has since 2007 enrolled more than 10,000 patients. COMPERA-CHD is a sub-registry for patients with PAH-CHD.

RESULTS

A total of 769 patients with PAH-CHD from 62 specialized centers in 12 countries were included into COMPERA-CHD from January 2007 through September 2020. At the last follow-up in 09/2020, patients [mean age 45.3±16.8 years; 512 (66%) female] had either post-tricuspid shunts (n=359; 46.7%), pre-tricuspid shunts (n=249; 32.4%), complex CHD (n=132; 17.2%), congenital left heart or aortic valve or aortic disease (n=9; 1.3%), or miscellaneous CHD (n=20; 2.6%). The mean 6-minute walking distance was 369±121 m, and 28.2%, 56.0%, and 3.8% were in WHO functional class I/II, III or IV, respectively (12.0% unknown). Compared with the previously published COMPERA-CHD data, after 21 months of follow-up, the number of included PAH-CHD patients increased by 91 (13.4%). Within this group the number of Eisenmenger patients rose by 39 (16.3%), the number of "Non-Eisenmenger PAH" patients by 45 (26.9%). Currently, among the 674 patients from the PAH-CHD group with at least one follow-up, 450 (66.8%) received endothelin receptor antagonists (ERA), 416 (61.7%) PDE-5 inhibitors, 85 (12.6%) prostacyclin analogues, and 36 (5.3%) the sGC stimulator riociguat. While at first inclusion in the COMPERA-CHD registry, treatment was predominantly monotherapy (69.3%), this has shifted to favoring combination therapy in the current group (53%). For the first time, the nature, frequency, and treatment of significant comorbidities requiring supportive care and medication are described.

CONCLUSIONS

Analyzing "real life data" from the international COMPERA-CHD registry, we present a comprehensive overview about current management modalities and treatment concepts in PAH-CHD. There was an trend towards more aggressive treatment strategies and combination therapies. In the future, particular attention must be directed to the "Non-Eisenmenger PAH" group and to patients with complex CHD, including Fontan patients.

TRIAL REGISTRATION

www.clinicaltrials.gov, study identifier: Clinicaltrials.gov NCT01347216.

Tricuspid annular abnormalities following different surgical strategies in adults with corrected tetralogy of Fallot (Results from the CSONGRAD Registry and MAGYAR-Path Study)

BACKGROUND

Although there is an increasing number of patients with corrected tetralogy of Fallot (cTOF), who reach adulthood due to recent successful surgical procedures, some of them suffers from late complications, including functional tricuspid regurgitation (FTR). The purpose of the present study was to examine tricuspid annular (TA) abnormalities in adult cTOF patients and their relationship right atrial (RA) volumes respecting the cardiac cycle assessed by three-dimensional speckle-tracking echocardiography (3DSTE). Moreover, the effect of different surgical procedures on TA morphologic and functional parameters was examined as well.

METHODS

The study comprised 24 cTOF patients (32.8±13.5 years, 9 males) in which early palliative surgery and late total correction were performed in 12 cases (pcTOF), while early total reconstruction was performed in 12 subjects (etrTOF). Their results were compared to those of 33 matched healthy adults (36.7±7.2 years, 15 males).

RESULTS

Dilated end-systolic and end-diastolic TA morphologic parameters and their body surface area-indexed counterpart could be detected in cTOF patients as compared to that of controls. TA fractional area change and TA fractional shortening proved to be reduced in cTOF patients as well as in etrTOF and pcTOF patients compared to controls. None of the TA morphologic and functional parameters showed any differences between etrTOF and pcTOF patients. Increased maximum, preatrial contraction and minimum RA volumes could be detected in cTOF patients compared to controls, which correlated with TA dimensions.

CONCLUSIONS

TA is dilated with reduced function in adult patients with cTOF. TA dilation is related to RA volumes. etrTOF and pcTOF patients have similar TA dimensions and TA functional properties.

KEYWORDS

Fallot; tricuspid annulus; three-dimensional (3D); speckle-tracking; echocardiography.