Diagnostics

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9 pages, 239 KiB

Open AccessArticle

Impact of Net Atrioventricular Compliance on Mitral Valve Area Assessment—A Perspective Considering Three-Dimensional Mitral Valve Area by Transesophageal Echocardiography

by Tony Li, Ryan Leow, Meei Wah Chan, William K. F. Kong, Ivandito Kuntjoro, Kian Keong Poh, Ching Hui Sia and Tiong Cheng Yeo

Diagnostics 2024, 14(15), 1595; https://doi.org/10.3390/diagnostics14151595 - 24 Jul 2024

Viewed by 553

Abstract

Background: Net atrioventricular compliance (C_n) can affect the accuracy of mitral valve area (MVA) assessment. We assessed how different methods of MVA assessment are affected by C_n, and if patients with abnormal C_n may be identified by clinical [...] Read more.

Background: Net atrioventricular compliance (C_n) can affect the accuracy of mitral valve area (MVA) assessment. We assessed how different methods of MVA assessment are affected by C_n, and if patients with abnormal C_n may be identified by clinical and/or echocardiographic parameters. Methods: We studied 244 patients with rheumatic MS. The concordance between mitral valve area (MVA) by 2D planimetry, pressure half-time (PHT), continuity equation (CE), Yeo’s index, and 3-dimensional mitral valve area assessed by transesophageal echocardiography (TEE 3DMVA) in patients with normal and abnormal C_n (C_n ≤ 4 mL/mmHg) were evaluated in the 110 patients with both transesophageal echocardiogram (TEE) and transthoracic echocardiogram (TTE). Variables that were associated with abnormal C_n were validated in the remaining 134 patients with only TTE. Results: Except for MVA by CE, concordance with TEE 3DMVA was poorer for all other methods of MVA assessment in patients with abnormal C_n. But, the difference in concordance was only statistically significant for MVA by PHT. Patients with MVA ≤ 1.5 cm² by 2D planimetry and PHT ≤ 130 ms were likely to have an abnormal C_n. (specificity 98.5%). This finding was validated in the remaining 134 patients (specificity 93%). Conclusions: MVA assessment by PHT is significantly affected by C_n. Abnormal C_n should be suspected when 2D planimetry MVA is ≤1.5 cm² together with an inappropriately short PHT that is ≤130 ms. In this scenario, MVA by PHT is inaccurate. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Heart Disease)

10 pages, 778 KiB

Open AccessArticle

Combining 2D Planimetry and Yeo’s Index Can Help Accurately Identify Patients with Severe Rheumatic Mitral Stenosis—A Perspective from a 3D Assessment Using Transoesophageal Echocardiography

by Tony Li, Ryan Leow, Meei Wah Chan, William K. F. Kong, Ivandito Kuntjoro, Kian Keong Poh, Ching Hui Sia and Tiong Cheng Yeo

Diagnostics 2024, 14(13), 1440; https://doi.org/10.3390/diagnostics14131440 - 5 Jul 2024

Cited by 1 | Viewed by 816

Abstract

Background: Yeo’s index is a novel measure of the severity of rheumatic mitral valve stenosis (MS). It is derived from the product of the mitral leaflet separation index and dimensionless index. This study aims to validate Yeo’s index using a transesophageal echocardiogram (TEE) [...] Read more.

Background: Yeo’s index is a novel measure of the severity of rheumatic mitral valve stenosis (MS). It is derived from the product of the mitral leaflet separation index and dimensionless index. This study aims to validate Yeo’s index using a transesophageal echocardiogram (TEE) three-dimensional (3D) mitral valve area (MVA) as a comparator and to compare the concordance of existing echocardiographic measures of the MVA with TEE 3DMVA. Methods and Results: We studied 111 patients with rheumatic MS who underwent both transthoracic echocardiography (TTE) and a TEE assessment of MS severity. Yeo’s index, the MVA determined by 2D planimetry, pressure half-time (PHT) and continuity equation (CE) measured on TTE were compared with the TEE 3DMVA. With a linear correlation, Yeo’s index showed the best correlation with TEE 3DMVA (r² = 0.775), followed by 2D planimetry (r² = 0.687), CE (r² = 0.598) and PHT (r² = 0.363). Using TEE 3DMVA as comparator, Yeo’s index (ρ_c = 0.739) demonstrated the best concordance, followed by 2D planimetry (ρ_c = 0.632), CE (ρ_c = 0.464) and PHT (ρ_c = 0.366). When both Yeo’s index and 2D planimetry suggested significant MS, the positive predictive value was high (an AUC of 0.966 and a PPV of 100.00% for severe MS, and an AUC of 0.864 and a PPV of 85.71% for very severe MS). When both measures suggested the absence of significant MS, the negative predictive value was also high (an AUC of 0.940 and an NPV of 88.90% for severe MS, and an AUC of 0.831 and an NPV of 88.71% for very severe MS). Conclusions: Yeo’s index performed well in identifying severe MS when compared with TEE 3DMVA and may be a useful adjunct to existing methods of measuring MS severity. Combining it with 2D planimetry could further enhance its accuracy. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Heart Disease)

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10 pages, 227 KiB

Open AccessArticle

Hypothyroidism and Heart Rate Variability: Implications for Cardiac Autonomic Regulation

by Carina Bogdan, Viviana Mihaela Ivan, Adrian Apostol, Oana Elena Sandu, Felix-Mihai Maralescu and Daniel Florin Lighezan

Diagnostics 2024, 14(12), 1261; https://doi.org/10.3390/diagnostics14121261 - 14 Jun 2024

Cited by 2 | Viewed by 2071

Abstract

Thyroid hormones have a pivotal role in controlling metabolic processes, cardiovascular function, and autonomic nervous system activity. Hypothyroidism, a prevalent endocrine illness marked by inadequate production of thyroid hormone, has been linked to different cardiovascular abnormalities, including alterations in heart rate variability (HRV). [...] Read more.

Thyroid hormones have a pivotal role in controlling metabolic processes, cardiovascular function, and autonomic nervous system activity. Hypothyroidism, a prevalent endocrine illness marked by inadequate production of thyroid hormone, has been linked to different cardiovascular abnormalities, including alterations in heart rate variability (HRV). The study included 110 patients with hypothyroid disorder. Participants underwent clinical assessments, including thyroid function tests and HRV analysis. HRV, a measure of the variation in time intervals between heartbeats, serves as an indicator of autonomic nervous system activity and cardiovascular health. The HRV values were acquired using continuous 24-h electrocardiogram (ECG) monitoring in individuals with hypothyroidism, as well as after a treatment period of 3 months. All patients exhibited cardiovascular symptoms like palpitations or fatigue but showed no discernible cardiac pathology or other conditions associated with cardiac disease. The findings of our study demonstrate associations between hypothyroidism and alterations in heart rate variability (HRV) parameters. These results illustrate the possible influence of thyroid dysfunction on the regulation of cardiac autonomic function. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Heart Disease)

14 pages, 1011 KiB

Open AccessArticle

The Influence of Pericardial Fat on Left Ventricular Diastolic Function

by Patrícia Coelho, Hugo Duarte, Carlos Alcafache and Francisco Rodrigues

Diagnostics 2024, 14(7), 702; https://doi.org/10.3390/diagnostics14070702 - 27 Mar 2024

Cited by 1 | Viewed by 1713

Abstract

Background: Heart failure is a major cause of morbidity and mortality worldwide; left ventricular diastolic dysfunction plays a leading role in this clinical context. Diastolic dysfunction may be predisposed by increased abdominal fat and, consequently, increased pericardial and epicardial adiposity. This study aimed [...] Read more.

Background: Heart failure is a major cause of morbidity and mortality worldwide; left ventricular diastolic dysfunction plays a leading role in this clinical context. Diastolic dysfunction may be predisposed by increased abdominal fat and, consequently, increased pericardial and epicardial adiposity. This study aimed to determine whether pericardial fat (PF) and epicardial fat (EF) are associated with left ventricular diastolic function. Methods: A total of 82 patients had their abdominal circumference measured and underwent transthoracic echocardiography to measure the thickness of PF and EF and assess the left ventricular diastolic function. Two groups were created based on mean pericardial fat (PF) thickness (4.644 mm) and were related to abdominal circumference and echocardiographic parameters. Results: Subjects in the PF High group showed a significant decrease in septal e’ (p < 0.0001), lateral e’ (p < 0.0001), and E/A ratio (p = 0.003), as well as a significant increase in E/e’ ratio (p < 0.0001), E wave deceleration time (p = 0.013), left atrial volume (p < 0.0001), the left ventricle mass (p = 0.003), tricuspid regurgitant jet velocity (p < 0.0001), and the left ventricle diameter (p = 0.014) compared to the PF Low group. Correlations were found between pericardial fat and nine echocardiographic parameters in the study, while epicardial fat (EP) only correlated with eight. Conclusions: Measurement of abdominal circumference, PF, and EF is an early indicator of diastolic changes with transthoracic echocardiography being the gold standard exam. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Heart Disease)

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12 pages, 4952 KiB

Open AccessArticle

Location, Location, Location: A Pilot Study to Compare Electrical with Echocardiographic-Guided Targeting of Left Ventricular Lead Placement in Cardiac Resynchronisation Therapy

by Panagiota A. Chousou, Rahul K. Chattopadhyay, Gareth D. K. Matthews, Vassilios S. Vassiliou and Peter J. Pugh

Diagnostics 2024, 14(3), 299; https://doi.org/10.3390/diagnostics14030299 - 30 Jan 2024

Viewed by 1012

Abstract

Introduction: Cardiac resynchronisation therapy is ineffective in 30–40% of patients with heart failure with reduced ejection fraction. Targeting non-scarred myocardium by selecting the site of latest mechanical activation using echocardiography has been suggested to improve outcomes but at the cost of increased resource [...] Read more.

Introduction: Cardiac resynchronisation therapy is ineffective in 30–40% of patients with heart failure with reduced ejection fraction. Targeting non-scarred myocardium by selecting the site of latest mechanical activation using echocardiography has been suggested to improve outcomes but at the cost of increased resource utilisation. The interval between the beginning of the QRS complex and the local LV lead electrogram (QLV) might represent an alternative electrical marker. Aims: To determine whether the site of latest myocardial electrical and mechanical activation are concordant. Methods: This was a single-centre, prospective pilot study, enrolling patients between March 2019 and June 2021. Patients underwent speckle-tracking echocardiography (STE) prior to CRT implantation. Intra-procedural QLV measurement and R-wave amplitude were performed in a blinded fashion at all accessible coronary sinus branches. Pearson’s correlation coefficient and Cohen’s Kappa coefficient were utilised for the comparison of electrical and echocardiographic parameters. Results: A total of 20 subjects had complete data sets. In 15, there was a concordance at the optimal site between the electrically targeted region and the mechanically targeted region; in four, the regions were adjacent (within one segment). There was discordance (≥2 segments away) in only one case between the two methods of targeting. There was a statistically significant increase in procedure time and fluoroscopy duration using the intraprocedural QLV strategy. There was no statistical correlation between the quantitative electrical and echocardiographic data. Conclusions: A QLV-guided approach to targeting LV lead placement appears to be a potential alternative to the established echocardiographic-guided technique. However, it is associated with prolonged fluoroscopy and overall procedure time. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Heart Disease)

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14 pages, 2076 KiB

Open AccessArticle

Analysis of Epicardial Adipose Tissue Texture in Relation to Coronary Artery Calcification in PCCT: The EAT Signature!

by Peter Mundt, Alexander Hertel, Hishan Tharmaseelan, Dominik Nörenberg, Theano Papavassiliu, Stefan O. Schoenberg, Matthias F. Froelich and Isabelle Ayx

Diagnostics 2024, 14(3), 277; https://doi.org/10.3390/diagnostics14030277 - 27 Jan 2024

Viewed by 1423

Abstract

(1) Background: Epicardial adipose tissue influences cardiac biology in physiological and pathological terms. As it is suspected to be linked to coronary artery calcification, identifying improved methods of diagnostics for these patients is important. The use of radiomics and the new Photon-Counting computed [...] Read more.

(1) Background: Epicardial adipose tissue influences cardiac biology in physiological and pathological terms. As it is suspected to be linked to coronary artery calcification, identifying improved methods of diagnostics for these patients is important. The use of radiomics and the new Photon-Counting computed tomography (PCCT) may offer a feasible step toward improved diagnostics in these patients. (2) Methods: In this retrospective single-centre study epicardial adipose tissue was segmented manually on axial unenhanced images. Patients were divided into three groups, depending on the severity of coronary artery calcification. Features were extracted using pyradiomics. Mean and standard deviation were calculated with the Pearson correlation coefficient for feature correlation. Random Forest classification was applied for feature selection and ANOVA was performed for group comparison. (3) Results: A total of 53 patients (32 male, 21 female, mean age 57, range from 21 to 80 years) were enrolled in this study and scanned on the novel PCCT. “Original_glrlm_LongRunEmphasis”, “original_glrlm_RunVariance”, “original_glszm_HighGrayLevelZoneEmphasis”, and “original_glszm_SizeZoneNonUniformity” were found to show significant differences between patients with coronary artery calcification (Agatston score 1–99/≥100) and those without. (4) Conclusions: Four texture features of epicardial adipose tissue are associated with coronary artery calcification and may reflect inflammatory reactions of epicardial adipose tissue, offering a potential imaging biomarker for atherosclerosis detection. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Heart Disease)

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Review

Jump to: Research, Other

19 pages, 539 KiB

Open AccessReview

The Role of Artificial Intelligence and Machine Learning in the Prediction of Right Heart Failure after Left Ventricular Assist Device Implantation: A Comprehensive Review

by Ozlem Balcioglu, Cemre Ozgocmen, Dilber Uzun Ozsahin and Tahir Yagdi

Diagnostics 2024, 14(4), 380; https://doi.org/10.3390/diagnostics14040380 - 9 Feb 2024

Viewed by 1726

Abstract

One of the most challenging and prevalent side effects of LVAD implantation is that of right heart failure (RHF) that may develop afterwards. The purpose of this study is to review and highlight recent advances in the uses of AI in evaluating RHF [...] Read more.

One of the most challenging and prevalent side effects of LVAD implantation is that of right heart failure (RHF) that may develop afterwards. The purpose of this study is to review and highlight recent advances in the uses of AI in evaluating RHF after LVAD implantation. The available literature was scanned using certain key words (artificial intelligence, machine learning, left ventricular assist device, prediction of right heart failure after LVAD) was scanned within Pubmed, Web of Science, and Google Scholar databases. Conventional risk scoring systems were also summarized, with their pros and cons being included in the results section of this study in order to provide a useful contrast with AI-based models. There are certain interesting and innovative ML approaches towards RHF prediction among the studies reviewed as well as more straightforward approaches that identified certain important predictive clinical parameters. Despite their accomplishments, the resulting AUC scores were far from ideal for these methods to be considered fully sufficient. The reasons for this include the low number of studies, standardized data availability, and lack of prospective studies. Another topic briefly discussed in this study is that relating to the ethical and legal considerations of using AI-based systems in healthcare. In the end, we believe that it would be beneficial for clinicians to not ignore these developments despite the current research indicating more time is needed for AI-based prediction models to achieve a better performance. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Heart Disease)

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18 pages, 1069 KiB

Open AccessReview

Wolf–Parkinson–White Syndrome: Diagnosis, Risk Assessment, and Therapy—An Update

by Radu Gabriel Vătășescu, Cosmina Steliana Paja, Ioana Șuș, Simona Cainap, Ștefana María Moisa and Eliza Elena Cinteză

Diagnostics 2024, 14(3), 296; https://doi.org/10.3390/diagnostics14030296 - 30 Jan 2024

Cited by 1 | Viewed by 4891

Abstract

Wolf–Parkinson–White (WPW) syndrome is a disorder characterized by the presence of at least one accessory pathway (AP) that can predispose people to atrial/ventricular tachyarrhythmias and even sudden cardiac death. It is the second most common cause of paroxysmal supraventricular tachycardia in most parts [...] Read more.

Wolf–Parkinson–White (WPW) syndrome is a disorder characterized by the presence of at least one accessory pathway (AP) that can predispose people to atrial/ventricular tachyarrhythmias and even sudden cardiac death. It is the second most common cause of paroxysmal supraventricular tachycardia in most parts of the world, affecting about 0.1–0.3% of the general population. Most patients with WPW syndrome have normal anatomy, but it may be associated with concomitant congenital heart disease or systemic diseases. Although many individuals are asymptomatic, during supraventricular arrhythmia episodes, they may experience severe symptoms, including syncope or even sudden cardiac death (mainly due to pre-excited atrial fibrillation over rapidly conducting AP). In addition to arrhythmia-related symptoms, for some specific locations of the APs with overt anterograde conduction, there might be a reduction in exercise capacity mediated by a reduction in LV systolic performance due to anomalous LV depolarization. Although it is typically diagnosed through electrocardiography (ECG), additional tests are necessary for risk assessment. Management of WPW syndrome may be quite challenging and can vary from only acknowledging the presence of the accessory pathway to pharmacological treatment or radiofrequency ablation. Early diagnosis, risk assessment, and appropriate treatment are critical steps in the management of WPW syndrome, aiming to improve the quality of life and reduce the risk of life-threatening arrhythmias. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Heart Disease)

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Other

Jump to: Research, Review

13 pages, 5691 KiB

Open AccessCase Report

Fusion Imaging of Non-Invasive and Invasive Cardiac Electroanatomic Mapping in Patients with Ventricular Ectopic Beats: A Feasibility Analysis in a Case Series

by Matilda Muça, Stepan Zubarev, Dirk Bastian, Janusch Walaschek, Veronica Buia, Harald Rittger, Arsenii Dokuchaev, Thomas Bayer and Laura Vitali-Serdoz

Diagnostics 2024, 14(6), 622; https://doi.org/10.3390/diagnostics14060622 - 15 Mar 2024

Viewed by 1130

Abstract

In patients with premature ventricular contractions (PVCs), non-invasive mapping could locate the PVCs’ origin on a personalized 3-dimensional (3D) heart model and, thus, facilitate catheter ablation therapy planning. The aim of our report is to evaluate its accuracy compared to invasive mapping in [...] Read more.

In patients with premature ventricular contractions (PVCs), non-invasive mapping could locate the PVCs’ origin on a personalized 3-dimensional (3D) heart model and, thus, facilitate catheter ablation therapy planning. The aim of our report is to evaluate its accuracy compared to invasive mapping in terms of assessing the PVCs’ early activation zone (EAZ). For this purpose, non-invasive electrocardiographic imaging (ECGI) was performed using the Amycard 01C system (EP Solutions SA, Switzerland) in three cases. In the first step, a multichannel ECG (up to 224 electrodes) was recorded, and the dominant PVCs were registered. Afterward, a cardiac computed tomography (in two cases) or magnetic resonance imaging (in one case) investigation was carried out acquiring non-contrast torso scans for 8-electrode strip visualization and contrast heart acquisition. For the reconstructed epi/endocardial meshes of the heart, non-invasive isochronal maps were generated for the selected multichannel ECG fragments. Then, the patients underwent an invasive electrophysiological study, and the PVCs’ activation was evaluated by a 3D mapping system (EnSite NavX Precision, Abbott). Finally, using custom-written software, we performed 3D fusion of the non-invasive and invasive models and compared the resulting isochronal maps. A qualitative analysis in each case showed the same early localization of the dominant PVC on the endocardial surface when comparing the non-invasive and invasive isochronal maps. The distance from the EAZ to the mitral or tricuspid annulus was comparable in the invasive/non-invasive data (36/41 mm in case N1, 73/75 mm in case N2, 9/12 mm in case N3). The area of EAZ was also similar between the invasive/non-invasive maps (4.3/4.5 cm² in case N1, 7.1/7.0 cm² in case N2, 0.4/0.6 cm² in case N3). The distances from the non-invasive to invasive earliest activation site were 4 mm in case N1, 7 mm in case N2, and 4 mm in case N3. Such results were appropriate to trust the clinical value of the preoperative data in these cases. In conclusion, the non-invasive identification of PVCs before an invasive electrophysiological study can guide clinical and interventional decisions, demonstrating appropriate accuracy in the estimation of focus origin. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Heart Disease)

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14 pages, 713 KiB

Open AccessSystematic Review

Arrhythmogenic Right Ventricular Cardiomyopathy in Children: A Systematic Review

by Stefana Maria Moisa, Elena Lia Spoiala, Eliza Cinteza, Radu Vatasescu, Lacramioara Ionela Butnariu, Crischentian Brinza and Alexandru Burlacu

Diagnostics 2024, 14(2), 175; https://doi.org/10.3390/diagnostics14020175 - 12 Jan 2024

Cited by 1 | Viewed by 1688

Abstract

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease characterized by the progressive replacement of the normal myocardium by fibroadipocytic tissue. The importance of an early diagnosis is supported by a higher risk of sudden cardiac death in the pediatric population. We reviewed [...] Read more.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease characterized by the progressive replacement of the normal myocardium by fibroadipocytic tissue. The importance of an early diagnosis is supported by a higher risk of sudden cardiac death in the pediatric population. We reviewed the literature on diagnosis, risk stratification, and prognosis in the pediatric population with ARVC. In case reports which analyzed children with ARVC, the most common sign was ventricular tachycardia, frequently presenting as dizziness, syncope, or even cardiac arrest. Currently, there is no gold standard for diagnosing ARVC in children. Nevertheless, genetic analysis may provide a proper diagnosis tool for asymptomatic cases. Although risk stratification is recommended in patients with ARVC, a validated prediction model for risk stratification in children is still lacking; thus, it is a matter of further research. In consequence, even though ARVC is a relatively rare condition in children, it negatively impacts the survival and clinical outcomes of the patients. Therefore, appropriate and validated diagnostic and risk stratification tools are crucial for the early detection of children with ARVC, ensuring a prompt therapeutic intervention. Full article

(This article belongs to the Special Issue Diagnosis and Prognosis of Heart Disease)

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