Associations of 2D speckle tracking echocardiography-based right heart deformation parameters and invasively assessed hemodynamic measurements in patients with pulmonary hypertension

Background: We aimed to evaluate associations of right atrial (RA) and right ventricular (RV) strain parameters assessed by 2D speckle tracking echocardiography (2D STE) with invasively measured hemodynamic parameters in patients with and without pulmonary hypertension (PH). Methods: In this study, we analyzed 78 all-comer patients undergoing invasive hemodynamic assessment by left and right heart catheterization. Standard transthoracic echocardiographic assessment was performed under the same hemodynamic conditions. RA and RV longitudinal strain parameters were analyzed using 2D STE. PH was defined as invasively obtained mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest and was further divided into pre-capillary PH (pulmonary capillary wedge pressure [PCWP] ≤ 15 mmHg), post-capillary PH (PCWP > 15 mmHg) and combined PH (PCWP > 15 mmHg and difference between diastolic PAP and PCWP of ≥7 mmHg). Correlation analyses between variables were calculated with Pearson's or Spearman's correlation coefficient as applicable. Results: Out of 78 patients, 45 presented with PH. Within the PH group, 39 had post-capillary, five had combined pre- and post-capillary PH, and one had pre-capillary PH. Patients with PH had a significantly increased RA area (PH 22.0 ± 9.2 cm2, non-PH 17.3 ± 10.7 cm2; p = 0.003) and end-systolic RV area (PH 14.7 ± 6.1, non-PH 11.9 ± 4.8 cm2; p = 0.022). RV mid strain was significantly reduced in PH (PH -17.4 ± 7.8, non-PH: - 21.6 ± 5.5; p = 0.019). Average peak systolic RA strain (RAS) and average peak systolic RV strain (RVS) showed a significant association with mPAP (r = - 0.470, p = 0.001 and r = 0.490, p = 0.001, respectively) and with PCWP (r = - 0.296, p = 0.048 and r = 0.365, p = 0.015, respectively) in patients with PH. Furthermore, RV apical, mid and basal strain as well as RV free wall strain showed moderate associations with mPAP. In patients without PH, there were no associations detectable between RA or RV strain parameters and mPAP and PCWP. Conclusion: In an all-comer cohort, RA and RV strain parameters showed significant associations with invasively assessed mPAP and PCWP in patients with predominantly post-capillary PH. These associations may be useful in clinical practice to assess the impact of post-capillary PH on myocardial right heart function

Évaluation de la brochure "Sport et Périnée: Exercices d’échauffement adaptés“: une étude d’acceptabilité

Dans certaines disciplines sportives, plus de la moitié des athlètes féminines ont déjà souffert, au moins une fois, d’incontinence urinaire. Malgré cette constatation, très peu de prévention est faite et, à ce jour, il n’existe aucun programme d’exercices validé visant à intégrer les muscles du plancher pelvien dans la pratique sportive. En 2018, Manon Mathez et Noémie-Laure Rondez ont élaboré une brochure d’exercices « Sport et Périnée : Exercices d’échauffement adaptés », pour combler cette lacune. Notre objectif est d’évaluer l’acceptabilité de cette brochure

Automated quantification of mitral valve tenting volume in functional mitral regurgitation by three‐dimensional echocardiography

Background: Tenting of the mitral leaflets is a major pathophysiological factor contributing to functional mitral regurgitation (FMR). A novel software tool allows automated quantification of the tenting volume (TnV) by 3D transesophageal echocardiography (TEE). The aims of this study are to investigate the correlations of biometric patient characteristics with the TnV and whether a threshold value for the diagnosis of a moderate or severe FMR can be calculated for the TnV. Methods: This explorative and hypothesis-generating study analyzed the TnV of the mitral valve obtained by clinically indicated TEE. The mid-systolic, threefold calculated and averaged TnV from 80 patients with no or mild FMR and 27 patients with moderate or severe FMR was determined using the TomTec 4D MV Assessment tool. Results: The TnV correlated significantly with the body size (r = 0.341), the weight (r = 0.272), and the body surface area (r = 0.320). After the adjustment to the body size, a threshold value of 1.25 cm(3)/m was determined for the TnV by using a receiver-operating characteristic curve. This value distinguished moderate to severe from none to mild FMR with a sensitivity of 85% and a specificity of 71%. The intra-observer variability and inter-observer variability were determined to be 0.96 and 0.85, respectively. Conclusions: Automated assessment of TnV has the potential to support the diagnostic evaluation of FMR. Further studies are needed to validate this result, detect additional factors influencing the size of the TnV, and determine further thresholds for any degree of FMR

Bathymetric Mapping Of The Seafloor - A German Contribution To Completing The Map By 2030, Cruise No. MSM88/1 + MSM88/2, November 28, 2019 - January 14, 2020, Mindelo (Cabo Verde) - Mindelo (Cabo Verde) - Bridgetown (Barbados)

Despite over 100 years of acoustic seabed mapping, only around 15% of the seafloor has ever been directly mapped and little of the mapping performed has been systematic or over larger areas. The result is that our knowledge of seafloor structure is rudimentary and our understanding of the processes which form them has, in principle, advanced little since the advent of plate tectonics. Societally, the seafloor plays a vital role in humanity’s "life support system", for example providing habitat for marine organisms, stimulating mixing of ocean water as part of the overturning circulation system and increasingly being the site of industrial installations. It is scientifically and societally imperative that we bring the level of knowledge of the surface of our planet up to that of bodies like Moon and Mars that are mapped with a resolution better than 100 m per pixel. It is also essential that the data are made freely available to all to support research and conservation. The aim of this cruise was to map previously uncharted part of the tropical Atlantic using the ship’s multibeam system and to provide the data to global open databases as well as to acquire magnetic gradient data along the same tracks. Magnetic anomalies from so-called Oceanic Core Complexes challenged the conventional view that marine magnetic anomalies arose in the upper, extrusive layer of the oceanic crust, because the crust has been stripped away at these complexes. We therefore collected magnetic data simultaneously to the multibeam data in order to constrain the interpretation of the observed seabed morphology

Impact of body mass index on worsening of diastolic function and impairment of left atrial strain in the general female urban population: a subanalysis of the Berlin female risk evaluation echocardiography follow-up study

Background: The association of body mass index (BMI) with diastolic dysfunction (DD) is well described in the literature. However, there is conflicting evidence and long-term follow-up data regarding effects of BMI on preclinical DD and left atrial (LA) function are scarce, highlighting the importance of early detection tools, such as myocardial strain. Purpose: The aim of our study was to prospectively analyze the impact of clinical and demographic parameters, especially of BMI, on worsening of diastolic function and left atrial strain (LAS) in an urban population of women with a low prevalence of cardiovascular risk factors. Methods and Results: An extensive clinical and echocardiographic assessment comprising the analysis of phasic LAS using two-dimensional speckle-tracking echocardiography (2D STE) was performed in 258 participants of the Berlin Female Risk Evaluation (BEFRI) trial between October 2019 and December 2020 after a mean follow-up period of 6.8 years. We compared clinical and echocardiographic parameters stratifying women by BMI < or ≥25 kg/m2, and we analyzed the impact of demographic characteristics on the worsening of DD and LA mechanics in the longer-term follow-up using univariate and multivariate regression analyses. 248 women were suitable for echocardiographic analysis of LAS using 2D STE. After a mean follow-up time of 6.8 years, LA reservoir strain (LASr) and LA conduit strain (LAScd) were significantly reduced in participants with a BMI ≥25 kg/m2 compared with women with a BMI <25 kg/m2 at baseline (30 ± 8% vs. 38 ± 9%, p < 0.0001; −14 ± 7% vs. −22 ± 8%, p < 0.0001). 28% of the overweighted women presented a deterioration of diastolic function at the time of follow-up in contrast with only 7% of the group with a BMI <25 kg/m2 (p < 0.0001). BMI remained significantly associated with LAS reductions after adjustment for other risk factors in multivariate regression analyses. Conclusion: Overweight and obesity are related to impaired LAS and to a worsening of diastolic function after a long-term follow-up in a cohort of randomly selected women

Impact of body mass index on worsening of diastolic function and impairment of left atrial strain in the general female urban population: a subanalysis of the Berlin female risk evaluation echocardiography follow-up study

BackgroundThe association of body mass index (BMI) with diastolic dysfunction (DD) is well described in the literature. However, there is conflicting evidence and long-term follow-up data regarding effects of BMI on preclinical DD and left atrial (LA) function are scarce, highlighting the importance of early detection tools, such as myocardial strain.PurposeThe aim of our study was to prospectively analyze the impact of clinical and demographic parameters, especially of BMI, on worsening of diastolic function and left atrial strain (LAS) in an urban population of women with a low prevalence of cardiovascular risk factors.Methods and ResultsAn extensive clinical and echocardiographic assessment comprising the analysis of phasic LAS using two-dimensional speckle-tracking echocardiography (2D STE) was performed in 258 participants of the Berlin Female Risk Evaluation (BEFRI) trial between October 2019 and December 2020 after a mean follow-up period of 6.8 years. We compared clinical and echocardiographic parameters stratifying women by BMI &lt; or ≥25 kg/m2, and we analyzed the impact of demographic characteristics on the worsening of DD and LA mechanics in the longer-term follow-up using univariate and multivariate regression analyses. 248 women were suitable for echocardiographic analysis of LAS using 2D STE. After a mean follow-up time of 6.8 years, LA reservoir strain (LASr) and LA conduit strain (LAScd) were significantly reduced in participants with a BMI ≥25 kg/m2 compared with women with a BMI &lt;25 kg/m2 at baseline (30 ± 8% vs. 38 ± 9%, p &lt; 0.0001; −14 ± 7% vs. −22 ± 8%, p &lt; 0.0001). 28% of the overweighted women presented a deterioration of diastolic function at the time of follow-up in contrast with only 7% of the group with a BMI &lt;25 kg/m2 (p &lt; 0.0001). BMI remained significantly associated with LAS reductions after adjustment for other risk factors in multivariate regression analyses.ConclusionOverweight and obesity are related to impaired LAS and to a worsening of diastolic function after a long-term follow-up in a cohort of randomly selected women

Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis

BackgroundHistologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD.MethodsThis was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0–4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0–2 vs F3 vs F4; LSM: 2·67; NFS: 0·676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226.FindingsOf 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44·7%] were female, median age was 54 years [IQR 44–63), and 1161 [46·1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33–91], the composite endpoint was observed in 145 (5·8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0·0001 for all comparisons). The tAUC at 5 years were 0·72 (95% CI 0·62–0·81) for histology, 0·76 (0·70–0·83) for LSM-VCTE, 0·74 (0·64–0·82) for FIB-4, and 0·70 (0·63–0·80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression.InterpretationSimple non-invasive tests performed as well as histologically assessed fibrosis in predicting clinical outcomes in patients with NAFLD and could be considered as alternatives to liver biopsy in some cases

Automatische Quantifizierung des Tentingvolumens der Mitralklappe bei funktioneller Mitralklappeninsuffizienz mittels dreidimensionaler Echokardiographie

Hintergrund: Das Tenting der Mitralklappensegel stellt einen entscheidenden pathophysiologischen Faktor der Mitralklappeninsuffizienz (MR) dar. Eine neue Software erlaubt dabei die automatische Bestimmung des Tentingvolumens (TV), also jenes Volumen zwischen Klappensegeln und -anulus, welches sich insbesondere bei einer funktionellen MR durch den apikalen Zug („tenting“) an den Klappensegeln der Mitralklappe (MV, mitral valve) vergrößert. Ziele dieser Studie waren eine Exploration möglicher Korrelationen biometrischer Patientendaten und echokardiographischer Graduierungsparameter mit dem ermittelten TV und eine Determinierung eines Schwellenwertes für die Diagnostik einer mittel- oder hochgradigen MR. Weiterhin wurde der Einfluss möglicher Erkrankungen auf das TV evaluiert. Abschließend wurde eine mögliche Differenzierung zwischen einer mittel- und hochgradigen MR mittels TV überprüft. Methodik: Diese klinische explorative Studie wertete das dreifach gemessene und gemittelte TV der MV, welches mittels klinisch indizierter transösophagealer Echokardiographie erhoben wurde, aus. Dabei ermittelte die Software TomTec 4D MV Assessment das mittsystolische TV von 80 Patienten mit keiner oder leichtgradiger MR (Gruppe A) und 27 Patienten mit mittel- oder hochgradiger MR (Gruppe B). Ergebnisse: Die quantitativen Parameter zur Graduierung einer MR korrelierten mit r-Werten zwischen 0,385-0,487 mit dem TV. Weiterhin konnte für das TV eine signifikante Korrelation mit der Körpergröße (r = 0,341), der Körperoberfläche (r = 0,320) und dem Körpergewicht (r = 0,272) eruiert werden. Daher wurde das TV auf die Körpergröße des Individuums normiert. Der Schwellenwert 1,25 cm3/m differenzierte dabei mit einer Sensitivität von 85,2 % und einer Spezifität von 71,2 % eine mittel- oder hochgradige MR von einer maximal leichtgradigen MR. Eine reduzierte Ejektionsfraktion, das männliche Geschlecht, ein implantierter Schrittmacher oder Defibrillator und Parameter einer ischämischen Herzerkrankung waren mit statistisch signifikanten Erhöhungen des TV assoziiert. Das TV eignete sich nicht zur Unterscheidung von Patienten mit mittel- zu Patienten mit hochgradiger MR, da sich die Mittelwerte nicht signifikant unterschieden. Abschließend wurde für das TV eine Inter- und Intraobserver-Übereinstimmung von 0,85 und 0,96 ermittelt. Schlussfolgerungen: Das TV besitzt das Potenzial, die Graduierung der MR zu unterstützen. Weitere Studien sind jedoch für eine Verifizierung des Schwellenwertes und der Einflussfaktoren notwendig. Anschließend sollten in Studien weitere Cut-off-Werte für das TV ermittelt werden, wodurch eine Graduierung der MR in drei Schweregrade erfolgen könnte.Background: Tenting of the mitral leaflets is a major pathophysiological factor contributing to mitral valve regurgitation (MR). A novel software tool allows automated quantification of the tenting volume (TV), i.e. the volume between the leaflets and annulus of the mitral valve (MV) which is increased by the apical tension ("tenting") on the leaflets, especially in functional MR. This study aimed to explore possible correlations of biometrical patient characteristics and echocardiographic grading parameters with TV and to determine a threshold for the diagnosis of a moderate or severe MR. Furthermore, the influence of comorbidities on the size of the TV was evaluated. Finally, a differentiation between a moderate and severe MR was investigated by using the TV. Methods: This clinical explorative study evaluated the triple measured and averaged TV of the MV, which was obtained by clinically indicated transesophageal echocardiography. The software TomTec 4D MV Assessment was used to determine the midsystolic TV of 80 patients with no or mild MR (group A) and 27 patients with moderate or severe MR (group B). Results: The quantitative parameters for the graduation of a MR correlated with r-values between 0.385-0.487 with the TV. Furthermore, a significant correlation with the body height (r = 0.341), the body surface (r = 0.320) and the weight (r = 0.272) was found for the TV. Therefore, the TV was adjusted to the body size of the individuals. With a sensitivity of 85.2 % and a specificity of 71.2 %, the threshold value of 1.25 cm3/m differentiated a moderate or severe MR from a maximal mild MR. A reduced ejection fraction, the male sex, an implanted pacemaker or defibrillator and parameters of an ischemic heart disease resulted in statistically significant increases in TV. However, the TV could not distinguish between patients with moderate and severe MR, because there were no statistically significant differences in mean values. Lastly, an inter- and intraobserver-variability of 0.85 and 0.96 was determined for the TV. Conclusion: The TV has the potential to facilitate the graduation of MR. Further studies are necessary to verify the threshold value and additional influencing factors. Subsequently, further cut-off values for TV should be determined in studies, which might allow a graduation of MR into three severities