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Pagourelias E, Boulmpou A, Alexandridis G, Tsarouchas A, Mouselimis D, Bakogiannis K, Karamanolis A, Vergopoulos S, Tsavousoglou C, Antoniadis A, Fragakis N, Papadopoulos CE, Vassilikos V. Total atrial conduction time and its relationship with morphological & functional characteristics in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Total atrial conduction time (TACT), estimated by tissue Doppler imaging (TDI), is an index reflecting left atrial (LA) structural and electrical remodeling, connected to atrial fibrillation (AF) development and heart failure progression in various substrates. In hypertrophic cardiomyopathy (HCM), the significance of TACT beyond AF and its determinants are not fully investigated.
Purpose
Aim of this study was to estimate TACT in a cohort of HCM patients without AF history and to examine its relationship with other parameters of atrial myopathy, such as LA volume index (LAVI) or LA reservoir strain (LARS). Additionally, to investigate TACT correlation with other phenotypic and functional characteristics of HCM.
Methods
We included 50 HCM patients (60 ± 16 years, 80% male, maximum wall thickness 18.6 ± 4.1mm) without history of AF who have consecutively undergone 2D-speckle tracking echocardiography and cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). TACT was measured from the onset P wave on electrocardiogram to the peak A’ wave of the lateral LA wall using TDI (left panel). Burden of fibrosis (percentage of LV mass) was defined by LGE extent (>5 standard deviations compared to nulled myocardium) in CMR slices. Cut-off points for TACT, LAVI and LARS were adopted by literature (≥115 msec, ≥34 mL/m2 and <21.3 % respectively).
Results
All HCM patients had preserved EF (61.8 ± 8%), while 13 (26%) presented outflow tract obstruction and 4 (8%) diastolic dysfunction stage≥2. LGE was observed in 32 patients (64%) occupying 7.2 ± 5% of left ventricular (LV) mass. Mean TACT was 139.9 ± 22 msec, with LAVI being 30.8 ± 16.1 mL/m2 and LARS 27.6 ± 13.9%. After assessing prevalence of atrial myopathy parameters, 41 patients (82%) presented a prolonged (≥115 msec) TACT with only 13 of them having also a significantly dilated LA (≥34 mL/m2) and 16 an impaired LARS. Among HCM demographic, phenotypic and functional characteristics tested, age and LV mass index were found to be the only independent regressors of TACT (r = 0.54, p < 0.0005 and r = 0.44, p = 0.002 respectively, right panels). On the contrary, no significant correlation was established between TACT and traditional diastolic dysfunction indices such as E/E’ or fibrosis extent.
Conclusions
Atrial electro-mechanical delay assessed through TDI based TACT, is very frequent among HCM patients irrespective of AF and even before LA dilatation and LA strain impairment. Age and hypertrophy magnitude are the main determinants of TACT, the prognostic significance of which remains to be further elucidated. Abstract Figure.
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Affiliation(s)
- E Pagourelias
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Boulmpou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - G Alexandridis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Tsarouchas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - D Mouselimis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - K Bakogiannis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Karamanolis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - S Vergopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - C Tsavousoglou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Antoniadis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - N Fragakis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - CE Papadopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - V Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
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Pagourelias E, Boulmpou A, Alexandridis G, Tsarouchas A, Mouselimis D, Bakogiannis K, Karamanolis A, Vergopoulos S, Tsavousoglou C, Antoniadis A, Fragakis N, Papadopoulos CE, Vassilikos V. Strain-volume loops for assessment of diastolic function in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Diastolic function assessment in patients with hypertrophic hearts and preserved ejection fraction (EF) is a rather challenging task, necessitating the introduction of new parameters. Strain-volume loops (SVLs), based on simultaneous frame-by-frame strain and volume changes’ recordings acquired by means of three-dimensional (3D) speckle tracking imaging, is an innovative tool which has been applied in various substrates. The ability of SVLs to assess diastolic function in hypertrophic cardiomyopathy (HCM) has not been investigated until now.
Purpose
Aim of this study was to investigate potential correlations between SVLs, traditional diastolic function indices and phenotypic features of HCM (thickness, obstruction and fibrosis) that may also reflect myocardial "stiffness".
Methods
We included 40 HCM patients (54.1 ± 14.3 years, 82.5% male, maximum wall thickness 19.3 ± 4.8mm) who have consecutively undergone 3D-speckle tracking echocardiography (panel A) and cardiovascular magnetic resonance (CMR) with late gadolinium enhancement (LGE). Values of 3D strain were plotted vs. volume for each frame to build an SVL. Peak of radial, longitudinal and circumferential systolic strain (Rsp, Lsp, and Csp, respectively), systolic slopes of the loops (RsSl, LsSl, CsSl), strain to end-diastolic volume (EDV) ratios (Rs/V, Ls/V, Cs/V) as well as the extent of systolic-diastolic uncoupling (difference between systolic and diastolic strain for the same volume) were computed for the analysis. Left atrial volume index (LAVI), E/E’ and tricuspid regurgitation velocity (TRvel) were measured to define diastolic dysfunction (DD) stage. Burden of fibrosis was evaluated by LGE extent in CMR slices.
Results
All HCM patients had preserved EF (60.5 ± 5,7%), while 16 (40%) had LV outflow tract obstruction (LVOTO > 30 mm Hg at rest). Mean LV mass index was 78.9 ± 14.5 g (evaluated by 3D echocardiography). LGE was observed in 23 patients (57.5%) occupying 5.2 ± 4.5% of LV mass. Concerning SVLs the following values were recorded for radial (Rsp 30.8 ± 9.8%, RsSl 0.4 ± 0.13 and Rs/V 0.25 ± 0.09), longitudinal (Lsp -9.4 ± 3.7%, LsSl 0.12 ± 0.06 and Ls/V 0.08 ± 0.04) and circumferential deformation (Csp -14.2 ± 3.5%, CsSl 0.18 ± 0.05 and Cs/V 0.11 ± 0.03). Traditional isolated diastolic indices (E/E’, LAVI, TRvel and DD stage) did not present significant correlations with SVL parameters or HCM phenotypic features. However, potentially "stiffer" hearts (combination of increased LVMI and fibrosis) presented a leftward transition of longitudinal SVLs, which also became wider (greater uncoupling) (panel B).
Conclusions
Traditional diastolic indices show modest only correlations with SVLs or HCM phenotypic characteristics, necessitating new approaches to DD of HCM patients. SVLs seem to be a promising-innovative tool for indirect assessment of myocardial "stiffness" and diastolic function. Abstract Figure.
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Affiliation(s)
- E Pagourelias
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Boulmpou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - G Alexandridis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Tsarouchas
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - D Mouselimis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - K Bakogiannis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Karamanolis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - S Vergopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - C Tsavousoglou
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - A Antoniadis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - N Fragakis
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - CE Papadopoulos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
| | - V Vassilikos
- Aristotle University of Thessaloniki, Third Cardiology Department, Hippokrateion University Hospital, Thessaloniki, Greece
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Tachmatzidis D, Filos D, Chouvarda I, Mouselimis D, Tsarouchas A, Bakogiannis K, Antoniadis A, Fragkakis N, Maglaveras N, Vassilikos V. 219A machine learning classification algorithm to detect patients with paroxysmal atrial fibrillation during sinus rhythm. Europace 2020. [DOI: 10.1093/europace/euaa162.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) - the most common sustained cardiac arrhythmia - while not a life-threatening condition itself, leads to an increased risk of stroke and high rates of mortality. Early detection and diagnosis of AF is a critical issue for all health stakeholders.
Purpose
The aim of this study is to identify P-wave morphology patterns encountered in patients with Paroxysmal AF (PAF) and to develop a classifier discriminating PAF patients from healthy volunteers.
Methods
Three-dimensional 1000Hz ECG signals of 5 minutes duration were obtained through the use of a Galix GBI-3S Holter monitor from a total of 68 PAF patients and 52 healthy individuals. Signal pre-processing, consisting of denoising, QRS auto-detection, and ectopic beats removal was performed and a signal window of 250ms prior to the Q-wave (Pseg) was considered for every single beat. P‑wave morphology analysis based on the dynamic application of the k‑means clustering process was performed. For those Pseg that were assigned in the largest cluster, the mean P-wave was computed. The correlation of every P-wave with the mean P-wave of the main cluster was calculated. In case that it exceeded a prespecified threshold, the P-wave was allocated to the main morphology. For the remaining P‑waves, the same approach was followed once again, and the secondary morphology was extracted (picture). The P-waves of the dominant morphology were further analyzed using wavelet transform, whereas time-domain characteristics were also extracted.
A Support Vector Machine (SVM) model was created using the Gaussian Radial Basis Function kernel and the forward feature selection wrapper approach was followed. ECGs were allocated to the training, internal validation, and testing datasets in a 3:1:1 ratio.
Results
The percentage of P-waves following the main morphology in all three leads was lower in PAF patients (91.2 ±7.3%) than in healthy subjects (96.1 ±3.5%, p = 0.02). Classification between the two groups highlighted 7 features, while the SVM classifier resulted in a balanced accuracy of 91.4 ± 0.2% (sensitivity 94.2 ± 0.3%, specificity 88.6 ± 0.1%)
Conclusion
An Artificial Intelligence based ECG Classifier can efficiently identify PAF patients during normal sinus rhythm.
Abstract Figure.
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Affiliation(s)
- D Tachmatzidis
- Aristotle University of Thessaloniki, 3rd Cardiology Department, Thessaloniki, Greece
| | - D Filos
- Aristotle University of Thessaloniki, Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Thessaloniki, Greece
| | - I Chouvarda
- Aristotle University of Thessaloniki, Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Thessaloniki, Greece
| | - D Mouselimis
- Aristotle University of Thessaloniki, 3rd Cardiology Department, Thessaloniki, Greece
| | - A Tsarouchas
- Aristotle University of Thessaloniki, 3rd Cardiology Department, Thessaloniki, Greece
| | - K Bakogiannis
- Aristotle University of Thessaloniki, 3rd Cardiology Department, Thessaloniki, Greece
| | - A Antoniadis
- Aristotle University of Thessaloniki, 3rd Cardiology Department, Thessaloniki, Greece
| | - N Fragkakis
- Aristotle University of Thessaloniki, 3rd Cardiology Department, Thessaloniki, Greece
| | - N Maglaveras
- Aristotle University of Thessaloniki, Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, School of Medicine, Thessaloniki, Greece
| | - V Vassilikos
- Aristotle University of Thessaloniki, 3rd Cardiology Department, Thessaloniki, Greece
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Georgiopoulos G, Stakos D, Bakogiannis K, Kontogiannis C, Augoulea A, Armeni E, Laina A, Mareti A, Petropoulos I, Kanakakis I, Karapanou L, Bampatsias D, Lambrinoudaki I, Papamichael C, Stamatelopoulos K. P1565Abdominal tissue echogenicity in postmenopausal women. A novel marker of morbid obesity? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Georgiopoulos
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - D Stakos
- Democritus University of Thrace, Cardiology Department, Alexandroupolis, Greece
| | - K Bakogiannis
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - C Kontogiannis
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - A Augoulea
- Aretaieio Hospital, 2nd Department of Obstetrics and Gynecology, Athens, Greece
| | - E Armeni
- Aretaieio Hospital, 2nd Department of Obstetrics and Gynecology, Athens, Greece
| | - A Laina
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, Athens, Greece
| | - A Mareti
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - I Petropoulos
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - I Kanakakis
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - L Karapanou
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - D Bampatsias
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - I Lambrinoudaki
- Aretaieio Hospital, 2nd Department of Obstetrics and Gynecology, Athens, Greece
| | - C Papamichael
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
| | - K Stamatelopoulos
- Alexandra University Hospital, Vascular Laboratory, Department of Clinical Therapeutics, National and Kapodistrian University, Athens, Greece
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