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Background: Left ventricular (LV) twist mechanics are a promising, sensitive tool for assessing pathophysiologic changes in patients with systolic heart failure. Although LV twist is known to be load dependent in healthy volunteers, this has not been examined in patients with "long-standing" dilated cardiomyopathy (DCM). The aim of this study was to determine whether LV twist remains load dependent in the setting of long-standing, nonischemic DCM., Methods: Thirty-four patients with DCM with baseline LV ejection fractions (LVEFs) < 40% and 13 subjects with preserved LVEFs (≥50%) were enrolled. After baseline measurements, pneumatic compression of the lower extremities (Pcom) was used to increase LV afterload. Subsequently, sublingual nitroglycerin (SL-NG) was administered to modify preload. Conventional echocardiographic parameters, LV end-systolic wall stress, net LV twist angle, and apex-to-base-rotation delay (ABRD) were assessed under each condition., Results: In patients with DCM, although LV end-systolic wall stress significantly increased under Pcom (196.9 ± 64.9 g/m(2) at baseline vs 231.8 ± 78.9 g/m(2) under Pcom, P < .017) and decreased after SL-NG application (231.8 ± 78.9 g/m(2) under Pcom vs 197.4 ± 67.4 g/m(2) after SL-NG, P < .017), net LV twist angle and ABRD showed no significant changes depending on LV loading condition (for LV twist, 7.63 ± 4.47° at baseline vs 7.03 ± 4.13° under Pcom vs 7.35 ± 4.36° after SL-NG, P = 0.65; for ABRD, 16.56 ± 13.81% at baseline vs 17.19 ± 14.81% under Pcom vs 15.95 ± 13.27% after SL-NG, P = .53). Careful examination of individual patient data revealed that LV twist was load independent when patients had LV twist < 12°. ABRD was also found to be load independent, but only in patients with LVEFs < 34%. In contrast, LV twist and ABRD were load dependent in patients with preserved LVEFs., Conclusions: LV twist and its component, ABRD, had relatively load insensitive properties in patients with long-standing DCM and can be used in future clinical trials as load-independent indexes of LV dyssynchrony., (Copyright © 2012 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.)

Background: We lack full understanding on the determinants of left ventricular (LV) systolic mechanical dyssynchrony. We here tried to evaluate the effect of preload alterations on LV dyssynchrony using echocardiographic tissue velocity imaging., Methods: Thirty-eight patients with a history of heart failure who were in sinus rhythm (24 men, mean age of 61 ± 12 years [range, 26-82]) were consecutively recruited. Twenty-four patients were allocated into a mild diastolic dysfunction group (Gr 1), and 14 to an advanced diastolic dysfunction group, which included pseudonormalization or restrictive mitral inflow patterns (Gr 2). The leg-raising maneuver was performed for 5 minutes in Gr 1, whereas two tablets (1.2 mg) of sublingual nitroglycerin (SLNG) were given to Gr 2 to manipulate preload status. An index representing LV systolic mechanical dyssynchony (DYSsys) was defined as the maximal differences in time intervals from the QRS onset to the systolic peak velocities in 4 basal segments derived from the apical four- and two-chamber views., Results: DYSsys decreased significantly after SLNG administration (74.2 ± 50.2 vs. 46.9 ± 34.8 ms, P < 0.01), whereas it showed a significant elevation after leg-raising maneuver (76.3 ± 33.5 vs. 88.8 ± 37.5 ms, P < 0.05). Maximal difference in DYSsys between before and after SLNG administration in a patient of Gr 2 was estimated to be 120.2, whereas with the leg-raising maneuver, maximal difference in DYSsys in a patient of Gr 1 was found to be 66.8. Changes in heart rate induced by preload manipulation did not display any association with changes in DYSsys., Conclusions: DYSsys is significantly affected by preload alterations, and thus it can be considered a "dynamic" parameter that could be modified depending on the loading status. Therefore, loading status of individual patients should be considered when DYSsys is assessed., (© 2011, Wiley Periodicals, Inc.)

Background: Velocity vector imaging (VVI) is based on myocardial feature tracking, which incorporates speckle and endocardial border tracking and allows myocardial strains, strain rates, and velocities to be quantified. However, the accuracies of VVI-derived left ventricular rotation-associated values have not been validated, and the aim of this study was thus to perform a head-to-head comparison of twist-related values determined by VVI and speckle-tracking echocardiography (STE)., Methods: Thirty-five patients with a wide spectrum of cardiac pathologies and 19 healthy subjects (a total of 54 subjects) were enrolled. Apical and basal short-axis images were obtained using GE Vivid 7 scanners at frame rates of 80 to 100 frames/s. Left ventricular rotation-related parameters were first obtained using EchoPAC version 7.0.1. For comparison purposes, the same basal and apical short-axis images were converted into uncompressed Digital Imaging and Communications in Medicine format and subsequently analyzed using Syngo version 3.0, which uses a VVI tracking algorithm., Results: Basal and apical peak rotation and peak twist determined using STE and VVI were well correlated (r = 0.80, P < .001, r = 0.87, P < .001, and r = 0.90, P < .001, respectively). With regard to rotation velocities, peak rotation and derotation velocities were moderately correlated at the basal (r = 0.70, P < .001, and r = 0.72, P < .001, respectively) and apical (r = 0.66, P < .001, and r = 0.51, P < .001, respectively) levels. Furthermore, twist and untwist velocities were moderately correlated between the two methods. However, the timings of peak rotation and derotation velocities and twist and untwist velocities were only weakly correlated at the basal and apical levels., Conclusions: VVI is a feasible modality for assessing twist-related parameters. Although VVI agreed well with STE for most of the rotation-related parameters, poor concordance was found between the two methods for a few parameters. It is hypothesized that this discrepancy originates from the different tracking algorithms used. The findings indicate that caution should be exercised when interpreting or comparing twist-related parameters obtained using different echocardiographic devices with proprietary image analyzers.

Background: Concerns about safety of drug eluting stents have stirred up controversy on their use in patients with acute STEMI. It is also unknown whether differences in efficacy and safety exist between sirolimus- (SES) and paclitaxel-eluting stents (PES)., Objective: To investigate the difference in angiographic results and clinical outcome between SES and PES in the treatment of acute STEMI, we analyzed "real world" 6 months angiographic and 1 year clinical outcome of 244 patients, comparing the results between SES and PES., Methods: 244 consecutive acute STEMI patients were analyzed retrospectively (185 patients in SES group (Group S), 59 patients in PES group (Group P). Immediate post PCI and six month angiographic findings were analyzed by quantitative coronary angiography. Clinical events up to 1 year including cardiovascular death, myocardial infarction, and target lesion revascularization were also analyzed., Results: Baseline clinical and immediate post-procedure angiographic characteristics were similar in the two groups except for mean stent diameter and length which was slightly wider and shorter in group P compared with group S (Mean stent diameterxlength: 3.12+/-0.34x24.4+/-5.1 vs. 3.01+/-0.34x26.6+/-7.2 mm in group P vs. S, p=0.02, p=0.03). At six months, late loss was significantly greater in group P compared with group S (0.35+/-0.62 vs. 0.07+/-0.42, p<0.01), although the difference in binary restenosis was not statistically significant. Diameter stenosis, which was similar immediately after PCI, was significantly greater in group P (22.0+/-17.1 vs. 15.6+/-13.4%, p=0.02). At 1 year, the incidence of stent thrombosis was similar in both groups (5.1% vs. 3.8% for group P vs. C). There were no differences between the two groups up to 1 year with regard to cardiovascular death, nonfatal myocardial infarction, and TLR. The free from adverse event rate was not statistically different between the two groups (84.2% vs. 90.2%, p=0.20 for group P vs. C)., Conclusion: In this group of Korean acute STEMI patients, SES stent showed lower late loss compared to PES at 6 months angiographic follow up, but there was no difference in clinical outcome up to 1 year.

Background: On the basis of the close association of left atrial compliance with pulmonary hypertension in patients with mitral stenosis, we hypothesized that: (1) Doppler-derived net atrioventricular compliance (C(n)) can be used for predicting the occurrence of mitral valve (MV) replacement or percutaneous mitral commissurotomy (PMC); and (2) determinants of exercise capacity are variable depending on C(n)., Methods: We consecutively enrolled 26 patients (22 women; mean age, 47.0 +/- 6.1 years; range, 35-59 years) with pure moderate or severe mitral stenosis, in whom comprehensive echocardiography was performed at rest. C(n) was derived from the equation that has been previously validated (ie, C(n) = 1270 x [MV area by 2-dimensional planimetry/mitral E-wave downslope]. Measurements of stroke volume and systolic pulmonary artery pressure were repeated immediately after symptom-limited treadmill exercise test within 60 seconds., Results: On the basis of earlier reports, C(n) less than 4 mL/mm Hg was selected to define abnormally small C(n). During a mean duration of 24-month follow-up, C(n) of less than 4 mL/mm Hg could reliably predict the occurrence of either MV replacement or PMC, which was confirmed by multivariate logistic regression analysis. In patients with C(n) less than 4 mL/mm Hg, exercise duration was found to be closely correlated primarily with resting systolic pulmonary artery pressure (r = -0.73, P = .03), whereas in patients with C(n) greater than or equal to 4 mL/mm Hg, postexercise stroke volume was the only determinant of exercise capacity (r = 0.49, P = .04). When combining C(n) less than 4 mL/mm Hg with MV area less than 1.0 cm(2) as a cut-off value for predicting MV replacement or PMC, the sensitivity improved from 63.6% to 81.8% (P = .05)., Conclusions: Left atrial compliance estimated by C(n) with Doppler echocardiography allows us to effectively predict the future occurrence of MV replacement or PMC, with a special usefulness in patients with moderate mitral stenosis. In addition, determinants of exercise capacity were variable depending on the degree of C(n).

Background: Speckle tracking echocardiography (STE) has a unique feature of angle independence and, thus, may provide a powerful means of assessing left ventricular (LV) torsion (LVtor). The aims of this study were to assess: (1) the feasibility of 2-dimensional STE in the measurement of LVtor; and (2) the relationship of LVtor with age and conventional echocardiographic parameters., Methods: We consecutively recruited 160 healthy volunteers. After obtaining conventional echocardiographic parameters, apical and basal short-axis rotations were assessed with STE. LVtor was defined as the net difference between rotation angles in the two short-axis planes normalized for LV longitudinal length., Results: Reliable LVtor measurement was possible only in 56 volunteers (35%). This low feasibility was largely a result of the failure to obtain reliable basal rotation values. In 56 volunteers who were finally enrolled in this study, a significant correlation was found between LV ejection fraction and LVtor (r = 0.56, P < .001) and this correlation was attributed to apical (r = 0.47, P < .001) but not basal (P = .14) rotation. There was no significant change in LVtor with aging. However, initial counterclockwise motion (r = -0.51, P = .001) and its interval (r = -0.44, P = .001) in the basal rotation gradually decreased with aging, and correlated with early transmitral inflow velocity (r = 0.44 and 0.49, respectively) and its deceleration time (r = -0.43 and -0.48, respectively) (all P < .001). In contrast, such correlations were not found for initial clockwise motion and its interval in the apical rotation., Conclusions: Currently, STE has limited feasibility in the measurement of LVtor. There was no significant age-related change in LVtor. In LV rotations, basal rotation was affected by the age-related changes in the LV early diastolic filling, whereas apical rotation was mainly related to LV systolic performance.

Background: Previous studies demonstrated impaired coronary vasodilatory response (VR) to nitroglycerin (NG) in patients with coronary atherosclerosis. We hypothesized that the effect of the NG on the coronary blood flow (CBF) is negligible compared with its effect on the epicardial coronary artery dilatation and, therefore, that CBF velocity reduction after NG can reflect the magnitude of epicardial coronary artery dilatation., Methods: Quantitative coronary angiography was performed at the left anterior descending coronary artery (LAD) before and after intracoronary NG (200 mug) infusion in 18 patients with normal-looking coronary angiogram. VR assessed by quantitative coronary angiography (VRangio) was defined as: (LAD diameter after NG)(2)/(LAD diameter before NG)(2). Mean values measured at the ostium and at the junction of mid and distal LAD were used in the analysis. Diastolic CBF velocity was evaluated by using a 7-MHz transducer at the distal LAD before and 3 minutes after sublingual NG. VR assessed by echocardiography (VRecho) was defined as: (mean diastolic CBF velocity before sublingual NG)/(mean diastolic CBF velocity after sublingual NG). In 11 patients, plaque burden was assessed by intravascular ultrasound and results were compared with VRangio and VRecho., Results: VRecho was found to correlate well with VRangio (r = 0.71, P = .001), and VRangio and VRecho showed significant negative correlations with plaque burden (r = -0.66, P = .03; r = -0.77, P = .005, respectively)., Conclusions: VR to NG can be evaluated noninvasively with transthoracic Doppler echocardiography.

Background: Screening and early diagnosis of mitral regurgitation (MR) are crucial for preventing irreversible progression of MR. In this study, we developed and validated an artificial intelligence (AI) algorithm for detecting MR using electrocardiography (ECG).Methods: This retrospective cohort study included data from two hospital. An AI algorithm was trained using 56,670 ECGs from 24,202 patients. Internal validation of the algorithm was performed with 3174 ECGs of 3174 patients from one hospital, while external validation was performed with 10,865 ECGs of 10,865 patients from another hospital. The endpoint was the diagnosis of significant MR, moderate to severe, confirmed by echocardiography. We used 500 Hz ECG raw data as predictive variables. Additionally, we showed regions of ECG that have the most significant impact on the decision-making of the AI algorithm using a sensitivity map.Results: During the internal and external validation, the area under the receiver operating characteristic curve of the AI algorithm using a 12-lead ECG for detecting MR was 0.816 and 0.877, respectively, while that using a single-lead ECG was 0.758 and 0.850, respectively. In the 3157 non-MR individuals, those patients that the AI defined as high risk had a significantly higher chance of development of MR than the low risk group (13.9% vs. 2.6%, p < 0.001) during the follow-up period. The sensitivity map showed the AI algorithm focused on the P-wave and T-wave for MR patients and QRS complex for non-MR patients.Conclusions: The proposed AI algorithm demonstrated promising results for MR detecting using 12-lead and single-lead ECGs. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to develop and validate deep-learning-based artificial intelligence algorithm for predicting mortality of AHF (DAHF). Methods and results: 12,654 dataset from 2165 patients with AHF in two hospitals were used as train data for DAHF development, and 4759 dataset from 4759 patients with AHF in 10 hospitals enrolled to the Korean AHF registry were used as performance test data. The endpoints were in-hospital, 12-month, and 36-month mortality. We compared the DAHF performance with the Get with the Guidelines–Heart Failure (GWTG-HF) score, Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score, and other machine-learning models by using the test data. Area under the receiver operating characteristic curve of the DAHF were 0.880 (95% confidence interval, 0.876–0.884) for predicting in-hospital mortality; these results significantly outperformed those of the GWTG-HF (0.728 [0.720–0.737]) and other machine-learning models. For predicting 12- and 36-month endpoints, DAHF (0.782 and 0.813) significantly outperformed MAGGIC score (0.718 and 0.729). During the 36-month follow-up, the high-risk group, defined by the DAHF, had a significantly higher mortality rate than the low-risk group(p<0.001). Conclusion: DAHF predicted the in-hospital and long-term mortality of patients with AHF more accurately than the existing risk scores and other machine-learning models. [ABSTRACT FROM AUTHOR]

Background: Although atrial fibrillation (AF) and decreased exercise capacity are common in chronic mitral regurgitation patients, the relationship between rhythm status and exercise capacity after corrective surgery is largely unknown. Methods: Seventy-one patients undergoing repair or replacement of mitral valve for chronic severe mitral regurgitation were examined with preoperative and 6 months'' postoperative cardiopulmonary exercise test and two-dimensional echocardiography. Patients were divided into three groups according to preoperative versus postoperative rhythm (sinus/sinus, SS [n = 42]; AF/sinus, AS [n = 17]; AF/AF, AA group [n = 12]). Results: Preoperative maximal oxygen consumption was lower and ventilatory efficiency was higher in the AS and AA groups compared with the SS group. However, maximal oxygen consumption improved only in the AS group at 6 months'' postoperative cardiopulmonary exercise test (24.0 ± 6.9 versus 24.6 ± 6.1 mL · kg−1 · min−1 in the SS group, 19.3 ± 5.9 versus 23.2 ± 6.4 mL · kg−1 · min−1 in the AS group, 19.8 ± 5.4 versus 18.8 ± 5.1 mL · kg−1 · min−1 in the AA group; p = 0.016 for maximal oxygen consumption by analysis of covariance) as well as ventilatory efficiency. Echocardiography verified more significant reduction of left atrial volume in the SS and AS groups than in the AA group (172.2 ± 68.0 versus 96.7 ± 31.0 mL in the SS group, 247.5 ± 77.8 versus 129.2 ± 25.7 mL in the AS group, 316.7 ± 210.0 versus 192.0 ± 95.0 mL in the AA group; p = 0.001 for left atrial volume by analysis of covariance) as well as pulmonary artery systolic pressure. When analyzed for significant predictors of postoperative maximal oxygen consumption, being in the AS group but not the SS group was a significant positive predictor when compared with the AA group (β = 5.475; p = 0.006). Conclusions: Successful sinus conversion of AF, preferably by maze operation, in patients undergoing surgical correction of chronic severe mitral regurgitation confers improved exercise capacity. Reduction of left atrial volume and pulmonary artery pressure may contribute to this improvement. [Copyright &y& Elsevier]

Background Preoperative right ventricular end-systolic area (RV-ESA) and haemoglobin level have been suggested to be independent predictors of long-term prognosis in patients undergoing corrective surgery for isolated severe tricuspid regurgitation (TR). Aims To investigate whether early postoperative echocardiography provides useful prognostic information in addition to preoperative clinical and echocardiographic variables. Methods 69 consecutive patients undergoing corrective surgery for isolated severe TR {60 women, mean 57.6±8.9 years) were studied. Comprehensive preoperative echocardiography was performed in all patients, with early postoperative echocardiography in all patients except one. During follow-up (median 40 months, range 6 -- 86 months), clinical events were investigated, defined as operative mortality, cardiovascular death, repeated open heart surgery and readmission due to cardiovascular problems. Results 28 patients (41%) were categorised as New York Heart Association class II, 36 (52%) as III and 5 (7%) as IV. 63 patients (91.3%) had undergone prior left-sided valve surgery. Seven (10.1%) patients died before discharge. Of the remaining 62 patients, three died during follow-up, and eight required readmission due to cardiovascular problems. On multivariate analyses using clinical and preoperative variables, RV-ESA {p=0.006) and haemoglobin level (p<0.001) were independent predictors of event-free survival. When early postoperative echocardiography variables were included, preoperative haemoglobin and early postoperative RV-FAC were predictors of long-term event-free survival. On receiver-operating characteristic curve analysis, early postoperative RV-FAC≥31% predicted event-free survival with a sensitivity of 90% and a specificity of 83% (p<0.001). The addition of early postoperative echocardiographic RV-FAC markedly improved the prognostic utility of the model containing preoperative haemoglobin level and echocardiographic RV-ESA (p<0.001). Conclusion Early postoperative RV-FAC, measured by echocardiography, provided valuable information additional to preoperative RV-ESA and hemoglobin level that was useful for predicting long-term clinical events following corrective TR surgery. [ABSTRACT FROM AUTHOR]

Objectives: This study set out to investigate the isolated impact of synchronous patterns of left ventricular (LV) contraction (i.e., LV synchronicity) on LV twist behavior. Background: Although the relationships between LV loading status/LV contractility and twist are well-established, no data are available regarding the relation between LV twist and LV synchronicity, without any interference by changes in LV pre-load, afterload, and contractility. Serial assessment of patients with Wolff-Parkinson-White syndrome before and after radiofrequency catheter ablation (RFCA) allows this to be explored. Method: Of the 40 Wolff-Parkinson-White patients initially screened, 34 were enrolled. Two-dimensional and Doppler echocardiography along with speckle tracking-derived LV twist mechanics, apical-basal rotation delay, and left ventricular dyssynchrony index (LVdys) were obtained before and after RFCA. The LVdys was defined as the maximal delay in time-to-peak radial strain of different LV segments at the papillary muscle level. Results: Overall, no significant changes were demonstrated in LV volumes, systolic and diastolic function, and end-systolic wall stress before versus after RFCA. After RFCA, median value of LVdys was attenuated from 33.5 (interquartile range [IQR]: 14.0 to 84.3) to 14.0 (IQR: 11.5 to 21.8) (p = 0.002), which was accompanied by a reduction in apical-basal rotation delay from 9.7% (IQR: 3.5 to 23.7) to 3.3% (IQR: 1.3 to 8.0) (p = 0.004). In contrast, LV twist increased from 14.2° (IQR: 9.1° to 18.4°) before to 19.7° (IQR: 15.0° to 22.6°) after RFCA (p = 0.002). Delta LV twist pre- to post-RFCA displayed a significant inverse correlation with changes in apical-basal rotation delay (r = −0.42, p = 0.01) and Delta LVdys (r = −0.39, p = 0.02). Conclusions: The LV synchronous contraction is significantly related to LV twist. [Copyright &y& Elsevier]

Background: Persistence of regional diastolic dysfunction after ischemic insult remains debatable. With speckle tracking echocardiography (STE), we sought to (1) prove the persistence of regional diastolic dysfunction, (2) assess the feasibility of applying persistent regional diastolic dysfunction to differentiating ischemic and nonischemic chest pain, and finally (3) examine statin effects on postischemic regional diastolic dysfunction. Methods: Nineteen patients with variant angina (VA) and 12 normal subjects were enrolled. Comprehensive echocardiographic examinations were performed before and 1 day after coronary angiography (CAG) with ergonovine provocation. Radial systolic (rSRsys) and diastolic (rSRdia) strain rates were obtained and averaged using standard segmentation models corresponding to the three major coronary territories assigned. Results: No significant changes in rSRsys and rSRdia values were observed for controls and in rSRsys for VA. However, rSRdia for VA demonstrated a weak, but significant, decrease from −2.25 ± 0.71/sec to −2.04 ± 0.71/sec (P = 0.003) 1 day after CAG. However, because of the wide overlap between rSRdia values in normal and ischemic segments for VA patients, predictability of remote ischemia based solely on the rSRdia was limited. Subgroup analysis according to statin prescription showed that statin administration contributed to the elimination of rSRdia reduction (−2.28 ± 0.84/sec on pre-CAG vs. −2.29 ± 0.77/sec on post-CAG, P = 0.72 for patients without statin premedication; −2.23 ± 0.64/sec for pre-CAG vs. −1.88 ± 0.65/sec for post-CAG, P = 0.002 for those without). Expectedly, rSRsys values showed no significant changes in all situations. Conclusions: The presence and sustained nature of regional diastolic dysfunction can be demonstrated with STE. Statin minimized the persistence of regional diastolic dysfunction after an acute ischemia. Although the clinical usefulness of rSRdia by STE appears to be limited, its clinical utility requires further consideration, given the brevity of the ischemia provoked during CAG with ergonovine and the protracted regional diastolic dysfunction. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to investigate the incidence and identify the predictors of significant tricuspid regurgitation (TR) development long after left-sided valve surgery. Methods: Of 615 patients who underwent surgery for left-sided valve disease between 1992 and 1995, 335 patients without significant TR who completed at least 5 years of clinical and echocardiographic follow-up were enrolled. Late significant TR development was assessed by echocardiography with a mean follow-up duration of 11.6 ± 2.1 years. Results: Significant late TR was found in 90 patients (26.9%). Patients with late TR showed an advanced age (47.6 ± 13.4 vs 44.3 ± 13.2 years, P = .04), a higher prevalence of preoperative atrial fibrillation (83.3 vs 46.5%, P < .001), a greater left atrial dimension (56.9 ± 13.2 vs 52.4 ± 11.5mm, P = .006), and a higher prevalence of prior valve surgery (40.0 vs 25.3%, P = .01). In addition, late TR occurred more frequently in patients who had undergone mitral valve surgery than in those who did not (93.3 vs 72.2%, P < .001). However, multivariate analysis showed that the presence of preoperative atrial fibrillation (odds ratio 5.37; 95% CI 2.71-10.65; P < .001) was the only independent factor of late TR development. Patients who developed late TR had a lower event-free survival rate than those who did not (P = .03). Conclusions: The development of significant TR long after left-sided valve surgery is not uncommon with an estimated incidence of 27% and is closely associated with a poor prognosis. The presence of preoperative atrial fibrillation was identified as the only independent predictor of the development of late TR. [Copyright &y& Elsevier]

OBJECTIVES The prognostic value of B-type natriuretic peptide (BNP) for surgical outcome in patients with mitral regurgitation (MR) has not been studied. The purpose of this study was to determine the prognostic value of BNP in patients with chronic severe MR, undergoing mitral valve surgery. METHODS In total, 117 patients with chronic severe MR undergoing surgery were evaluated from the MR registry of Seoul National University Hospital. Patients were excluded if they had acute MR or acutely decompensated heart failure, and significant renal, pulmonary, coronary or other significant valvular heart disease. The plasma BNP level assay and echocardiographic studies were done before surgery. Study endpoint was a composite of cardiac death and cardiac hospitalization during follow-up. RESULTS The median duration of the follow-up was 4.5 years, and the study endpoint was reached in 11 (9.4%) patients. Receiver-operating characteristic curve analysis yielded an optimal cut-off point of 125 pg/ml for BNP that distinguished patients with poor prognosis. Kaplan–Meier survival analysis with the log-rank test and multivariate Cox proportional hazards model showed that patients with BNP ≥125 pg/ml had a worse clinical outcome after surgery (log rank 7.606, P = 0.006; adjusted hazard ratio = 5.536 [95% confidence interval 1.189–25.788], P = 0.029). CONCLUSIONS Among patients with chronic severe MR undergoing mitral valve surgery, BNP independently predicts the poor clinical outcome. The BNP measurement should be considered in the risk stratification of these patients. [ABSTRACT FROM AUTHOR]

Screening and early diagnosis of pulmonary hypertension (PH) are critical for managing progression and preventing associated mortality; however, there are no tools for this purpose. We developed and validated an artificial intelligence (AI) algorithm for predicting PH using electrocardiography (ECG). This historical cohort study included data from consecutive patients from 2 hospitals. The patients in one hospital were divided into derivation (56,670 ECGs from 24,202 patients) and internal validation (3,174 ECGs from 3,174 patients) datasets, whereas the patients in the other hospital were included in only an external validation (10,865 ECGs from 10,865 patients) dataset. An AI algorithm based on an ensemble neural network was developed using 12-lead ECG signal and demographic information from the derivation dataset. The end-point was the diagnosis of PH. In addition, the interpretable AI algorithm identified which region had the most significant effect on decision making using a sensitivity map. During the internal and external validation, the area under the receiver operating characteristic curve of the AI algorithm for detecting PH was 0.859 and 0.902, respectively. In the 2,939 individuals without PH at initial echocardiography, those patients that the AI defined as having a higher risk had a significantly higher chance of developing PH than those in the low-risk group (31.5% vs 5.9%, p < 0.001) during the follow-up period. The sensitivity map showed that the AI algorithm focused on the S-wave, P-wave, and T-wave for each patient by QRS complex characteristics. The AI algorithm demonstrated high accuracy for PH prediction using 12-lead and single-lead ECGs. [ABSTRACT FROM AUTHOR]