Bettia Edith Celestin

All Publications

• Association Between Predicting Risk of Cardiovascular Disease Events (PREVENT) Risk Scores and Subclinical Cardiovascular Disease: Insights From the Project Baseline Health Study. Journal of the American Heart Association Fahed, G., Gjermeni, D., Cauwenberghs, N., Santana, E. J., Celestin, B. E., Bagherzadeh, S. P., Alexander, K. M., Salerno, M., Kusnetsova, T., Shah, S. H., Daubert, M. A., Rodriguez, F., Maron, D. J., Douglas, P. S., Mahaffey, K. W., Haddad, F. 2026: e045753

  Abstract

  The American Heart Association Predicting Risk of Cardiovascular Disease Events risk scores estimate cardiovascular disease (CVD) risk, including heart failure (HF) and atherosclerotic CVD (ASCVD) events. Whether they associate with subclinical CVD in an asymptomatic community population is unknown.We analyzed 1138 participants from the multicenter PBHS (Project Baseline Health Study) cohort, who underwent echocardiography and coronary artery calcium scoring and were free of known CVD. Subclinical CVD was defined as the presence of subclinical HF or subclinical coronary artery disease. Subclinical HF included left ventricular diastolic dysfunction, left ventricular hypertrophy, or low ejection fraction (<50%). Subclinical coronary artery disease was defined as coronary artery calcium >0. Predicting Risk of CVD Events 10-year risk score associations with subclinical CVD were assessed using logistic regression and area under the receiver operating characteristic curve analysis.Median age was 52 (41-64) years; 64% were White; and 57% were women. Subclinical HF was found in 182 (16%) participants, predominantly with left ventricular diastolic dysfunction (14%). Diastolic dysfunction prevalence increased from 5.8% in low-risk HF groups to 44.1% in intermediate-/high-risk HF groups. Each unit increase in 10-year HF risk corresponded to 2.67-fold higher odds of diastolic dysfunction (95% CI, 2.25-3.18; area under the curve, 0.81). Subclinical coronary artery disease was present in 466 (41%) participants, with prevalence increasing from 28.5% in low-risk ASCVD groups to 79.3% in intermediate-/high-risk ASCVD groups. Each unit increase in 10-year ASCVD risk was associated with 2.91-fold higher odds of any coronary calcification (95% CI, 2.54-3.35; area under the curve, 0.80), increasing to 4.76-fold for coronary artery calcium >100 (95% CI, 3.70-6.12; area under the curve, 0.86) and 5.60-fold for coronary artery calcium >300 (95% CI, 3.89-8.05; area under the curve, 0.87).In an asymptomatic CVD-free community sample, subclinical CVD was increasingly associated with higher 10-year HF and ASCVD risks calculated by the Predicting Risk of CVD Events equations.

  View details for DOI 10.1161/JAHA.125.045753

  View details for PubMedID 42216265

• Impact of Donor Left Ventricular Geometric Remodeling and Hypertrophy on Heart Acceptance and Recipient Survival. JACC. Heart failure O'Donnell, C., Kim, J. S., Tarun, A., Celestin, B. E., Karius, A. K., Bagherzadeh, S. P., Intrieri, T. A., Tapaskar, N., Zhang, S., Weng, Y., Zaroff, J., Sun, L. Y., Wayda, B., Haddad, F., Khush, K. K. 2026: 103150

  Abstract

  Current guidelines recommend screening donor hearts for hypertrophy using solely left ventricular (LV) wall thickness measurements, but this does not capture the type of LV geometric remodeling. Remodeling patterns have been shown to be predictive of clinical outcomes in many cardiovascular diseases but have not been evaluated in donor heart assessment.The purpose of this study was to describe the prevalence and clinical impact of geometric remodeling patterns in brain-dead donor heart acceptance and recipient survival.The DHS (Donor Heart Study) collected echocardiograms from brain-dead donors across the United States from February 2015 to May 2020. Donor hearts were classified by LV geometric remodeling patterns using ASE (American Society of Echocardiography) guidelines and were compared with LV wall thickness measurements of >1.3 cm for the association with transplant acceptance and 3-year recipient mortality, using multivariable modeling.Concentric remodeling (58.5%) was the most common geometric remodeling pattern in 3,647 brain dead donors. Donor hearts with increased LV wall thickness (>1.3 cm) were more likely reclassified as concentric remodeling (52.1%) than concentric hypertrophy (43.8%). Donors with nonacceptance surveys (n = 1,874) commonly (20.3%) had LV hypertrophy listed as a reason for rejection, but most of those hearts had normal geometry (10.8%) or concentric remodeling (60.0%). Neither increased LV wall thickness (adjusted HR [aHR]: 0.94; 95% CI: 0.73-1.21), concentric remodeling (aHR: 1.13; 95% CI: 0.86-1.47), nor concentric hypertrophy (aHR: 0.64; 95% CI: 0.35-1.15) correlated with 3-year recipient survival.Classifying donor hearts using LV geometric remodeling patterns may reduce the number turned down for "hypertrophy" without compromising recipient survival.

  View details for DOI 10.1016/j.jchf.2026.103150

  View details for PubMedID 42159513

• Impact of the 2025 ASE Guidelines on the Classification of LV Diastolic Dysfunction in the Community: A Project Baseline Health Study. Circulation. Cardiovascular imaging Herrera-Leaño, N., Celestin, B., Santana, E., Sandoval, R., Fahed, G., Khoury, P., O'Sullivan, J. W., Kuznetsova, T., Cauwenberghs, N., Mahaffey, K. W., Douglas, P. S., Daubert, M., Haddad, F. 2026: e019402

  Abstract

  The 2016 American Society of Echocardiography (ASE) guidelines for left ventricular diastolic dysfunction (LVDD) classification resulted in a significant proportion of indeterminate classifications and grades. To address these limitations and incorporate new evidence, the ASE updated its recommendations in 2025. The impact of these revisions in community cohorts remains unclear.We studied 1953 Project Baseline Health Study participants who underwent comprehensive transthoracic echocardiography. LVDD was classified using the 2016 and 2025 ASE recommendations. For the 2025 recommendations, fixed and age-specific thresholds were evaluated separately. We compared LVDD prevalence, reclassification patterns, associations with cardiovascular risk factors, and prognostic value for major adverse cardiovascular events over a median follow-up of 4.3 years.Median age was 50.6 years (Q1-Q3: 36.3-64.2); 56.3% were female, 35.3% had hypertension, and 14.2% had diabetes. The prevalence of LVDD was higher with the 2025 recommendations than with the 2016 algorithm: fixed criteria 308 (15.8%), age-specific criteria 220 (11.3%) versus ASE 2016 154 (8.0%). Among 119 (6.1%) participants classified as indeterminate by the 2016 algorithm, the 2025 recommendations reclassified 51.2% as no LVDD and 31.8% as Grade 2 LVDD. Participants reclassified as no LVDD had event-free survival that was not statistically different from those without LVDD (P=0.26), whereas those reclassified as Grade 2 had higher event rates (12.5% versus 3.8%; P=0.02). Major adverse cardiovascular events occurred in 98 (5.0%) participants over the follow-up period. LVDD by all classification approaches was independently associated with major adverse cardiovascular events after adjustment for baseline risk factors.The 2025 ASE recommendations identified more participants with LVDD than the 2016 algorithm without indeterminate classification or grading. LVDD by the 2025 classification was significantly associated with major adverse cardiovascular events, supporting the clinical relevance of the revised framework.

  View details for DOI 10.1161/CIRCIMAGING.125.019402

  View details for PubMedID 42131912

• Incident Atrial Fibrillation and Flutter in Patients With Pulmonary Arterial Hypertension: Influence of Right Ventricular Dilatation and Reduced Right Atrial Function. Journal of the American Heart Association Mohama, D., Worapongsatitaya, P., Celestin, B., Kazmirczak, F., Bagherzadeh, S. P., Daniel, V., Prins, K. W., Prisco, S. Z., Weir, E. K., Archer, S. L., Zamanian, R., Haddad, F., Thenappan, T. 2026: e045587

  Abstract

  The relationship between right atrial (RA) structural and functional remodeling and risk of incident atrial fibrillation/flutter (AF/AFL) in pulmonary arterial hypertension remains poorly defined.In a multicenter observational cohort study of 326 patients with pulmonary arterial hypertension, we evaluated associations between RA structure and function, as determined by echocardiography, and incident AF/AFL. Incidence rates were calculated using time-to-event analysis. Cox proportional hazards models identified factors associated with incident AF/AFL, and Harrell's C-statistics compared predictive performance. Survival decision tree and restricted cubic spline analyses identified thresholds associated with increased risk of AF/AFL.The mean age was 51±15 years, 79% were women, and the mean REVEAL (Registry to Evaluate Early and Long-Term Outcomes in Pulmonary Arterial Hypertension) Lite score was 7.4±2.9. Over a median follow-up of 6.1 years, 56 patients (17.1%) developed AF/AFL, corresponding to an incidence rate of 25.3 cases (95% CI, 19.5-32.8) per 1000 person-years. Each 5% decrease in RA emptying fraction (hazard ratio [HR], 1.38 [95% CI, 1.03-1.86]; P=0.03) and each 1-cm increase in right ventricular basal diameter (HR, 1.55 [95% CI, 1.18-2.05]; P=0.002) were independently associated with 38% and 55% higher hazards of incident AF/AFL, respectively. The C-statistics for predicting incident AF/AFL were 0.62 for RA emptying fraction and 0.65 for right ventricular basal diameter. Survival decision tree and restricted cubic spline analyses identified thresholds for right ventricular basal diameter (≥5.4 cm) and RA emptying fraction (<17% and <45%) associated with increased AF/AFL risk.Larger right ventricular basal diameter and lower RA emptying fraction are associated with increased risk of incident AF/AFL in patients with pulmonary arterial hypertension and may help identify individuals at higher risk.

  View details for DOI 10.1161/JAHA.125.045587

  View details for PubMedID 42003609

• The added value of ECG on the PREVENT CVD risk score for the prediction of subclinical cardiac disease - insights from Project Baseline Health Study Gjermeni, D., Fahed, G., Santana, E., Celestin, B., Cauwenberghs, N., Bagherzadeh, S. P., Shah, S. H., Kusnetsova, T., Douglas, P. S., Daubert, M. A., Mahaffey, K. W., Haddad, F. OXFORD UNIV PRESS. 2025

  View details for DOI 10.1093/eurheartj/ehaf784.1412

  View details for Web of Science ID 001675926300001

• Artificial Intelligence-Based Echocardiography in Pulmonary Arterial Hypertension. Chest Celestin, B., Bagherzadeh, S. P., Santana, E., Frost, M., Iversen, M., Hermansson, F. N., Sweatt, A., Zamanian, R. T., Hummel, Y. M., Rendon, G. G., Yen, J., Sandros, M., Salerno, M., Haddad, F. 2025

  Abstract

  Echocardiography is central when assessing pulmonary hypertension (PH), but manual interpretation can be time-consuming and prone to error.Is a fully automated deep learning (DL) workflow in echocardiography reliable when assessing PH?The study had two parts: the first determined the bias and precision of DL reads using Us2.ai software version 1.4.5 with core laboratory (CL) readers as the reference; the second assessed DL's ability to discriminate milder PH in patients referred for right heart catheterization (mean pulmonary artery pressure [MPAP] between 20 and 35 mmHg). The first cohort (case-control) included 213 healthy individuals and 221 patients with pulmonary arterial hypertension (PAH). Parameters included peak tricuspid regurgitation velocity (TRV), right ventricular (RV) basal diameter, tricuspid annular plane systolic excursion (TAPSE), right atrial (RA) area, and RV fractional area change (RVFAC). The referral cohort included 196 patients, with 171 patients having measurable peak TRV signals. Robust measures of bias and precision were reported, and area under the curve (AUC) analysis assessed discrimination.In patients with PAH, mean age was 48 years, 78% were female, and MPAP was 52 mmHg. No significant bias was observed for peak TRV (0.90%, -0.17 to 1.57), RA area (1.71%, 0.59 to 3.34), and TAPSE (1.28%, -0.51 to 3.18), while RVFAC exhibited a significant bias of 11.46% (8.43-14.74). For all measurements except RVFAC, robust percentile precision remained below 15%. In the case-control cohort, peak TRV had AUCs of 0. and 0.98 for CL and DL reads, respectively. The AUC for PH detection in the referral cohort was 0.79 for clinical laboratory reads and 0.75 for DL reads (p = 0.068).A fully automated DL workflow for echocardiography in PH is promising and likely to improve efficiency in clinical practice.Not applicable.

  View details for DOI 10.1016/j.chest.2025.06.052

  View details for PubMedID 40876740

• Comparison of the Prognostic Value of Right Atrial Echocardiographic Parameters in Pulmonary Arterial Hypertension. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Mohama, D., Worapongsatitaya, P., Celestin, B., Kazmirczak, F., Bagherzadeh, S. P., Prins, K. W., Prisco, S. Z., Weir, E. K., Zamanian, R., Haddad, D. F., Thenappan, T. 2025

  Abstract

  Pulmonary arterial hypertension (PAH) guidelines advocate measures of area for right atrial (RA) dimensions, while echocardiographic guidelines recommend RA volume. We compared the prognostic value of RA echocardiographic parameters to predict transplant-free survival in 332 adult PAH patients. RA area correlated strongly with volume (r=0.96). After adjusting for age and sex, for every one-standardized unit increase in RA area index, volume index, and major axis dimension, there were 21%, 18%, and 18% higher hazards of mortality or transplant, respectively. However, no RA parameter was independently associated with transplant-free survival when adjusted for REVEAL lite score. RA area index had the highest area under the curve for predicting transplant-free survival.

  View details for DOI 10.1016/j.healun.2025.03.009

  View details for PubMedID 40120996

• Reference equations for peak oxygen uptake for treadmill cardiopulmonary exercise tests based on the NHANES lean body mass equations, a FRIEND registry study. European journal of preventive cardiology Santana, E. J., Kim, D. S., Christle, J. W., Cauwenberghs, N., Celestin, B. E., Tso, J. V., Wheeler, M. T., Ashley, E. A., Peterman, J. E., Gardner, C., Arena, R., Harber, M., Kaminsky, L. A., Kuznetsova, T., Myers, J. N., Haddad, F. 2025

  Abstract

  Cardiorespiratory fitness (CRF), measured by peak oxygen uptake (VO2peak), is a strong predictor of mortality. Despite its widespread clinical use, current reference equations for VO2peak show distorted calibration in obese individuals. Using data from the Fitness Registry and the Importance of Exercise National Database (FRIEND), we sought to develop novel reference equations for VO2peak better calibrated for overweight/obese individuals - in both males and females, by considering body composition metrics.Graded treadmill tests from 6,836 apparently healthy individuals were considered in data analysis. We used the National Health and Nutrition Examination Survey equations to estimate lean body mass (eLBM) and body fat percentage (eBF). Multivariable regression was used to determine sex-specific equations for predicting VO2peak considering age terms, eLBM and eBF.The resultant equations were expressed as VO2peak (male) = 2633.4 + 48.7✕eLBM (kg) - 63.6✕eBF (%) - 0.23✕Age2 (R2=0.44) and VO2peak (female) = 1174.9 + 49.4✕eLBM (kg) - 21.7✕eBF (%) - 0.158✕Age2 (R2=0.53). These equations were well-calibrated in subgroups based on sex, age and body mass index (BMI), in contrast to the Wasserman equation. In addition, residuals for the percent-predicted VO2peak (ppVO2) were stable over the predicted VO2peak range, with low CRF defined as < 70% ppVO2 and average CRF defined between 85-115%.The derived VO2peak reference equations provided physiologically explainable and were well-calibrated across the spectrum of age, sex and BMI. These equations will yield more accurate VO2peak evaluation, particularly in obese individuals.

  View details for DOI 10.1093/eurjpc/zwaf045

  View details for PubMedID 39920345

• Echocardiographic Grading of Right Ventricular Afterload in Left Heart Disease: Relation to Right Ventricular Function, Pulsatile and Resistant Load, and Outcome. Pulmonary circulation Celestin, B. E. 2025; 15 (1): e70055

  View details for DOI 10.1002/pul2.70055

  View details for PubMedID 39990645

  View details for PubMedCentralID PMC11842453

• A generalized equation for predicting peak oxygen consumption during treadmill exercise testing: mitigating the bias from total body mass scaling. Frontiers in cardiovascular medicine Santana, E. J., Cauwenberghs, N., Celestin, B. E., Kuznetsova, T., Gardner, C., Arena, R., Kaminsky, L. A., Harber, M. P., Ashley, E., Christle, J. W., Myers, J., Haddad, F. 2024; 11: 1393363

  Abstract

  Indexing peak oxygen uptake (VO2peak) to total body mass can underestimate cardiorespiratory fitness (CRF) in women, older adults, and individuals with obesity. The primary objective of this multicenter study was to derive and validate a body size-independent scaling metric for VO2peak. This metric was termed exercise body mass (EBM).In a cohort of apparently healthy individuals from the Fitness Registry and the Importance of Exercise National Database, we derived EBM using multivariable log-normal regression analysis. Subsequently, we developed a novel workload (WL) equation based on speed (Sp), fractional grade (fGr), and heart rate reserve (HRR). The generalized equation for VO2peak can be expressed as VO2peak = Cst × EBM × WL, where Cst is a constant representing the VO2peak equivalent of one metabolic equivalent of task. This generalized equation was externally validated using the Stanford exercise testing (SET) dataset.A total of 5,618 apparently healthy individuals with a respiratory exchange ratio >1.0 (57% men, mean age 44 ± 13 years) were included. The EBM was expressed as Mass (kg)0.63 × Height (m)0.53 × 1.16 (if a man) × exp (-0.39 × 10-4 × age2), which was also approximated using simple sex-specific additive equations. Unlike total body mass, EBM provided body size-independent scaling across both sexes and WL categories. The generalized VO2peak equation was expressed as 11 × EBM × [2 + Sp (in mph) × (1.06 + 5.22 × fGr) + 0.019 × HRR] and had an R 2 of 0.83, p < 0.001. This generalized equation mitigated bias in VO2peak estimations across age, sex, and body mass index subgroups and was validated in the SET registry, achieving an R 2 of 0.84 (p < 0.001).We derived a generalized equation for measuring VO2peak during treadmill exercise testing using a novel body size-independent scaling metric. This approach significantly reduced biases in CRF estimates across age, sex, and body composition.

  View details for DOI 10.3389/fcvm.2024.1393363

  View details for PubMedID 39720208

  View details for PubMedCentralID PMC11666446

• Novel Reference Equations for Pulmonary Artery Size and Pulsatility Using Echocardiography and their Diagnostic Value in Pulmonary Hypertension. Chest Bagherzadeh, S. P., Celestin, B. E., Santana, E. J., Salerno, M., Nadeau, K. C., Sweatt, A. J., Zamanian, R. T., Haddad, F. 2024

  Abstract

  BACKGROUND: According to the most recent pulmonary hypertension (PH) guidelines, a main pulmonary artery (MPA) diameter>25 mm on transthoracic echocardiography (TTE) supports the diagnosis of PH. However, the size of the pulmonary artery(PA) may vary according to body size, age, and cardiac phases.RESEARCH QUESTIONS: 1)What are the reference limits for PA size on TTE, considering differences in body size, sex, and age? 2)What is the diagnostic value of PA size for classifying pulmonary hypertension? 3)How does the selection of different reference groups (healthy volunteers versus patients referred for right heart catheterization (RHC)) influence the diagnostic odds ratio (DOR)?STUDY DESIGN AND METHODS: The study included a reference cohort of 248 healthy individuals as controls, 693 PH patients proven by RHC, and 156 non-PH patients proven by RHC. In the PH cohort, 300 had group-1 PH, 207 had group-2 PH, and 186 with group-3 PH. MPA and right PA(RPA) diameters and areas were measured in the upper sternal short-axis and the suprasternal notch views. Reference limits (5th-95th percentile) were based on absolute values and height-indexed measures. Quantile regression analysis was used to derive median and 95th quantile reference equations for the PA measures. DORs and probability diagnostic plots for PH were then determined using healthy controls and non-PH cohorts.RESULTS: The 95th percentile for indexed MPA diameter was 15mm/m in diastole and 19mm/m in systole in both sexes. Quantile regression analysis revealed a weak age effect (pseudo R2 of 0.08 to 0.10 for MPA diameters). Among measures, the MPA size in diastole had the highest DOR, 156.2(68.3-357.5), for detection of group-1 PH. Similarly, the DORs were also high for group-2 and 3 PH when compared to controls but significantly lower compared to non-PH cohort.INTERPRETATION: The study presents novel reference limits for MPA based on height indexing and quantile regression.

  View details for DOI 10.1016/j.chest.2024.06.3805

  View details for PubMedID 39025204

• Factors associated with lower quarter performance-based balance and strength tests: a cross-sectional analysis from the project baseline health study. Frontiers in sports and active living Taylor, K. A., Carroll, M. K., Short, S. A., Celestin, B. E., Gilbertson, A., Olivier, C. B., Haddad, F., Cauwenberghs, N. 2024; 6: 1393332

  Abstract

  Physical performance tests are predictive of mortality and may screen for certain health conditions (e.g., sarcopenia); however, their diagnostic and/or prognostic value has primarily been studied in age-limited or disease-specific cohorts. Our objective was to identify the most salient characteristics associated with three lower quarter balance and strength tests in a cohort of community-dwelling adults.We applied a stacked elastic net approach on detailed data on sociodemographic, health and health-related behaviors, and biomarker data from the first visit of the Project Baseline Health Study (N = 2,502) to determine which variables were most associated with three physical performance measures: single-legged balance test (SLBT), sitting-rising test (SRT), and 30-second chair-stand test (30CST). Analyses were stratified by age (<65 and ≥65).Female sex, Black or African American race, lower educational attainment, and health conditions such as non-alcoholic fatty liver disease and cardiovascular conditions (e.g., hypertension) were consistently associated with worse performance across all three tests. Several other health conditions were associated with either better or worse test performance, depending on age group and test. C-reactive protein was the only laboratory value associated with performance across age and test groups with some consistency.Our results highlighted previously identified and several novel salient factors associated with performance on the SLBT, SRT, and 30CST. These tests could represent affordable, noninvasive biomarkers of prevalent and/or future disease in adult individuals; future research should validate these findings.ClinicalTrials.gov, identifier NCT03154346, registered on May 15, 2017.

  View details for DOI 10.3389/fspor.2024.1393332

  View details for PubMedID 39081837

  View details for PubMedCentralID PMC11287662

• Tricuspid annular plane systolic excursion in pulmonary hypertension-Moving beyond the sector plane. Pulmonary circulation Ichimura, K., Celestin, B. E., Bagherzadeh, S. P., Zamanian, R. T., Salerno, M., Spiekerkoetter, E., Haddad, F. 2024; 14 (3): e12416

  Abstract

  Tricuspid annular plane systolic excursion (TAPSE) is usually measured with M-mode using sector line, however, this may not align with the anatomical shortening of the right ventricular (RV). In this study, we compared the different methods to measure TAPSE using three different reference lines (sector line, anatomical line, and apico-annular line). We included 148 patients diagnosed with pulmonary arterial hypertension (PAH) who underwent TTE and right heart catheterization within 2 weeks of each other. TAPSE was measured by M-mode (sector, anatomical), 2D (sector, anatomical), or as tricuspid apico-annular displacement (TAAD). Agreement between measures was assessed using coefficient of variation (COV), Spearman's correlation, and Bland-Altman analysis. Receiver-operating characteristics and Kaplan-Meier analysis were used to explore associations with the combined outcome of death or lung transplantation at 5 years. There was a good concordance between anatomical and sector M-mode with a COV of 15.5 ± 1.6% and a bias of -0.6 ± 3.2 mm. In contrast, anatomical M-mode TAPSE and TAAD differed significantly with the mean difference of 3.3 ± 3.8 mm (COV 30.5 ± 6.1%; p < 0.0001). Among the different 2D methods, anatomical 2D agreed well with anatomical M-mode TAPSE (COV of 11.8 ± 2.0%; r = 0.89; p < 0.0001). Among the five methods, TADD had the strongest association with the combined endpoint of death or transplantation at 5 years (C-statistic 0.64, 95% confidence interval [CI] 0.57-0.71). We concluded that different measures of TAPSE are not interchangeable.

  View details for DOI 10.1002/pul2.12416

  View details for PubMedID 39247630

  View details for PubMedCentralID PMC11377954

• Identifying consistent echocardiographic thresholds for risk stratification in pulmonary arterial hypertension. Pulmonary circulation Celestin, B. E., Bagherzadeh, S. P., Ichimura, K., Santana, E. J., Sanchez, P. A., Tobore, T., Hemnes, A. R., Noordegraaf, A. V., Salerno, M., Zamanian, R. T., Sweatt, A. J., Haddad, F. 2024; 14 (2): e12361

  Abstract

  Several indices of right heart remodeling and function have been associated with survival in pulmonary arterial hypertension (PAH). Outcome analysis and physiological relationships between variables may help develop a consistent grading system. Patients with Group 1 PAH followed at Stanford Hospital who underwent right heart catheterization and echocardiography within 2 weeks were considered for inclusion. Echocardiographic variables included tricuspid annular plane systolic excursion (TAPSE), right ventricular (RV) fractional area change (RVFAC), free wall strain (RVFWS), RV dimensions, and right atrial volumes. The main outcome consisted of death or lung transplantation at 5 years. Mathematical relationships between variables were determined using weighted linear regression and severity thresholds for were calibrated to a 20% 1-year mortality risk. PAH patients (n=223) had mean (SD) age of 48.1 (14.1) years, most were female (78%), with a mean pulmonary arterial pressure of 51.6 (13.8) mmHg and pulmonary vascular resistance index of 22.5(6.3) WU/m2. Measures of right heart size and function were strongly related to each other particularly RVFWS and RVFAC (R 2=0.82, p<0.001), whereas the relationship between TAPSE and RVFWS was weaker (R 2=0.28, p<0.001). Death or lung transplantation at 5 years occurred in 78 patients (35%). Guided by outcome analysis, we ascertained a uniform set of parameter thresholds for grading the severity of right heart adaptation in PAH. Using these quantitative thresholds, we, then, validated the recently reported REVEAL-echo score (AUC 0.68, p<0.001). This study proposes a consistent echocardiographic grading system for right heart adaptation in PAH guided by outcome analysis.

  View details for DOI 10.1002/pul2.12361

  View details for PubMedID 38800494

• The Echocardiographic Evaluation of the Right Heart: Current and Future Advances. Current cardiology reports O'Donnell, C., Sanchez, P. A., Celestin, B., McConnell, M. V., Haddad, F. 2023

  Abstract

  PURPOSE OF REVIEW: To discuss physiologic and methodologic advances in the echocardiographic assessment of right heart (RH) function, including the emergence of artificial intelligence (AI) and point-of-care ultrasound.RECENT FINDINGS: Recent studies have highlighted the prognostic value of right ventricular (RV) longitudinal strain, RV end-systolic dimensions, and right atrial (RA) size and function in pulmonary hypertension and heart failure. While RA pressure is a central marker of right heart diastolic function, the recent emphasis on venous excess imaging (VExUS) has provided granularity to the systemic consequences of RH failure. Several methodological advances are also changing the landscape of RH imaging including post-processing 3D software to delineate the non-longitudinal (radial, anteroposterior, and circumferential) components of RV function, as well as AI segmentation- and non-segmentation-based quantification. Together with recent guidelines and advances in AI technology, the field is shifting from specific RV functional metrics to integrated RH disease-specific phenotypes. A modern echocardiographic evaluation of RH function should focus on the entire cardiopulmonary venous unit-from the venous to the pulmonary arterial system. Together, a multi-parametric approach, guided by physiology and AI algorithms, will help define novel integrated RH profiles for improved disease detection and monitoring. Advances in right heart echocardiography will incorporate a physiologic, multi-parametric approach that is augmented by deep learning to develop integrated right heart phenotypes. Ao Aorta, LV left ventricle, RA right atria, RV right ventricle, PA pulmonary artery.

  View details for DOI 10.1007/s11886-023-02001-6

  View details for PubMedID 38041726

• Right Ventricular Dysfunction Patterns Among Patients with COVID-19 in the Intensive Care Unit - a Retrospective Cohort Analysis. Annals of the American Thoracic Society Sanchez, P. A., O'Donnell, C. T., Francisco, N., Santana, E. J., Moore, A. R., Pacheco-Navarro, A., Roque, J., Lebold, K. M., Parmer, C. M., Pienkos, S. M., Celestin, B. E., Levitt, J. E., Collins, W. J., Lanspa, M. J., Ashley, E. A., Wilson, J. G., Haddad, F., Rogers, A. J. 2023

  Abstract

  Right ventricular (RV) dysfunction is common among patients hospitalized with COVID-19; however, its epidemiology may depend on the echocardiographic parameters used to define it.To evaluate the prevalence of abnormalities in three common echocardiographic parameters of RV function among COVID-19 patients admitted to the intensive care unit, as well as the effect of RV dilatation on differential parameter abnormality and the association of RV dysfunction with 60-day mortality.Retrospective cohort study of COVID-19 ICU patients between March 4th,2020 to March 4th, 2021, who received a transthoracic echocardiogram within 48 hours before to at most 7 days after ICU admission. RV dysfunction and dilatation respectively defined by guideline thresholds for tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RVFAC), RV free wall longitudinal strain (RVFWS), and RV basal dimension or RV end-diastolic area. Association of RV dysfunction with 60-day mortality assessed through logistic regression adjusting for age, prior history of congestive heart failure, invasive ventilation at time of TTE and APACHE II score.116 patients were included, of which 69% had RV dysfunction by > 1 parameter and 36.3% of these had RV dilatation. The three most common patterns of RV dysfunction included: Presence of 3 abnormalities, the combination of abnormal RVFWS and TAPSE, and isolated TAPSE abnormality. Patients with RV dilatation had worse RVFAC (24% vs 36%, p = 0.001), worse RVFWS (16.3% vs 19.1%, p = 0.005), higher RVSP (45mmHg vs 31mmHg, p = 0.001) but similar TAPSE (13mm vs 13mm, p = 0.30) compared to those with normal RV size. After multivariable adjustment, 60-day mortality was significantly associated with RV dysfunction (OR 2.91, 95% CI 1.01 - 9.44), as was the presence of at least 2 parameter abnormalities.ICU patients with COVID-19 had significant heterogeneity in RV function abnormalities present with different patterns associated with RV dilatation. RV dysfunction by any parameter was associated with increased mortality. Therefore, a multiparameter evaluation may be critical in recognizing RV dysfunction in COVID-19.

  View details for DOI 10.1513/AnnalsATS.202303-235OC

  View details for PubMedID 37478340

• Determinants of adherence to oral hygiene prophylaxis guidelines in patients with previous infective endocarditis. Archives of cardiovascular diseases Celestin, B., Habensus, E. I., Tubiana, S., Préau, M., Millot, S., Lescure, F. X., Kerneis, C., Para, M., Duval, X., Iung, B. 2023; 116 (4): 176-182

  Abstract

  Infective endocarditis (IE) is characterized by low incidence but high mortality. Patients with a history of IE are at highest risk. Adherence to prophylaxis recommendations is poor. We sought to identify determinants of adherence to oral hygiene guidelines on IE prophylaxis in patients with a history of IE.Using data from the cross-sectional, single-centre POST-IMAGE study, we analysed demographic, medical and psychosocial factors. We defined patients as adherent to prophylaxis if they declared going to the dentist at least annually and brushing their teeth at least twice a day. Depression, cognitive status and quality of life were assessed using validated scales.Of 100 patients enrolled, 98 completed the self-questionnaires. Among these, 40 (40.8%) were categorized as adherent to prophylaxis guidelines, and were less likely to be smokers (5.1% vs. 25.0%; P=0.02) or have symptoms of depression (36.6% vs. 70.8%; P<0.01) or cognitive decline (0% vs. 15.5%; P=0.05). Conversely, they had higher rates of: valvular surgery since the index IE episode (17.5% vs. 3.4%; P=0.04), searching for information on IE (61.1% vs. 46.3%, P=0.05), and considering themselves as adherent to IE prophylaxis (58.3% vs. 32.1%; P=0.03). Tooth brushing, dental visits and antibiotic prophylaxis were correctly identified as measures to prevent IE recurrence in 87.7%, 90.8% and 92.8% of patients, respectively, and did not differ according to adherence to oral hygiene guidelines.Self-reported adherence to secondary oral hygiene guidelines on IE prophylaxis is low. Adherence is unrelated to most patient characteristics, but to depression and cognitive impairment. Poor adherence appears related more to a lack of implementation rather than insufficient knowledge. Assessment of depression may be considered in patients with IE.

  View details for DOI 10.1016/j.acvd.2023.01.003

  View details for PubMedID 36797077

• Impact of Systematic Whole-body 18F-Fluorodeoxyglucose PET/CT on the Management of Patients Suspected of Infective Endocarditis: The Prospective Multicenter TEPvENDO Study. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Duval, X., Le Moing, V., Tubiana, S., Esposito-Farèse, M., Ilic-Habensus, E., Leclercq, F., Bourdon, A., Goehringer, F., Selton-Suty, C., Chevalier, E., Boutoille, D., Piriou, N., Le Tourneau, T., Chirouze, C., Seronde, M. F., Morel, O., Piroth, L., Eicher, J. C., Humbert, O., Revest, M., Thébault, E., Devillers, A., Delahaye, F., Boibieux, A., Grégoire, B., Hoen, B., Laouenan, C., Iung, B., Rouzet, F. 2021; 73 (3): 393-403

  Abstract

  Diagnostic and patients' management modifications induced by whole-body 18F-FDG-PET/CT had not been evaluated so far in prosthetic valve (PV) or native valve (NV) infective endocarditis (IE)-suspected patients.In sum, 140 consecutive patients in 8 tertiary care hospitals underwent 18F-FDG-PET/CT. ESC-2015-modified Duke criteria and patients' management plan were established jointly by 2 experts before 18F-FDG-PET/CT. The same experts reestablished Duke classification and patients' management plan immediately after qualitative interpretation of 18F-FDG-PET/CT. A 6-month final Duke classification was established.Among the 70 PV and 70 NV patients, 34 and 46 were classified as definite IE before 18F-FDG-PET/CT. Abnormal perivalvular 18F-FDG uptake was recorded in 67.2% PV and 24.3% NV patients respectively (P < .001) and extracardiac uptake in 44.3% PV and 51.4% NV patients. IE classification was modified in 24.3% and 5.7% patients (P = .005) (net reclassification index 20% and 4.3%). Patients' managements were modified in 21.4% PV and 31.4% NV patients (P = .25). It was mainly due to perivalvular uptake in PV patients and to extra-cardiac uptake in NV patients and consisted in surgery plan modifications in 7 patients, antibiotic plan modifications in 22 patients and both in 5 patients. Altogether, 18F-FDG-PET/CT modified classification and/or care in 40% of the patients (95% confidence interval: 32-48), which was most likely to occur in those with a noncontributing echocardiography (P < .001) or IE classified as possible at baseline (P = .04), while there was no difference between NV and PV.Systematic 18F-FDG-PET/CT did significantly and appropriately impact diagnostic classification and/or IE management in PV and NV-IE suspected patients.NCT02287792.

  View details for DOI 10.1093/cid/ciaa666

  View details for PubMedID 32488236

• Phase 3 Trial of RNAi Therapeutic Givosiran for Acute Intermittent Porphyria. The New England journal of medicine Balwani, M., Sardh, E., Ventura, P., Peiró, P. A., Rees, D. C., Stölzel, U., Bissell, D. M., Bonkovsky, H. L., Windyga, J., Anderson, K. E., Parker, C., Silver, S. M., Keel, S. B., Wang, J. D., Stein, P. E., Harper, P., Vassiliou, D., Wang, B., Phillips, J., Ivanova, A., Langendonk, J. G., Kauppinen, R., Minder, E., Horie, Y., Penz, C., Chen, J., Liu, S., Ko, J. J., Sweetser, M. T., Garg, P., Vaishnaw, A., Kim, J. B., Simon, A. R., Gouya, L. 2020; 382 (24): 2289-2301

  Abstract

  Up-regulation of hepatic delta-aminolevulinic acid synthase 1 (ALAS1), with resultant accumulation of delta-aminolevulinic acid (ALA) and porphobilinogen, is central to the pathogenesis of acute attacks and chronic symptoms in acute hepatic porphyria. Givosiran, an RNA interference therapy, inhibits ALAS1 expression.In this double-blind, placebo-controlled, phase 3 trial, we randomly assigned symptomatic patients with acute hepatic porphyria to receive either subcutaneous givosiran (2.5 mg per kilogram of body weight) or placebo monthly for 6 months. The primary end point was the annualized rate of composite porphyria attacks among patients with acute intermittent porphyria, the most common subtype of acute hepatic porphyria. (Composite porphyria attacks resulted in hospitalization, an urgent health care visit, or intravenous administration of hemin at home.) Key secondary end points were levels of ALA and porphobilinogen and the annualized attack rate among patients with acute hepatic porphyria, along with hemin use and daily worst pain scores in patients with acute intermittent porphyria.A total of 94 patients underwent randomization (48 in the givosiran group and 46 in the placebo group). Among the 89 patients with acute intermittent porphyria, the mean annualized attack rate was 3.2 in the givosiran group and 12.5 in the placebo group, representing a 74% lower rate in the givosiran group (P<0.001); the results were similar among the 94 patients with acute hepatic porphyria. Among the patients with acute intermittent porphyria, givosiran led to lower levels of urinary ALA and porphobilinogen, fewer days of hemin use, and better daily scores for pain than placebo. Key adverse events that were observed more frequently in the givosiran group were elevations in serum aminotransferase levels, changes in serum creatinine levels and the estimated glomerular filtration rate, and injection-site reactions.Among patients with acute intermittent porphyria, those who received givosiran had a significantly lower rate of porphyria attacks and better results for multiple other disease manifestations than those who received placebo. The increased efficacy was accompanied by a higher frequency of hepatic and renal adverse events. (Funded by Alnylam Pharmaceuticals; ENVISION ClinicalTrials.gov number, NCT03338816.).

  View details for DOI 10.1056/NEJMoa1913147

  View details for PubMedID 32521132