Shantanu P. Sengupta

Bio: Shantanu P. Sengupta is an academic researcher from Icahn School of Medicine at Mount Sinai. The author has contributed to research in topics: Speckle tracking echocardiography & Ejection fraction. The author has an hindex of 10, co-authored 19 publications receiving 321 citations.

American Society of Echocardiography: Remote Echocardiography with Web-Based Assessments for Referrals at a Distance (ASE-REWARD) Study.

Abstract: Background Developing countries face the dual burden of high rates of cardiovascular disease and barriers in accessing diagnostic and referral programs. The aim of this study was to test the feasibility of performing focused echocardiographic studies with long-distance Web-based assessments of recorded images for facilitating care of patients with cardiovascular disease. Methods Subjects were recruited using newspaper advertisements and were prescreened by paramedical workers during a community event in rural north India. Focused echocardiographic studies were performed by nine sonographers using pocket-sized or handheld devices; the scans were uploaded on a Web-based viewing system for remote worldwide interpretation by 75 physicians. Results A total of 1,023 studies were interpreted at a median time of 11:44 hours. Of the 1,021 interpretable scans, 207 (20.3%) had minor and 170 (16.7%) had major abnormalities. Left ventricular systolic dysfunction was the most frequent major abnormality (45.9%), followed by valvular (32.9%) and congenital (13.5%) defects. There was excellent agreement in assessing valvular lesions (κ = 0.85), whereas the on-site readings were frequently modified by expert reviewers for left ventricular function and hypertrophy (κ = 0.40 and 0.29, respectively). Six-month telephone follow-up in 71 subjects (41%) with major abnormalities revealed that 57 (80.3%) had improvement in symptoms, 11 (15.5%) experienced worsening symptoms, and three died. Conclusions This study demonstrates the feasibility of performing sonographer-driven focused echocardiographic studies for identifying the burden of structural heart disease in a community. Remote assessment of echocardiograms using a cloud-computing environment may be helpful in expediting care in remote areas.

Three-Dimensional Principal Strain Analysis for Characterizing Subclinical Changes in Left Ventricular Function

Abstract: Background Subendocardial strain analysis is currently feasible in two-dimensional and three-dimensional (3D) echocardiography; however, there is a lack of clarity regarding the most useful strain component for subclinical disease detection. The aim of this study was to test the hypothesis that strain analysis along the direction of strongest and weakest systolic compression (referred to as principal and secondary strain, respectively) circumvents the need for multidirectional strains and provides a more simplified assessment of left ventricular subendocardial function. Methods Strain analyses were performed by using two-dimensional and 3D echocardiography in 41 consecutive subjects with normal results on electron-beam computed tomography, including 15 controls and 26 patients with systemic hypertension. The direction of principal strain referenced the myofiber geometry obtained from diffusion tensor magnetic resonance imaging of a normal autopsied human heart. The incremental value of principal strain over multidirectional two-dimensional and 3D strain was analyzed. Results In healthy subjects, 50 ± 3% of the subendocardial shortening occurred in the cross-fiber direction (left-handed helical); this balance was significantly altered in patients with hypertension ( P = .01). The magnitude of longitudinal and circumferential strain was similar in patients with hypertension and controls. However, the alteration of the directional contraction pattern resulted in reduced secondary strain magnitude in patients with hypertension ( P = .01), and the differences were further exaggerated when the secondary strain was normalized by the principal strain magnitude ( P = .004). Conclusions Two-component principal and secondary strain analysis can be related to left ventricular myofiber geometry and may simplify the assessment of 3D left ventricular deformation by circumventing the need to assess multiple shortening and shear strain components.

Effects of Percutaneous Balloon Mitral Valvuloplasty on Left Ventricular Deformation in Patients with Isolated Severe Mitral Stenosis: A Speckle-Tracking Strain Echocardiographic Study

Abstract: Background Previous studies have reported abnormal left ventricular (LV) contraction in patients with mitral stenosis (MS). The aim of this study was to explore the serial changes in LV mechanics in patients with severe MS undergoing balloon mitral valvuloplasty (BMV) to understand the reversibility and determinants of abnormal LV contractile function. Methods Fifty-seven patients with severe MS and 19 healthy controls underwent echocardiographic examinations, including two-dimensional speckle-tracking-based LV global longitudinal strain (GLS) and global circumferential strain measurements. In patients with MS, the same measurements were repeated 72 hours after BMV. Results In comparison with controls, patients with MS had faster heart rates and lower LV end-diastolic volumes and LV ejection fractions ( P = .008). The magnitudes of both GLS and global circumferential strain were reduced in patients with MS ( P P Conclusions LV deformation is reduced in patients with severe MS and is related to the hemodynamic severity of MS. BMV results in rapid improvement of LV deformation, which is correlated with serial improvement in LV diastolic loading. These findings suggest that reduced LV diastolic filling rather than an irreversible myocardial structural abnormality contributes predominantly to reduced LV mechanical performance in patients with MS.

Value of interactive scanning for improving the outcome of new-learners in transcontinental tele-echocardiography (VISION-in-Tele-Echo) study.

Abstract: Background Point-of-care (POC) echocardiography may be helpful for mass triage, but such a strategy requires adequately trained sonographers at the remote site. The aim of this study was to test the feasibility of using a novel POC echocardiography training program for improving physicians' imaging skills during preanesthetic cardiac evaluations performed in a community camp organized for treating cataract blindness. Methods Seventeen physicians were provided 6 hours of training in the use of POC echocardiography; nine were taught on site and eight were taught online through a transcontinental tele-echocardiography system. The trained physicians subsequently scanned elderly patients undergoing cataract surgery. The quality of images was graded, and agreement between local physicians' interpretations and Web-based interpretations by worldwide experts was compared. Results A total of 968 studies were performed, with 660 used for validating physicians' competence. Major cardiac abnormalities were seen in 136 patients (14.2%), with 32 (3.3%) deemed prohibitive to surgery in unmonitored settings. Although good-quality images were obtained more frequently by physicians trained on site rather than online ( P = .03), there were no differences between the two groups in agreement with expert interpretations. The majority of physicians (70.6%) expressed satisfaction with the training (average Likert-type scale score, 4.24 of 5), with no difference seen between the two groups. The training resulted in significant improvements in self-perceived competence in all components of POC echocardiography ( P Conclusions This study establishes the feasibility of using short-duration, one-on-one, personalized transcontinental tele-echocardiography education for wider dissemination of echocardiographic skills to local physicians in remote communities, essential for optimizing global cardiovascular health.

Early impairment of left ventricular function in patients with systemic hypertension: New insights with 2-dimensional speckle tracking echocardiography

Abstract: Background Two-dimensional strain imaging allows rapid and accurate analysis of regional left ventricular (LV) principal strains in the longitudinal, radial, and circumferential directions. The aim of this study was to assess the ability of subtle differences in LV principal strains to characterize features of subclinical LV dysfunction in patients with systemic hypertension and apparently preserved LV systolic function.

Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors

Abstract: Aims Carotid–femoral pulse wave velocity (PWV), a direct measure of aortic stiffness, has become increasingly important for total cardiovascular (CV) risk estimation. Its application as a routine tool for clinical patient evaluation has been hampered by the absence of reference values. The aim of the present study is to establish reference and normal values for PWV based on a large European population. Methods and results We gathered data from 16 867 subjects and patients from 13 different centres across eight European countries, in which PWV and basic clinical parameters were measured. Of these, 11 092 individuals were free from overt CV disease, non-diabetic and untreated by either anti-hypertensive or lipid-lowering drugs and constituted the reference value population, of which the subset with optimal/normal blood pressures (BPs) (n = 1455) is the normal value population. Prior to data pooling, PWV values were converted to a common standard using established conversion formulae. Subjects were categorized by age decade and further subdivided according to BP categories. Pulse wave velocity increased with age and BP category; the increase with age being more pronounced for higher BP categories and the increase with BP being more important for older subjects. The distribution of PWV with age and BP category is described and reference values for PWV are established. Normal values are proposed based on the PWV values observed in the non-hypertensive subpopulation who had no additional CV risk factors. Conclusion The present study is the first to establish reference and normal values for PWV, combining a sizeable European population after standardizing results for different methods of PWV measurement.

Focused cardiac ultrasound: recommendations from the American Society of Echocardiography.

Abstract: 1. Why is a guideline needed? 567 2. Definitions 568 a. What is FCU? 568 b. Terminology 568 3. Differentiation of FCU and ‘‘Limited TTE’’ 568 a. Examination Expectations 569 b. Equipment 570 c. Image Acquisition 570 d. Image Interpretation 570 e. Billing 571 4. Considerations for Successful Use of FCU as an Adjunct to Physical Examination 571 a. Personnel 571 b. Equipment 571 c. Potential Limitations of FCU 572 5. FCU Scope of Practice 573 a. FCU When Echocardiography is Not Promptly Available 573 b. FCU When Echocardiography is Not Practical 574

Identification of heart rate–associated loci and their effects on cardiac conduction and rhythm disorders

Abstract: Elevated resting heart rate is associated with greater risk of cardiovascular disease and mortality. In a 2-stage meta-analysis of genome-wide association studies in up to 181,171 individuals, we identified 14 new loci associated with heart rate and confirmed associations with all 7 previously established loci. Experimental downregulation of gene expression in Drosophila melanogaster and Danio rerio identified 20 genes at 11 loci that are relevant for heart rate regulation and highlight a role for genes involved in signal transmission, embryonic cardiac development and the pathophysiology of dilated cardiomyopathy, congenital heart failure and/or sudden cardiac death. In addition, genetic susceptibility to increased heart rate is associated with altered cardiac conduction and reduced risk of sick sinus syndrome, and both heart rate-increasing and heart rate-decreasing variants associate with risk of atrial fibrillation. Our findings provide fresh insights into the mechanisms regulating heart rate and identify new therapeutic targets.

Tissue Tracking Technology for Assessing Cardiac Mechanics: Principles, Normal Values, and Clinical Applications

Abstract: Tissue tracking technologies such as speckle tracking echocardiography and feature tracking cardiac magnetic resonance have enhanced the noninvasive assessment of myocardial deformation in clinical research and clinical practice. The widespread enthusiasm for using tissue tracking techniques in research and clinical practice stems from the ready applicability of these technologies to routine echocardiographic or cardiac magnetic resonance images. The technology is common to both modalities, and derived parameters to describe myocardial mechanics are the similar, albeit with different accuracies. We provide an overview of the normal values and reproducibility of the clinically applicable parameters, together with their clinical validation. The use of these technologies in different clinical scenarios, and the additive value to current imaging diagnostics are discussed.

Mobile technology and the digitization of healthcare.

Abstract: The convergence of science and technology in our dynamic digital era has resulted in the development of innovative digital health devices that allow easy and accurate characterization in health and disease. Technological advancements and the miniaturization of diagnostic instruments to modern smartphone-connected and mobile health (mHealth) devices such as the iECG, handheld ultrasound, and lab-on-a-chip technologies have led to increasing enthusiasm for patient care with promises to decrease healthcare costs and to improve outcomes. This ‘hype’ for mHealth has recently intersected with the ‘real world’ and is providing important insights into how patients and practitioners are utilizing digital health technologies. It is also raising important questions regarding the evidence supporting widespread device use. In this state-of-the-art review, we assess the current literature of mHealth and aim to provide a framework for the advances in mHealth by understanding the various device, patient, and clinical factors as they relate to digital health from device designs and patient engagement, to clinical workflow and device regulation. We also outline new strategies for generation and analysis of mHealth data at the individual and population-based levels.