bluuebunny/crossref_metadata_2025 huggingface dataset:
Dispersal patterns of Reeves’s pheasant based on genetic and behavioral evidence
Authors: Lu Shuai , Hou Xian , Tian Shan , Liu Zhengxiao , Wang Yunqi , Jin Ting , Li Jianqiang , Wang Pengcheng , Xu Jiliang
Published: June 2023

Dispersal is an important life history trait that plays a crucial role in avoiding inbreeding. Uncovering the dispersal pattern of a threatened species facilitates conservation efforts. Most species of Galliformes are forest-dwelling terrestrial birds with a weak dispersal ability and high conservation priorities. However, little is known about the dispersal behavior and dispersal pattern of Galliformes species such as Reeves’s pheasant Syrmaticus reevesii, a globally vulnerable species endemic to China. Here, we integrated behavioral and genetic analyses to investigate the dispersal pattern of Reeves’s pheasant. Our results revealed that both females and males would disperse, although the overall dispersal pattern was more likely to be male-biased. Reeves’s pheasant population had a low level of genetic diversity and a mild level of inbreeding. Speculation low genetic diversity was resulted from fragmented habitat, and male-biased dispersal may reduce the opportunity of inbreeding. Our research indicated that sex-biased dispersal patterns may be a behavioral mechanism adopted by wildlife to avoid inbreeding in a fragmented habitat.
Changes in left ventricular systolic function for 1 year in patients with acute heart failure <50 years of age
Authors: Kim H J , Kim M A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Though old age is an important risk factor for cardiovascular disease including heart failure (HF), HF can develop in young patients and can have a greater impact on a quality of life because they are active individuals.

Purpose

We evaluated the clinical characteristics and prognosis according to change of left ventricular (LV) function in younger patients with acute HF.

Methods

Study data were obtained from a multicenter cohort that included patients hospitalized for acute HF. Patients who were under 50 years of age and had available data regarding baseline and one-year follow-up left ventricular ejection fraction (LVEF) were included in this analysis. Patient were classified into two groups according changes in LVEF: the improved or stationary group whose LVEF improved or maintained at one-year follow-up; the aggravated LVEF group whose LVEF deteriorated at one-year follow-up.

Results

Among 437 patients, 14.6% of patients had experienced worsening of LVEF at the one-year follow-up. The patients in aggravated LVEF group had a worse clinical profile than patients with improved or stationary LVEF. During follow-up (median 1946 days), a total of 56 patients (12.8%) died. Among them, the aggravated LVEF group had higher incidence of all-cause death (32.8% vs. 9.4%, p < 0.001). The aggravated LVEF group showed significant lower cumulative all-cause death free survival rate than improved or stationary LVEF group (Figure). In addition, the aggravated LVEF group had significantly higher incidence of cardiac death (14.1% vs. 2.9%, p < 0.001), readmission (76.6% vs. 55.5%, p = 0.002), readmission due to cardiac cause (57.8% vs.30.8%, p < 0.001), and HF readmission (51.6% vs. 26.0%, p < 0.001). After adjusting for confounding factors, Cox regression analysis showed that use of angiotensin converting enzyme inhibitors at discharge was independently associated with 63% reduced risk of aggravated LVEF (Odds ratio 0.37, 95% confidence interval 0.168–0.791, p = 0.001).

Conclusions

Poor clinical prognosis is expected if LVEF worsens after 1 year in young patients with HF. Clinicians need to be aware of the deteriorating characteristics of young HF patients and provide delicate treatment.
Using echocardiography based deep learning to early detect the infarct related artery in patients with acute coronary syndrome
Authors: Chang W , He Y U E J I
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

In patients with acute coronary syndrome (ACS), echocardiography detected regional wall motion abnormalities (RWMA) facilitates the recognition of ischemic heart disease and infarct related artery. Nevertheless, the differentiation of RWMA relies on the experiences of performers. Notably, in ACS patients without transmural infarction, RWMA may not be visible upon naked eyes.

Purpose

This study aims to investigate whether the application of 3D Convolution Neural Network could assist clinicians to differentiate patients with and without ACS based on echocardiography detected RWMA.

Methods

From 2018 to 2021, we collected echocardiographic imaging in 796 patients without ACS (Normal Control; NC), 759 with ACS and detectable RWMA (RWMA) and 267 with ACS but not detectable RWMA (uncertain; UC). The diagnosis of ACS was defined by the obstructive coronary arterial disease (CAD) in coronary angiography. Apical four, two and long chamber viewer were acquired and RWMAs were defined by cardiologists. Cardiac-Echo Net consists the techniques of 3D Convolution Neural Network and 3D MaxPooling.

Results

After exclusion echocardiographic imaging not qualified for analysis, we collected 40813 and 5928 images for establishing the model of Cardiac-Echo Net. In the final model, areas under the receiver operating characteristic curve are 98.9 and 89.2% for the training and validation, respectively. In the external validation dataset, the sensitivity was 81.8% and specificity was 81.6%. Notably, compared with cardiologists, Cardiac-Echo Net showed a superior accuracy in differentiating NC from RWMA (0.89 v.s. 0.815). Likewise, in differentiating NC from UC, Cardiac-Echo Net has a persistently higher accuracy than cardiologists (0.87 v.s. 0.65).

Conclusions

Superior to previous deep learning models, this novel one combined several neural-networking from different fields. Cardiac-Echo Net could spontaneously detect the subtle myocardial ischemia in ACS patients without eye-catching RWMA while further external validation is necessary.
Prevalence and correlates of low-flow state by 3-dimensional automated echocardiography in aortic stenosis with normal ejection fraction
Authors: Laus V , Barbieri A , Albini A , Bonini N , Chiusolo S , Forzati N , Maisano A , Muto F , Passiatore M , Stuani M , Torlai Triglia L , Ziveri V , Boriani G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Measurement of left ventricular (LV) stroke volume normalized for the body surface area (SVi) is required in aortic stenosis (AS) to calculate aortic valve area (AVA) and determine flow status. However, the LV outflow tract in most patients is hourglass rather than cylindrical, leading to a significant overestimation of the low-flow state and AS severity. Therefore, an accurate LV volumetric approach may potentially outperform the standard linear method in SVi measurement.

Aims

To investigate the prevalence of low-flow state (SVi ≤35 ml/m2) in patients with AS and normal ejection fraction (EF) by automated machine learning 3D echocardiography based on an adaptive analytics algorithm.

Materials and Methods

Consecutive patients with AS (peak velocity>2.5 m/s) and EF>50% underwent Dynamic Heart Model (DHM) using the larger settings of the boundary detection sliders (end-diastolic position = 60/60; end-systolic position = 30/30). Exclusion criteria were > moderate aortic or mitral regurgitation, rheumatic valve disease or endocarditis, and previous valve repair or replacement.

Results

We included 68 patients (mean 75 ± 12 years; 60% men, mean AVA 1,12 ± 0,40 cm2). On DHM, 10/68 patients (15%) demonstrated low SVi. The LVEDVi, LVESVi, AVA, LV mass, and EFLA were significantly lesser in patients with low SVi (Table).

Conclusions

When quantified with the modern 3D volumetric method, the prevalence of low-flow state in patients with AS and normal EF may be significantly lower than previously reported. The phenotypic profile of patients with low SVi can be refined when new metrics by DHM are employed.
Deep learning-based quantification of epicardial adipose tissue volume in cardiac magnetic resonace predicts major adverse cardiovascular events in patients with known or suspected CAD
Authors: Guglielmo M , Penso M , Carerj M L , Giacari C M , Fusini L , Baggiano A , Mushtaq S , Fazzari F , Annoni A , Guaricci A , Van Der Bilt I , Van Der Harst P , Pepi M , Caiani E , Pontone G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Increased epicardial adipose tissue (EAT) volume quantified with cardiac magnetic resonance (CMR) has been associated with the development of major adverse cardiac events (MACE). We sought to investigate the additional prognostic role EAT volume in patients with known or suspected coronary artery disease (CAD) undergoing CMR imaging.

Methods

702 consecutive patients (age: 63±10 y, male 84%) with known or suspected CAD underwent clinically indicated CMR. Using a new DL algorithm, EAT volume was quantified on short-axis stack steady state free precession (SSFP) images. Firstly, a training set of 300 patients with manually traced EAT (ground truth) was randomly split (patient-wise) into development (n=240, 80%) and held-out testing (n=60, 20%) cohorts. Secondly, we applied our segmentation network on a validation set of 402 patients with unlabeled data for automated EAT segmentations. Finally, we applied the algorith to the entire population (702 patients) to quantify EAT. EAT volume, normalized for the body mass index (EAT index), was compared to standard clinical and imaging variables for the prediction of MACE defined as non-fatal myocardial infarction and cardiac deaths.

Results

52 patients (7.4%) developed MACE during a follow-up of 5.8±1.2 years. Left ventricular ejection fraction (LVEF) < 50% (HR 2.271 [95% CI 1.117–4.616]), p = 0.023, late gadolinium enhancement (LGE) presence (HR 2.456 [95% CI 1.077–5.602]), p = 0.033 and EAT index ≥ 1,8 (HR 6.187 [95% CI 1.879–20.372]), p = 0.003 were independent predictors of MACE. Adding EAT index in a model including LVEF and LGE provided a significant improvement in predicting the endpoint with a Harrell C statistic of 0.75.

Conclusions

In patients with known or suspected CAD undergoing CMR, fully automated EAT volume quantification provides additional prognostic information on top of standard clinical and imaging parameters.
Radiotherapy-induced changes in right ventricular function in patients with early-stage breast cancer
Authors: Horosh O , Lehmonen L , Kivisto S , Skytta T , Moisander M , Kellokupu-Lehtinen P L , Raatikainen P , Nikus K , Virtanen V , Tuohinen S
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Finnish state research funding for university-level health research

Background

In breast cancer patient’s adjuvant RT nearly doubles cardiac mortality, and in some subgroups long-term cardiovascular mortality exceeds cancer mortality. The effects of RT on left ventricle are well established, but studies concerning right ventricular (RV) changes are sparse.

Methods

The study population consisted of 31 patients with early-stage left-sided breast cancer who had undergone adjuvant therapy using modern RT delivery techniques. Echocardiographic examinations including right ventricular (RV) strain analysis were performed prior to the RT, immediately after, as well as three and six years after the RT. In addition, the patients underwent cardiac magnetic resonance (CRM) imaging at six-year control.

Results

The mean RT dose to the RV free wall was 5.75±2.49 Gy. In echocardiography, basal early diastolic strain rate increased from 1.8±0.8 1/s to 2.3±0.9 1/s (p = 0.045), and the ratio of tricuspid inflow e and a-waves declined from 1.3±0.2 to 1.1±3.0 (p = 0.035), but there were no changes in global or regional strain or strain values in the six-year follow-up. In addition, In CMR imaging, the global circumferential strain values were associated with RV free wall RT dose (p = 0.005) with each mean Gy inducing 0.395% reduction in the circumferential strain [95% CI; −0.658, −0.120] whereas longitudinal strain was not associated with the RT dose.

Conclusions

Modern conformal breast cancer RT did not influence RV systolic function or result in clinically meaningful cardiac sequelae during six-year follow-up. Minor changes in RV diastolic function and the association between circumferential strain in CRM and the RT dose indicate that these parameters might be more sensitive in detecting RT-induced cardiac changes.
Extracellular volume is an independent predictor of peak cardiac power in asymptomatic patients with moderate-to-severe aortic stenosis
Authors: Haris M , Alfuhied A , Aslam S , Marsh A , Sian M , Gulsin G , Arnold J R , Mccann G P , Singh A
Published: June 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): The PRIMID study was funded by an NIHR fellowship (Post-Doctoral Fellowship supported by the National Institute for Health Research (NIHR-PDF 2011–04–51 Gerald P McCann.)

Background

Cardiac power (CP) describes the cardiac work done to maintain arterial pressure in the vasculature and peak CP is the ceiling of pumping performance the heart can achieve. Mean pressure gradient adjusted CP (MPG-CP) gives a more accurate representation of afterload in patients with aortic stenosis (AS) but its association with left-ventricular remodelling parameters is unknown.

Purpose

To establish the determinants of peak MPG-CP in asymptomatic patients with AS.

Methods

In this prospective, multi-centre observational study, asymptomatic patients with moderate to severe AS underwent echocardiography, cardiovascular magnetic resonance (CMR) imaging and cardiopulmonary exercise testing. Peak MPG-CP was calculated at peak exercise during an incremental symptom-limited exercise test on semi-supine ergometer, using the formula shown (Figure-1). Clinical and imaging univariable and multivariable associations of peak MPG-CP were assessed by linear regression.

Results

Peak MPG-CP was measured in 86 patients (mean age 66±12 years, 77% male, mean aortic valve area (AVA) 1.08±0.33 cm^2). On univariable analysis, peak MPG-CP was directly correlated with echocardiogram-measured AVA, peak pressure gradient, max velocity, and CMR-measured myocardial perfusion reserve (MPR), LV mass index (LVMI) and LV end-diastolic volume index (LVEDVI), and inversely correlated with extracellular volume (ECV) and NT-proBNP (Table-1). ECV was the only variable independently associated with peak MPG-CP regardless of which measure of AS severity was inputted in the multivariable model.

Conclusions

ECV, a marker of diffuse interstitial fibrosis, is an independent predictor of peak MPG-CP in asymptomatic patients with moderate-severe AS. Given ECV's role as a prognosticator, CP parameters may be important markers of subclinical disease and serve as surrogates for fibrotic burden and risk-stratification tools in asymptomatic AS.
Prognostic significance of echocardiographic abnormalities in patients with heart failure with preserved ejection fraction
Authors: Chiong J , Oo M M , Lang C C , Mordi I R
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Heart failure with preserved ejection fraction (HFpEF) is recognised as a highly heterogenous condition (1). This extends to its echocardiographic phenotype, which according to the latest ESC diagnostic criteria, can include the presence of left ventricular hypertrophy (LVH), left atrial (LA) enlargement and elevated pulmonary artery systolic pressure (PASP) amongst others (2). The relative prognostic significance of these abnormalities however has not been well-described.

Purpose

The aim of this study was to evaluate the relative prognostic significance of echocardiographic abnormalities in a community-based cohort of patients with HFpEF and elevated NT-proBNP.

Methods

We analysed the echocardiograms of patients referred from the community with clinical signs of HF and elevated NTproBNP. We specifically evaluated the presence of LVH, LA enlargement and elevated PASP according to EACVI criteria. We excluded patients with NT-proBNP <125 pg/ml. The primary outcome was time to all-cause mortality or cardiovascular hospitalisation.

Results

The total cohort included 473 patients (mean age 78 years, 66% female, median NT-proBNP 587 pg/ml). Median follow-up was 27 months. 88 individuals had an occurrence of the primary outcome (18.6%). LA enlargement was the commonest abnormality (48.2%), then LVH (37.2%) and elevated PASP (18.4%).

After adjustment for age, sex and NTproBNP, LA enlargement was significantly associated with the primary outcome in patients in sinus rhythm but not atrial fibrillation (sinus: hazard ratio 2.02, 95% CI 1.09–3.73, p = 0.025; AF: hazard ratio 0.68, 95% CI 0.31–1.48, p = 0.20; interaction p value 0.013). Neither elevated PASP (HR 1.50, 95% CI 0.94–2.39, p = 0.09) or LVH (HR 0.99, 95% CI 0.64–1.55, p = 0.98) were independently associated with the primary outcome. There did however appear to be a stepwise increase in risk based on the number of echocardiographic abnormalities present, with individuals with 2 or more abnormalities being significantly more likely to have an incidence of the primary outcome than those with fewer (Figure).

Conclusion

There may be differences in prognosis of HFpEF patients based on echocardiographic structural and functional parameters. These may therefore require different therapeutic approaches. The number of abnormalities appear to have a cumulative adverse effect on prognosis.
Higher incidence of heart failure and atrial fibrillation in valvular heart disease post-COVID-19
Authors: Milovancev A , Mandic D , Ilic A , Petrovic M , Miljkovic T , Stojsis Milosavljevic A , Velicki L , Mironicki Pekaric M , Dudas V , Saroskovic B
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Patients with cardiovascular diseases are at higher risk of Coronavirus disease 2019 (COVID-19) complications. The data if post-COVID-19 patients are more susceptible to postoperative cardiac surgery complications are scarce. There are limited pieces of information on the possible consequences for patients with severe valvular disease undergoing valvular cardiac surgery. The study aimed to assess the impact of COVID-19 on patients with severe valvular disease and its postoperative course and outcomes.

Methods

We retrospectively identified 34 severe valvular disease patients indicated for surgery that underwent cardiac valvular surgery post-COVID-19. Adverse cardiovascular events in post-COVID-19 (heart failure (HF) and paroxysmal atrial fibrillation (AF) were recorded. All patients underwent control echocardiography preoperatively to assess changes in ejection fraction (EF), right ventricular systolic pressure (RVSP), and diastolic filling (E/e’). The patients were also followed for the postoperative course and hospital outcomes. All these data were compared to a historical cohort of 94 non-COVID-19 patients.

Results

There were no differences in mean age in post-COVID 65.2±11.6 vs. non-COVID-19 group 63.9±11.7, p = 0.57 or sex 74.6% vs. 70.7% of males, p = 0.38 or BMI 28.9± 4.5 vs. 28.2 ± 3.9, p = 0.42, with borderline significance in Euroscore 3 ± 4 vs. 1.6 ± 1.8, p = 0.05. retrospectively. Post-COVID-19 patients had a significantly higher prevalence of symptomatic HF 43.3% vs. 21.4%, p = 0.03, and AF 37.1% vs. 17%, p = 0.02 on admission. There were no significant differences between post-COVID-19 and COVID-19 in EF 56.9 ± 10.2 vs. 53.5 ± 12.6, p = 0.2, RVSP 38.1 ± 13.1 vs. 44.9 ± 12.8, p = 0.1 or E/e’ 13.8 ± 4.4 vs. 56.9 ± 10.2, p = 0.9. There were no significant differences in postoperative outcomes when post-COVID-19 group was compared to the non-COVID-19 group, the incidence of pneumonia was 8.6 vs. 6.9, p = 0.7, sepsis 2.9 vs. 4.3, p = 0.58, stroke 0% vs. 6.4%, p = 0.14, acute kidney failure 2.9 vs. 1.1, p = 0.47, postoperative acute MI 2.9% vs. 0%, p = 0.1, and mortality 0% vs. 1.1%, p = 0.5, retrospectively. There was a significantly higher incidence of transfusion in the post-COVID-19 group 77.1% vs. 41.5%, p < 0.01. Hospital stay for post-COVID-19 patients was 8.8 ± 4.4, vs. 8.7 ± 4 days, p = 0.94, total hospital stay 13 ± 7.4, vs. 11.4 ± 4.5, p = 0.2 and ICU stay 31.4 ± 37.8, vs. 44.4 ± 32.4 hours, p = 0.13.

Conclusions

Patients with severe valvular heart disease after COVID-19 are prone to develop heart failure and atrial fibrillation. The post-COVID-19 period following cardiac surgery is not associated with increased postoperative complications.
Coronary artery calcium score as a gatekeeper for further testing in patients with low probability of obstructive coronary artery disease: a cost-effectiveness analysis
Authors: Gomes D , Albuquerque F , Lopes P , Freitas P , Silva C , Guerreiro S , Abecasis J , Santos A , Saraiva C , Ferreira J , De Araujo Goncalves P , Marques H , Mendes M , M Ferreira A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Current guidelines recommend not to routinely test patients with chest pain and low pretest probability (PTP <15%) of obstructive coronary artery disease (CAD) but envisage the use of risk modifiers such as coronary artery calcium score (CACS) to refine patient selection for testing. The aim of this study was to assess the cost-effectiveness (CE) of three different testing strategies in the approach to symptomatic patients with low PTP of obstructive CAD: A) not test; B) perform CACS, withholding testing if = 0 and proceeding to coronary CT angiography (CCTA) if > 0; and C) perform CCTA in all cases, without prior CACS.

Methods

We developed a CE model using data from a two-centre study of 1385 patients with non-acute chest pain and PTP <15% who underwent CACS immediately followed by CCTA. Key input data included the proportion of patients with obstructive CAD on CCTA (10.3%), the proportion with CACS=0 (57%), and the negative predictive value of CACS for obstructive CAD on CCTA (98.9%), which was considered the gold standard for this simulation.

The CE of each strategy was defined as the cost per correct diagnosis. Direct costs were calculated using the price list from the Portuguese National Health Service. Indirect costs, including incidental findings, were estimated according to the literature. The cost attributable to a false-negative was set at 3 times the cost of a false-positive, as customary.

Results

Not testing would correctly classify 89.7% of cases, and would cost €121.433 per 1000 patients, due to the cost imputed to false negatives. Using CACS as a gatekeeper for CCTA would correctly diagnose 98.9% of cases, and cost €247.116 per 1000 patients. Employing CCTA as first-line test would correctly classify all patients, at a cost of €271.007 for 1000 diagnosed patients.

Overall, the added cost for an additional correct diagnosis was €1.366 for CACS±CCTA strategy vs. no testing, and €2.172 for CCTA vs. CACS±CCTA. The corresponding cost-effectiveness thresholds (CET) were €943–€3.450 for men; and €1.527–€1.972 for women (Table 1).

Conclusions

Not testing patients with low PTP of obstructive CAD should be disfavoured unless the CET is below €1.366 per correct diagnosis. First-line CCTA yields the most correct diagnoses and is cost-effective above CET over €2.172 per additional correct diagnosis. Using CACS as a gatekeeper for further testing is cost-effective between these thresholds, which are wider for men than for women. These findings may inform decisions on testing, but the most suitable strategy will ultimately depend on the costs and amount of missed diagnoses stakeholders are willing to accept.
Left atrial stiffness in young patients with cryptogenic stroke: insights from the SECRETO-study
Authors: Bach Sindre R , Gerdts E , Eilertsen R , Midtboe H , Putaala J , Cramariuc D
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Finnish Medical Foundation.

DC recieves funding from Helse Vest

Background

Cryptogenic ischemic stroke (CIS) in young adults is an increasing health issue with potentially different etiologies than stroke at older age. Low left atrial (LA) reservoir strain (LASr) is a predictor of both recurrent stroke and subclinical cerebral infarct in older populations. LASr and LA stiffness have not yet been explored in young CIS patients.

Purpose

To assess LA stiffness and associated factors in patients experiencing CIS before the age of 50 years.

Methods

In the prospective, multi-center SECRETO (Searching for Explanations for Cryptogenic Stroke in the Young: Revealing the Triggers, Causes, and Outcome) study, patients aged 18–49 years with first-ever imaging-proven CIS underwent echocardiography within 2 weeks after admission. LA volumes were measured at end-diastole (minimum) and end-systole (maximum) and LA strain assessed as LASr and contractile strain. LA stiffness was derived from the ratio: mitral peak E-wave velocity divided by the mitral annular e’ velocity (E/e´) / LASr and classified as increased for age if ≥ 0.22. Systemic arterial compliance (SAC) was calculated as the left ventricular Doppler stroke volume divided by pulse pressure.

Results

Among 146 CIS patients (mean age 39 ± 8 years, 45% women, 34% normal weight), LA stiffness was increased in 34% of patients and more often in overweight and obese patients with low SAC (p<0.001, Figure 1A). Patients with high LA stiffness for age had larger minimum LA volumes and LV mass, and lower LA ejection fraction (EF) and LA contractile strain (p<0.001, Figure 1B). In multivariate regression analysis, increased LA stiffness was independently associated with higher age and body mass index, and lower LA EF and SAC after adjustment for sex and LV EF. In subsequent models, replacing LA EF with LA volume, increased LA stiffness was associated with larger minimum LA volume (p<0.001), but not maximum LA volume.

Conclusion

LA stiffness is increased in one-third of young patients with CIS, reflecting in part the cardiac remodeling induced by increased body mass index, reduced SAC, and ageing. This provides mechanistic insights into the link between these risk factors and the occurrence of CIS in young patients.
Overestimation of the pretest probability of coronary heart disease with the Diamond and Forrester algorithm in low prevalent Mediterranean area
Authors: Marcos-Alberca P , De Agustin J A , Gomez De Diego J J , Pozo-Osinalde E , Bustos A , Cabeza B , Luaces M , Martin-Lores I , Mateo P , Vidal M , Arrazola J , Villacastin J
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Initial diagnostic approach for chest pain includes: nature of pain (non coronary, typical or atypical), sex and age. This probabilistic Bayesian method is called the Diamond and Forrester algorithm. It uses as benchmarks coronariography and autopsy, but strongly depends of ischemic heart disease (IHD) prevalence. In low prevalent countries of IHD, as Mediterranean area, the very high negative predictive value of cardiac CT could overcome Diamond and Forrester algorithm.

Objective

To compare pre-test probability of IHD in patients with atypical chest pain using the algorithm of Diamond and Forrester. (expected) opposite to cardiac computed tomography (observed).

Methods

Patients examined with cardiac CT. All patients were pretreated with metoprolol 5–20 mg. e.v., unless contraindications, to obtain sinus rhythm <60 bpm and 0.4 mg of sublingual nitro-glycerine. Prospective studies or retrospective at fixed phase at 75% of RR interval when appropriated were used for standardized reconstruction. Postprocessing accomplished with double reading.

Results

A subset of 175 consecutive PP submitted for atypical chest pain was compared according to its expected prevalence (Diamond and Forrester) and that observed. Mean age 66 ± 12 years, 54% male, prevalence of hypertension was 50%, hypercholesterolemia 36%, diabetes 19% and smoking 11%. CHD was demonstrated in 37% vs 58% expected from the method of Diamond and Forrester (p <0.05). Age related dichotomic analysis of the expected probability disclosed the highest difference when age <60 yo. (expected 42% vs. observed 11%; p<0.05) and lesser when ≥60 yo (expected 64% vs. observed 47%; p<0.09).

Conclusion

In low prevalent Mediterranean area, clinical evaluation of patients with a history of atypical chest pain using Bayesian calculation overestimates the true prevalence of coronary heart disease, especially in those less than 60 year old. Our results would remark the crescent role of cardiac CT as an efficient, gatekeeper tool for overwhelming and costly health systems.
Automated leaflet assessment and recognition of tricuspid regurgitation with deep neural network
Authors: Huang M , Tsai W C , Lin W C , Chen Y D , Hsiao T A , Li W Y
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Timely recognition and intervention of severe tricuspid regurgitation (TR) improve clinical outcomes, especially given advancing transcatheter devices nowadays. We developed deep neural network model to automatically recognize significant tricuspid regurgitation through echocardiography in both assessing color flow and leaflet morphology.

Method

With careful annotation of corresponded images, we developed three stage models. First model to perform view classification, second joint models to do image processing including 2D image segmentation, leaflet pose estimation, and color image regurgitation flow segmentation, and the third model conduct detection of significant TR. Cross validation was performed stage by stage to confirm performance and model stability.

Result

The first view classification EfficientNetB5 model reached averaged classification accuracy 94.8%. The second joint models designed in Hourglass structure to achieve averaged 97.1% and 83.3% intersection over union (IOU) for regurgitation flow and chamber segmentation, respectively, and 0.9%-1.6% mean square error for 4 nodes each of three cuspid of tricuspid valve. With the joint of abovementioned post-processing information and original raw image, our model possessed averaged 88% accuracy to detect significant tricuspid regurgitation.

Conclusion

Our study confirmed that with the utilization of color flow and morphological information, deep neural network model can achieve reliable automatic recognition presence of significant TR.
Relative dilatation of left ventricle and left atrium in patients with Parkinson disease
Authors: Panovsky R , Mojica-Pisciotti M L , Bockova M , Rektor I , Holecek T , Feitova V , Kincl V
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This study was supported by Czech Health Research Council AZV NU21-04-00445 and by the European Regional Development Fund - project ENOCH (No. CZ.02.1.01/0.0/0.0/16_019/0000868)

Introduction

Morbus Parkinson (MP) is the second most common neurodegenerative disease that progressively affects the nervous system. Accompanying heart problems may include mainly cardiovascular autonomic dysfunction. So far, very little is known about structural and functional cardiac changes in patients with MP.

Purpose

This pilot study aimed to analyse left ventricular (LV) and left atrial (LA) function and volumes using cardiovascular magnetic resonance (CMR).

Methods

In this study, 37 patients with MP (mean age 59,0 ± 8,0 years) without a history of cardiac disease or symptoms were compared to 37 sex- and age-matched control subjects without any heart disease history (mean age 54,5 ± 11,4 years). All patients underwent CMR examination at 1,5 MR scanner, including cine images for assessment of LV and LA volumetric and functional parameters. LA volumes (LAV) were measured at LV end-systole (maximum LAV - LAVmax), before the atrial contraction (pre-atrial contraction volume - LAVpac), and at late LV diastole (minimum LAV - LAVmin) and indexed (I) to the body surface area. LA strains were analysed for all LA phases: reservoir strain (LSr), conduit strain (LScd), and contractile strain (LSct). Descriptive statistics are reported as the mean (SD) or median (IQR) for normally and non-normally distributed continuous variables. All the p-values were adjusted using a false discovery rate for multiple comparisons.

Results

MP patients had normal global and regional systolic LV function – LV ejection fraction (EF) 65,9 ± 6,8% vs 68,9 ± 7,0% (p = NS). On the contrary, all indexed LV volumes were significantly higher in comparison to controls: LV end-diastolic volume index was 67,3 ± 12,1 ml/m2 vs 58,3 ± 11,7 ml/m2 (p = 0,013), LV end-systolic volume index was 22,0 (17,8 to 27,5) ml/m2 vs 18,9 (13,2 to 21,9) ml/m2 (p = 0,027), and LV stroke volume index was 43,8 ± 7,2 ml/m2 vs 39,8 ± 6,3 ml/m2 (p = 0,035). Similarly, indexed LAVmax and LAVpac were also relatively increased: LAVImax 42,7 ± 9,0 ml/m2 vs 35,7 ± 10,3 ml/m2 (p = 0,014), LAVIpac 29,8 ± 7,1 vs 23,8 ± 7,6 ml/m2 (p = 0,012). LAVImin was similar in both groups: 17,3 ± 5,5 ml/m2 vs 14,3 ± 6,7 ml/m2 (p = NS). LA strains were slightly lower in the MP cohort during the reservoir and conduit phase, and slightly higher in the contractile one. However, the difference did not reach statistical significance in any phase.

Conclusion

Patients with Parkinson´s disease have enlarged LV and LA compared to controls.
Myocardial work of the systemic right ventricle and its association with outcomes
Authors: Surkova E , Lakatos B K , Fabian A , Kovacs A , Senior R , Li W
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Impaired systolic function of the systemic right ventricle (SRV) is well-known factor associated with adverse outcomes in patients with transposition of great arteries after atrial switch operation or with congenitally corrected transposition of great arteries. A recently proposed echocardiographic method of evaluating the RV myocardial work enables quantitative assessment of myocardial deformation also accounting for afterload and myocardial dyssynchrony.

Purpose

To evaluate clinical and prognostic significance of myocardial work parameters of the SRV.

Methods

Adult patients with the SRV were enrolled in a single-centre prospective observational study.SRV systolic function was assessed by 3D-echocardiography (3DE) derived ejection fraction (EF), 2D longitudinal strain and myocardial work analysis. The study endpoint was the combination of all-cause mortality and heart transplantation.

Results

38 patients were included (mean age 45 ± 12 years, 63% male). Global constructive work (GCW) and global work index (GWI) demonstrated moderate correlation with the 3DE SRV EF (Rho 0.64, p<0.0001 and Rho 0.63, p<0.0001, respectively). GCW showed strong correlation with the BNP level (Rho −0.77, p<0.0001), closely followed by GWI, 4-chamber longitudinal strain and 3DE EF (all Rho −0.73, p<0.0001). GCW and GWI were significantly lower in patients with moderate or severe tricuspid regurgitation compared with less than moderate regurgitation (1226±439 vs 1509±264mmHg%, p = 0.02, and 984±348 vs 1259±278 mmHg%, p = 0.01, respectively).

During a follow-up period of 3.5 (2.8–3.9) years, 7 patients (18%) died and one received transplantation (3%). They had significantly lower GCW and GWI compared with patients who did not reach the study endpoint (Figure 1). Cox regression including GCW, GWI and 3DE SRV EF were the best-fit models based on the Akaike Information Criterion, outperforming longitudinal strain parameters (Figure 2).

Conclusion

GWI and GCW provided reliable quantification of the SRV systolic function. GWI, GCW and 3DE-derived SRV parameters were the best predictors of all-cause mortality and heart transplantation in patients with the SRV.
Prognostic value of CMR regional longitudinal strain beyond global function and tissue characteristics in patients with suspected myocarditis
Authors: Stark A W , Joss P , Greisser N , Bernhard B , Schuetze J , Safarkhanlo Y , Fischer K , Guensch D , Boscolo M , Spano G , Bastiaanson J A M , Pavlicek M , Benz D , Kwong R Y , Graeni C
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiovascular magnetic resonance imaging (CMR) feature tracking (FT) regional longitudinal peak strain (RLS) is a novel method to assess regional myocardial deformation. The aim of this study was to investigate the prognostic value of CMR-FT RLS in patients with suspected myocarditis.

Purpose

Risk-stratification in patients with myocarditis is challenging. While left ventricular ejection fraction (LVEF) and global longitudinal peak strain (GLS) have shown predictive power in patients with myocarditis, the role of RLS is unknown.

Methods

Patients meeting clinical criteria for suspected myocarditis who were referred for CMR were included. Global/regional functional and CMR tissue characteristics were analyzed and associated with first major adverse cardiac event (MACE, i.e. heart failure hospitalization, sustained ventricular tachycardia, recurrent myocarditis and all-cause death). RLS was defined as following: anterior-/septal-(inferoseptal-/anteroseptal-))/inferior-/lateral-(anterolateral-/inferolateral). Patients with normal versus impaired function (i.e. according to LVEF and GLS) were selected for further sub-analysis.

Results

773 consecutive patients met the inclusion criteria and were included in the final analysis. Mean age was 48.3±16 years, 286 (37%) were female, and at a median follow up of 3.5 years, MACE was present in 131 (17%) of all patients. RLS of all regions were associated with outcome in the univaribale analysis. Lateral-, inferolateral- and anterolateral- RLS remained independent, significant outcome predictors after correcting for cardiovascular risk factors and CMR tissue characteristics/function (HR 1.05–1.08, c-statistics 0.711–0.721). In the 394 (51%) patients with normal LVEF and GLS, septal-, inferoseptal- and inferolateral-RLS were all significant independent predictors for MACE after adjustment for cardiovascular risk factors (HR between 1.11 and 1.13 (95%CI: 1.07–1.17, a c-statistics 0.707–0.721 ). In patients with impaired LVEF/GLS only all but anterior and anterolateral-RLS wereas independently associated with outcome.

Conclusion

Regional longitudinal strain was independently associated with outcome beyond clinical and CMR tissue characteristsics and might therefore represent a more granular marker to refine risk stratification in suspected myocarditis with impaired- or normal left ventricular function.
Three-dimensional left ventricular strain analysis in Fabry disease: correlation with heart failure severity, myocardial scar and impact on long-term prognosis
Authors: Marek J , Chocholova B , Rob D , Palecek T , Masek M , Dostalova G , Linhart A
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Charles University Research program “Cooperatio - Cardiovascular Science”.

Introduction

Fabry disease (FD) is a multisystemic lysosomal storage disorder caused by a defect in the gene coding the alpha-galactosidase A enzyme. Cardiac involvement typically manifests as a phenocopy of hypertrophic cardiomyopathy. Three-dimensional echocardiography can analyze myocardial deformation of the left ventricle (LV) in both circumferential and longitudinal dimensions.

Purpose

We assessed 3D echocardiographic strain of the LV in FD patients in relation to heart failure severity, the presence of cardiovascular magnetic resonance (CMR) scar and long-term prognosis.

Methods

3D echocardiography was feasible in 75/99 FD patients. Baseline natriuretic peptides and CMR late gadolinium enhancement were assessed together with long term outcome (death, heart failure decompensation or cardiovascular hospitalization) over a median follow-up of 3.1 years.

Results

The average age was 47 ± 14 years, 44% of patients were male and 51% expressed hypertrophy or concentric remodeling of the LV. Average LV ejection fraction (EF) was 65 ± 6%. A stronger correlation was observed for NTproBNP levels with 3D global longitudinal strain (GLS) (r = 0.49, p < 0.0001) than with 3D global circumferential strain (GCS) (r = 0.38, p < 0.001). LV EF by 3D weakly correlated with NTproBNP levels (r = 0.25, p = 0.036). Individuals with posterolateral scar on CMR had significantly lower local 3D circumferential strain at corresponding region (p = 0.008). 3D GLS was associated with long-term outcome (adjusted HR 0.84, CI 0.75, 0.95, p = 0.004) while 3D GCS was not (HR 0.94, CI 0.85 – 1.10, p = 0.284). 3D LV EF was not associated with long-term outcome.

Conclusion

3D GLS is strongly associated with both heart failure severity measured as natriuretic peptides levels and long-term prognosis. Only borderline association of 3D GCS with HF severity and no association with prognosis was observed. Decreased local 3D CS reflects typical posterolateral scarring in FD. Where feasible, 3D-strain echocardiography can be used for comprehensive mechanical assessment of the LV in FD patients.
New 2022 ESC/ERS definition of pulmonary hypertension: can we rely on the same non-invasive echocardiographic parameters?
Authors: Lacerda Teixeira B , Ferreira A , Grazina A , Almeida Morais L , Reis J , Galrinho A , Cacela D , Ramos R , Fiarresga A , Cruz Ferreira R
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

The hemodynamic definition of pulmonary hypertension (PH) has been updated, with lowering of the mean pulmonary arterial pressure (mPAP) threshold from 25 to 20 mmHg according to the new 2022 ESC/ERS Guidelines. Although there is no single echocardiographic parameter that reliably informs about PH status, some of the echocardiographic parameters cut-offs remained the same, including a peak tricuspid regurgitation velocity (PTRV) >2.8m/s. The potential underdiagnosis of PH has not been evaluated.

Objectives

To evaluate the screening power of the standard echocardiographic parameters to detect PH according to the new guidelines and to establish new predictors.

Methods

A prospective registry of consecutive intermediate-high- and high-risk PE pts submitted to CDT in a single tertiary center was used. 3 months after the procedure, the patients were submitted to a right heart catheterization and echocardiogram to screen chronic thromboembolic pulmonary hypertension (CTEPH). According to new PH criteria, patients were divided in two groups, and echocardiographic parameters were analyzed regarding their predictive power. A ROC curve analysis was performed to evaluate optimal cut-offs in predicting PH according the new guidelines.

Results

17 pts (60% women, mean age 59 ± 16 years) were included. Among these, 7 pts (41,2%) were diagnosed with pre-capillary PH by RHC at 3 months of follow-up. Among echocardiographic parameters, PTRV (p 0.015), presence of tricuspid regurgitation (0.034) and right ventricle-pulmonary artery (RV-PA) coupling (p 0.041) were significantly different between groups (Fig 1 A). Other parameters, such as right ventricle dilation (p 0.849), TAPSE (p 0.100), annular tricuspid s’ velocity (p 0.646), right ventricle outflow tract acceleration time (p 0.229) and the presence of pericardial effusion (p 0.849) did not show significant differences. Regarding the PTRV, a ROC curve analysis revealed an PTRV optimal cut-off of 2.6 m/s (pressure gradient 27mmHg) in our population (AUC 0.911, p 0.030, Sn 71.4%, Sp 100%), compared to the conventional cut-off of 2.8 m/s (pressure gradient 31 mmHg) (p 0.470, Sn 28.6%, Sp 100%). The use of PTRV > 2.6 m/s allows to reduce false negatives without losing specificity (Fig 1 B, C and D).

Conclusion

With the recent update in PH criteria, the use of the conventional PTRV cut-off leads to a significant underdiagnosis in our population. Lowering the PTRV threshold seems to increase sensitivity, without losing specificity. Other standard echocardiographic parameters did not seem to predict accurately the presence of PH.
Right atrial remodeling and outcome in patients with secondary tricuspid regurgitation
Authors: Tomaselli M , Radu D N , Badano L P , Perelli F P , Cascella A , Gavazzoni M , Mihaila S B , Hadareanu D R , Caravita S , Baratto C , Pece C , Giorgio O , Curti E , Parati G , Muraru D
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Secondary tricuspid regurgitation (STR) is independently associated with patients’ morbidity and mortality and right atrial remodeling (RAR) is a proven marker of disease progression.

Purpose

The aim of our study is to investigate the prognostic value of RAR in terms of RA volume (RAVi) and strain (RAS) in patients with STR.

Methods

We retrospectively enrolled 400 adult patients (46% men, 72.5±14.0 years) with both atrial and ventricular STR (mild 26%, moderate 40%, severe 34%). Exclusion criteria were primary TR, cardiac implantable electronic device, previous TV intervention, poor apical acoustic window, and lack of follow-up. Complete two-dimensional echocardiography, including right atrial volume (RAVi), speckle-tracking analyses of RA reservoir strain (RARS) and right ventricular strain (RVLS) on focused apical 4-chamber views, were obtained. The primary outcome was the composite endpoint of death from any cause and heart failure hospitalization.

Results

After a median follow-up of 13 months (IQR: 6–23), the combined endpoint was reached by 158 patients (39%). Patients who experienced events had larger RV and RA size, more impaired RVLS and RARS, and higher pulmonary artery pressure. By receiving operating curve (ROC) analysis, the ideal cut-offs for RARS and RAVi were 14% and 48 mL/m2 (p<0.0001). RAS < 14% [HR 2.40, p<0.0001] and RAVi > 48 mL/m2 [HR 2.10, p<0.0001] were strongly associated with outcome. Patients with both RAS < 14% and RAVi > 48 mL/m2 had significantly lower survival rates compared to patients with RAS ≥ 14% and RAVi ≤ 48 mL/m2 (log-rank χ²= 31 and χ²= 22 respectively, p<0.001) (Figure 1). RAS <14% was associated with higher cumulative event rates, regardless of baseline patients’ rhythm (log-rank χ²= 35, p<0.001). Moreover, patients having both RAS <14% and RAVi >48 mL/m2 had a higher rate of adverse events (log-rank χ²= 53, p<0.001) compared to those with a single RA parameter abnormal, or those who had both parameters normal. On multivariable analysis, RAS >14% (HR1.53; 95% CI, 1.00–2.33; p = 0.02) and RAVi >48 mL/m2 (HR 1.42; 95% CI, 0.96–2.11; p = 0.04) remained independently associated with the combined endpoint. RAR provided incremental prognostic value over RV size and function, including RVLS.

Conclusions

In patients with STR, RARS is associated with an increased risk for HF hospitalization and all-cause mortality. Assessment of RARS could improve risk stratification of patients with STR, potentially identifying those who may benefit from optimization of medical therapy and earlier surgical/percutaneous treatment.

Figure 1. Kaplan-Meier plots for the analysis of the cumulative event-free survival according to RAS (Panel A) and RAVi (Panel B) values.