bluuebunny/crossref_metadata_2025 huggingface dataset:
Political Machines
Authors: Albrecht Eduardo
Published: January 2025

Globally, governments are increasingly using artificial intelligence to collate information about their citizens and allocate resources, effectively creating political machines. As technology evolves, these machines are making progressively more complex decisions, which can be considered a form of political automation. This chapter examines existing debates in the academic literature in areas such as predictive policing, the impact on democracy, the ethics of algorithmic technologies, and regulatory aspects such as privacy. The chapter also considers the changes occurring in culture due to what are termed roboprocesses—or the hidden algorithms that shape how we think about and interact with the world. The structure and main objectives of the book are also laid out, and a brief introduction is given to the notion of a novel institutional body to bridge the divide between political machines and the citizenry.
The Eye of Nations
Authors: Albrecht Eduardo
Published: January 2025

This chapter reviews the endeavors of multilateral organizations like the United Nations to collect information about peoples’ wider environment to predict, and potentially prevent, collective violence such as armed conflict. Starting with the League of Nations, the history of the multilateral system’s data collection efforts is explored, as well as the variety of data and technologies used to map and understand international security dynamics and support peacekeeping efforts. The chapter then discusses contemporary uses of data analytics, machine learning, and predictive technologies in conflict prevention and the development of the field referred to as “peacetech.” The concern is addressed that these technologies may be vulnerable to manipulation in myriad ways and, consequently, there is a need for ethical guidance related to consent, privacy, data ownership, social harms, and potential geopolitical biases.
Synopsis
Authors: Malcolm Rosalind , Pointing John
Published: January 2025

This book is concerned with the law and practice of statutory nuisances falling under Part III of the Environmental Protection Act 1990 (EPA 1990). Statutory nuisance lies at the heart of the controls available to local councils with which to deal with environmental complaints. Situated at the front line of public health are to be found local authority environmental health practitioners. Seldom does their work catch the public eye in the same way as that of the national enforcement agencies, but the moment a local resident finds himself embroiled in a public health issue, then it is the local council which is the first port of call. Whether a complaint is about noise, smells, accumulations of rubbish, or other such nuisances, it will be dealt with locally by publicly accountable authorities whose decisions and actions will have an immediate impact on the quality of life of ordinary residents and people working in the area.
Premises
Authors: Malcolm Rosalind , Pointing John
Published: January 2025

Premises may be in such a state that they constitute a statutory nuisance to the occupier of those premises (an ‘internal nuisance’) or to an adjoining occupier. When premises fall into the internal nuisance category, this will, normally, fall under the health limb of section 79(1)(a) of the Environmental Protection Act 1990 (EPA 1990) since there is no element of a private or public nuisance present. Some actual or threatened injury to health must then be shown.
Accumulations And Deposits
Authors: Malcolm Rosalind , Pointing John
Published: January 2025

It first appeared in section 8 of the Nuisances Removal Act 1855: ‘Any Accumulation or Deposit which is a Nuisance or injurious to Health’. It was consolidated in section 92(c) of the Public Health Act 1936: ‘any accumulation or deposit which is prejudicial to health or a nuisance’ and is now contained in the EPA 1990 with the same wording.
Artificial Light
Authors: Malcolm Rosalind , Pointing John
Published: January 2025

Artificial light was included in the list of statutory nuisances by section 102 of the Clean Neighbourhoods and Environment Act 2005.
Section 82 Proceedings
Authors: Malcolm Rosalind , Pointing John
Published: January 2025

As a key mechanism for the local control of polluting activities which are harmful to people, the control of statutory nuisances lies principally with local authorities. However, there is also a route whereby a private individual may prosecute such proceedings himself. This may be necessary where a local authority fails to act or where the action is against the local authority itself.
Other Remedies and Alternative Proceedings to the Abatement Notice Procedure
Authors: Malcolm Rosalind , Pointing John
Published: January 2025

The enforcement regime provided by section 80 of the Environmental Protection Act 1990 (EPA 1990) should not be seen in isolation and there are several fields that impinge on the statutory nuisance regime.
Overview of Evidential Issues and Preparation for Court
Authors: Malcolm Rosalind , Pointing John
Published: January 2025

Prosecuting for a failure to comply with an abatement notice under section 80(4) of the Environmental Protection Act 1990 (EPA 1990), appealing against an abatement notice under section 80(3), or bringing summary proceedings under section 82(1), follow the usual procedures applying in the magistrates’ courts. Aspects of statutory nuisance cases may cause particular problems. Notable among these are the evidential issues pertaining to the investigation of the statutory nuisance and the use of expert technical and scientific evidence. The rules of advance disclosure can also cause difficulties. This chapter therefore focuses on evidential issues which the practitioner may encounter when appealing against an abatement notice, or when prosecuting or defending in criminal proceedings.
Age-related differences in staging, treatment and net survival in relation to frailty in adults with colon cancer in England: an analysis of the COloRECTal cancer data repository (CORECT-R) resource
Authors: Pilleron Sophie , Birch Rebecca J , Taylor John , O'Hanlon Shane , Morris Eva J A
Published: January 2025

Objective

To describe the distribution of disease stages, receipt of major surgery, 1-year net survival (NS) and 1-year conditional NS in relation to age and frailty in adults aged ≥50 diagnosed with colon cancer in England.

Methods

We obtained data on adults aged 50–99 diagnosed with colon cancer between 2014 and 2019, followed up through December 2021, from the national population-based COloRECTal cancer Repository. Frailty was assessed using the Secondary Care Administrative Records Frailty (SCARF) index categorised into fit, mild, moderate and severe frailty. Data on major resection were obtained through linkage with Hospital Episode Statistics dataset. Major resection rates were calculated in adults with stage I–III cancer. Descriptive statistics were used as appropriate. One-year NS from cancer diagnosis and 1-year conditional NS were estimated using the Pohar-Perme estimator.

Results

Out of 130 360 individuals (48% females—50% over 75), 48.9% were fit, ranging from 69% in the 50–64 age group to 31% in the 85–99 age group. Over 80% of adults with stage I–III cancer underwent a major resection. This percentage was 58% amongst fit adults aged over 85. One-year NS decreased as age increased across all frailty levels. Differences in NS between the 50–64 age group and the 85–99 age group were reduced in adults who survived beyond 1 year from diagnosis except for severely frail adults.

Conclusion

This population-based study shows that a non-negligible proportion of older adults diagnosed with colon cancer and deemed ‘fit’ through the SCARF did not receive surgery that may impact their survival.
Off-label use of tralokinumab in the treatment of bullous pemphigoid: a case series
Authors: Maglie Roberto , Didona Dario , Solimani Farzan , Pipitò Carlo , Baffa Maria Efenesia , Hertl Michael , Antiga Emiliano
Published: January 2025

This study reports the efficacy of tralokinumab in five patients with bullous pemphigoid.
Revolutionising osseous biopsy: the impact of artificial intelligence in the era of personalized medicine
Authors: Isaac Amanda , Klontzas Michail E , Dalili Danoob , Akdogan Asli Irmak , Fawzi Mohamed , Gugliemi Giuseppe , Filippiadis Dimitrios
Published: January 2025

In a rapidly evolving healthcare environment, artificial intelligence (AI) is transforming diagnostic techniques and personalized medicine. This is also seen in osseous biopsies. AI applications in radiomics, histopathology, predictive modelling, biopsy navigation, and interdisciplinary communication are reshaping how bone biopsies are conducted and interpreted. We provide a brief review of AI in image- guided biopsy of bone tumours (primary and secondary) and specimen handling, in the era of personalized medicine. This article explores AI’s role in enhancing diagnostic accuracy, improving safety in biopsies, and enabling more precise targeting in bone lesion biopsies, ultimately contributing to better patient outcomes in personalized medicine. We dive into various AI technologies applied to osseous biopsies, such as traditional machine learning, deep learning, radiomics, simulation, and generative models. We explore their roles in tumour-board meetings, communication between clinicians, radiologists, and pathologists. Additionally, we inspect ethical considerations associated with the integration of AI in bone biopsy procedures, technical limitations, and we delve into health equity, generalizability, deployment issues, and reimbursement challenges in AI-powered healthcare. Finally, we explore potential future developments and offer a list of open-source AI tools and algorithms relevant to bone biopsies, which we include to encourage further discussion and research.
Validation of a fully automated AI system for accurate left ventricular ejection fraction measurement in echocardiography
Authors: Sveric K , Platzek I , Haussig S , Linke A
Published: January 2025

Background

Two-dimensional echocardiography (Echo) is a feasible method for assessing left ventricular (LV) ejection fraction (EF) in clinical routine. However, LVEF assessment is dependant on the user’s expertise and is time consuming.

Purpose

We aimed to compare the accuracy of an artificial intelligence (AI) system in evaluating Echo exams and calculating biplane LVEF against human interpretation and cardiac computed tomography (CT), which was regarded as the gold standard.

Methods

A diverse cohort of patients (n=190) with symptomatic heart valve disease underwent both Echo and cardiac spiral CT on the same day. Biplane LVEF was manually traced online on apical 4- and 2-chamber views by experienced cardiologists (Human). After completion of the exam,a novel vendor-neutral AI system performed both automated evaluation of Echo exams, appropriate view selection, and calculations of biplane LVEF in one workflow (Figure 1A). LVEF results from CT were supervised by an experienced radiologist (>10 years) (Figure 1B). Pearson’s correlation coefficient (R), regression analysis, and mean absolute error (MAE) were used to assess the agreement of LVEF values between methods.

Results

The final cohort consisted of 182 patients with complete LVEF assessment by the AI (feasibility: 96%). Although LVEF from AI and Human showed good agreement (R=0.79 and MAE= 5.9), AI exhibited higher agreement with CT (R=0.88, MAE=5.1) than Human LVEF calculations with CT (R=0.79, MAE=5.9), as shown in Figures 1C and 1D.

Conclusion

The findings highlight the potential of a novel AI system for assessing biplane LVEF from Echo exams, comparing its performance to human operator-dependent methods and CT as the gold standard. By potentially enhancing accuracy in LVEF measurements, this AI system could represent a viable advancement in the field of Echo, aligning closely with the precision of CT assessments.
Automated artificial intelligence and machine learning based software assists to identify wall motion abnormalities in the left anterior descending territory
Authors: Liel-Cohen N , Yaacobi M , Becher M , Semo S , Sadikov A , Geri O , Ankri Y , Carasso S , Kobal S , Labovitz A
Published: January 2025

Background

Echocardiography is widely used for identification of wall motion abnormalities in patients with suspected coronary artery disease. Segmental wall motion (SWM) is evaluated in practice, qualitatively, by visual estimation. SWM evaluation is known to be complex and time consuming, demands high level of expertise and subjective, especially when providing segmental scores to individual segments. To assess regional rather than global impairment, individual segments, when identified as abnormally contracting, are further evaluated to assess if they are linked to a muscle territory supplied by a specific coronary artery, which may imply impairment in blood supply. We labeled this decision-making process as "Territory logic" (TLG). The Left Anterior Descending (LAD) coronary artery supplies blood to a large mass of the left ventricular muscle, thus, when involved, proximal obstruction is life threatening and early diagnosis may be crucial.

An artificial intelligence (AI) based platform for automated analysis of echocardiographic examination includes a machine learning based module, trained using 735 echo exams, for automated SWM evaluation. The module utilizes the four, two and three chamber apical views and provides segmental scores based on 16 segments model, scoring each segment as normal, hypokinetic or akinetic.

Purpose

To evaluate the ability of an AI based application to identify contractility impairment in the LAD territory compared to visual estimation, when applying TLG to both methods.

Methods

A total of 161 exams collected from two medical centers were included in the study, 64% male, mean age 60±16 years. 48 (29%) had normal LV function, 76 (47%) had previous myocardial infarction. The SWM evaluation by visual estimation was used as reference. Four, two and three chamber apical clips were manually selected from each exam. The module processed the clips automatically. The identification of impairment in the LAD was evaluated by applying TLG to both methods (Fig.1).

Results

143 exams (89%) in which automated processing was possible for all three apical views were included in the analysis. The comparison between the automated and reference results showed a good ability to identify impairment in the LAD by TLG, with specificity and sensitivity of 87% and 80% respectively. The results are summarized in (Table-1).

Conclusions

The AI based platform for automated SWM evaluation can assist in identifying wall motion impairment in the LAD territory, comparable to the logic used in clinical practice.
Automated reading of handheld echocardiograms is feasible and shows strong agreement with high-resolution echocardiography - Results from the PAVE project
Authors: Krieger L , Le Maire M , Pelin D , Chen M , Hitschrich N , Schummers G , Schreckenberg M , Pryss R , Gelbrich G , Karch O , Lengenfelder B , Hu K , Frantz S , Stoerk S , Morbach C
Published: January 2025

Background

We recently showed that population data-based machine-learning can improve the automated echocardiographic quantification of cardiac structure and function. The respective gain in accuracy and precision strengthens the confidence into automated echocardiographic readings and carries potential for applications in various settings.

Purpose

We applied the automated detector to high-resolution standard echocardiograms and to echocardiograms acquired with a handheld device.

Methods and Results

PAVE (Pathology-oriented reading of echocardiography) is a cooperation project between University Hospital Wuerzburg (UKW) and Tomtec Imaging Systems using an established federated machine-learning environment. We recruited 2043 patients (mean age 64±16, 44% women) presenting at the UKW for transthoracic echocardiography (TTE). After high-resolution standard TTE (Vivid E95, GE) trained sonographers acquired images with a handheld ultrasound device (Lumify 2.0, Philips) according to a pre-specified protocol. Images of both modalities were loaded into the analysis platform of the Academic CoreLab Ultrasound-based Cardiovascular Imaging (TomtecArena®, Tomtec, Germany). For the current analysis, we selected n=51 random patients (mean age 65±16, 39% women) from the PAVE cohort. Reading of high-resolution and handheld TTE, respectively, was performed by a trained sonographer (>14 days apart and blinded to the reading results) as well as by the automated detector.

We here present first results regarding 2D (parasternal long axis) measurements of interventricular septum (IVS), left ventricular diameter (LVD) and posterior wall thickness (PW) at end-diastole from manual CoreLab reading (CL) and automated detector reading (AD) of high-resolution TTE (11.3±4.1mm, 10.9±2.5mm; 48.3±8.1mm, 49.5±7.4mm; PW 9.3±3.2mm, 10.0±1.7mm) as well as of the respective handheld echocardiograms (IVS 10.7±3.4mm, 11.0±2.2mm; LVD 47.7±7.4mm, 48.3±6.6mm; PW 9.7±2.7mm, 10.2±1.6mm). The agreement between measurements performed in high-resolution and handheld TTE was assessed using Bland-Altman analysis (Table 1; Figure 1).

Conclusions

The application of an automated detector to handheld TTE was feasible and led to measurement values in the same range but with higher agreement of measurements when compared to human reading. Our results await extension to further echocardiographic parameters and confirmation in larger cohorts but suggest that automated echocardiographic reading might become a valuable tool in patient care. Accurate automated reading of handheld TTE might extend applicability of echocardiography to non-expert settings.
A new paradigm for structural heart disease detection: cost savings of screening with AI-ECG and POCUS
Authors: Schlesinger R , Alexandrino F , Bird J , Kane G , Deshmukh A , Pellikka P , Oh J , Noseworthy P , Lopez-Jimenez F , Friedman P , Pislaru S , Tsaban G
Published: January 2025

Background

AI-enhanced electrocardiogram (AI-ECG) is a cost-effective tool for left ventricular dysfunction screening. However, its cost-effectiveness for other forms of structural heart disease (SHD) is unknown. While AI-ECG is inexpensive, the relatively low positive predictive value (PPV) of many models can lead to high costs from unnecessary follow-up tests like transthoracic echocardiography (TTE). Therefore, strategies to improve the yield of AI-ECG-based screening are needed.

Purpose

To evaluate the cost savings of a stepwise approach to SHD screening using AI-ECG followed by point-of-care ultrasound (POCUS) compared to AI-ECG alone.

Methods

286 adult outpatients undergoing AI-ECG were randomly selected to undergo same-day POCUS. All participants were required to have a recent TTE, our gold standard for SHD diagnosis, for comparison purposes.

We evaluated four SHDs: aortic stenosis, cardiac amyloidosis, hypertrophic cardiomyopathy, and left ventricular dysfunction (defined as left ventricular ejection fraction <50%). The costs of AI-ECG ($75/test) and TTE ($1,305/test) were sourced from Healthcare Bluebook, while the cost of POCUS ($100/test) was independently estimated.

We compared the costs of screening with AI-ECG alone to stepwise screening with AI-ECG followed by POCUS. Costs were analyzed for two paradigms: screening for all forms of SHD in parallel and screening for each SHD individually.

Results

AI-ECG alone identified potential SHD in 125 out of 286 patients. When compared to TTE, only 39 out of 125 were true positives (31% PPV). Among the AI-ECG-positive patients, POCUS demonstrated findings of SHD in 52 out of 125 cases. When compared to TTE, this stepwise approach yielded 32 true positives and 20 false positives (62% PPV).

In the parallel screening paradigm, the cost per patient diagnosed with SHD was $4,733 with AI-ECG alone, which decreased to $3,182 with stepwise screening (33% cost savings). For the individual SHD screening paradigm, cost reductions were as follows: aortic stenosis ($18,724 to $6,315, 66% savings), cardiac amyloidosis ($21,023 to $12,230, 42% savings), hypertrophic cardiomyopathy ($9,883 to $6,175, 38% savings), and left ventricular dysfunction ($4,019 to $3,582, 11% savings).

Conclusions

Stepwise SDH screening with AI-ECG followed by POCUS markedly reduces costs compared to AI-ECG alone. The greatest cost savings for individual SHD screening were observed for aortic stenosis and cardiac amyloidosis, conditions where AI-ECG models have lower PPVs.

Parallel screening for multiple SHDs is also less costly than screening for any individual SHD alone. Therefore, a parallel screening approach may maximize SHD detection while minimizing screening costs.

Stepwise Screening Approach for SHD

SDH Screening Costs
Deep learning in echocardiography: real-time measurements of left ventricular wall thickness and chamber dimensions in the parasternal long-axis view
Authors: Holmstrom V , Smistad E , Ostvik A , Holte E , Stolen S , Lovstakken L , Dalen H , Grenne B
Published: January 2025

Background

Accurate measurements of left ventricular (LV) wall thickness and chamber dimensions in the parasternal long-axis view (PLAX) are essential in the standard echocardiographic examination. Manual assessments introduce variability, and conducting the numerous measurements required for a comprehensive echocardiographic assessment is time-consuming. Therefore, there is potential for improving workflow.

Purpose

To develop a novel deep learning (DL)-based method for fully automated, real-time measurements of LV wall thickness and chamber dimensions while scanning the patient, and to validate its performance in an unselected prospective cohort.

Methods

PLAX recordings from 207 subjects were annotated to train DL networks for cardiac segmentation, timing of end-systole and end-diastole, measurements of LV wall thickness and chamber dimensions. The application presents results from three consecutive cardiac cycles in real-time to the operator for review (Figure 1). Agreement and correlation with reference measurements were evaluated, and the combined acquisition and measurement times for both the novel- and reference methods were recorded.

Results

Feasibility for real-time measurements in PLAX was 98%, with one patient excluded due to poor acoustic window. Agreement with reference measurements was good for interventricular septal diameter (IVSd) (bias - 0.7 mm, limits of agreement (LoA) -4.38 to 2.94 mm), posterior wall thickness (PWd) (bias 0.8 mm, LoA -2.32 to 3.84 mm) and left ventricular internal diastolic diameter (LVIDd) (bias 0.0 mm, LoA -7.0 to 6.9 mm, Figure 2A). Strong correlations were found for IVSd (R=0.84), PWd (R=0.66) and LVIDd (R=0.85), all significant (p <0.001). The average time for acquiring PLAX images was 53 ± 22 seconds, with an additional 42 ± 11 seconds for reference analysis, totaling 94 ± 27 seconds to complete reference PLAX measurements. In contrast, the real-time application took only 59 ± 34 seconds to obtain the same measurements (Figure 2B), resulting in a mean time reduction of 36 seconds (95% CI 24-47 seconds).

Conclusion

This novel DL-based method for fully automated, real-time analysis of key metrics in PLAX is time-efficient, feasible, and yields measurements in good agreement with manual reference. This method has the potential to substantially improve efficiency and precision of PLAX assessment in clinical practice.
Effect of SGLT2i on cardiac remodeling in patients with chronic kidney disease undergoing peritoneal dialysis
Authors: O'neill Gonzalez P , Marco I , Garcia Carro C , Calvo M , Barbieri D , Sanchez Fructuoso A I , Restrepo M A , Olmos C , De Agustin J A , Goirigolzarri J
Published: January 2025

Background/Introduction

Sodium-glucose Cotransporter-2 inhibitors (SGLT2i) are one of the cornerstone therapies for cardiorenal protection in chronic kidney disease (CKD). However, its use has been restricted in patients with very low glomerular filtration rates (GFR). Therefore, evidence of their use in patients with renal replacement therapy (RRT) is limited. Recent data suggest the positive impact of SGLT2i on cardiac remodeling parameters measured by echocardiogram in patients with heart failure.(1) The use of SGLT2i could be beneficial in patients with CKD undergoing peritoneal dialysis as their cardiovascular risk is high and therapies are limited in such scenarios.

Purpose

Our aim was to evaluate changes in echocardiographic parameters of cardiac remodeling in patients with CKD and peritoneal dialysis after the use of SGLT2i.

Methods

Retrospective analysis of a prospective cohort of patients with KDIGO stage 5 CKD receiving peritoneal dialysis. Echocardiographic parameters were measured prior to the introduction of SGLT2i and at a median follow-up of 6.6 months after the initiation of SGLT2i.

Results

11 patients were included, mean age was 69.2 years [9.2] , women represented 36.3% of the total and 54.6% of them had a history of congestive heart failure (HF) admission. (Table 1). The mean left ventricular ejection fraction was preserved (54% [9.9]) but subclinical damage was evident by GLS (-13.8% [4.5]). Left Atrial (LA) dilatation and dysfunction were frequent in the basal study, with a mean LA volume index maximum (LAVI max) of 42 ml/m2 [33.1-66.8] and LA reservoir strain of 20.9% [10.6] (Table 2).

In the follow-up studies, there was a non-significant trend towards a reduction in LA volume at the expense of LAVI reservoir (-7.1ml/m2; p=0.09). However, there was no improvement regarding LA and LV function parameters. The medication was safe and well tolerated, no new HF admissions occurred during the follow-up.

Conclusions

Patients with CKD and peritoneal dialysis have echocardiographic signs of atrial enlargement and dysfunction, as well as subclinical LV damage, with reduced GLS. A non-significant trend of LAVI reservoir reduction was observed with the use of SGLT2i and medication was well tolerated. Larger studies are necessary.

Table 1. Baseline characteristics

Table 2. Echocardiographic parameters
Prevalence, characteristics and predictors of left bundle branch block induced cardiomyopathy following transcatheter aortic valve implantation
Authors: Khoury S , Gvili Perelman M , Avivi I , Tzuberi M , Laufer-Perl M , Banai S , Topilsky Y
Published: January 2025

Background

Left bundle branch block is a relatively common conduction disturbance that can occur as a complication of transcatheter aortic valve implantation (TAVI) procedures. LBBB-induced cardiomyopathy (LBBB-CM) develops due to the mechanical dyssynchrony caused by the conduction abnormality. This dyssynchrony can lead to adverse left ventricular remodeling over time, resulting in a decline in cardiac function. Nevertheless, data on iatrogenic LBBB due to TAVI resulting in cardiomyopathy is lacking.

Purpose

To investigate the prevalence, characteristics and predictors for LBBB-CM following TAVI.

Methods

This was a retrospective single center study. A total of 1792 patients underwent TAVI between 2013 and 2021. New LBBB was documented in medical records in 353 patients. After exclusions (figure 1), we remained with 88 patients who were discharged from hospital with complete LBBB, had no pacemaker in situ and had at least 1 year of follow-up. The median follow-up in this study was 40 [17-64] months. LBBB-CM was defined as an absolute decline of >10% in ejection fraction (EF) due to clear septal dyssynchrony and in the absence of an alternative explanation.

Results

A total of 8 out of 88 patients (9%) developed LBBB-CM over the study period. During the first two years of follow-up, the prevalence was low but gradually increased with extended follow-up. The mean age at discharge from hospital in LBBB-CM group was 83 ± 5 years and the mean EF was 59% ± 3. Patients in the LBBB-CM group had a longer PR interval compared to the no LBBB-CM group (255 ±36 vs 191 ± 38ms, p=0.02) and were more likely to have atrial fibrillation at discharge (50% vs 6%, p<0.001). On Cox regression analysis, both PR interval and QRS duration were identified as significant predictors for the development of LBBB-CM. The HR for PR interval was 1.04 (95% CI 1-1.07, p=0.02) and HR for QRS duration was 1.12 (95% CI 1-1.25, p=0.05).

Conclusions

This is the largest study to date focusing on LBBB-CM following TAVI. LBBB-CM complicates about 9% of patients discharged with a new complete LBBB, occuring within a median follow-up of 40 [17-64] months. Electrocardiographic predictors for the development of LBBB-CM include prolonged QRS duration and PR interval at discharge. Closer follow-up may be required in this group of patients for timely diagnosis and intervention.

Figure
Misinterpretation of indeterminate diastolic dysfunction: awareness and insights from a nationwide survey among Brazilian cardiologists
Authors: Rassi D C , Rassi S , Assef J E , Beck A L S , Felix A S , Cruz C B B V , Barberato S H
Published: January 2025

Introduction

Cardiac diastolic dysfunction is highly prevalent and is associated with significant morbidity and mortality. The latest American Society of Echocardiography and European Association of Cardiovascular Imaging (ASE/EACVI) guidelines have simplified the definition of diastolic dysfunction and introduced the classification of indeterminate diastolic dysfunction (IDF). Despite these advancements, IDF remains poorly understood in clinical practice, with variable prevalence rates.

Purpose

This study aims to assess the understanding of IDF among non-echocardiographer cardiologists across Brazil, eight years after the guideline update.

Methods

A nationwide online survey was conducted among non-echocardiography readers cardiologists, distributed via mobile messaging platforms. A brief questionnaire, using anonymous responses, assessed awareness and interpretation of IDF.

Results

A total of 570 cardiologists participated from all regions of Brazil, with good representation across Southeast (29.65%), Central-West (23.80%), Northeast (18.77%), South (16.14%), and North (11.58%). Most participants (64.21%) had over ten years of clinical experience. While 71% correctly identified degrees 2 or 3 as indicative of elevated filling pressures, only 34.21% accurately understood the criteria for reporting IDF. Misconceptions attributing IFD included presence of pathologies that interfere with accurate assessment (49.12%) or technical limitations of echocardiography machines (3.33%) or lack of knowledge among echocardiographers (4.91%). Additionally, 46.7% encountered IDF rarely in reports, 33.51% believed it influenced patient management, and 43.51% felt that the examination could have been better executed.

Conclusion

Despite widespread knowledge of diastolic dysfunction grading, misinterpretation of DIF persists among Brazilian non-echocardiographer cardiologists. Enhanced education and perhaps clearer guidelines are necessary to improve clinical echocardiographic collaboration and accurate diagnosis.
Heart failure with preserved ejection fraction: incidence and impact on mortality in patients with secondary tricuspid regurgitation
Authors: Pugliesi G , Anand V , Singh S , Scott C G , Pislaru S V , Nkomo V T , Borlaug B A
Published: January 2025

Introduction

Secondary tricuspid regurgitation (STR) is a highly prevalent valve disease. STR and Heart Failure with preserved Ejection Fraction (HFpEF) share common features including exertional intolerance and high burden of atrial fibrillation (AF) and pulmonary hypertension (PH), making it challenging to disentangle HFpEF from TR. The incidence of clinically-recognized HFpEF in STR and its impact on mortality are not well established.

Purposes

To define the incidence of newly diagnosed HFpEF and its impact on mortality in a cohort of patients with significant STR and to evaluate the likelihood of a larger hidden burden of HFpEF.

Methods

Patients with a first diagnosis of ≥moderate-severe STR between 2004-2019 at our institution were retrospectively included. Patients with left ventricle ejection fraction <50%, left-sided valve diseases, and intracardiac device leads were excluded. HFpEF was identified by manual chart review as well as by use of ICD codes. The estimated prevalence of HFpEF was evaluated using an H2FPEF score ≥6, which corresponds to a ≥90% probability of having HFpEF.

Results

Of 2118 patients (mean age 70 ± 14, 36% females), 1057 (50%) had systemic hypertension (HTN) and 1091 (51%) had AF, with median 2.3 years of follow-up. From this cohort, 536 (25%) patients were diagnosed with HFpEF based upon chart review during the follow up period, while ICD diagnosis was only present in fewer than 50% of these patients (254). High H2FPEF score was present in 880 patients (41.5%), of whom 383 received a chart diagnosis of HFpEF, while 153 patients with H2FPEF score <6 received a chart HFpEF diagnosis. The cumulative incidence of chart-based diagnosis of HFpEF was 20.8% (N=158) at 1-year and 38.6% (N=273) at 5-years in patients with an H2FPEF score ≥6 and 5.5%(N=60) at 1-year and 11.1%(N=111) at 5-years in those with a score <6 (Figure). In Cox regression analyses, the diagnosis of HFpEF during follow-up was associated with increased mortality (HR 2.14, CI 1.86-2.46, p < 0.001) after adjusting for age, sex, body mass index, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease, diuretics, HTN, pulmonary hypertension, chronic kidney disease and AF.

Conclusions

The incidence of clinically documented HFpEF in a cohort of patients with significant STR at index evaluation is high (25%). Use of ICD code underestimates clinical recognition, with the actual burden of HFpEF probably being even greater, as indicated by an H2FPEF score ≥ 6. Among those with significant STR, HFpEF diagnosis is an independent risk factor for mortality.
Feasibility of non-invasive echocardiographic estimates of intraventricular pressure differences by blood speckle tracking in adults
Authors: Witso M , Luo H , Holm T , Kristiansen H M , Frostelid V C , Aalen J , Sorensen K , Fadnes S , Nyrnes S A , Lovstakken L , Flattum M , Stugaard M , Kongsgaard E , Skulstad H , Remme E W
Published: January 2025

Introduction

Non-invasive estimation of the intraventricular pressure difference (IVPD) in early diastole using high-frame-rate ultrasound-based blood speckle tracking (BST) has been reported in pediatric cardiology of various pathologies. This novel echocardiographic technology has recently become available in probes suitable for the adult population.

Purpose

We tested the feasibility by analyzing intra- and interobserver variability and investigating if IVPD in the left ventricular inflow exhibited the expected differences in controls vs a group of heart failure patients to indicate the ability of this new index to assess diastolic function.

Methods

Apical BST images of LV inflow were acquired using a GE Vivid E95 ultrasound scanner and the M5Sc probe in healthy volunteers (n=9) and patients with heart failure and left bundle branch block (LBBB) (n=15) implanted with cardiac resynchronization therapy (CRT) 6±2 months (mean±SD) earlier. Echocardiography was performed both with CRT turned on and off. IVPD was analyzed from the BST acquisitions using custom software (Figure 1). Blinded intra- and interobserver variability analysis were performed on the measurements from the healthy controls with the same observer and two other observers, respectively.

Results

All the controls and 11 of the 15 patients had BST acquisitions eligible for IVPD-analysis, giving a total feasibility of 83%. Intraobserver reliability was excellent (intraclass correlation coefficient 0.96 [0.85, 0.99], mean and 95% CI) and interobserver reliability was good (intraclass correlation coefficient 0.88 [0.59, 0.97] and 0.84 [0.48, 0.96]) respectively. IVPD was highest in controls (-1.7±0.5 mmHg), and higher with CRT on (-1.3±0.7 mmHg, p=NS vs controls) than off (-0.9±0.5 mmHg, p<0.05 compared to both on and controls) in the patients.

Conclusions

Estimating the intracavitary pressure difference that accelerates blood into the LV during early filling seems feasible and reproducible in adult hearts by BST. IVPD is reduced in patients with heart failure and LBBB, and increases in patients with LBBB when treated with CRT. IVPD based on BST is a potential new echocardiographic method to evaluate diastolic function. Future improvements of the technology are warranted for widespread use.
Changes in myocardial function related to plasma potassium: a POTCAST substudy
Authors: Sakthivel T , Winsloew U , Zheng C , Danielsen E M , Bosselmann H , Haugan K J , Bruun N E , Joens C , Bundgaard H , Risum N
Published: January 2025

Background

Derangement of plasma potassium (p-K) is associated with an increased risk of developing cardiac arrhythmias. Small studies indicate that variations in p-K levels may also affect the mechanical function of cardiomyocytes. A recent clinical study demonstrated improvements in myocardial function by echocardiography after a short follow-up in patients randomized to p-K increasing treatment. However, the long-term effect of increasing p-K on cardiac function is unknown.

Purpose

To investigate if p-K increasing treatment improves diastolic and systolic myocardial function measured by echocardiography after an extended follow-up time.

Methods

The "Targeted potassium levels to decrease arrhythmia burden in high-risk patients with cardiovascular diseases trial" (POTCAST), randomizes patients at high risk of malignant cardiac arrhythmias (1:1) to either the intervention group or the control group. Patients in the intervention group were treated with oral potassium supplements and mineralocorticoid receptor antagonists (MRA) to reach high-normal levels of p-K (4.5-5.0 mmol/l). In total, 289 consecutive patients from the POTCAST trial were included in this substudy. Echocardiographies were performed at baseline and after at least six months of follow-up and compared by left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global constructive work (GCW), and diastolic parameters (E, e’, and E/e’).

Results

Patients (mean age: 58 years (SD±13.4), 77.5% male) had a median follow-up time of 729 days (IQR 475 days). The mean difference in change of p-K was 0.22 mmol/l (95%CI -0.31; -0.13), P<0,001 when comparing the intervention group to the control group between follow-up and baseline. No significant differences in changes in systolic function were found with LVEF -0.6% (-2.22; 1.08), p=0.5, GLS -0.26% (-0.96; 0.45), p=0.5 or GCW -3.99 mmHg (-89.5; 61.6), p=0.9. An improvement was found in the parameters e’lat with a mean difference in change of 0.77 cm/s (0.13; 1.4), p= 0.019, and E/e’ lat with a mean difference in change of -1.16 (-2.07; -0.26), p= 0.012. However, no difference in change was found in e’, E/e’ or other diastolic parameters.

Conclusion

When evaluating long-term effects of p-K increasing treatment on myocardial function by echocardiography, no overall differences were found in diastolic or systolic myocardial function when comparing the intervention group to the control group.
Identifying biomarkers and establishing their threshold values concordantly with LV remodeling for predicting long-term MACE following STEMI
Authors: Krasniqi X , Bakalli A , Kocinaj D , Krasniqi F , Vincelj J
Published: January 2025

Background

Following STEMI, diastolic function is altered by myocardial necrosis and microvascular disfunction. Consistent with these changes, the cardiac troponins are degraded and the release of cardiac natriuretic hormones inhibit the pathophysiological mechanisms responsible for ventricular remodeling (adverse diastolic remodeling, worsening of diastolic function ≥ 1 grade or persisting of restrictive pattern), thus NT-proBNP in non-acute phase of STEMI (early phase of ventricular remodeling) is a strong predictor of heart failure and mortality.

Methods

Prospective study population consisted of 96 consecutive patients with STEMI of onset <12h who underwent primary percutaneous coronary intervention (pPCI). The levels of creatine kinase (CK), the MB fraction of creatine kinase (CK-MB), troponin I, NT-proBNP, CRP, and other routine laboratory parameters were measured. In particular, we evaluated the levels troponin I on the first and seventh days (enzyme-linked immunosorbent assay (ELISA) ) and NT-proBNP in seventh day ( electro-chemiluminiscence method) after reperfusion therapy in all patients.

Results

The follow-up period was 12 months. Baseline clinical characteristics of patients are presented in table 1. A receiver operating characteristics (ROC) curve plots the true positive rate against the false positive rate at different cut-off points for NT-proBNP AUC=0.69 (95% CI, 0.53-0.85), p=0.012 and other biomarkers (Figure 1 and Table 2). Kaplan-Meier curves were used to show the number of MACE and the proportion of patients that survived at each even time point based on the cut-off value of NT-proBNP on the seventh day (1131pg/mL). The log-rank test for the difference in survival resulted in a p value of 0.007 (Figure 2.) In total 17 (17.7%) patients suffered from heart failure, 5 (5.2%) among patients with NT-proBNP value ≤ 1131pg/mL and 12 (12.49%) with value > 1131pg/mL (p < 0.001).

Conclusions

Adverse diastolic remodeling in the non-acute phase of STEMI (early phase of ventricular remodeling) were associated with high rates of MACE after STEMI, with significant variability in the NT-proBNP values.
Presence of paradoxical mid-systolic longitudinal strain (stretching) with speckle tracking in the basal inferior-to-lateral segments in mitral valve prolapse
Authors: Auriti A , Monaco L , Rauseo E , Antonini L , Colivicchi F
Published: January 2025

Background and Purpose

Abnormality in the motion of the inferior papillary muscle was found, in the past, in Mitral Valve Prolapse (MVP). We visually observed an odd movement not only in the inferior wall but also in the anterolateral and inferolateral basal walls in several MVP patients as well. Therefore, the purpose of this work was to analyze this findings with the help of Strain (Speckle Tracking).

Methods

60 MVP patients, having a superior displacement of the posterior leaflet of at least 2 mm, and 20 normal controls were included. Longitudinal Strain was calculated in the 3 apical views (Philips iE 33 Matrix - implemented Strain software). The Strain in the 3 above mentioned basal segments was measured at 160 msec from the beginning of systole (mid-systole) and then averaged to form a "triad" that could be compared among the groups for statistical calculations. The Global Longitudinal Strain (GLS) was calculated for all as well. The Mann-Whitney U-test for comparisons was used. A "p" value ≤ 0.05 was considered significant.

Results

According with the Strain patterns, we could identify two Groups of MVP patients: Group 1: having a "paradoxical" Strain at 160 msec (positive, that means stretching) in at least one of the three told basal segments (n = 35), and Group 2 : not having a "paradoxical" Strain (n = 25) in any of the told three basal segments at the same mid-systolic point. Statistical significance was found between Groups 1 and 2 at 160 msec (fig 1) and at the peak (p< 0.0001 for both) and for GLS (p< 0.01) as well. Group 1 vs controls also displayed significant difference in the Strain at 160 msec (p<0,0001) while Group 2 vs controls did not do and even not at the peak (bull-eye summary view in fig 2 ).

Conclusions

According with our results, there is a MVP population (more than the half in our series) having a "paradoxical" Strain (stretching) in one of the basal inferior-to-lateral segments in mid-systole. The passive continuous stretching of myocardial cells is known to lead, with time, to the replacement with fibrosis (and fibrosis is a condition that is well known to be a source of arrhythmias, and even malignant). Cardiac Magnetic Resonance (CMR) already demonstrated the presence of fibrosis just in the same basal wall segments in some MVP patients. Thus, considering our results in the Strain, in MVP patients with ventricular arrhythmias it is mandatory to analyze the Strain (not expensive tool), and then, if the Strain were to be found to be "paradoxical" even in only one segment of this previously called "triad", a further evaluation with CMR (even if expensive) is highly recommended to look for the presence of fibrosis. The Strain is highly recommended because the topic is implicated in prognosis, in the further study of arrhythmias, and in the choice of a proper therapy as well.

Fig 1

Fig 2
Severe secondary tricuspid regurgitation is associated with nonfatal heart failure hospitalization but not with mortality in patients with chronic heart failure aged 80 years or older
Authors: Kawata T , Ikeda A
Published: January 2025

Background

Previous studies have shown that tricuspid regurgitation secondary to heart failure (HF) is common with considerable effect on their outcomes. However, impact of secondary tricuspid regurgitation (sTR) on survival and hospitalization in patients with ultra-elderly HF are uncertain.

Purpose

To investigate impact of severe sTR in ultra-elderly HF.

Methods

We retrospectively enrolled 163 patients (median age, 87 years, 72 male) with HF aged ≥ 80 years-old admitted to our hospital for the treatment of decompensated HF. Clinical characteristics including echocardiographic data were obtained before discharge. In the present study, severe sTR was defined as vena contracta width ≥ 7mm based on the current guidelines. The date of discharge was considered the entry time-point of observation. Primary outcomes were defined as all-cause death, cardiac death or nonfatal HF hospitalization.

Results

Severe sTR was present in 35 patients (21.5%). During a median follow-up period of 500 (interquartile range, 255-1268) days, 60 all-cause deaths, 41 cardiac deaths and 51 nonfatal HF hospitalizations were occurred. In univariate Cox proportional hazards analysis, age, body mass index, albumin, hemoglobin, B-type natriuretic peptide (BNP), estimated glomerular filtration rate and the ratio of peak early diastolic trans-mitral flow velocity to annular velocity (E/e’) were associated with all-cause death. In multivariate Cox proportional hazards analysis, hemoglobin [hazard ratio (HR) 0.73, 95% confidence interval (CI) 0.59-0.90, p = 0.0037] and BNP levels (HR 1.003, 95%CI 1.001-1.004, p = 0.0008) were independently associated with all-cause death. Similarly, age, body mass index, presence of ischemic heart disease, albumin, hemoglobin, BNP and E/e' were associated with cardiac death in univariate analysis, and multivariate analysis showed that hemoglobin (HR 0.74, 95%CI 0.58-0.93, p = 0.013) and BNP (HR 1.003, 95%CI 1.001-1.004, p = 0.0034) were independently associated with cardiac death. Severe sTR was not associated with mortality even in univariate analysis. On the other hand, univariate analysis showed that age, albumin, hemoglobin and severe sTR were associated with nonfatal HF hospitalization, and multivariate analysis revealed that severe sTR (HR 1.91, 95%CI 1.02-3.42, p = 0.044) was the only factor independently associated with nonfatal HF hospitalization.

Conclusion

In ultra-elderly patients with chronic HF aged ≥ 80 years, severe sTR was associated with nonfatal HF hospitalizations but not with both cardiac and all-cause deaths. This result may indicate that percutaneous therapies should focus on the optimal timing of intervention in patients with severe sTR with respect to overall survival and quality of life.