bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary CT angiography a new promising tool in Heart transplanted patients: from clinical and economical benefits to coronary inflammation detection
Authors: Dellino C , Cozza E , Amato F , Savo M , De Conti G , Galzerano D , Tarantini G , Tessari C , Motta R , Gerosa G , Iliceto S , Pergola V
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Heart transplanted patients are usually monitored with invasive diagnostic techniques for detecting cardiac allograft vasculopathy (CAV). However coronary CT angiography (CCTA) is a new promising tool in the initial stages of CAV bringing clinical and economical benefits.

Purpose

1) assess the non-inferiority of CCTA in comparison to coronary angiography (CA), in terms of radiation and contrast dose, costs, hospitalization hours, complications and diagnostic accuracy; 2) analyse the different role of immunological and non-immunological risk factors predicting CAV in patients undergoing CCTA; 3) Investigate the rule of coronary inflammation through the pericoronary-fat-attenuation-index (pFAI) at CCTA in the progression of CAV.

Methods

179 heart transplanted patients were retrospectively analysed: 78 performed a CCTA and 101 performed a CA between March 2021 and May 2022.

Results

CCTA and CA showed similar radiation doses (8.47 [1.46–30] versus 8.15 [1.38–87.34]; p = 0.796) and rate of complications (0 (0%) vs 3 (3%); p = 0,258). CCTA in comparison with CA required less hours of hospitalization (0.5 hours versus 23.7 12.31 hours; p<0.001), lower costs (120 euros versus 2800 euros; p<0.001) and less contrast agent (60.4 8.7 ml versus 95.68 47.6ml; p<0.001). Diagnostic accuracy was similar between CCTA and CA (95% vs 100%; p = 0,169). Among the non immunological risk factors for CAV, only smoking showed a statistically significance in predicting CAV (p = 0.015). Among immunological risk factors, TNF was the only independent predictor in the progression of CAV (HR 8.23; IC 95% 1.47–45.81; p = 0.019). There were no statistically correlation between pFAI at CCTA either as a continuous variable or as a categorical variable (>-70.1HU) and the progression of CAV (p = NS).

Conclusions

CCTA is similar to CA in terms of radiation dose and rate of complications and is superior in terms of hospitalization hours, costs and contrast agent injected. Diagnostic accurancy was equivalent between CCTA and CA. TNF was the only independent predictor in the progression of CAV. Pericoronary inflammation assessed by pFAI at CCTA was not associated with the progression of CAV.
Spontaneous coronary artery dissection: the role of Coronary CT angiography in the follow-up management
Authors: Dellino C , Continisio S , Montonati C , Mattesi G , Cozza E , Savo M , Galzerano D , Tarantini G , De Conti G , Motta R , Iliceto S , Pergola V
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Spontaneous coronary artery dissection (SCAD) is one of the causes of acute coronary syndrome (ACS), myocardial infarction (MI) and sudden death (SD). Diagnosis is done with coronary angiography (CA); nevertheless, coronary computed tomography angiography (CCTA) is a new useful tool in the acute diagnosis and at follow-up. Treatment could involve a conservative approach or an invasive approach with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).

Purpose

1) analyze the clinical and CCTA features at baseline of patients with a SCAD diagnosis; 2) evaluate the clinical and anatomic outcome at follow-up of patients with a SCAD diagnosis treated with a conservative or invasive approach; 3) evaluate in the conservative approach treated patients the clinical and anatomic outcome of those dismissed with single or double antiplatelet therapy.

Methods

A retrospective analysis of 57 patients affected by SCAD followed up with Coronary CT angiography (CCTA) between 2010 and 2022. Clinical and anatomic data were collected at baseline and at the follow-up (FU). The clinical endpoints evaluated were: all cause mortality, hospitalization for cardiovascular cause, SCAD or PCI ex-novo and MI; the anatomic endpoints were: patency of coronary artery and/or stents and length dissection changing from baseline.

Results

57 patients were divided in 2 groups: 46 (80,7%) patients underwent a conservative treatment and 11 (19,3%) patients a PCI treatment. Patients treated with PCI has a significative incidence of smokers (45,5% vs 15,2%; p = 0,042), peripherical arteriopathy (18,2% vs 0%; p = 0,034), higher troponin peak (40425,8 vs 13436; p = 0,011) and lower ejection fraction (51,4±11,0 vs 57,1±7,6; p = 0,050). Moreover the PCI population has a significant involvement of more than one coronary artery (72,7% vs 6,5%; p<0,001), of the proximal tracts of the coronary arteries (22,8% vs 13 %; p = 0,001) and of the truncus communis (45,4% vs 0%; p<0,001). At the follow up, there were no statistical differences for the clinical and anatomic endpoints between the conservative and invasive treated patients (p>0,05). Among patients treated with conservative therapy, there were a significant recurrence of SCAD in those treated with DAPT than in those treated with SAPT (33,3% vs 5,9%; p = 0,033).

Conclusions

patients with SCAD managed with PCI have more cardiovascular risk factors, a major myocardial infarction extension and a more complex coronary arteries involvement; conservative management is comparable to the PCI treatment for the clinical and anatomic endpoints evaluated; DAPT at discharge was associated with a higher rate of SCAD recurrence at follow-up.
Behaviour of natural myocardial shear waves in children and adolescents: determinants and reproducibility
Authors: Youssef A , Salaets T , Bezy S , Wouters L , Orlowska M , Caenen A , Duchenne J , Puvrez A , Cools B , Gewillig M , Dhooge J , Voigt J U
Published: June 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Egyptian ministry of higher education and research

Background

Ultrafast echocardiography allows the direct non-invasive assessment myocardial shear waves (SW). These waves are naturally generated after mitral valve closure (MVC) and aortic valve closure (AVC) and their propagation velocities has been found to be linked to myocardial stiffness (MS) in adults. However, little experience exist regarding behaviour of such waves in children and normal values of SW velocities in children are lacking.

Purpose

This study aimed at setting up a reference range for SW velocities in paediatrics, determining influencing factors and exploring the reproducibility of their measurements in children.

Methods

One hundred-four healthy children (mean age 10 ±4 years old; range 2–18 years) were recruited. Participants were scanned with a research ultrasound scanner using divergent waves to yield a high frame rate of 1580 ±113 Hz. Parasternal long axis views (PLAX) were recorded for offline analysis. An anatomical M-mode was drawn along interventricular septum to visualize the propagation of shear waves after both MVC and AVC. Tissue Doppler acceleration maps were extracted and SW velocities were measured semi-automatically as the spatiotemporal slope of these waves (figure 1). Intra-class correlation coefficient (ICC) (2-way mixed model, absolute agreement between single measures) was used to check the reproducibility of these measurements among three raters.

Results

SW propagation velocities showed an association with clinical variables ; age (Figure2), body mass index (BMI) and body surface area (BSA). In addition, SW speeds showed association with local cardiac factors; ventricular septal thickness, LV mass and left ventricular end-systolic (LVESV) & end-diastolic volumes (LVEDV). Using a multivariate model; predictors of SW velocities after MVC are: age and LV mass (R2=0.59), while predictors of SW after AVC are: age, LV mass and LV volumes (R2= 0.33). In twenty-five randomly selected participants, moderate to good inter-observer reliability were noted among the three observers (ICC 0.84 [CI 0.70 to 0.92] after MVC, and ICC 0.83 [CI 0.69 to 0.92] after AVC).

Conclusions

Naturally occurring myocardial shear waves in children can easily be measured with acceptable reproducibility. Values are lower than in adults. SW velocities in children showed clear dependency on age, presumably due to growing heart size and increased myocardial muscle mass.
Determinants and prognosis of aortic valve calcification in conjunction with carotid atherosclerosis and left ventricular function
Authors: Kim M J , Choi E Y
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Aortic valve (AV) sclerosis is known as a progressive atherosclerotic disease causing aortic stenosis (AS). However, its contributors and prognostic value in patients without overt AS have not been well investigated.

Purpose

In this study, we sought to evaluate its determinants and prognostic value in conjunction with carotid atherosclerosis and left ventricular (LV) function.

Methods

Consecutive 4,689 patients who underwent both carotid ultrasound and echocardiography were followed during 3.6 ± 1.3 years after exclusion of patients with bicuspid aortic valve (n=12), rheumatic heart disease (n=7), overt AS (n=62) and AV replacement status (n=10). AV sclerosis was classified as pure AV sclerosis and AV sclerocalcification according to cusp thickening and presence of hyper-echogenicity in any cusps.

Results

Their mean age was 61.1±11.7 years and 1,836 (39%) were women. Of them 2,003 (43%) had pure AV sclerosis and 523 (11%) had AV sclerocalcification. Presence of AV sclerocalcification was independently correlated with age, presence and degree of carotid plaques, ventricular septal thickness, high density lipoprotein level and presence of atrial fibrillation. Presence of AV sclerocalcification was significantly related with composite cardiovascular events (all CVE, unstable angina, acute myocardial infarction and all cause death; log rank p = 0.011) and future heart failure (HF) admission (p<0.001) but not with pure AV sclerosis. In multivariate analysis, presence of carotid plaques was most strongly associated with all CVE, however when adding AV sclerocalcification on carotid plaques, it added the significant prognostic values (p = 0.015). Regarding future HF admission, the significance was attenuated after introducing left atrial volume index and LV ejection fraction.

Conclusions

AV sclerocalcification has additive prognostic value on carotid plaque for future atherosclerotic events. Although, AV sclerocalcification was related to future HF admission it was mainly mediated by concomitant LV dysfunction, suggesting a surrogate marker rather than independent risk factor.
Diastolic vortex ring derangements in ischemic cardiomyopathy left ventricles: a 4D Flow MRI study
Authors: Riva A , Saitta S , Sturla F , Camporeale A , Tondi L , Pica S , Giese D , Castelvecchio S , Menicanti L , Lombardi M , Redaelli A , Votta E
Published: June 2023

Funding Acknowledgements

Type of funding sources: Private hospital(s). Main funding source(s): This work was supported by IRCCS Policlinico San Donato, a Clinical Research Hospital partially funded by the Italian Ministry of Health.

Introduction

Blood flowing into the left ventricle (LV) forms a 3D vortex ring starting from the free margin of mitral valve leaflets and encompassing the inflow jet. Vortex ring formation is presumed to store part of the kinetic energy of the entering jet and help directing blood flow towards the aorta [1]. Changes in vortex formation are associated to altered endocardial wall motion and LV chamber remodeling, as in case of ischemic cardiomyopathy (ICM). 4D Flow MRI is currently the unique volumetric imaging technique to assess in vivo changes of diastolic vortex ring.

Purpose

To characterize changes in LV diastolic vortex ring and associated energetics in a cohort of ICM patients (n = 12) vs. controls (n = 12) with comparable age.

Methods

4D Flow MRI data were acquired for ICM patients presenting with anterior myocardial infarction and in healthy controls. The diastolic vortex ring was assessed at peak E-wave and at peak A-wave through the λ2 method [2]. Geometrical features of the vortex ring, e.g., circularity index (CI) and vortex orientation (α), were extracted (Figure 1). Kinetic energy (KE), rate of viscous energy loss (EL), vorticity and volume were computed for each vortex ring core; the ratios with the respective quantities computed for the entire LV were derived.

Results

At peak E-wave, the vortex ring was less circular (p = 0.017) and formed a smaller α with the mitral valve plane (p = 0.024) in ICM patients as compared to controls. At peak A-wave, the vortex ring core remained less circular (p = 0.027) in ICM patients, while vortex orientation remained comparable between the two groups. KE ratio, EL ratio, vorticity ratio and volume ratio significantly decreased for ICM patients at both E-peak and A-peak (Table 1).

Conclusions

Though ICM is primarily addressed and investigated as a systolic dysfunction, diastolic function can be deranged too, as highlighted by altered diastolic vortex ring shape and energetics.
Interaction between uric acid and obesity with myocardial dysfunction in diabetes
Authors: Li S M , Huang J Y , Wu M Z , Ng M Y , Lin Q S , Wu M , Liu M Y , Wang R , Cao G Z , Chen C , Ren Q W , Yiu K H
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Both obesity and hyperuricemia are major risk factors for cardiovascular diseases. Few studies have investigated their impact on cardiac structural and functional changes in patients with diabetes.

Purpose

This study aims to evaluate the impact of obesity, hyperuricemia and their interaction on myocardial dysfunction in patients with diabetes.

Methods

A total of 1567 patients with diabetes were recruited from two Hospitals. Uric acid (UA), body mass index (BMI) and myocardial structure and function indicators, including left ventricular hypertrophy (LVH), left ventricular ejection function (LVEF), left ventricular global longitudinal strain (GLS), circumferential strain (CS) and radial strain (RS). Multivariate linear regression was conducted to evaluate the association between myocardial structure and function with UA in obesity and non-obesity. The generalised linear models were used to test for the interaction effects of obesity on the associations between UA level and myocardial structure and function.

Results

Compared to non-hyperuricemia patients, those who were hyperuricemia had a greater left ventricular mass index (LVMi), a higher proportion of LVH and worse GLS and CS (all P <0.05). Similar patterns were found for those with obesity compared to non-obesity (all P<0.05). In patients with obesity and non-obesity, increasing UA was independently related with decreased GLS and CS. There is a significant interaction between hyperuricemia and obesity on LVMi and GLS in patients with diabetes (P for interaction <0.05) but not on LVEF, CS and RS.

Conclusions

Obesity and hyperuricemia were associated with worse left ventricular remodeling and left ventricular myocardial function. Those who were obesity and with hyperuricemia had more pronounced LVMi and GLS. Our finding emphasizes lowering UA and BMI in patients with diabetes may effectively prevent myocardial remodeling and dysfunction.
Polygenic risk scores in predicting the presence of coronary artery disease in symptomatic patients - A validation study utilizing an accurate phenotype based on state-of-the-art imaging
Authors: Kujala I , Vangipurapu J , Maaniitty T , Saraste A , Kere J , Knuuti J
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Academy of Finland Turku University Hospital.

Background

Clinical risk scores for coronary artery disease (CAD) are used routinely in clinical practice to identify high risk patients in which diagnostic testing and therapy are warranted. Several recent studies suggested that polygenic risk scores (PRS) derived from millions genetic variants and hundreds of thousands subjects are able to identify those with higher risk of developing CAD. PRSs have been proposed to be included in clinical care, but their performance in clinical setting has not been validated.

Purpose

Our aim was to assess the predictive power of 4 established PRSs in prediction of CAD.

Methods

The study was carried out in 943 symptomatic patients with suspected CAD for whom the phenotype has been accurately characterized using state-of-the-art anatomic (CTA) and functional imaging (PET perfusion).

Results

The ROC curves for models combining clinical data and PRS in predicting obstructive CAD are shown in Figure. The predictive accuracy of the models combining clinical data and different PRS varied between 0.778–0.805 (in terms of AUROC), being close to the model including only clinical variables (AUROC 0.769) and yielding an improvement of only 0.9–3.6 percentage points over clinical data alone. The difference between clinical model and combined clinical + PRS model was not significant for PRS1 (p = 0.479), PRS2 (p = 0.627) and PRS4 (p = 0.061), respectively. Only PRS3 slightly (AUC change 0.036) but nominally significantly improved the predictive power of the model (p = 0.04).

Conclusions

We found that the addition of PRSs to conventional risk factors did not clinically significantly improve the predictive accuracy for either coronary atherosclerosis or obstructive CAD, suggesting that current PRSs are not justified for clinical routine for CAD.
Focused echocardiographic screening of the aortic valve and aorta in elite rugby players
Authors: Chatrath N , Forster J , Fyyaz S , Bhatia R , Marwaha S , Scrocco C , Ensam B , Howes R , Al-Turaihi S , Sharma S , Tome M , Papadakis M
Published: June 2023

Funding Acknowledgements

Type of funding sources: Other. Main funding source(s): Grant from the charitable organisation Cardiac Risk in the Young.

Background

Pre-participation cardiac screening (PPS) of professional rugby players in the United Kingdom consists of an ECG-based evaluation. However, structural abnormalities that would not manifest on an ECG, such as aortic dilatation might be underdiagnosed and aortic dissection has previously been identified as a cause of sudden cardiac death in athletes (1).

Purpose

To trial focused transthoracic echocardiography (FTTE) screening for aortopathy as part of PPS and to determine normative aortic root measurements in rugby players, comparing dimensions with sedentary controls.

Methods

Professional male rugby players undergoing PPS were consented to have an FTTE performed as part of their cardiac evaluation. The aortic valve was visualised in the parasternal long and short axis views to delineate valve morphology. Aortic root measurements were taken at the sinus of Valsalva (SOV), sinotubular junction (STJ) and ascending aorta (AA) at end-diastole, from inner edge to inner edge. All measurements were indexed to the individuals height (in metres). Dilatation was defined as a dimension of >40mm at any aortic level. The findings were compared with a control population of sedentary age, and height-matched volunteers (defined as <2 hours physical activity per week) recruited from a national screening programme offered by the charitable organisation Cardiac Risk in the Young (CRY).

Results

131 rugby players were screened, mean age 20.5years and on average engaged in 16 hours of mixed aerobic and strength-based training per week. 187 age-and-height-matched sedentary controls were included. Overall, rugby players had a significantly larger aortic root at all levels measured, compared with controls (Table 1). The only exception was the indexed ascending aorta dimensions. 2 rugby players had aortic dimensions >40mm at the SOV compared with no controls. A bicuspid aortic valve (BAV) was identified in 1 in one rugby player and 2 controls. These were excluded from the comparison of aortic dimensions due to the likelihood of them having an associated aortopathy.

Conclusion

Incorporating FTTE as part of existing PPS algorithms is an inexpensive way of screening for aortopathy and BAV. Identifying abnormalities may enable individuals to be suitably followed-up. Elite rugby players have a larger aortic root than sedentary controls. The significance of this requires corroboration in larger-scale, longitudinal studies.
Validation of coronary CTA based-British cardiovascular intervention society Jeopardy score (CT-BCIS-JS) against invasive BCIS-JS - a feasibility and reproducibility study
Authors: Schaab J S , Candreva A C , Garefa C G , Pazhenkottil A P P , Benz D C B , Kaufmann P A K , Buechel R R B , Staehli B E S , Giannopoulos A
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Promedica Stiftung and the Iten-Kohaut Foundation in collaboration with the USZ Foundation

Background/Introduction

The invasive British Cardiovascular Intervention Society Jeopardy Score (iBCIS-JS) is a simple angiographic scoring system, enabling quantification of the extent of jeopardized myocardium related to clinically significant coronary artery disease (CAD). Ranging from 0 (no significant CAD) to 12 (CAD jeopardizing the whole LV- myocardium), the score is used for the entire spectrum of CAD including left main coronary artery and coronary artery bypass graft disease. A score of ≥6 identifies patients with anatomically high-risk CAD. Non-invasive CAD assessment with coronary CTA is hampered by modest specificity, leading potentially to increased utilization of downstream diagnostic tests.

Purpose

To validate coronary CTA-based assessment of the BCIS-JS (CT-BCIS-JS) against the iBCIS-JS and to assess its feasibility and reproducibility.

Methods

A total of 137 patients who underwent clinically indicated coronary CTA and subsequent invasive coronary angiography within 90 days were included in the analysis. Eleven patients were excluded due to suboptimal CTA image quality. CT-BCIS-JS and iBCIS-JS were calculated. Correlations were assessed with the Spearman’s rank correlation coefficient and agreement between scores with Bland-Altman (BA) analysis and with weighted kappa statistics. Inter-observer variability was investigated in a subset of 51 randomly selected patients.

Results

Median and interquartile range (IQR) of CT-BCIS-JS was 4 (IQR=8) and of iBCIS-JS 4 (IQR=8) (Figure 1). A CT-BCIS-JS of ≥6 and was observed in 56 (44%) patients and an iBCIS-JS of ≥6 in 54 patients (43%). An excellent correlation between the iBCIS-JS and the CT-BCIS-JS was observed (rho=0.97, p<0.0001; Figure 2A) with high agreement (BA bias 0.1 and limits of agreement −2.0 to 2.2; Figure 2B). Kappa analysis demonstrated excellent aagreement for identification of a iBCIS-JS of ≥6 (Kappa Weighted= 0.94, 95% CI 0.87–0.99). Inter-observer analysis revealed excellent correlation (rho=0.98, p<0.0001) and agreement (BA bias 0.12 and limits of agreement −1.33 to 1.57).

Conclusions

The CT-BCIS-JC represents a feasible and highly reproducible tool for accurate, non-invasive identification of patients with anatomically high-risk CAD. Hence, the CT-BCIS-JC may serve as reliable gatekeeper for invasive testing in the management of patients with CAD.
Plasma exosomes reflect myocardial injury detected by cardiac magnetic resonance in STEMI patients
Authors: Baggiano A , Zara' M , Banfi C , Campodonico J , Tedesco C , Amadio P , Gili S , De Dona G , Sandrini L , Maragna R , Junod D , Fusini L , Marenzi G , Pontone G , Barbieri S
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Cardiac magnetic resonance (CMR) is the gold standard technique to detect microvascular obstruction (MVO) and myocardial salvage index (MSI) in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). Exosomes are lipid vesicles released by all cells that reflect the metabolic status of the releasing cells, thus representing potential biomarkers of disease. The aim of this study is to evaluate the correlation between exosome profile and myocardial infarction characteristics as detected by CMR in patients after STEMI.

Methods

Exosomes were isolated from plasma of 42 patients by different commercial kits, their concentration and size distribution determined by Nanoparticle Tracking Analysis, exosomal surface epitopes by the MACSPlex Exosome Kit and GPIIb-IIIa expression by ELISA kit. Data obtained were correlated with parameters of myocardial damage (STEMI location, culprit lesion, time to revascularization, MVO and MSI).

Results

Levels of circulating plasma exosomes were higher in patients with anterior STEMI (p = 0.0002) and when the culprit lesion was located in LAD (p = 0.045). In addition, a high number of exosomes was measured in the subset of patients who underwent a late revascularization (> 3 h from onset of symptoms; p = 0.038). Patients with MVO and low MSI (< 0.5) have smaller exosome (p = 0.0015 and p = 0.014, respectively). By analysing the expression of 37 surface protein markers, the strongest signals are plateletspecific markers (CD41b and CD42a) followed by endothelial and immune cells markers. Interestingly, a lower expression of platelet marker GPIIb-IIIa was detected in both patients with MVO and anterior STEMI (p = 0.039 and p = 0.0038, respectively). Univariate analysis demonstrated that exosome size and GPIIb-IIIa were independent predictors of MVO/MSI and ROC analysis demonstrated that dimension and GPIIb-IIIa can identify patients with MVO/MSI (AUC 0.75 and 0.71, respectively).

Conclusion

The plasma exosome profile well reflects CMR-assessed myocardial injury after STEMI. In particular, the exosome dimension and the expression of platelet marker GPIIb-IIIa are independently associated with MVO. Future studies with larger populations are required to confirm the role of platelet-derived exosomesin risk stratification after STEMI.
Right ventricular myocardial work characterization in patients with pulmonary hypertension and association with pulmonary hypertension severity
Authors: Lacerda Teixeira B , Santos A R , Albuquerque F , Ferreira A , Reis J , Galrinho A , Cruz Ferreira R
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Right ventricular myocardial work (RVMW) assessed by transthoracic echocardiography allows to study and analyze the right ventricular (RV) function non-invasively, using RV pressure-strain loops. The association between these novel indexes of RVMW and invasive hemodynamic parameters has not yet been extensively studied, namely in precapillary pulmonary hypertension (PH) population.

Objectives

To evaluate the relationship between RVMW and the severity of PH through invasive indices of right heart catheterization (RHC) in a cohort of patients with group I and group IV PH.

Methods

A prospective registry of pre-capillary PH patients evaluated in a single tertiary center was used. Echocardiography and right heart catheterization were performed in the same day. Dedicated software for left ventricle myocardial work was used for the RV. RV global myocardial work index (RVGWI) was calculated as the area of the RV pressure-strain loops. From RVGWI, RV global constructive work (RVGCW; work contributing to myocardial shortening during systole and lengthening during isovolumic relaxation), RV global wasted work (RVGWW; work contributing to myocardial lengthening during systole and shortening during isovolumic relaxation), and RV global work efficiency (RVGWE; relation between RVGCW and RVGWW) were estimated. Pearson’s correlation was applied to assess correlations between continuous variables.

Results

17 pts (80% women, mean age 67 ± 10 years) were included. Conventional echocardiographic parameters for the evaluation of RV systolic function, such as TAPSE, annular tricuspid s’ velocity and fractional area change (FAC), did not correlate with mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR). Strong correlations were found between right ventricle-pulmonary artery (RV-PA) coupling and mPAP (r = -0,655, p = 0,006) and RVP(r = - 0,610, p = 0,017), as well as with RV GLS (r = 0,749, p = 0,001 and r = 0,622, p = 0,01, respectively). Of the RVMW indexes, RVGWI, RVGWW and RVGWE strongly correlated with mPAP and PVR: as these invasive parameters increase, RVGWI (r = -0,581, p = 0,015 and r = -0,536, p = 0,027, respectively) and RVGWE (r = -0,779, p < 0,001 and r = -0,773, p < 0,001, respectively) decline significantly, whereas RVGWW (r = 0,735, p = 0,001 and r = 0,800, p < 0,001) increases. In our population, only RVGCW didn’t correlate significantly with high afterload (r= −0,304, p = 0,235 for mPAP, and r = -0,181, p = 0,488 for RVP).

Conclusions

New methods to evaluate RV function are crucial in patients with RV hemodynamic overload, since conventional echocardiographic parameters do not perform well. Novel echocardiographic assessment of RVMW are associated with severity of PH in our population.
The incremental value of PET perfusion imaging over coronary CT angiography in predicting outcome. A study using machine learning
Authors: Kujala I , Lehtonen E , Tamminen J , Maaniitty T , Saraste A , Teuho J , Knuuti J , Klen R
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Academy of Finland, Turku University Hospital

Background

Coronary computed tomography angiography (CTA) and myocardial perfusion imaging (MPI) are powerful non-invasive tools to evaluate the patients with suspected coronary artery disease (CAD).

Purpose

The goal of this study was to evaluate the incremental value of these imaging methods in predicting short- and long-term cardiac events using machine learning (ML) approaches.

Methods

2411 patients with clinically suspected CAD underwent coronary CTA and subsequent positron emission tomography (PET) MPI. Following our local routine, if obstructive CAD cannot be ruled-out by coronary CTA, PET MPI using 15O-water is performed. The incremental prognostic value of PET imaging was tested using several ML models of which XGBoost models consistently outperformed others and were chosen for further analyses. XGBoost models were trained by using clinical data from medical records and coronary imaging findings: one set of models used all the available variables, while a second set of models used only clinical and CTA-based variables. Differences in the performances of the models were then used to assess the incremental value of PET perfusion variables in outcome prediction.

Results

After the removal of incomplete data entries, data from 2284 patients was retained for further analysis. During 8-year follow-up period 210 patients had a major cardiac event (these endpoints correspond to 59 myocardial infarctions, 35 unstable angina pectoris, and 116 deaths). The PET perfusion imaging data improved the predictive power of CTA during the first 4 years of observation time. After that, no significant difference in the predictive power was observed between the considered sets of XGBoost models, which either included or did not include PET perfusion data in the input variables. The highest area under the receiver operating characteristic curve (AUC) was at the observation time of 2 years (0.81, 95% CI 0.805–0.823) when PET data were included. The corresponding AUC when PET data were not included was at the observation time of 2 years (0.79, 95% CI 0.785–0.802).

Conclusions

Based on ML approach PET perfusion imaging improves the power in predicting cardiac events over anatomical CTA imaging for the first 4 years. The results illustrate the differences and complementary nature of anatomic and perfusion information in predicting outcome of patients with suspected CAD.
Impact of coronary CT image quality on the accuracy of the FFRCT Planner
Authors: Belmonte M , Andreini D , Penicka M , Paolisso P , Mileva N , Norgaard B L , Ko B , Otake H , Koo B K , Updegrove A , Taylor C , Leipsic J , Sonck J , De Bruyne B , Collet C
Published: June 2023

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The study was sponsored by the Cardiac Research Institute Aalst (Aalst, Belgium) with unrestricted grants from HeartFlow (Redwood City, California, USA) and CardioPath (University of Naples, Naples, Italy).

Aims

To assess the accuracy of a virtual stenting tool based on coronary CT angiography (CCTA) and fractional flow reserve (FFR) coronary derived from CCTA (FFRCT Planner) across different levels of image quality.

Methods and results

Prospective, controlled, multicenter, single-arm study of patients with chronic coronary syndromes and significant lesions based on invasive FFR ≤0.80. All patients underwent clinically indicated CCTA performed with recent generation scanners. CCTA image quality was adjudicated using the four-point Likert scale at per-vessel level by an independent committee blinded to the results of the FFRCT Planner. The FFRCT Planner was applied mirroring the percutaneous coronary intervention (PCI) to determine the agreement with invasively measured post-PCI FFR. Overall, 120 patients (123 vessels) were included. Mean age was 64.0±9.2 years, 27% were diabetics. Invasive post-PCI FFR was 0.88±0.06 and Planner FFRCT was 0.86±0.06 (mean difference 0.02 FFR units, LLA −0.12, ULA 0.15). CCTA image quality was assessed as excellent (Likert score 4) in 48.3%, good (Likert score 3) in 45% and sufficient (Likert score 2) in 6.7% of patients. The FFRCT Planner was accurate across the different levels of image quality with a mean difference between FFRCT Planner and invasive post-PCI FFR of 0.02±0.07 in Likert score 4, 0.02±0.07 in Likert score 3 and 0.03±0.08 in Likert score 2, p = 0.695.

Conclusion

The FFRCT Planner was accurate to predict post-PCI FFR independent of CCTA image quality.
A new simplified cardiac damage staging for aortic stenosis: the role of longitudinal global strain and right ventricular arterial coupling
Authors: Gutierrez Ortiz E , Olmos C , Carrion I , Jimenez P , Nombela L , Parraga R , Gil S , Mahia P , Luaces M , De Agustin A , Islas F
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Transcatheter aortic valve replacement (TAVR) continues to evolve as a treatment for patients with severe aortic stenosis (AS) in different clinical scenarios. As aortic valve disease progresses, secondary cardiac damage sets in; this damage is not always reversible and determines the prognosis by itself. Concerning extra-valvular repercussions, different staging systems of cardiac damage have been published and proposed as a prognostic tool that may help to improve the selection of candidates to TAVR.

Purpose

The aims of our study were to identify independent risk factors for 1-year mortality in patients with severe AS undergoing TAVR and to develop a new cardiac damage staging system to stratify these patients.

Methods

patients undergoing TAVR from 2017 to 2021 were included in a single-center prospective registry. Transthoracic echocardiography was performed in all patients before TAVR. Logistic regression analysis and Cox’s regression were used to identify predictors of 1-year all-cause mortality. Applying variables from the regression analyses, a new staging model was proposed. The area under the ROC curve (AUC ROC) was used to measure the discriminatory capacity of different staging models to predict 1-year mortality risk.

Results

496 patients (mean age 81.9±6.2 years, 67% men) were included. 1-year mortality in our population was 22.3% (n= 111). Left ventricle ejection fraction (LVEF), moderate mitral regurgitation (MR), severe tricuspid regurgitation (TR), and right ventricular-arterial coupling (RVAc) were found to be independent predictors of all-cause 1-year mortality. A new classification system with three different stages was developed:

Stage 0) No cardiac damage: LVEF ≥ 60%; left ventricle global longitudinal strain (LV-GLS) < −15%, RVAc ≥ 0.35 and absence of MR.

Stage 1) Left side subclinical damage: LVEF 50–59.9% or LV-GLS ≥ −15% or presence of moderate or severe MR.

Stage 2) Left or right ventricular damage: LVEF < 50% or RVAc < 0.35.

The area under the ROC curve for this model was 0.67 (95% confidence interval 0.60–0.73), and its predictive performance was superior compared to the previously published systems (p = 0.009). A stepwise increase in 1-year all-cause mortality for each category increment in this new cardiac staging system was found.

Conclusion

Cardiac damage staging might have an important role in patients’ selection and better timing for TAVR. A model that includes new parameters, such as LV GLS and RVAc, may help to both improve prognostic stratification and contribute to better selection and earlier programming of TAVR.
4D flow cardiovascular magnetic resonance for the assessment of aortic valve repair with ozaki technique
Authors: Maragna R , Pirola S , Pirola S , Mastroiacovo G , Baggiano A , Bonomi A , Mushtaq S , Frappampina A , Tassetti L , Volpe A , Nanci G , Junod D , Fileccia D , Polvani G , Pontone G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Aortic valve neocuspidalization (Av-Neo) aims to replace the three aortic cusps with autologous pericardium pre-treated with glutaraldehyde and is becoming a valid alternative to traditional aortic valve replacement (AVR). 4D-flow cardiac magnetic resonance (4D-CMR) imaging of patients allows the derivation of shear stress on the aortic wall (WSS). Different studies support the presence of a link between increased WSS at 4D-CMR and the presence of histological alterations of the aortic wall.

Purpose

To compare the WSS of the ascending aorta in patients who underwent Av-Neo vs AVR with biological prostheses.

Methods

We performed 4D-flow CMR on 20 patients who underwent AV-Neo (Group A) or AVR (Group B), 10 patients for each group.

Results

The WSS in the Ozaki group was significantly lower in the proximal and distal aortic outer curvature compared to AVR patients (p 0.0179 and 0.0412, respectively, Figure 1 and 2). WSS levels remained significantly lower at the proximal aorta’s outer curvature segment in the Av-Neo population, also after adjusting the WSS for the ejection fraction and the LVOT-Aorta angle (p 0.02).

Conclusions

Av-neo hemodynamical features showed to be non-inferior to the ones provided by the commercially available bioprosthetic valves. Av-Neo procedures may be considered in patients affected by collagenopathy and other predisposing risk factors for the development of ascending aortic aneurism and aortic dissection other than classical AVR.
Prognostic value of myocardial scar burden using cardiac magnetic resonance in ischemic and non-ischemic cardiomyopathy
Authors: Laymouna R , Elsharkawy E , Salah El-Tahan S , Mohamed Elfeky M
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Myocardium is a unique muscle type designed to perform a specific function; conducting electrical activity to both ventricle simultaneously to contract and relax in a synchronized manner. Therefore, evaluation of the myocardial muscle function only using left ventricular ejection fraction (LVEF) would be inaccurate. However, assessment of the myocardium on the tissue level, is expected to provide more precise data regarding the ability to conduct, contract and relax properly.

Purpose

is to evaluate the prognostic value of myocardial scar using CMR on the clinical outcome in patients with ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM).

Methods

154 patients with either ICM or NICM underwent CMR (using 1.5T) for assessment of LVEF, detection and quantification of any myocardial scar by calculating the percentage (%) of scar mass to the whole myocardial mass (using manual quantification of scarred tissue in each myocardial segment, summed and divided by the total myocardial mass). Patients were followed up for at least 6 months for any cardiac events.

These events were scaled according to severity from 1 (asymptomatic) to 7 (most severe), including; no symptoms, mild non-acute chest pain, mild dyspnoea (NYHA I-II), hospital admission due to decompensated heart failure, syncope, documented ventricular arrhythmia and sudden cardiac arrest/death, respectively.

Statistical correlation between the amount of scarred myocardium in both ICM (group I) and NICM (group II) patients and the severity of the clinical events during the period of the follow up was performed.

The study included 154 patients, 56% were males, mean age of 61 years with minimal follow up duration of 6 months.

Patients were divided into: group I with ICM (58%) and group II with NICM (42%). Clinical presentation was ranging from eventless (10%), chest pain (18%), heart failure (15%), hospitalization (35%), syncope (1%), ventricular tachycardia (<1%) and up to cardiac arrest (<1%).

Direct relationship was observed between scar size and event severity in the two groups (P value < 0.001). However, inverted relationship between LVEF and event severity in group I (P value of < 0.001) was detected but not in group II (P value 0.128), as shown in figure 1. Low EF was mainly linked with hospitalization in both ICM and NICM.

It was observed that serious cardiac events were less detected in patient with mean scar mass < 5.4–8.4% . However, patients who have experienced sudden cardiac arrest have a mean scar mass of 15.9 % and patients with ventricular tachycardia with mean of 9.8%.

Conclusion

The amount of scarred myocardium is found to be directly linked to the severity of the clinical event in both ICM and NICM. Therefore, quantification of myocardial scar could be used as a predictor for cardiac events, hospitalization and sudden cardiac death.
New insights into left ventricular mechanics assessed by cardiac magnetic resonance and myocardial work analysis in non-compaction
Authors: Visoiu I S , Rimbas R C , Mihaila-Baldea S , Magda S L , Mihalcea D , Memis H , Nicula A I , Vinereanu D
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 2 National Grants of the Romanian Ministry of Research and Innovation - UEFISCDI: "Heart Preserved" and "PRO HEART 3D.

Background

The so-called left ventricle non-compaction (LVNC), better described as excessive trabeculation, is a highly debated myocardial phenotype. One of the main debates is whether excessive trabeculation is a remodeling feature due to volume load and LV dilation, or is the primary cause of LV dysfunction with LV dilation in the advanced stages.

Purpose

We aim to evaluate the relationship of LV trabeculations with LV volumes and systolic function in patients with LVNC.

Methods

50 patients with suspected LVNC were evaluated by cardiac magnetic resonance (CMR), transthoracic echocardiography (TTE), and N-terminal prohormone of brain natriuretic peptide (NTproBNP). To avoid over-diagnosis of LVNC, we analyzed 27 patients confirmed by CMR, with a positive Jacquier criterion [the percentage of non-compact myocardium mass (NCCM) >20%], excluding those having only a positive Petersen criterion. By CMR, we measured left ventricular end-diastolic volume index (LVEDVi), left ventricular end-systolic volume index (LVESVi), and left ventricular ejection fraction (LVEF). By TTE, we measured global longitudinal strain (GLS), and we performed myocardial work analysis (MWA), as a less afterload-dependent parameter than GLS, measuring global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE).

Results

Clinical and biological characteristics, CMR, GLS, and MWA results are detailed in Table 1. Mean percentage of NCMM was 29.45±10.3%. 89% of patients had HF, with LVEF ranging from 17% to 73%. There was no correlation between percentage of NCMM and LVEDVi. Instead, percentage of NCMM correlated positively with LVESVi (R=0.389, p = 0.045) and negatively with LVEF (R=-0.507, p = 0.007) (Figure 1). There was also no correlation between percentage of NCMM and GLS. Percentage of NCMM correlated negatively with GWE (R=-0.539, p = 0.004) (Figure 1), but not with GWI (p = 0.161), GCW (p = 0.249), or GWW (p = 0.060). By linear regression, per 10% increase in NCMM, LVEF decrease by 8.3% and GWE decrease by 4.2%. Percentage of NCCM had a trend to correlate positively with logNTproBNP (R=0.321, p = 0.103).

Conclusions

Our results suggest that excessive trabeculation in patients with LVNC is not a marker of chronic preload. LVNC seems to be a distinct cardiomyopathy, with a spectrum of systolic impairment proportional to the degree of hypertrabeculation. MWA is a promising tool to evaluate the functional implication of LV trabeculations.
Association between left ventricular strain and fibrosis in severe aortic regurgitation with preserved ejection fraction: a magnetic resonance and histology study
Authors: Kockova R , Hlubocka Z H , Medilek K M , Linkova H L , Paskova E P , Mraz T M , Prokopova M P , Sedmera D S , Kelen De Oliviera E K , Cerny S C , Skalsky I S , Penicka M P
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Institutional Grant Na Homolce Hospital

Background

The presence and extent of myocardial fibrosis are associated with poor outcomes in patients with severe aortic regurgitation. In the present study, we tested a correlation between left ventricular (LV) strain derived by using feature-tracking cardiac magnetic resonance (MRI) and diffuse myocardial fibrosis percentage (DMF%) at quantitative histology.

Methods

A study population included 23 patients (age 51 ± 12 years, 78% males) who underwent perioperative myocardial biopsy during aortic valve surgery for severe aortic regurgitation and who had a satisfactory pre-surgery MRI. Myocardial specimens obtained with a deep needle technique from the basal interventricular septum were stained with picrosirius red, digitalized, and analyzed using Image J software by a pathologist blinded to imaging findings. The DMF% was calculated as a ratio of the total collagen content to the total area. MRI-derived global longitudinal-(GLS), circumferential- (GCS), and radial (GRS) strain, as well as their ratio to heart rate and systolic blood pressure, were assessed using a feature-tracking technique by a certified imager blinded to histological analysis.

Results

Compared to normal values, all patients showed increased DMF% (19 ± 9%) and decreased GLS (15 ± 2%) despite preserved LV ejection fraction (64 ± 7%). Out of all the imaging parameters, only GLS/heart rate ratio, GCS/heart rate ratio and extracellular volume fraction showed a significant correlation with DMF% (Table 1, Figure 1). In contrast, GLS and GCS only tended to correlate with DMF%. The remaining parameters including GRS did not show a significant association. Patients with focal midwall scar in late gadolinium enhancement imaging (n=8, 35%), which was mainly localized in the basal septum, had similar GLS as than patients without focal scar (14.5±2.3 vs 15.3±2.3, p = 0.768).

Conclusions

Feature-tracking-derived ratios of LV GLS and GCS over heart rate are the most promising indices for non-invasive assessment of diffuse myocardial fibrosis in severe aortic regurgitation with preserved ejection fraction.

Figure 1 Legend

Correlation of a GLS/HR ratio 1A) and GLS 1B) with diffuse myocardial fibrosis %. Myocardial histology stained with Picrosirius red (collagen fibers are in red).