bluuebunny/crossref_metadata_2025 huggingface dataset:
Progression of atherosclerotic plaque determined by computed tomography angiography: a practical CCTA-based SCORE
Authors: Volpe A , Mushtaq S , Baggiano A , Annoni A , Carerj M L , Cilia F , Fazzari F , Formenti A , Fusini L , Mancini M E , Marchetti F , Maragna R , Tassetti L , Rossi A , Pontone G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Currently, no recommendations are endorsed by the different scientific societies on the clinical use of repeated coronary computed tomography angiography (CCTA) in patients with non-obstructive coronary artery disease (CAD).

Purpose

The aim of this study was to develop and validate a practical and simple CCTA risk score to predict medium-term disease progression in symptomatic patients at low-to-intermediate probability of CAD.

Methods

Six hundred forty-six [430 (derivation cohort) and 216 (validation cohort)] symptomatic patients with two repeated, clinically indicated CCTA scans, non-obstructive stenosis, and absence of high-risk plaque at baseline CCTA were included. Disease progression was defined as the new occurrence of obstructive CAD (stenosis≥50%) and/or high-risk plaque features at follow-up CCTA.

Results

In the derivation cohort a total of 167 (27%) patients experienced disease progression. Hazard ratios for disease progression derived from multivariable Cox proportional hazard model were as follows: 1.8 (95% confidence interval: 1.1–2.8) for active smoking, 1.2 (1.1–1.3) for segment involvement score, 0.45 (0.29–0.69) for calcified plaque (vs. non-calcified plaque), 2.7 (1.8–4.0) for stenosis 25–49% (vs. stenosis <25%), and 1.6 (1.1–2.4) for left main or proximal left anterior descending coronary artery location. The C-statistic of the derived score was 0.69 (0.63–0.74) and 0.62 (0.54–0.71) in the derivation and validation cohorts, respectively. Figure shows 2 explicative cases.

Conclusions

The new CCTA-based risk score is a simple and practical tool which can predict mid-term CAD progression in symptomatic patients with non-obstructive CAD.
The cardioprotective effects of pharmacological postconditioning with mangafodipir in ST-elevation myocardial infarction, a 4–7 years follow up study
Authors: El-Saadi W , Engvall J , Karlsson J E , Maret E
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Futurum - the academy for health and care, Jönköping.

Background/Introduction

The prevalence of heart failure is increasing as more patients survive a myocardial infarction (MI). MI scar extent is a strong predictor of the development of heart failure due to left ventricular adverse remodeling. Reperfusion injury occurs in the early phase of reperfusion and is linked to the increase of reactive oxygen species (ROS) with calcium overload disrupting the mitochondrial structure, which in turn results in further cell necrosis. Manganese dipyridoxyl diphosphate (mangafodipir) has superoxide dismutase mimetics and may act as a ROS scavenger in the acute phase of myocardial ischemia, hence supporting the myocardial cells in the neutralization of the chemically reactive molecules reducing the MI extent [1–3].

Purpose

Our aim was to investigate the cardioprotective role of pharmacological postconditioning with mangafidipir in patients with ST-elevation myocardial infarction (STEMI).

Methods

Twenty patients with acute STEMI were enrolled between 2009–2014 and followed up 2017. The subjects were randomized in the cath lab into blinded treatment with i.v mangafodipir or control treatment receiving i.v saline prior to restoration of blood flow in the occluded coronary artery. Cardiac magnetic resonance imaging (CMR) at baseline and at follow-up (4–7 years) was performed to evaluate MI scar, LV end diastolic volume (LVEDV), LV end systolic volume (LVESV), LV stroke volume (LVSV), LV ejection fraction (LVEF) and LV mass (LVM). The study was approved by the ethical review board in Linkoping (Dnr 2016/212-31) and registered in the public database at clinicaltrials.gov (NCT 00966563).

Results

There was no significant difference between the groups in MI scar or LV geometrical and functional properties at baseline, although the duration of ischemia was significantly longer in the mangafodipir group (206 min vs. 144 min, p < 0.05) and a better TIMI grade before pPCI was observed in the control group. The group that underwent pharmacological postconditioning with mangafodipir had lower volumes and higher LVEF (p < 0.05) at follow-up, while the placebo group showed increased LV volumes, see Table 1 and Figure 1.

Conclusion

Pharmacological postconditioning with mangafodipir in STEMI may have a cardioprotective role in the development of left ventricular adverse remodeling. Due to the limited number of participants, the benefit of mangafodipir needs confirmation in larger studies.
Pre-CABG assessment of coronary stenosis with FFR-CT predicts future graft failure
Authors: Kruk M , Wardziak L , Demkow M , Kepka C
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): National Institute of Cardiology grant.

Objectives

To evaluate, whether a pre-CABG coronary computed tomography based FFR (FFR-CT) result at the site of a future anastomosis would predict the graft failure in patients undergoing CABG.

Background

Functional guidance of surgical coronary revascularization remains debatable. Recently FFR-CT is recognized as suitable for the diagnosis of vessel-specific ischemia.

Methods

In 43 patients (mean age 65.14y (± 9.91), 15 women) who had CCTA performed less than 6 months prior to the isolated CABG, follow-up CCTA were acquired >12 months post CABG procedure (at median of 903[IQR:468–1669] days). Based on the pre-CABG CCTA, FFR-CT values were simulated. On the basis of follow-up CCTA the anastomosis sites and the graft patency were determined. The graft failure was defined as either its stenosis >50% or occlusion.

Results

98 (44 saphenous, 54 LIMA/RIMA) grafts were assessed. 18 graft from 16 patients were dysfunctional on follow-up CCTA. FFR-CT values measured at the location of the future anastomosis were significantly higher in the dysfunctional than normal grafts (0.77[0.71–0.81] vs 0.60[0.56–0.66] respectively, p = 0.0007). According to multivariable Cox regression model pre-CABG FFR-CT (HR=1.1;95%CI:1.0–1.1, p = 0.0230), and bypass graft to RCA (HR=3.7; 95%CI:1.4–9.3 vs. LAD) were independent predictors of graft dysfunction during follow-up. The optimal threshold of FFR-CT to predict graft failure was >0.68 (sensitivity 88.9% (95%CI:65.3–98.6), specificity 63.7% (95%CI:52.2–74.2), PPV 35.6% (95%CI:28.3%-43.5%), NPV 96.2% (95%CI:87.2%-99.0%).

Conclusions

Pre-CABG functional FFR-CT predicts future coronary bypass graft failure. This shows utility of FFR-CT for guiding coronary revascularization and also suggests significance of physiological assessment prior to CABG.
Dark papillary muscles sign: a novel prognostic marker for cardiac magnetic resonance
Authors: Licordari R , De Gori C , Ianni U , Restivo L , Grilli G , Barison A , Todiere G , Grigoratos C , De Luca A , Sinagra G , Di Bella G , Neri E , Aquaro G D
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

the prognostic role of left ventricular (LV) papillary muscle abnormalities in patients with preserved LV systolic ejection fraction (LVEF) is unknown.

Aim

to evaluate the prevalence and the clinical and prognostic impact of papillary muscle abnormalities by CMR in patients with ventricular arrhythmias, preserved LVEF with no cardiac disease.

Methods

391 patients with >500/24h premature ventricular complexes and/or with non-sustained ventricular tachycardia (NSVT), preserved LVEF and no cardiac disease, were enrolled. Different features of LV papillary muscles were considered: supernumerary muscles, papillary thickness, the attachment, late gadolinium enhancement (LGE). The end-systolic hypointensity was defined when its measured signal intensity (SI) was lower than the SI of the septum in early post-contrast cine CMR images. Dark-Paps was defined when both the main papillary muscles had systolic hypointensity. Mitral valve prolapse, mitral annular disjunction (MAD), myocardial LGE were considered. The outcome of hard cardiac events was define as a composite of cardiac death, resuscitated cardiac arrest, and appropriate implantable cardioverter defibrillator (ICD) shock, sustained ventricular tachycardia (lasting ≥30 s at ≥100 beats/min).

Results

Dark-Paps was found in 79 (20%) patients and was more frequent in females. It was associated with higher prevalence of mitral valve prolapse and MAD. During a median follow-up of 2534 days, 22 hard cardiac events occurred. At Kaplan-Meier curve (Figure) analysis patients with Dark-Paps were at higher risk of events than those without (p<0.0001). Dark-Paps was significantly associated with hard cardiac events in all the multivariate models performed. Dark-Paps improved prognostic estimation when added to NSVT (p = 0.0006), to LGE (p = 0.005) and to a model including NSVT+LGE (p = 0.014). Dark-Paps allowed a significant net reclassification when added to NSVT (NRI 0.30, p =0.03), to LGE (NRI 0.25, p =0.04), and to NSVT + LGE (NRI 0.32, p =0.02).

Conclusions

Dark-Paps sign could be considered a novel imaging prognostic marker in patients with ventricular arrhythmias and preserved ejection fraction.
Prognostic value of right atrial strain in patients with isolated severe tricuspid regurgitation
Authors: Merin R , Zornitzki L , Shporn O , Granot Y N , Banai S , Topilsky Y , Flint N
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Moderate or severe isolated Tricuspid regurgitation (TR) can lead to right ventricular (RV) dysfunction and adverse outcome. Only few patients with significant TR undergo intervention, and the optimal timing for intervention remains elusive. The right atrium (RA) is the receiving chamber of the tricuspid regurgitant volume. Changes in RA function has been described in chronic severe TR, specifically reduction in right atrial reservoir strain (RARS). The aim of this study was to evaluate the prognostic value of RA function in a cohort of patients with isolated severe TR.

Materials and Methods

Clinical, laboratory and echocardiographic data from 105 consecutive patients with isolated moderate-severe TR (grade≥+3) were analyzed. RARS was evaluated by two-dimensional speckle-tracking echocardiography using a semi-automated software (TOMTEC, Philips). The cohort was divided into two groups: RARS value above or below 10.9%, according to an optimal threshold obtained by a receiver operating characteristic (ROC) curve.

Results and discussion

A total of 105 patients (mean age 79Y, 59% female) were included. Compared with patients with higher RARS, patients with RARS≤10.9% had higher rate of atrial fibrillation and worse RV function. Lower RARS was also associated with larger inferior vena cava diameter, abnormal cholestatic liver enzymes and higher rate of diuretic use. During a median follow-up period of 19 months (IQR:8–25), 39 (37%) patients died. Patients with RARS ≤10.9% had significantly lower survival rates compared with patients with RARS>10.9 (60% vs. 20%; P<.001). A multivariable analysis (including age, RV longitudinal strain, systolic pulmonary artery pressure and atrial fibrillation) showed that lower RARS was independently associated with higher all-cause mortality (OR 2.47, 95%CI [1.07–6.06]; P=0.03).

Conclusions

Impaired RA function assessed by echocardiographic RA reservoir strain is independently associated with all-cause mortality in patients with isolated severe TR. Serial measurement of RARS can potentially aid in optimizing timing for intervention in patients with TR.
Hybrid CTA/PET imaging of coronary artery disease in non-diabetic, prediabetic and diabetic patients evaluated for chest pain
Authors: Maenpaa M , Kujala I , Harjulahti E , Stenstrom I , Nammas W , Knuuti J , Saraste A , Maaniitty T
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Academy of Finland Finnish foundation for cardiovascular research.

Background

Patients with prediabetes or diabetes are at increased risk of developing cardiovascular disease and cardiac events. First-line coronary computed tomography angiography (CTA) followed by selective use of positron emission tomography (PET) myocardial perfusion imaging is a feasible strategy to diagnose and risk-stratify patients with suspected coronary artery disease (CAD).

Purpose

To study whether prediabetes or diabetes affects the relationship between imaging-defined CAD and patient outcome.

Methods

We retrospectively identified consecutive symptomatic patients who underwent coronary CTA for suspected CAD. In patients with suspected obstructive CAD on CTA, myocardial ischemia was routinely evaluated by 15O-water PET myocardial perfusion imaging. The relationship of CAD phenotype and long-term outcome was investigated according to patient’s diabetic status. A composite outcome included all-cause mortality, myocardial infarction (MI), and unstable angina pectoris.

Results

A total of 1743 patients were included: 1214 (70%) non-diabetic, 259 (15%) prediabetic, and 270 (16%) type 2 diabetic patients. During 6.43 years of follow-up, 164 (9%) adverse events occurred, including 106 deaths, 41 MIs and 17 episodes of unstable angina. The prevalence of normal coronary arteries on CTA was highest in the non-diabetic patients (39%). The prevalence of hemodynamically significant CAD (i.e., obstructive stenosis and abnormal perfusion) increased from 14% in non-diabetic patients to 20% in prediabetic and to 27% in diabetic patients. The lowest event rate was seen in patients with normal coronary arteries (annual event rate 0.2%) and highest in patients with concomitant type 2 diabetes and hemodynamically significant CAD (annual event rate 4.7%). However, neither prediabetes nor diabetes were independent predictors of the composite adverse outcome after adjustment for the clinical risk factors and imaging findings.

Conclusions

Coronary CTA followed by selective downstream use of PET myocardial perfusion imaging predicts long-term outcome similarly in type 2 diabetic, prediabetic, and non-diabetic patients.
Non-invasive pressure-volume analysis by 3-dimensional echocardiography: a novel method for left ventricular stroke work estimation
Authors: Hammersboen L E R , Boe E , Aalen J M , Odland H H , Villegas-Martinez M , Frostelid V C , Sletten O J , Witsoe M , Skulstad H , Smiseth O A , Stugaard M , Remme E W
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): Institute for Surgical Research, Oslo University Hospital.

Introduction

Left ventricular pressure-volume analysis is a powerful method to quantify left ventricular function. A major limitation of its clinical utility, however, is the need for invasive pressure and volume measurements. We hypothesized that accurate non-invasive left ventricular (LV) stroke work analysis is feasible by combining continuous 3-dimensional (3D) echocardiographic LV volume measurements with non-invasive LV pressure curve estimation.

Purpose

To investigate if LV stroke work can be estimated non-invasively by combining 3D echocardiographic volume measurements with non-invasive pressure curve estimation.

Methods

In 21 open-chest anesthetized canines, piezoelectric crystals were placed in the LV subendocardium for volume measurements and a micromanometer catheter was placed in the LV cavity for pressure measurements. Echocardiography was performed directly on the heart to acquire 3D LV volumes and timings of mitral and aortic valve events. The estimated LV pressure curve was obtained by adjusting the cardiac phases of an LV reference pressure curve to these valve events and adjusting its amplitude to measured peak LV pressure. Stroke work was calculated as the area under the pressure-volume curve from mitral valve closure to mitral valve opening. Non-invasively estimated and invasively measured stroke work were compared. Recordings were done during baseline, aortic constriction, dobutamine infusion and after induction of left bundle branch block by ablation.

Results

Panel A in the Figure illustrates non-invasive (left) and invasive (right) pressure-volume loops from a representative experiment. Baseline and the different interventions are colour-coded allowing visual comparison of the similar non-invasive and invasive stroke work. Panel B shows the pooled data from all experiments. There was a strong correlation (r=0.98, p<0.0001) and good agreement between the non-invasive and invasive stroke work. Furthermore, the non-invasive method captured similar changes in stroke work during interventions as compared to the invasive method (Panel C).

Conclusions

Non-invasive pressure-volume analysis by combining 3D echocardiography and estimated pressure for stroke work evaluation, is feasible and accurate.
TAPSE/systolic pulmonary artery pressure in patients with repaired TOF: Does it correlate with cardiac magnetic resonance indices?
Authors: Pirat B , Varan B , Has Hasirci S , Ozkan M , Sade L E , Ozin B , Muderrisoglu H
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background and Purpose

Potential benefits and optimal timing of pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (rTOF) are still questionable because of high morbidity due to the need for reinterventions. Cardiac magnetic resonance (CMR) is a valuable tool for the detection of irreversible right ventricular (RV) remodelling. We sought to evaluate the relation between CMR derived volumes and peak tricuspid annular systolic excursion (TAPSE)/invasively measured systolic pulmonary artery pressure (sPAP) ratio in patients who underwent right heart catheterization.

Methods

One hundred and forty-eight patients with rTOF were evaluated; 26 of the patients either had right ventricular outflow tract obstruction or had corrective surgery with a pulmonary conduit. Patients with severe pulmonary regurgitation underwent CMR to quantify RV volumes and EF either before PVR or as part of the follow-up protocol including those who had previous PVR and recurrent pulmonary regurgitation. Echocardiographic indices of RV function were measured according to the EACVI 2015 recommendations for chamber quantification. In a subset of patients who underwent right heart catheterization, systolic RV pressure, sPAP were recorded and TAPSE/invasively measured sPAP ratio was calculated. CMR derived volumes and EF were compared with TAPSE/sPAP.

Results

Forty-six patients with matching studies for echo, CMR and right heart catheterization were analyzed. Mean age of the patients were 28.0 ± 7.3 years. Mean tricuspid systolic annular velocity (S’), TAPSE, and fractional area change were 11.4 ± 2.9 cm/sec, 16.8 ± 2.9 cm, and 31.7 ± 4.2 %, respectively. CMR derived end-diastolic volume index, end-systolic volume index and EF were 154.6 ± 38.5 ml/m2, 97.4 ± 26.5 ml/m2and 40.0 ± 7.6 %, respectively. There was a negative correlation between TAPSE/sPAP and CMR derived end-diastolic volume index (r= −0.44, p = 0.049) and end-systolic volume index (r= −0.50, p = 0.024) but not with RV EF.

Conclusion

In patient with rTOF and significant pulmonary regurgitation, TAPSE/invasively measured sPAP is more strongly correlated to CMR derived end-systolic volume index as opposed to end-diastolic volume index. Our findings support the use of CMR derived end-systolic volume index preferentially in the decision making for PVR.
Prognostic value of right ventricular function in patients with severe tricuspid regurgitation undergoing tricuspid valve intervention
Authors: Bellettini M , Ancona F , Margonato D , Stella S , Ingallina G , Biondi F , Paci G , Mula C , De Bonis M , Denti P , Alfieri O , Margonato A , De Ferrari G M , Maisano F , Agricola E
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Indications and optimal timing of intervention for severe tricuspid regurgitation (TR) remain controversial due to insufficient evidence. Right ventricular (RV) function assessment, a key factor of preoperative evaluation, remains challenging due to limitations of conventional echocardiographic indexes, particularly with concomitant severe TR. Right ventricular free wall longitudinal strain (RVFWLS) is able to evaluate intrinsic systolic function and to identify RV dysfunction at early stage compared to conventional echocardiographic indices.

Purpose

to analyze the prognostic implications of pre-operative RV dysfunction, evaluated through conventional and speckle-tracking echocardiography, in patients with severe TR undergoing tricuspid valve intervention.

Methods

In this single-center retrospective study, we enrolled consecutive patients with severe TR who underwent surgical or transcatheter tricuspid valve intervention (TTVI) between November 2016 and July 2021. The primary endpoint was all-cause mortality. For a secondary exploratory analysis, to compare outcomes of operated versus conservatively treated patients, we enrolled consecutive patients with severe TR who underwent echocardiographic evaluation in the same time period and who undergo conservative management.

Results

Study population included 100 patients: 78 patients underwent isolated TV surgical intervention and 22 TTVI. ROC curve analysis showed RVFWLS as the best echocardiographic parameter to predict all-cause mortality (AUC: 0.726, IC 0.57–0.88 P = 0.006). Estimated 4-years survival was significantly lower in patients with RV dysfunction (defined as an absolute value of RVFWLS ≤ 21%, cutoff derived from ROC analysis with sensitivity 60% and specificity 87%) compared to patients with normal RV function: 70.0% vs 93.9% p = 0.002 (Figure 1). Independent prognostic role of RVFWLS was confirmed at multivariable analysis adjusted for significative clinical and echocardiographic variables (OR 0.88, 95% CI 0.80–0.98; P = 0.016). At secondary exploratory analysis, patients treated conservatively had a worst estimated 4-year survival compared to operated patients (59.6% vs 84.0%, p = 0.001). Stratifying this population according to the presence of RV dysfunction, in the group with lower RVFWLS values there were no significative differences in overall survival between operated and conservatively-treated patients (Figure 2).

Conclusions

Preoperative RV dysfunction defined by echocardiographic strain analysis is independently associated with outcomes after TV intervention. RVFWLS could be useful for indication and timing of intervention for severe TR.
Clinical and cardiac magnetic resonance profile in patients with partial late gadolinium resolution at 6 months after acute myocarditis
Authors: Parada Barcia J , Rodriguez Perez A , Barreiro Perez M , Pazos Lopez P , Matajira Chia T , Calvo Iglesias F , Iniguez Romo A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Introduction

Cardiovascular magnetic resonance (CMR) is established as the gold standard non-invasive test for the diagnosis of acute myocarditis. However, current evidence on CMR after an acute myocarditis in the follow-up is contradictory. There are patients who can show an improvement on late gadolinium enhancement (LGE) extension but timing for CMR follow-up and the amount of this improvement is unclear. A better comprehension of patients’ profiles is therefore needed.

Purpose

To explore the clinical profile and index CMR findings in patients with acute myocarditis and persistent LGE in follow-up CMR focusing on the differences between those who present mild improvement (less than fifty percent of previously affected segments) versus patients who present a better improvement (more than fifty percent).

Methods

All patients with an acute myocarditis diagnosis from June 2021 to June 2022 and a follow-up CMR were retrospectively evaluated. Myocarditis was defined by modified Lake Louise criteria (mLLC). Electronic medical records were analyzed to collect data on baseline clinical variables, CMR features, treatment and follow-up events. A CMR was performed on follow-up based on clinician’s criteria.

Results

A total of 49 consecutive patients fulfilled updated LLC for myocarditis. 30 cases (61.2 %) had a follow-up CMR. The mean time to first CMR control was 186 +/- 95 days (6,2 months). After excluding patients with no LGE at index CMR, 22 patients were analysed. Of those, 13 had reduced LGE extent in less than fifty percent of previously affected segments, and 9 showed an improvement of more than fifty percent. There were no differences in cardiovascular risk factors or baseline comorbidities (Table 1). There were no differences between groups in terms of left and right ventricular ejection fraction. T1, T2 and ECV maps were similar en both groups. Patients with less LGE improvement tend to have more initial edema extension although this tendency was not statistically significant whilst there were no differences in LGE extension at index CMR. Both groups presented similar affected segments and in both cases inferolateral segments were the most affected (Table 2). There were no differences in clinical events after 13 months of mean follow-up time, there were no differences between groups regarding to corticoid, colchicine and NSAID prescription.

Conclusions

In our cohort, there were no differences in baseline characteristics, CMR findings, treatment and clinical events between patients with significant LGE improvement at 6 months after an acute myocarditis and those with only mild improvement.
Resting abnormalities encountered in stress echocardiography predict long-term outcomes among patients admitted for chest pain
Authors: Shekhar A , Chaudhry F , Narula J , Argulian E
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Patients hospitalized with chest pain frequently undergo stress echocardiography for detecting inducible ischemia, but other cardiac pathology is often noted on rest imaging. The long term significance of these findings is not well studied. We hypothesized that such findings indicative of cardiovascular pathology on the resting portion of a stress echocardiogram have prognostic significance for patients admitted with chest pain.

Methods

We examined patients admitted with chest pain at an academic tertiary care medical center over a 2-year period who had stress echocardiography as the primary diagnostic test. Patients admitted with heart failure symptoms or syncope or patients referred for presurgical/prerehabilitation clearance were excluded. Resting and stress echocardiograms were evaluated by cardiologists with board-certification in echocardiography, and resting abnormalities were analyzed for any effect on cardiovascular outcomes, assessed over 3 years of follow up. Survival of patients with echocardiographic abnormalities on the resting study (resting wall motion abnormalities) was compared with an age- and sex-matched cohort of admitted chest pain patients without resting abnormalities.

Results

A total of 587 patients met inclusion criteria, and 198 (34%) had resting echocardiographic abnormalities. The most common abnormality involved the left ventricle. Left ventricular hypertrophy (LVH) was seen in 16% (96), and resting wall abnormalities were seen in 15% (90); among the 90 patients with resting wall motion abnormalities, segmental wall motion abnormality was seen in 57 (9.7% of total sample), and global LV dysfunction was seen in 33 (5.6% of total sample). LVH in the absence of hypertension was found in 5% (28), raising the diagnostic possibility of hypertrophic cardiomyopathy. Moderate or greater left heart valvular abnormalities were found in 3% (18). Abnormal pericardial effusions greater than mild (excluding trivial effusion) were found in 3 patients (0.5%), and pulmonary hypertension was detected in 13 patients (2%). At 3-year follow-up, patients with resting wall motion abnormalities were found to have a higher mortality than an age and sex-matched cohort of chest pain patients without these abnormalities at rest; 85% vs. 97%, p<0.015.

Conclusions

In patients hospitalized for chest pain, cardiac diagnoses with prognostic significance are often detected on the resting echocardiographic examination. These abnormalities offer insight into outcomes, given their propensity to determine mortality three years post admission, and an opportunity to institute adequate therapy that alters adverse outcomes.
Assessment of primary mitral regurgitation and lung water content using 15O-water positron emission tomography
Authors: Sigfridsson J , Harms H J , Lubberink M , Kero T , Baron T , Flachskampf F , Sorensen J
Published: June 2023

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): Swedish Heart-Lung Foundation, Stockholm, Sweden.

Introduction

Severe primary mitral valve regurgitation (MR) is associated with significant hemodynamic changes in the cardio-pulmonary system, eventually resulting in lung congestion. The gold standard for assessing the regurgitation volume and fraction (RegVol; RegFraction), and severity of MR is cardiac magnetic resonance (CMR). The PET-tracer 15O-water is considered the gold standard for non-invasive quantitation of myocardial blood flow, but techniques for performing other functional assessments are evolving: using first-pass imaging total LV stroke volume (SV) can be measured with ECG-gating, and cardiac output (CO), forward SV (FSV) and pulmonary transit time (PTT) can be measured with indicator dilution techniques.

Purpose

The purpose of this study was to evaluate the method for calculating RegVol and RegFraction with 15O-water PET compared to CMR, and to assess the correlation to PWV.

Methods

N=19 patients with asymptomatic or mildly symptomatic severe MR were imaged on the same day with CMR and 15O-water PET. The PET-examinations were conducted on a digital PET/CT scanner (Discovery MI, GE Healthcare). The scans were performed in resting state and a 4-lead ECG was connected during the procedure. 400 MBq 15O-water was injected as an automated intravenous bolus simultaneous to starting a 4 min PET-emission in list mode. The list mode data was reconstructed into a 4 min dynamic series, and 16 ECG-gated images using the first 50 s of the scan only. The reconstructions were analysed using a semi-automatic software developed in-house. We calculated RegVol=total SV- FSV, RegFraction=RegVol/total SV *100 and PWV=CO*PTT. PWV was indexed against body surface area. Bland-Altman and linear regression analyses were performed and P < 0.05 was considered statistically significant.

Results

PET-based RegVol and RegFraction correlated significantly with CMR (r=0.94 and 0.89, both p<0.001). Bland-Altman plots showed a systematic underestimation for RegVol and RegFraction calculated by PET compared to CMR, but no proportional bias was present. PET and CMR- based RegFraction correlated significantly with PWV (r=0.70 and 0.78, both p<0.001).

Conclusions

15O-water PET can be used to measure the severity of primary mitral regurgitation and the backward impact of regurgitation on lung water accumulation.
A deep learning approach for accurate and robust T1 estimation from cardiac magnetic resonance MOLLI sequences
Authors: Altur Pastor P , Ortiz-Perez J T , Doltra A , Prat S , Perea R J , Domenech B , Pujol P , Sotes S , Sitges M , Camara O , Delso G
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

T1 parametric maps of the myocardium are a recent development in cardiac Magnetic Resonance Imaging (MRI). They can be used to characterize the composition of the heart and identify alterations that can be indicative of a pathology. A common method of T1 estimation involves pixel-wise non-linear curve fitting from Modified Look-Locker Inversion Recovery (MOLLI) series [1]. Whilst relatively accurate, this method presents several drawbacks. Firstly, it assumes magnetization recovery to be a purely exponential process dependent on T1, thus neglecting other parameters such as T2 and B1 that can interfere in the process. Secondly, it does not consider that each acquisition during an inversion recovery experiment inverts the magnetization vector by a given angle and thus interferes with the recovery leading to the measurement of a shorter T1* rather than the actual T1 [2]. Additionally, since it considers each pixel individually, neglecting spatial information, it is sensitive to image quality [3]. Finally, since non-linear curve fitting is an iterative algorithm, it is computationally expensive and time-consuming.

Methods

To address these issues a convolutional neural network, DeepBLESS [4], and two spatially aware variants of it, were trained to predict T1, T2, and B1 with a dataset of MOLLI series simulated from experimental data. The simulation was performed using Bloch simulations and parameters extracted from a dataset composed of 27 single-slice MOLLI series acquired with the 5(3s)3 protocol using a b-SSFP readout at a main magnetic field strength of 3 Tesla. Thus, a dataset could be generated without relying on exponential fitting for ground truth generation.

Results

The exponential fitting of T1 was shown to consistently underestimate true T1 values by 138 +- 90 ms. In comparison, the spatially naïve DeepBLESS approach showed a mean absolute error of 14 +- 9 ms and the spatially aware DeepBLESS approach (Median-DeepBLESS) showed a mean absolute error of 13 +- 9 ms. As can be seen in Figure 1, Median-DeepBLESS also showed considerably more resilience to noise than exponential fitting and the spatially naïve version of DeepBLESS. Additionally, the deep learning approaches showcased promising results with regards to the estimation of T2 and B1 from MOLLI sequences (See Figure 2).

Conclusions

It was shown that the Deep Learning approaches eliminated the underestimation bias of exponential fitting with the spatially aware network Median-DeepBLESS being more robust to noise than both exponential fitting and the standard DeepBLESS network for myocardial T1 estimation. Relatively accurate estimation of T2 and B1 from MOLLI sequences was also accomplished through the Deep Learning approach, which may lead to simultaneous T1, T2, and B1 estimation in common clinical practice in the future.
Assessment of the left ventricular longitudinal deformation failed to detect early changes after the second-stage percutaneous coronary intervention in patients with the acute coronary syndrome
Authors: Dankowski R , Leszniewski M , Lesiak M , Sacharczuk W , Kalmucki P , Ozegowski S , Szyszka A
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Primary intervention in acute coronary syndrome (ACS) is often followed by the second-stage procedure when other atherosclerotic lesions are present. However, there is no data regarding the early effects of such a strategy on left ventricular function. Speckle-tracking echocardiography has been proven a sensitive method in assessing myocardial function.

Purpose

The study aimed to assess the early results of the second stage of percutaneous coronary intervention (PCI) in patients with ACS.

Methods

The study group consisted of 61 patients aged from 47 to 92 (mean age 66,3± 9,8) years, 21 women (34,4%) and 40 men (65,6%) who had ACS. Primary treatment involved culprit-lesion only. All pts were optimally treated regarding ischemic heart disease. The second-stage PCI was performed up to four months after ACS. Patients underwent transthoracic echocardiography 48 hours before and after the second-stage PCI. Using automated functional imaging (AFI), we analyzed the global longitudinal strain (GLS) of the left ventricle, GLS in the four-chamber view (GLS-4CH), the two-chamber view (GLS-2CH), and the three-chamber view (GLS-3CH). We also assessed the mean of the peak longitudinal strain of the myocardial segments according to the standard assignment to coronary artery territories, i.e. left anterior descending (LAD), right coronary artery (RCA) and circumflex coronary artery (LCX).

Results

The following second-stage PCI were performed in the study group: 33 procedures regarding the left anterior descending artery, 15 procedures regarding the left circumflex artery and 13 procedures regarding the right coronary artery. The mean value of the GLS of the left ventricle before the second-stage PCI was slightly reduced compared to the currently established norm (GLS= −16.7%). The second-stage PCI did not result in early changes in the GLS. We also did not observe any significant changes in the mean peak longitudinal strain according to the coronary artery territories (Table 1).

Conclusions

Despite the proven sensitivity of the deformation imaging technique in assessing left ventricular function, the present work does not show an early effect of the percutaneous coronary intervention on either the global longitudinal strain of the left ventricle or the longitudinal strain of the segments allocated to each coronary arterial territory.
Long postcovid injury on left ventricle function
Authors: Tselov N , Hristova K , Marinov R , Zlatancheva G , Velikov T
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Post COVID19 condition occurs in individuals with a history of probable or confirmed SARS Cov2 infection, usually 3 months from the onset of COVID19 with symptoms that last for up to at least 2 months and cannot be explained by an alternative diagnosis.

Common symptoms include fatigue, shortness of breath, cognitive dysfunction, but also arterial hypertension and generally have an impact on everyday function. Symptoms may be new onset following initial recovery from an acute COVID 19 episode or persist from the initial illness.

Aim

COVID 19 pneumonia initiates new onset arterial hypertension (AH) and aggravates the structural and functional myocardium remodeling in the long term after hospitalization.

Methods

The study population /initially questioned 1500 patients for symptoms after acute COVID 19 pneumonia / included 220 patients without history of any disease, mean age of 45±12 years, male 145 (43±10 years) female 75 ( 52± 14 years).We used Speckle tracking echocardiography to analyze the global longitudinal strain (GLS).

GLS was extracted by 3, 4 and 2 chamber apical view images on 70 fr/s for left ventricle ( LV ) and right ventricle( RV ).CMR with LGE was performed at 3rd (3mFU) and 12th months (12mFU) also to confirm our resulst.

AMBP analysis, MAP and HR were performed at baseline /30–40 days after acute infection/ 3rd and 12th months follow up.

Results

From initial population /1500 pts/ self-reported symptoms at 12mFU are 1265 ( 84.6 % ) and 235 (15.4 % ) are symptom free at 12mFU. AH presence at 3mFU in 143( 65% of patients )up to 161 patients (73% at 12mFU).

Symptoms of heart failure with preserved EF were found at 3mFU in 91 pts (41%) and in 99 pts (45%) at 12mFU

Despite normal EF, GLS / minus 18.5 %, p<0.01) and segmental LS in all apical and mid anteroseptal, inferoseptal and basal anteroseptal and inferoseptal levels ( minus 16% to minus 18%, p <0.01) and RV ( 22.3% to 24%) at 12mFU shown diminished and still preserved values, even in 3 level layers. Performed CMR confirmed injured segments.

Conlusions

New onset AH is one of major symptoms after COVID 19 and remains at 12mFU. Despite of satisfactory improvement of conventional parameters for LV and RV function, GLS indicate worsening of the LV systolic function. In pts with COVID-19 pneumonia echocardiography showed predominantly decrease of the load on the right heart at 3mFU. LV function showed slightly improvement at 12mFU.
Impact of left coronary artery bifurcation angle on computed tomography derived fractional flow reserve in normal coronary artery disease
Authors: Tsugu T , Tanaka K , Nagatomo Y , Belsack D , Devos H , Buls N , Cosyns B , Argacha J F , De Maeseneer M , De Mey J
Published: June 2023

Funding Acknowledgements

Type of funding sources: None.

Background

Computed-tomography (CT) derived fractional-flow-reserve (FFRCT) decreases from the proximal to the distal part of vessel due to the influence of various factors. The energy loss due to the bifurcation angle may potentially contribute to a progressive FFRCT decline. However, the association of the bifurcation angle with FFRCT is still not entirely understood.

Purpose

This study aimed to investigate the impact of various bifurcation angles on FFRCT decline below the clinically crucial pathological value of 0.80 in normal coronary arteries.

Methods

A total of 83 consecutive patients who underwent both CT angiography including FFRCT and invasive coronary angiography, resulting in normal coronary arteries were evaluated. ΔFFRCT was defined as the magnitude of the change in FFRCT from the proximal to the distal vessel in the left anterior descending (LAD) and left circumflex (LCX). Both LAD angle and LCX bifurcation angle were measured as the crossing angle between the centrelines of the left main trunk and each coronary artery (LAD or LCX) on the 3-dimensional volume rendered image of the coronary artery tree (Figure 1). Vessel length, lumen volume, non-calcified plaque volume, and calcified plaque volume were assessed.

Results

Bifurcation angle was significantly lower in LAD angle (LAD angle, 31.1 ± 6.6°; LCX angle, 42.8 ± 14.9°, p < 0.0001). FFRCT showed a continuous gradual decline from the proximal to the distal in both LAD (from 0.95 ± 0.03 to 0.81 ± 0.06) and LCX (from 0.96 ± 0.03 to 0.88 ± 0.06). ΔFFRCT was significantly greater in LAD angle (LAD angle, 0.13 ± 0.06; LCX angle, 0.08 ± 0.05, p < 0.0001) ΔFFRCT was significantly correlated with each bifurcation angle (LAD angle, r = 0.35, p = 0.001; LCX angle, r = 0.26, p = 0.02) and vessel length (LAD angle, r = 0.30, p = 0.005; LCX angle, r = 0.49, p < 0.0001) (Figure 2A). In LAD, vessel length was the strongest predictor for distal FFRCT of ≤ 0.80 (β-coefficient = 0.56, p = 0.0002), immediately followed by the bifurcation angle (β-coefficient = 0.24, p = 0.02). The bifurcation angle was a good predictor for a distal FFRCT ≤ 0.80 (LAD angle, cut-off 31.0°, AUC 0.70, 95% CI 0.58–0.83, sensitivity 74%, specificity 68%; LCX angle, cut-off 52.6°, AUC 0.86, 95% CI 0.76–0.96, sensitivity 88%, specificity 85%) (Figure 2B).

Conclusions

The change in FFRCT depended on the bifurcation angle. In normal coronary arteries, vessel length was the most influential factor on FFRCT, immediately followed by the bifurcation angle.
The role transmural strain gradient in assessment of functionally single ventricle contractility
Authors: Kowalczyk M , Kordybach-Prokopiuk M , Kowalski M , Hoffman P
Published: June 2023

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The funds of the Ministry of Education and Science.

Background

Cardiac imaging in patients with FSV (functionally single ventricle) underwent the Fontan procedure is a challenge. One of the most difficult issue to be resolved in FSV patients is myocardial contractility. Thus, we sought for deformation parameters analysis by STE (Speckle Tracing Echocardiography), for haemodynamic and structural reason. We incorporated a novel STE (Speckle Tracing Echocardiography) parameter– TG (transmural strain gradient) representing the difference in strain between subendocardial and subepicardial layer to assess FSV contractile reserve. The role of TG in assessment of FSV after Fontan palliation has not been evaluated yet.

Purpose

The study aimed to introduce/evaluate transmural longitudinal strain gradient (TG) at rest and during exercise as marker of FSV contractility and exercise performace.

Methods

The group of 37 patients with FSV after Fontan palliation were enrolled in our study at least 12 months after Fontan operation and in sinus rhythm on ECG. We performed an transthoracic echocardiography at rest and during exercise on a semi-supine cycle ergometer. The apical-chamber views were registered for subsequent post-processing analysis. Due to heterogeneous FSV morphology and primary defects as well as accompanying intraventricular septum segments malformation in majority of cases, we decided to measure and analyse FSV free wall longitudinal strain only. The values of layer-specific: subendocardial and subepicardial longitudinal free wall systolic strain were assessed and the gradient between them was calculated. The TG at rest and during exercise were compared with the cardiopulmonary exercise test results, NYHA class, FSV systolic function studied by CMR (Cardiac Magnetic Resonance) and NT-proBNP concentration.

Results

The values of TG at rest and during exercise correlated with peak oxygen uptake during the cardio-pulmonary exercise test (p = ,012 for TG at rest, p = ,031). TG during exercise was negatively correlated with CMR-derived ejection fraction (p = ,031) . There was no relationship between TG and NYHA-class and NT-proBNP.

Conclusion(s)

TG is a promising parameter for FSV contractility assessment. Our preliminary study suggests that it can complete traditional imaging technics and derived parameters. TG is highly associated to exercise capacity. However, utility of TG requires further investigation.
(p)ppGpp and moonlighting RNases influence the first step of lipopolysaccharide biosynthesis in Escherichia coli
Authors: Brückner Simon , Müller Fabian , Schadowski Laura , Kalle Tyll , Weber Sophia , Marino Emily C , Kutscher Blanka , Möller Anna-Maria , Adler Sabine , Begerow Dominik , Steinchen Wieland , Bange Gert , Narberhaus Franz
Published: June 2023

The outer membrane (OM) protects Gram-negative bacteria from harsh environmental conditions and provides intrinsic resistance to many antimicrobial compounds. The asymmetric OM is characterized by phospholipids in the inner leaflet and lipopolysaccharides (LPS) in the outer leaflet. Previous reports suggested an involvement of the signaling nucleotide ppGpp in cell envelope homeostasis in Escherichia coli. Here, we investigated the effect of ppGpp on OM biosynthesis. We found that ppGpp inhibits the activity of LpxA, the first enzyme of LPS biosynthesis, in a fluorometric in vitro assay. Moreover, overproduction of LpxA resulted in elongated cells and shedding of outer membrane vesicles (OMVs) with altered LPS content. These effects were markedly stronger in a ppGpp-deficient background. We further show that RnhB, an RNase H isoenzyme, binds ppGpp, interacts with LpxA, and modulates its activity. Overall, our study uncovered new regulatory players in the early steps of LPS biosynthesis, an essential process with many implications in the physiology and susceptibility to antibiotics of Gram-negative commensals and pathogens.