bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right ventricular dysfunction parallels left ventricular functional involvement in women with breast cancer experiencing subclinical cardiotoxicity
Authors: Santoro C , Soloperto R , Casciano O , Esposito R , Luciano F , Canonico M , Lembo M , Arpino G , De Placido S , Galderisi M 
Published: November 2020

Abstract

Background
Cancer therapy related cardiac toxicity disease (CRCTD) of the left ventricle (LV)can influence the outcome of oncologic patients. Little is known on CRCTD related right ventricular (RV)dysfunction even though RV involvement has been proven to be a remarkable prognosticator in heart failure.

Purpose
To analyse parallel changes in LV and RV function occurring during the course of cancer therapy in women affected by breast cancer by using both standard and speckle tracking echocardiography.

Methods
Fifty Her-2 positive breast cancer women (age = 53.6±11.7 years) underwent sequential cancer therapy protocol including anthracycline (ANT) epirubicine + cyclophosphamide (4 cycles) followed by a total amount of 18 cycles with trastuzumab (TRZ) + paclitaxel. A complete echo-Doppler exam, including LV and RV global longitudinal strain (GLS)as well as RV septal and free wall longitudinal strain (SLS and FWLS respectively) assessment, was performed at baseline, after ANT end and after TRZ completion. Patients with overt heart failure and LV ejection fraction &lt;50%, coronary artery disease,atrial fibrillation, hemodinamically significant valve disease and inadequate echo were excluded. Overt CRCTD was defined according guidelines and both subclinical LV and RV CRCTD as a LV and RV GLS drop from baseline &gt;15%.

Results
None of the patients experienced overt CTCRD but 6 patients (14%) showed subclinical LV dysfunction and 33 (66%) had a significant drop of RV longitudinal function.The comparison of standard echo-Doppler exam at baseline and after ANT and TRZ completion did not show significant changes of LV and RV systolic and diastolic parameters. Conversely, a progressive significant reduction of RV GLS (p&lt;0.002 after TRZ), SLS and FWLS and, with a lower extent, of LV GLS (p&lt;0.02 after TRZ) was observed after ANT and TRZ completion (Figure). Percentage reduction in RV GLS (DRV GLS) from baseline to ANT end correlated with LV GLS both at EC end (r=−0.40, p=0.006) and after TRZ completion (r=−0.62, p&lt;0.0001).

Conclusions
Detrimental cardiac effects of cancer therapy involve both LV and RV systolic longitudinal function. Progressive RV dysfunction is evident through ANT and TRZ treatment. Early RV dysfunction parallels LV involvement and predicts subsequent LV subclinical dysfunction. A comprehensive LV and RV longitudinal function assessment might better predict the onset of CRCTD in breast cancer patients.
LV and RV strain during cancer therapy

Funding Acknowledgement
Type of funding source: None
Assessment of biventricular function using advanced echocardiography in patients with Ebstein's anomaly pre and post-tricuspid valve surgery
Authors: Ricci P , Ostenfeld E , Flick C , West C , Babu-Narayan S , Nihoyannopoulos P , Li W 
Published: November 2020

Abstract

Background
Ebstein's anomaly (EA) is a right ventricular myopathy with failure of tricuspid valve (TV) delamination. While conventional echocardiographic measurements of ventricular function such as tricuspid annular plane systolic excursion (TAPSE), tissue Doppler imaging RV systolic velocity (s'), fractional area change (FAC) and left ventricle ejection fraction (LV EF) are load dependent measures of systolic function and may not reflect true myocardial function, speckle tracking echocardiography (STE) evaluates more subtle myocardial deformation on a regional level. However, the role of STE for the biventricular assessments in an adult cohort of EA before and after tricuspid valve repair/replacement (TVR) is not fully elucidated.

Purposes
To assess biventricular function by conventional echocardiographic parameters and global and regional longitudinal strain (GLS, RLS) using speckle tracking echocardiography in adult patients with EA pre- and post-TVR.

Methods
47 patients with EA (57% women, age at operation 37±16 years) who had TV repair/replacement (17/30) between 2005 and 2019 were retrospectively identified from Echo database. 2D conventional echocardiographic parameters (TAPSE, s', FAC and LV EF) and biventricular GLS and RLS were assessed pre-TVR, at 1-, 2- and 5-year post-TVR. RV and LV segments were visually graded for STE feasibility assessment (Figure 1).

Results
TAPSE and s' declined after TVR with no further changes over 5 years (both p&lt;0.0001); FAC decreased after TVR (p=0.005) with some amelioration but remaining impaired at 5 years. RV GLS deteriorated at 1 year post-TVR with improvements at 2 and 5 years (p&lt;0.0001, Table 1). LV EF remained preserved (p=0.2), however, LV GLS was low pre-TVR and decreased at 1 year with improvements at 2 and 5 years (p=0.004). Least feasible segments were RV mid (pre-TVR and 1y and 5y post-TVR) and apical free wall (both pre- and post-operative) and LV apical lateral (pre-TVR and 2y post-TVR) all with median score of 1.

Conclusions
Despite the TV regurgitation reduction, TV surgeries have led to RV dysfunction with only some amelioration of RV longitudinal strain and all conventional echocardiographic parameters after 5 years. The segmental analysis showed that the basal septal segment was the most negatively affected. LV strain was reduced before and after surgery despite preserved ejection fraction. Hence, speckle tracking echocardiography is a feasible and a sensitive method in detecting myocardial dysfunction in patients with Ebstein's anomaly.
Feasibility assessment

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Royal Brompton Hospital; Imperial College
Artificial intelligence applied to non-contrast-enhanced cardiac computed tomography for the prediction of cardiovascular events
Authors: Chiappino S , Della Latta D , Martini N , Ripoli A , Aimo A , Piagneri V , Susini C.L , Clemente A , Emdin M , Zanetti V , Battipaglia E , Chiappino D 
Published: November 2020

Abstract

Background
Non-contrast-enhanced cardiac computed tomography (CT) may provide two measures that are emerging as independent predictors of cardiovascular events: coronary calcium score (CCS) and the volume of epicardial fat, a metabolically and immunologically active tissue surrounding the coronary arteries. The quantification of epicardial fat volume (EFV) is not routinely performed in clinical practice for the long time required for image reconstruction and the intra- and inter-observer variability.

Purpose
We evaluated if artificial intelligence (AI) might prove a valuable tool to interpret the CT data-set, and to better understand the relative prognostic value of CCS and EFV compared to “traditional” cardiovascular risk factors.

Methods
The Montignoso HEart and Lung Project is a community-based study carried out in a small town of Northern Tuscany (Italy). Starting from 2009, asymptomatic individuals from the general population underwent a baseline screening including a non-contrast cardiac CT, and were followed-up. For the present study, CCS and EFV were automatically measured from CT scans through a deep learning (DL) strategy based on convolutional neural networks. Because of the low incidence of the primary endpoint (myocardial infarction [MI]), the observed cardiac events were predicted with a random forest model built using a subsampling approach.

Results
Study participants (n=1528; 48% males, age 40 to 77 years) experienced 47 MI events (3%) over 5.5±1.5 years. CCS and EFV independently predicted this endpoint (p values &lt;0.001 and 0.005, respectively) in a model including other predictors, namely weight, age, male gender, and hypertension. The model displayed a good prognostic performance, with an out-of-bag accuracy of 80.43% (accuracy on non-event prediction: 81.17%; performance on event prediction: 57,45%). The CCS emerged as the most important predictor, followed by EFV, weight and age. Interestingly, the incidence of cardiovascular events linked with CCS levels was associated with elevated EFV and the subjects with elevated CCS values but low EFV had no events (figure 1).

Conclusions
The tools of AI allow to perform an automated analysis of non-contrast-enhanced CT scans, with rapid and accurate measurement of CCS and EFV through a DL approach. In asymptomatic individuals from the general population, these features are more predictive of non-fatal MI than other variables related to the cardiovascular risk, as we can be demonstrated through an application of AI.
Figure 1

Funding Acknowledgement
Type of funding source: None
Predictors of cerebral embolisation after percutaneous transfemoral aortic valve implantation (TAVI) in the RETORIC substudy
Authors: Suhai F , Varga A , Nagy A.I , Apor A , Panajotu A , Szilveszter B , Bartykowszki A , Karady J , Merkely B , Maurovich-Horvat P 
Published: November 2020

Abstract

Purpose
To evaluate the predictors, occurrence and distribution of TAVI-related silent ischemic brain lesions using diffusion MRI.

Methods and materials
We investigated 109 consecutive patients with severe aortic stenosis from the prospective arm of the RETORIC study who underwent brain MRI one week afterpercutaneous transfemoral aortic valve implantation TAVI. To determine the occurrence and distribution of periprocedural cerebral ischemic lesions averaged diffusion-weighted images (trace) and mean diffusivity (MD) maps from the DTI dataset were used. To evaluate the aortic valve calcium score (AVCS), we assessed the preoperative prospectively ECG-triggered cardiac CT (256-slice MDCT). We also assessed the periprocedural factors such as periprocedural time, pre- and postdilatation. Multivariate linear regression analysis was performed to identify the independent predictors of TAVI-related ischemic lesions.

Results
After TAVI, a total of 918 new cerebral ischemic lesions were detected in 100/109 patients (92%). The median ischemic lesion volume was 237 μl (interquartile range 89.5–650) with a median lesion number of 6 (2–10) per patient. 759/918 lesions (83%) were supratentorial (389 left vs 370 right). Most lesions (628/918, 68%) were subcortical; the left and right MCA territories were the most affected (190. The vast majority of ischemic lesions were clinically silent (96%); 4% of patients had stroke which was proven by MRI. The median AVCS was 2769 (interquartile range 1858–4537). Balloon predilatation during TAVI procedure showed significant correlation with increased total ischemic lesion volume (p&lt;0.001, β = 0.370) on univariate analysis, AVCS, periprocedural time, or postdilatation were not associated with ischemic load on MRI (p&lt;0.05).

Conclusions
Periprocedural ischemic lesions are frequent (92%), most of them are clinically silent, however. Only balloon dilatation during TAVI was a predictor of increased ischemic load.
Aortic valve Ca scoring and DWI MRI

Funding Acknowledgement
Type of funding source: None
Cardiac damage grading in patients with aortic stenosis using multi-detector computed tomography and the impact on prognosis after transcatheter aortic valve intervention
Authors: Hirasawa K , Rosendael P.J , Fortuni F , Singh G.K , Kuneman J , Vollema E.M , Ajmone Marsan N , Delgado V , Bax J.J 
Published: November 2020

Abstract

Introduction
A staging of severe aortic stenosis (AS) based on additional extra-valvular cardiac damage has been associated with prognosis after transcatheter aortic valve implantation (TAVI). Multi-detector row computed tomography (MDCT) has a central role in the evaluation of AS patients undergoing TAVI and can detect extra-valvular cardiac damage.

Purpose
To evaluate the prognostic implications of an MDCT staging system of severe AS in patients undergoing TAVI.

Methods
Patients who underwent full-beat MDCT prior to TAVI were included. Patients with intra-cardiac devices, prior valvular surgery, and insufficient image quality were excluded. The extent of cardiac damage was assessed by MDCT and classified into following 5 groups; stage 0 (no cardiac damage), stage 1 (left ventricular damage), stage 2 (left atrium and mitral valve damage), stage 3 (right atrial damage), stage 4 (right ventricular damage). The primary end-point was all-cause mortality.

Results
A total of 405 patients (80±7 years, 52% men) were stratified according to the MDCT staging system: 27 (7%) were in stage 0, 96 (24%) in stage 1, 152 (38%) in stage 2, 78 (19%) in stage 3, and 52 (13%) in stage 4 (left panel). During follow-up (median 3.7 years, IQR: 1.7–5.5 years), 150 (37%) died (right panel). On multivariable analysis, cardiac damage stage, presence of chronic obstructive pulmonary disease, NYHA ≥3, eGFR, and transapical approach were independently associated with all-cause mortality. When evaluating each stage, stage 3 (HR: 4.725, P=0.033) and stage 4 (HR 5.678, P=0.018) were independently associated with worse outcomes as compared to the other stages.

Conclusion
MDCT-based staging system of severe AS identifies the patients who are at higher risk of death after TAVI.
MDCT staging and the mortality

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): ESC research grant
Dynamics of the right atrio-ventricular junction in human: a spatial high-resolution study with multiphase computed tomography
Authors: Jouan J , Masari I , Bliah V , Soulat G , Craiem D , Mousseaux E 
Published: November 2020

Abstract

Introduction
In order to improve knowledge of the tricuspid valve (TV) function and its coupling with the right atrio-ventricular junction (RAVJ) and right ventricle (RV), new four-dimensional high-definition imagery methods are mandatory (3D+t).

Purpose
Using an innovative reconstruction method based on multiphase cardiac computed tomography imaging (4D-MCCTI), we finely analyzed the morphological & dynamical features of tricuspid annulus (TA) and RAVJ components in order to assess new functional parameters of TV and RV functions.

Methods
Volume imaging data sets through time were obtained from 4D-MCCTI of 30 subjects (sex ratio 1, mean age 57±11y.) with no rhythm, valvular or ventricular abnormalities on echocardiography and implemented in a custom software for 3D semi-automated delineation of 18 points around TA perimeter. Coordinates of these points in each of the 10 time-phases within an RR interval were used to calculate specific geometrical features of TA such as 3D/2D areas, perimeters, 360°-diameters and vertical deformation. Subsequently, RV and Right Atrium (RA) inner contours were also delineated (Figure).

Results
TA shape was elliptical in horizontal projection with a mean eccentricity index (EcI) of 0.58±0.12; and saddle-shapped in vertical projection with a horn nearby the antero-septal commissure. This feature remained throughout the cardiac cycle but TA was more planar (minimal TA-height: 4.47±1.04 mm) and circular (minimal EcI=0.44±0.14) in mid-diastole when TA-3Darea and TA-3Dperimeter reached a maximum of 6.98±1.21 cm2/m2 and 7.41±0.91 cm, respectively. Correlation between TA-3Darea, TA-2Darea and latero-septal diameter (LSD) were R2=0.99 and R2=0.73, respectively. LSD was minimal in early-systole (18.83±3.04 mm/m2) and maximal in mid-diastole (20.04±3.05 mm/m2). Correlation of TA-3Darea with RV and RA cross-sectional areas were R2=0.82 and R2=0.71, respectively. Conversely, there was no significant correlation between TA, RV and RA concentric contractions.

Conclusions
Our method for 4D-MTCCI analysis has allowed confirming the shape and dynamics function of RAVJ throughout the cardiac cycle in healthy subjects, and giving new reference parameters for TV and RV evaluation.
Software multiplanar view of TA

Funding Acknowledgement
Type of funding source: None
The usefulness of coronary artery calcium score to rule out obstructive coronary artery disease before transcatheter aortic valve replacement
Authors: Natanzon S.S , Mazin I , Barbash I , Segev A , Guetta V , Konen E , Goitein O , Fardman A , Brodov Y 
Published: November 2020

Abstract

Introduction
Coronary clearance in patients undergoing TAVR is performed by invasive coronary angiography (ICA) or computed tomography angiography (CTA). We aimed to investigate whether CTA-derived low coronary calcium (CAC) score may rule out obstructive coronary artery disease (CAD) in these patients.

Methods
We included 232 consecutive patients with severe aortic stenosis (mean age 80±8; 50% female) who underwent both pre-TAVR CTA and ICA between 2012–2019. Obstructive CAD was defined as a &gt;50% in left main or &gt;70% in the 3 main epicardial vessels. Patients with prior coronary stents or bypass grafts were excluded. CAC score was calculated by Agatston method. Receiver operating characteristic (ROC) was applied to establish the CAC threshold for obstructive CAD, and adjustment for age, gender, diabetes and renal failure was applied.

Results
CAC scores range was 3.5–5200 (median = 1028). Eighty-eight patients (38%) had obstructive CAD. ROC curves showed high negative predictive value (NPV) for LAD - CAC score 280, NPV 95%; LCX - CAC score 320, NPV 93%; and RCA - CAC score 347, NPV 90% (figure). Binary logistic regression confirmed CAC score cutoffs per vessel as an independent predictor of obstructive CAD [LAD (OR 3.9, CI 1.1–14, p-0.033); CX (OR 5.7, CI 2.4–12, p&lt;0.001); RCA (OR-5.6, CI 2.5–12, p&lt;0.001)].

Conclusion
CAC score per-vessel can be useful to rule out obstructive CAD in patients with severe aortic stenosis undergoing TAVR. Using specific CAC cut offs can identify patients who may omit ICA
CAC per vessel

Funding Acknowledgement
Type of funding source: None
Pericoronary adipose tissue inflammation on coronary computed tomography in patients with vasospastic angina
Authors: Ueno H , Hoshino M , Sugiyama T , Kanaji Y , Nogami K , Horie T , Yamaguchi M , Hada M , Sumino Y , Misawa T , Hirano H , Yonetsu T , Sasano T , Kakuta T 
Published: November 2020

Abstract

Background
A recent study has demonstrated that coronary spasm is associated with inflammation of peri-coronary adipose tissue (PAT) by using the combination of 18F-fluorodeoxyglucose positron emission tomography and computed tomography (CT). PAT attenuation (FAI) on CT angiography (CTA) has been reported to reflect PAT inflammation. We sought to investigate if FAI on CTA was associated with coronary vasospasm in patients with suspected vasospastic angina (VSA).

Methods
A total of 88 patients who underwent CTA and acetylcholine provocation test (SPT) for suspected VSA were retrospectively investigated. FAI was assessed by the crude analysis of the mean CT attenuation value of 3 major coronary arteries on CTA. FAI was evaluated for the proximal reference diameter (FAI-Ref) and inner 2mm adipose tissue layer (FAI-2mm) from the vessel wall. Diagnosis of VSA (VSA group) was made by SPT and the subjects with negative SPT without organic coronary lesions served as non-VSA group. Association between VSA diagnosis and FAI was assessed and the predictors of VSA was explored by univariable and multivariable analyses.

Results
In 45 patients (51.1%), VSA was diagnosed (VSA group). There were no significant differences in baseline characteristics between the VSA and non-VSA groups. RCA-FAI was significantly higher in patients of VSA group than in non-VSA group. RCA-FAI-2mm provided significantly better diagnostic performance for VSA than RCA-FAI-Ref and LCA-derived FAI values. Furthermore, RCA-FAI-2mm showed a significant relationship with the severity of spasm evaluated by most stenotic segment diameter during SPT. (r=−0.28, p&lt;0.001) Multivariable logistic regression analysis revealed that RCA-FAI-2mm was an independent predictor of predicting VSA (P&lt;0.001).

Conclusion
Coronary spasm may be linked with PAT inflammation detected by CTA-derived RCA-FAI, particularly by inner PAT assessment close to the vessel wall.
Representative cases for FAI analyses

Funding Acknowledgement
Type of funding source: None
High-risk plaque regression after intensive dietary intervention in patients with non-obstructive coronary artery disease: a randomised computed tomography angiography study (DISCO-CT)
Authors: Henzel J , Makarewicz-Wujec M , Wardziak L , Trochimiuk P , Kruk M , Kepka C , Dzielinska Z , Demkow M 
Published: November 2020

Abstract

Background
Lifestyle and diet modification are the forefront in the management of coronary artery disease (CAD), however, there is no data whether they may stop progression of atheroslcerosis. Some coronary plaque characteristics are known to increase the risk of future cardiovascular events independently of coronary stenosis severity. These plaques are characterized by the presence of lipids and necrotic elements, and can be identified with coronary computed tomography angiography (CTA).

Purpose
To study the effect of intensive dietary intervention on changes in atherosclerotic plaque volume and composition.

Methods
We enrolled 89 patients (41% women, mean age 60±7.7 years) with nonobstructive coronary lesions (&lt;70% stenosis) identified by CTA (2x192-multislice scanner, temporal resolution 66 ms), qualified to medical treatment. All participants were subjected to optimal medical therapy (OMT). Patients were randomised (1:1) to either A) OMT with regular follow-up (after 1, 3, 6, 9 and 12 months) by a dietitian to stick to Dietary Approaches to Stop Hypertension (DASH) model, or B) routine management, ie. OMT alone. CTA was repeated in all patients after the mean time of 66.9±13.7 weeks. An experienced observer blinded to the allocated treatment group and other clinical data evaluated all of the scans. The outcome was change in total plaque volume, percent plaque volume and plaque composition, assessed with a dedicated software system. Based on tissue attenuation ranges in Hounsfield units (HU), the following components of atheroma were distinguished: dense calcium (&gt;351 HU), fibrous plaque (151 to 350 HU), and fibrofatty plaque plus necrotic core (−100 to 150 HU), regarded as the vulnerable plaque component.

Results
Total plaque volume did not change significantly in any group (p=0.41; Figure 1A). Percent atheroma volume increased in the control arm vs. no significant change in the experimental arm, with no significant intergroup difference (p=0.79; Figure 1B). Vulnerable plaque component decreased in both subgroups, by 52.9±82.2 mm3 in the experimental vs. 20.8±58.5 mm3 in the control arm, and there was a significant difference in the reductions between the groups (p=0.04; Figure 1C). Fibrous plaque volume and dense calcium volume did not change significantly in any group (+9.5±117.8 mm3 in the experimental vs. +7.6±92.1 mm3 in the control arm, p=0.93, and +33±68.9 mm3 vs. +30.2±52.5 mm3, p=0.78, respectively).

Conclusions
Intensive diet intervention atop OMT can stop the progression of atherosclerosis and lead to a significant reduction in vulnerable plaque component compared to OMT alone.
Figure 1

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Institute of Cardiology in Warsaw, Poland