bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of pulmonary arterial hypertension specific treatment on the left ventricle in patients with pulmonary arterial hypertension
Authors: Mouratoglou S.A , Wessels J.N , Marcus J.T , Meijboom L.J , Handoko-De Man F , Vonk Noordegraaf A 
Published: November 2020

Abstract

Background
Pulmonary arterial hypertension (PAH) is characterized by right ventricular (RV) pressure overload, leading to RV dilation, failure and death. In the course of the disease, the left ventricle (LV) is often impaired, due to interventricular interaction. Although the impact of PAH treatment on the RV has been well described, less is known on the LV.

Purpose
To examine effects of advanced PAH treatments on the volumes, function and strain of the left atrium and ventricle.

Methods
This is a retrospective study. All patients underwent CMR and right heart catheterization, both at diagnosis and at 12-months follow up. Ventricular volumes and LV filling rate were calculated from the stack of short axis cine images using Simpsons method while left atrial (LA) volumes from the 4-chamber cine images using the area-length method. Tissue tracking was used for the evaluation of myocardial deformation. The LV endocardial and epicardial borders were manually delineated in all analysed sections with the initial contour set at end-diastole. All analyses were performed offline using dedicated software.

Results
In total, 66 patients (mean age 56.3±17.9 years, 67%women, 77%idiopathic and heritable PAH, 23% connective tissue disease associated PAH) and 29 normal controls were included. The improvement in metrics of right and left heart size and function after the initiation of advanced PAH treatment, are presented in panel A. Of note, LV stroke volume was markedly increased (54.6±19.6ml at baseline vs 70.8±21.7ml at follow up, p&lt;0.0001) to reach controls. LV filling was markedly increased in latter two-thirds of the diastolic phase (panel B), especially at atrial kick point (arrow). Change in LA max volume was associated with changes in diastolic filling (r=0.354, p=0.004), LV end-diastolic and end-systolic volumes and stroke volume. These correlations were more robust in patients that increased LV filling compared to those that failed to increase LV filling (panels C-E). No association between changes in LV circumferential strain and LV volume load was observed. A weak correlation of change of LV peak longitudinal strain with stroke volume (r=−0.345, p=0.006), LV end diastolic volume (r=−0.284, p=0.027), LV ejection fraction (r=−0.337, p=0.008) and LA maximum area (r=−0.447, p&lt;0.0001) was observed. The changes of LV strain showed no correlation with the changes in patients' haemodynamics.

Conclusion
Improvement in stroke volume after the initiation of advanced PAH treatment is associated with an increase in LA size, LV end diastolic volume and normalisation of strain. This reflects the improved filling state of the left ventricle and the potential of the left atrium to monitor treatment effects.
Changes after PAH treatment

Funding Acknowledgement
Type of funding source: None
Are there real differences between the treatment for young and elderly patients with chronic thromboembolic pulmonary hypertension?
Authors: Cristo Ropero M.J , Lopez Gude M.J , Velazquez Martin M , Perez-Olivares Delgado C , Martinez Santos P , Perez Vela J.L , Arribas F , Cortina Romero J.M , Escribano Subias P 
Published: November 2020

Abstract

Background
Chronic thromboembolic pulmonary hypertension (CTEPH) is a potentially curable type of pulmonary hypertension, but it is poorly characterized in elderly patients.

Purpose
This study aimed to investigate the clinical characteristics, treatment strategy and survival of elderly patients with CTEPH.

Methods
All CTEPH patients evaluated at our institution between 2000 and 2018 were collected. They were divided into two groups according to 75th percentile of age. Thrombotic lesions were considered proximal when affecting the main pulmonary artery, lobular and proximal segmental arteries. All patients were discussed at a multidisciplinary team meeting. Pulmonary thromboendarterectomy (PTE) was the treatment of choice. Balloon pulmonary angioplasty (BPA) and vasodilator treatment were second-line strategies for those considered inoperable in view of unfavourable pulmonary vascular anatomy or comorbidities. As BPA program was started in our centre in 2013.

Results
484 patients were included. Baseline distinctive features are described in table 1. Medical therapy alone was more frequently considered in elderly patients. However, when adjusted for thrombotic lesions location, there were no differences in treatment strategies (p&lt;0.0005). Mortality was higher in the elderly patients group (p&lt;0.00005), with differences in cumulative survival distribution (p&lt;0.00005). This differences was maintained even after adjusted analysis for thrombotic lesions location (p=0.01) (picture 1).

Conclusion
CTEPH in elderly patients shows more incidence of distal involvement, which limits the number of patients suitable for PTE. After adjusted for the location of the injuries, treatment strategies were similar between both groups. Nevertheless, mortality is still higher in elderly patients.
Picture 1

Funding Acknowledgement
Type of funding source: None
Increased arterial stiffness during acute myocardial infarction results in adverse cardiac remodelling: a two year follow-up study
Authors: Ikonomidis I , Tsilivarakis D , Katsanos S , Vlastos D , Thymis J , Makavos G , Katogiannis K , Kostelli G , Parisis J , Illiodromitis E 
Published: November 2020

Abstract

Increased arterial stiffness is associated with adverse cardiac events. However, it not clear whether increased arterial stiffness at the early phase of acute myocardial infraction (AMI) is associated with adverse left ventricular remodelling.

Methods
We examined 80 patients with STEMI (53±16 years, 80% male, 42% anterior AMI, LVEF=49±15%) after successful revascularisation by echocardiography 48h after admission and 2 years after the index event. We measured a) left-ventricular end-diastolic (LVEDV) and end-systolic volumes (LVESV) using the Simpson Method b) global longitundinal strain (GLS) by speckle tracking imaging c) carotid-femoral pulse wave velocity (PWV, augmentation index and central Aortic pressures by Complior apparatus d) The ratio of PWV/GLS as a marker of ventricular-arterial interaction.

Results
LVEDV and LVESV were decreased while GLS was improved after the 2-year follow-up period (from 103.3±30 to 89.1±37ml, p=0.004, 58.3±25 to 57.6±25, p=0.05, −16.1±4.7 to 17.5±3.2%, p=0.03 respectively). Baseline PWV, GLS and the ratio PWV/GLS were associated with the percent change of LVESV at 2 years (p=0.033, p=0.04 and p=0.035 respectively) after adjustment for type of MI (anterior vs other location), baseline troponin blood pressure and medication.
Patients with PWV &gt;10.6 m/s (upper tercile) had similar baseline LVESV (56.5±18 to 57.2±24 ml, p=0.8) but higher LVESV at 2 years follow-up (74.4±35 to 55.9±24 ml, p=0.03) resulting in a greater percent increase of LVESV compared to patients with baseline PWV &lt;10.6m/s (+26% vs −5% p=0.012).

Conclusion
Increased arterial stiffness in the early phase of AMI impairs ventricular-arterial coupling resulting in adverse LV remodeling despite successful revascularization.

Funding Acknowledgement
Type of funding source: None
Normal and reference values for MRI-based pulse wave velocity in the middle-aged general population
Authors: Van Hout M.J.P , Dekkers I.A , Westenberg J.J.M , Schalij M.J , De Mutsert R , Rosendaal F.R , De Roos A , Jukema J.W , Scholte A.J.H , Lamb H.J 
Published: November 2020

Abstract

Background
Aortic stiffness, assessed through pulse wave velocity (PWV), is an independent predictor for cardiovascular (CV) risk. However, the scarce availability of normal and reference values for magnetic resonance imaging (MRI) based PWV is limiting clinical implementation.

Purpose
The aim of this study was to determine normal and reference values for MRI-PWV in the general population.

Methods
From the 2,484 participants of the NEO study that have available MRI-PWV data, we selected 1,639 participants that were free from CV disease or treatment for diabetes, hypertension or dyslipidaemia (age range 45–65 years, 51% male). Participants were categorized by sex, age and blood pressure (BP) subgroups. Normal values were specified for healthy (&lt;130/80 mmHg) and elevated BP (≥130/80 and &lt;140/90 mmHg) and reference values for high BP (≥140/90 mmHg) subgroups. Differences between groups were tested with either an independent samples t-test or ANOVA.

Results
Overall mean PWV was 6.5 m/s [95% CI 6.4–6.6]. PWV increased significantly with advancing age and BP categories (both p&lt;0.001). There was no difference in PWV between men and women, however a stronger increasing trend for women above 55 years old was observed (figure). The 95% CI's were smaller for participants &lt;55 years old as compared to participants &gt;55, indicating an increasing variability of PWV with age. The elevated PWV upper limits for the higher blood pressure subgroups are particularly evident in participants above 55 years old.

Conclusion
This study provides normal and reference values for MRI-assessed PWV per sex, age and blood pressure category.
PWV percentiles (10, 25, 50, 75 and 90th)

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): The NEO study is supported by the participating departments, the Division and the Board of Directors of the Leiden University Medical Centre, and by the Leiden University, Research Profile Area “Vascular and Regenerative Medicine”
Natural history of the enlarged ascending thoracic aorta: an observational long term study
Authors: Schroeder E , Bihin B , Buche M , Eucher P.H , Felix J , Gabriel L , Gerard M , Guedes A , Hanet C , Seldrum S , Marchandise B 
Published: November 2020

Abstract

To assess the long-term outcome of patients with an enlarged ascending thoracic aorta (ATA), a retrospective study was performed.

Methods
Inclusion criteria: ATA diameter of 38 mm or more by ETT (813 consecutive cases).
Inclusion period: 1.1.2003–31.12.2016.

Results
At baseline, the mean diameter of the ATA was 42±3 mm, the mean Z-score was 2.7±0.8.
In the subgroup of patients with 2 ETT examinations (and no surgical cure of the ATA), the mean diameter was 41.9±4.8 mm, the mean Z-score 2.4±1.1 after a mean follow-up of 6 years.
During the follow-up, 52 patients had an intervention on the ATA, 26 patients were operated within the first 3 months after the diagnostic echocardiogram. 26 patients were operated during FU.
In the 791 remaining patients (without early intervention), the event rate (death, intervention on the ATA) were assessed by the competing risk model.
In the group of patients with a baseline ATA diameter of less than 41 mm (Group A: n=254), the cumulative incidence of death at 5 and 10 y was 34% and 61%; in the group of patients with an ATA diameter of 41–42 mm (Group B: n=238) the incidence was 34% and 61% respectively, in the group of patients with an ATA diameter of 43–44 mm (Group C: n=147), the incidence was 32% and 58%, in the group of patients with a diameter of 45 and more (Group D: n=150), the incidence was 31.1% and 61% (NS).
The cumulative incidence of surgical interventions on the ATA at 5 and 10 years was 0.4% and 1% in group A, 1.3 and 1.8% in group B, 0.7 and 1.4% in group C and 9.8 and 12.9% in group D (p&lt;0.05).
Similar results were observed in patients according to the Z-scores. In the group of patients (221) with a Z-score &gt;3, the incidence of intervention at 5 and 10 y was respectively 7.6% and 10.7% (p=0.01).

Conclusions
– The mean diameter of the enlarged ATA remained nearly unchanged over a period of 6 years.
– No impact of the enlarged ATA on survival was observed.
– Only patients with an ATA diameter of 45 mm and more (or a Z-score of 3 and more) needed an intervention on the ATA at a rate of ± 10% at 10 y after the initial echocardiographic diagnosis.

Funding Acknowledgement
Type of funding source: None
Relationship between aortic distensibility and aortic regurgitation depending on aortic valve anatomy. A CMR study
Authors: La Mura L , Teixido-Tura G , Guala A , Ruiz-Munoz A , Servato M.L , Fassano N , Valente F , Lopez-Sainz A , Galian-Gay L , Gonzalez-Alujas T , Cinque A , Ferreira I , Evangelista A , Galderisi M , Rodriguez-Palomares J.F 
Published: November 2020

Abstract

Background
Aortic regurgitation (AR) can be evaluated by cardiac magnetic resonance (CMR).The most commonly used method to quantify AR is direct measurement using phase contrast (PC) imaging, at the aortic root (as close as possible to the aortic valve), for the calculation of regurgitant fraction (RF). Aortic distensibility (AD) may affect aortic valve dynamics and, as a result, aortic regurgitation grade. However, the impact of aortic distensibility in this evaluation remains unknown.

Purpose
The aim of the study was to evaluate the relationship between AD and AR in patients with different aortic valve anatomy.

Methods
213 patients with different AR severity grades and aortic valve anatomy (tricuspid (TAV) and bicuspid valve (BAV) patients) were enrolled (32.2% female, 74% BAV, 55.5±15.4 years), excluding connective tissue disease. All patients underwent a CMR study with PC sequences for the evaluation of regurgitant fraction at the aortic valve level. AR was considered as mild (&lt;15%), moderate (15–30%) or severe (&gt;30%) depending on RF value. Furthermore we used cine-sequences to estimate aortic diameters and distensibilities, using Art Fun software. Distensibility was calculated as (change in aortic area between systole and diastole/diastolic area)/brachial pulse pressure.

Results
159 (73.7%) AR were mild, 30 (14.1%) moderate and 24 (11.3%) severe. RF significantly correlated with aortic root diameter (r=0.337, p&lt;0.001) and did not correlate with AD at the level of proximal descending aorta (r=0.121 and p=0.107). Furthermore descendig aorta distensibility correlated with age (r=−0.631, p&lt;0.001) and aortic root diameter (r=−0.224, p=0.002). Dividing population in two different groups, depending on aortic valve anatomy, in TAV patients RF continued to not correlate with AD (r=0.159, p=0.369). In contrast, RF in BAV patients was positively correlated with AD (r=0.223, p=0.007) even after adjustment for aortic diameter and age in a multiple regression model (p&lt;0.001, R2=0.478).

Conclusions
In our study, aortic regurgitation is positively related to descending aorta distensibility in BAV patients, regardless of age and aortic root diameter. Thus, AD may play a role in the evaluation of AR in case of bicuspid valves. In contrast, in TAV patients, distensibility does not seem to influence the assessment of AR severity.
Descending aorta distensibility

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Research grant provided by the Cardiopath PhD program
Risk stratification on admission for predicting death or need for surgery in patients with acute type A intramural hematoma receiving medical therapy – validation cohort
Authors: Kageyama S 
Published: November 2020

Abstract

Background
There has been continuing discussion regarding the treatment strategy for acute type A intramural hematoma (IMH). We previously examined the risk factors of death or need for surgery for acute type A IMH in patients receiving medical treatment using clinical findings on hospital arrival and developed a simple risk score using the factors.

Purpose
We examined the accuracy of the risk score in the validation cohort.

Methods
From 2009 to 2014, 57 consecutive patients diagnosed with acute type A IMH who were receiving initial medical treatment were retrospectively included for derivation cohort. Primary endpoint was a composite of cardiovascular death and operation within 1 year after onset. On admission, the primary endpoint could be predicted with 89.7% sensitivity and 75% specificity if the patient had ulcer-like projection (ULP) and/or ≥2 of the following factors: systolic blood pressure (SBP) &lt;120 mmHg, ascending aorta diameter&gt;45 mm, and pericardial effusion (PE). In the current study, validation cohort study was performed from 2015 to 2020 in 73 consecutive patients who met the same inclusion criteria for derivation cohort to evaluate the risk factors and the accuracy of the risk score.

Result
Mean age of onset was 74 years old. Mean SBP on arrival was 134 mmHg. Computed tomography (CT) on arrival showed a mean ascending aorta diameter of 46 mm. ULP and PE were seen in 27% and 41% of cases, respectively. Thirty-three patients (45.2%) reached the primary endpoint (cardiovascular death, 8 cases [11%]; operation, 25 cases [34.2%]). In univariate analysis of admission values, the primary endpoint group had significantly lower SBP (116±29 vs 147±35 mmHg), higher ascending aorta diameter (49±8 vs 45±9 mm), and higher frequency of ULP (50% vs 10%) and PE (56% vs 29%) than did the event-free group. Multivariate analysis showed that ULP and SBP were significant predictors of the primary endpoint. The total risk score ≥2 could predict the primary endpoint with 87.5% sensitivity and 71.7% specificity (area under the receiver operating characteristic curve, 0.791).

Conclusion
The risk score was useful to predict cardiovascular death and the need for surgery in patients with acute type A IMH receiving medical therapy in the validation cohort study.
ROC curve for the risk score

Funding Acknowledgement
Type of funding source: None
18F-sodium fluoride positron emission tomography-computed tomography in acute aortic syndrome
Authors: Syed M , Fletcher A.J , Dweck M , Forsythe R.O , Tambyraja A.L , Van Beek E , Newby D.E 
Published: November 2020

Abstract

Background
Acute aortic syndrome is characterised by diseases that disrupt the intima and weaken the aorta. This damaged aorta is prone to aneurysmal dilation and ultimately rupture – a catastrophic event. 18F-sodium fluoride positron emission tomography and computed tomography (PET-CT) is a promising multimodality imaging technique that informs on the pathological state of the aorta. In abdominal aortic aneurysms (a chronic aortic disease), 18F-sodium fluoride PET uptake is associated with aortic expansion and requirement for aortic repair.

Purpose
The aim of this study was to describe aortic 18F-sodium fluoride uptake in patients with acute aortic syndrome for the first time.

Methods
Patients with intramural haematomas, aortic dissections or penetrating aortic ulcers, along with healthy control subjects, underwent contrast-enhanced 18F-sodium fluoride PET-CT. 18F-Sodium fluoride uptake was assessed using standardised uptake values and corrected for background blood pool activity to obtain tissue-to-background ratios (TBR).

Results
Forty-six patients and twenty healthy control subjects were matched for age, gender, body mass index, ischaemic heart disease and diabetes mellitus. Participants with acute aortic syndrome had widespread aortic 18F-sodium fluoride uptake. Radiotracer binding in patients with acute aortic syndrome was substantially greater than healthy subjects (TBR 2.00±0.45 vs 1.36±0.39, p&lt;0.001). Subgroup analysis in patients with untreated type B acute aortic dissection revealed peak radiotracer binding at the site of intimal disruption compared to the proximal reference aorta (TBR [inter-quartile range] 1.61 [1.38–1.88] vs 1.18 [1.08–1.39] respectively; p&lt;0.001).
Radiotracer uptake was highest in patients with penetrating aortic ulcers, followed by aortic dissection and intramural haematomas (TBR (±SD) 2.19±0.55 vs 1.99±0.43 vs 1.71±0.27 respectively; p=0.046). No difference in radiotracer uptake was observed between patients with sub-acute and chronic disease (TBR (±SD) 1.94±0.37 vs 2.04±0.51, p=0.497). 18F-sodium fluoride uptake was similar between Stanford Type A and Type B dissections (TBR (±SD) 1.98±0.49, 2.00±0.44, p=0.851). 18F-Sodium fluoride binding was independent of maximum aortic diameter (R2 = 0.036, p=0.21).

Conclusion
Our preliminary findings suggest that aortic 18F-sodium fluoride uptake is increased in patients with acute aortic syndrome, especially around the site of intimal disruption or penetrating aortic ulcers. This technique appears to identify disease activity that may have clinical applications for assessing prognosis and guiding therapeutic interventions.
18F-NaF PET/CT in Acute Aortic Syndrome

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
Impact of endovascular repair on the outcomes of octogenarians with ruptured abdominal aortic aneurysms: a nationwide Japanese study
Authors: Yamaguchi T , Nakai M , Sumita Y , Kodama T , Ogino H 
Published: November 2020

Abstract

Objective
This study aimed to clarify the impact of endovascular aneurysm repair (EVAR) on clinical outcomes in Japanese patients of advanced age with ruptured abdominal aortic aneurysm (rAAA).

Methods
This was a national registry based retrospective comparative study, using data from the Japanese Registry Of All cardiac and vascular Diseases-Diagnostic Procedure Combination (JROAD-DPC), a nationwide claim based database from more than 600 hospitals. Patients admitted with rAAA between April 1, 2012, and March 31, 2015 were included in the study. Patient characteristics, management, and outcomes were compared between the elderly (aged ≥80 y) and the less old. The primary endpoint was in hospital mortality; the secondary endpoint was the functional status at discharge.

Results
Of 3 969 eligible patients, 49.9% were categorised as elderly. Elderly patients had a higher prevalence of female gender (41.8% vs. 17.0%, p&lt;0.001) and disturbance of consciousness on admission (28.6% vs. 20.7%, p&lt;0.001). They were less likely to undergo open surgical repair (31.6% vs. 56.7%, p&lt;0.001), although EVAR was performed similarly in both groups (13.7% vs. 14.8%, p&lt;0.33). The unadjusted mortality rate (61.8% vs. 37.6%, p&lt;0.001) and mean Barthel index at discharge (73.0 vs. 91.8, p&lt;0.001) were statistically significantly worse in the elderly. Multilevel mixed effect logistic regression analyses showed that old age was detected as an independent predictor of in hospital death (odds ratio 2.75; 95% confidence interval, 2.39–3.17; p&lt;0.001). However, for patients who received EVAR, old age was not statistically significant (odds ratio 1.13; 95% confidence interval, 0.77–1.66; p&lt;0.53).

Conclusion
Elderly patients with rAAA were less likely to be offered open surgical repair, and the mortality among those who received surgery was high. However, for the small subgroup of elderly patients currently selected for EVAR there was a favourable outcome. The further implementation of EVAR for rAAA in Japan, especially for elderly patients with suitable anatomy, may be justified.

Funding Acknowledgement
Type of funding source: None