bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ten years of high-sensitivity cardiac troponin testing in the Netherlands: impact on the diagnosis of myocardial infarction
Authors: Kimenai D.M , Appelman Y , Den Ruijter H.M , Mills N.L , Meex S.J.R 
Published: November 2020

Abstract

Introduction
High-sensitivity cardiac troponin (hs-cTn) assays have enhanced sensitivity for myocardial injury and may lead to an increase in the diagnosis of myocardial infarction. Few real-world studies have investigated the transition from conventional cardiac troponin (cTn) to hs-cTn. We evaluated the impact of implementing hs-cTn assays and sex-specific thresholds in the Netherlands on the diagnosis of myocardial infarction in women and men.

Methods
Twelve Dutch hospitals were included (hs-cTnI assay [sex-specific thresholds], n=4; hs-cTnT assay [uniform threshold], n=8). Data from the health insurance claims of consecutive patients with anginal symptoms were collected before (cTn period) and after (hs-cTn period) implementation from January 2008 to December 2017. The proportion of patients with a diagnosis of myocardial infarction overall, and in men and women separately, and one-year mortality was compared before and after implementation of the hs-cTn assay.

Results
Across twelve hospitals, a total number of 77,464 patients presenting with anginal symptoms were included (cTn period: 35,409 [36.6% women]; hs-cTn period: 42,055 [34.6% women]). Following implementation of hs-cTn testing the proportion of patients with anginal symptoms diagnosed with myocardial infarction doubled from 24% (3,111/12,970) to 48% (7,014/14,560) in women, and from 25% (5,712/22,439) to 51% (13,912/27,495) in men, with similar increases in sites implementing hs-cTnI and hs-cTnT. The proportion of patients diagnosed with myocardial infarction who were women increased in sites implementing sex-specific thresholds (from 36.4% [1,435/3,941] to 37.5% [1,700/4,532], absolute change 1.1%), but did not increase in sites using a uniform threshold (from 34.3% [1,676/4,882] to 32.4% [5,314/16,394], absolute change −1.9%). In patients with a diagnosis of myocardial infarction, one-year mortality was 15.6% (485/3,111) and 11.6% (814/7,014) in women, and was 11.8% (673/5,712) and 9.4% (1,303/13,912) in men, before and after implementation of hs-cTn.

Conclusions
In patients presenting with anginal symptoms, the diagnosis of acute myocardial infarction doubled after implementation of hs-cTn testing in both women and men. Use of sex-specific thresholds increased the proportion of patients with myocardial infarction who were women compared to use of a uniform threshold. Implementation was associated with a reduction in one-year mortality, but further research is needed to understand whether this is due to differences in the risk profile of patients with myocardial infarction or improvements in treatment.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): This study was supported by a grant from Abbott Laboratories to S.J.R.M.
Enriching artificial intelligence ST-elevation myocardial infarction (STEMI) detection algorithms with differential diagnoses
Authors: Mehta S , Niklitschek S , Fernandez F , Villagran C , Escobar E , Avila J , Cardenas G , Rocuant R , Vera F , Frauenfelder A , Vieira D , Quintero S , Vijayan Y , Merchant S , Tamayo C.J 
Published: November 2020

Abstract

Background
STEMI outcomes, although improved with systems of care, are hamstrung by delayed presentation and prevaricates of a 12-lead ECG. We report an artificial intelligence (AI) guided, single lead EKG algorithm for a self-administered tool to reliably detect STEMI and trigger ambulance dispatch.

Purpose
To provide a reliable and improved AI-guided Single Lead EKG methodology.

Methods
From our cardiologist-annotated repository, we assigned a dataset of 11,118 classified ECG. Ontology organized 5 groups apportioned for an interclass balance among commoner STEMI differential diagnoses. This anonymous, pre-classified data included 5,549 STEMI, 1,391 normal, 1,393 Bundle Branch Block, 1,393 non-specific ST-T changes and 1,392 miscellaneous. Each ECG was fragmented into individual 1-lead strips. Algorithm: 1-D Convolutional Neural Networks. Gender and age were included before the last dense layer. Training and Testing: Preset 90% dataset (10,008 ECG) train, 10% test (1,110 ECG). Statistical Analysis and ROC curves: Digitized dataset, 500 samples/second, 10s duration, total 5,000 samples per lead. Statistical mean for each lead was calculated and subtracted from the original lead. Statistical values and ROC curves were assessed.

Results
Most Accurate: Lead V2 – 91%; Most Sensitive: Lead I – 92% Most Specific: Lead III – 96%. Best AUC: Lead V2 – 91%.

Conclusions
Incorporating subtypes of STEMI differential diagnosis enriches the single lead AI algorithm. Validating the derived algorithm with our entire database of 18 million ECG will further strengthen the results.

Funding Acknowledgement
Type of funding source: None
Predictors of plaque erosion in current smokers and non-current smokers presented with ST-segment elevation myocardial infarction: an optical coherence tomography study
Authors: Wang Y , Dai J , Fang C , Zhang S , Wang J , Yin Y , Jiang S , Guo J , Lei F , Tu Y , Xing L , Hou J , Yu B 
Published: November 2020

Abstract

Background
Plaque erosion with subsequent coronary thrombosis is considered as an important cause of ST-segment elevation myocardial infarction (STEMI). Smoking is a major risk factor for acute coronary thrombosis. However, the relationship between current smoking status and plaque erosion has not been systematically investigated.

Purpose
The present study aimed to investigate predictors of plaque erosion in current smokers and non-current smokers with STEMI by using optical coherence tomography (OCT).

Methods
Between January 2015 to December 2017, a total of 1313 STEMI patients underwent pre-intervention OCT of culprit lesion were enrolled and divided into two groups based on current smoking status: current smoking group (n=713) and non-current smoking group (n=600). Using established criteria, quantitative and qualitative underlying plaque characteristics were assessed by OCT. Clinical, angiographic and OCT characteristics of all enrolled patients were recorded. Univariable and multivariable logistic regression analyses were used to identify predictors of plaque erosion in two groups.

Results
Plaque erosion were found in 30.9% (220/713) culprit lesions in current smoking group and 20.8% (125/600) of those in non-current smoking group detected by OCT. In multivariate regression analysis, the predictors that strongly related to plaque erosion in the current smoking group were nearby bifurcation (OR: 4.84; 95% CI:2.38–9.87; p&lt;0.001); the minimum fiber cap thickness (FCT, OR:1.05; 95% CI:1.03–1.08; p&lt;0.001); thin-cap fibroatheroma (TCFA, OR: 0.22; 95% CI: 0.07–0.67; p=0.007) and lipid core length (OR: 0.91; 95% CI: 0.84–0.97; p=0.007). The predictors in the non-current smoking group were nearby bifurcation (OR: 4.84; 95% CI: 2.38–9.87; p=0.006); the minimal FCT (OR: 1.09; 95% CI: 1.06–1.13; p&lt;0.001); multi-vessel disease (MVD, OR: 0.43; 95% CI: 0.19–0.97; p=0.042) and dyslipidemia (OR: 0.34; 95% CI: 0.14–0.84; p=0.020).

Conclusions
Predictors of plaque erosion causing STEMI onset are different between current smokers and non-current smoker, with nearby bifurcation and thicker minimal FCT both predicting plaque erosion in two groups of patients.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Key Research and Development Program of China, National Natural Science Foundation of China.
Myocardial infarction with non-obstructive coronary artery disease: the prognostic role of infarct size predictors
Authors: Donati F , Toniolo S , Bergamaschi L , Paolisso P , D'Angelo E.C , Magnani I , Angeli F , Bartoli L , Stefanizzi A , Foa' A , Rinaldi A , Casella G , Pizzi C , Galie' N 
Published: November 2020

Abstract

Background
In patients with Acute Myocardial Infarction (AMI) the levels of cardiac troponin T and absolute neutrophil count have been shown to correlate with infarct scar size and left ventricular ejection fraction (LVEF) as well as conferring a risk for major cardiovascular adverse events (MACE). In the context of myocardial infarction with non-obstructive coronary arteries (MINOCA) the prognostic role of such indicators has never been explored.

Purpose
To evaluate the prognostic role of known myocardial infarct size indicators in a MINOCA population compared to patients with obstructive AMI (Ob – AMI).

Methods
Among 1990 patients admitted to our coronary care unit from 2016 to 2019 with AMI, we enrolled 186 consecutive MINOCA patients according to the current ESC diagnostic criteria. We compared troponin peak levels, absolute neutrophil count at the time of hospital admission and LVEF in MINOCA patients versus Ob–AMI. Furthermore we assessed the prognostic value of these indicators. All-cause mortality and a composite end - point of all-cause mortality and myocardial re-infarction were evaluated. The median follow-up time was 19.6±12.9 months.

Results
MINOCA patients were more frequently females (64,9% vs 35,1%; p&lt;0.001), non-smokers (42,3% vs 61,8%; p&lt;0.001) with a lower prevalence of diabetes (9.9% vs 23.7%; p&lt;0.001) compared to the Ob-AMI population. Conversely, no differences were found in hypertension and dyslipidemia. As far as infarct size predictors are concerned, MINOCA patients showed lower levels of troponin value and absolute neutrophil count measured at the time of hospital admission (1838.27±601.0 ng/L vs 13543±3350.6 ng/L; p&lt;0.001, 6.7±1.36x109/L vs 7.1±1.29x109/L; p=0.001, respectively). Moreover, these patients exhibited a higher LVEF (56.1±10% vs 49.3±11%; p&lt;0.001) as compared to Ob-AMI.
Among our MINOCA patients, 13 (10.6%) all-cause deaths and 3 (4.3%) myocardial re-infarction were observed during follow-up. Multivariable Cox-regression model demonstrated that mean troponin level, absolute neutrophil count and LVEF were not independent predictors of MACE (HR = 1.0, 95% CI: 0.9–1.1, p=0.6; HR = 0.96, 95% CI: 0.9–1.1, p=0.187; HR = 0.9, 95% CI: 0.79–1.02, p=0. 12 respectively).

Conclusion
MINOCA patients show a similar prognosis compared to the worldwide AMI population.
However, in this study the outcome in the MINOCA population was not influenced by commonly used infarct size predictors, in contrast to what is observed in Ob-AMI patients. These results once again emphasize both the complexity of MINOCA patients and the importance of a better understanding of the different underlying pathophysiological mechanisms.

Funding Acknowledgement
Type of funding source: None
Troponin T but not C-reactive protein is associated with myocardial mass and risk for, and time to future surgery for aortic stenosis; a population-based study
Authors: Soderberg S , Holmgren A , Ljungberg J , Hultdin J , Bergdahl I , Naslund U , Johansson B 
Published: November 2020

Abstract

Objective
High-sensitivity troponin T (hs-TnT) and high-sensitivity C-reactive protein (hs-CRP) may convey prognostic information in patients with aortic stenosis (AS). However, many association studies were cross-sectional, and the presence of myocardial hypertrophy and concomitant coronary artery disease (CAD) were usually not described. This study evaluated if hs-TnT and hs-CRP relate to myocardial mass, and associate with risk of and time to future surgery for AS in patients with and without concomitant CAD.

Design
In total, 336 patients who underwent surgery due to AS after participation in large population surveys were identified. Median age [interquartile range] was 59.8 [10.3] years at survey and 68.3 [12.7] years at surgery, and 48% were women. The median time between survey and surgery was 10.9 [9.3] years. Preoperatively, myocardial mass and the presence of CAD were assessed. Two matched referents were allocated for each case, and hs-TnT and hs-CRP were determined in stored plasma samples from the baseline survey. Uni- and multivariable conditional logistic regression analyses were used to estimate the risk (odds ratio [95% confidence interval]) related to one (ln) standard deviation increase in hs-TnT and hs-CRP. Time to surgery was evaluated by Kaplan-Mayer analysis and Cox regression.

Results
Hs-TnT was independently associated with surgery for AS in patients with concomitant CAD (odds ratio [95% confidence interval]) (1.22 [1.02–1.46]) and without concomitant CAD (1.39 [1.05–1.84]). Hs-CRP was not associated with surgery for AS after adjustment for traditional cardiovascular risk factors (1.06 [0.92–1.23]).
Patients with high hs-TnT levels had shorter time to surgery compared those with low levels (Figure, p&lt;0.001) whereas hs-CRP did not associate with time to surgery. Hs-TnT levels at survey associated independently with myocardial mass at surgery (p=0.002) but not with CAD and severity of stenosis.

Conclusions
Hs-TnT – but not hs-CRP – was associated with increased risk for, and shorter time to future surgery for AS. Hs-TnT associated with myocardial mass at surgery which indicates that Hs-TnT may be used as a clinical tool and allow for identification of patients with AS who could benefit from earlier intervention.
Time to surgery; tertiles of hs-TnT

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Swedish Heart–Lung Foundation
Left ventricular myocardial work in patients with secondary mitral regurgitation
Authors: Yedidya I , Lustosa R.P , Fortuni F , Van Der Bijl P , Namazi F , Vo N.M , Ajmone Marsan N , Delgado V , Bax J 
Published: November 2020

Abstract

Background
Assessment of left ventricular (LV) function in patients with secondary mitral regurgitation (SMR) remains challenging because LV ejection fraction (LVEF) reflects changes in LV volume without taking into account the direction of the blood flow. LV global longitudinal strain better reflects active LV myocardial deformation but does not incorporate afterload. LV myocardial work derived from pressure-strain loops integrates speckle tracking echocardiography with non-invasive blood pressure measurement.

Purpose
To evaluate LV myocardial work components to better characterize LV function in patients with SMR.

Methods
378 patients (72% men, median age 68 [range 60 to 74 years]) with various grades of SMR were retrospectively analysed. LV myocardial constructive work, wasted work and work efficiency were measured with speckle tracking echocardiography.

Results
145 patients had mild SMR, 130 moderate SMR and 103 severe SMR. Patients with severe SMR had larger LV volumes, lower LVEF and more impaired LV GLS (Table 1). While LV constructive work was more impaired in patients with severe SMR, wasted work was lower as compared to mild SMR (Table 1). Consequently, patients with severe SMR had better myocardial work efficiency than patients with mild MR. This could reflect, the regurgitant volume which is pumped into a low pressure chamber (the left atrium) resulting in less myocardial wasted work and preservation of myocardial efficiency.

Conclusion
In patients with severe SMR, LVEF, LV GLS and myocardial constructive work are more impaired when compared to mild SMR. However, myocardial wasted work is lower, resulting in higher better LV myocardial work efficiency.

Funding Acknowledgement
Type of funding source: None
How accurate is cardiac magnetic resonance in quantitation of primary mitral regurgitation?
Authors: Baron T , Kristensson J , Flachskampf F.A 
Published: November 2020

Abstract

Background
Since evaluation of mitral regurgitation (MR) in patients with mitral prolapse by echo may be challenging, cardiac MRI (CMR) has been used for identification of patients with severe valve disease. Little is known about potential factors influencing accuracy of this approach.

Purpose
To study the impact of left ventricular (LV) contouring methods and interobserver variability on quantitation of MR severity.

Methods
A total of 50 asymptomatic patients with echocardiographically moderate or severe MR were included to LV-REGURGE study and evaluated with CMR by two independent reviewers. LV volumes were calculated on SSFP short axis stack including or excluding intracavitary myocardium into/from the LV volume (“including” or “excluding” method, respectively). Aortic flow volumes were obtained using phase contrast method. Mitral regurgitant volume (RegVol) was calculated by subtracting forward aortic volume from LV stroke volume. Severe MR was diagnosed when RegVol &gt;60mL and/or RegVol/LV stroke volume (RF) &gt;40%. Agreement between MR grading into severe and non-severe, obtained by different tracing methods and different reviewers was assessed using kappa coefficient.

Results
Left ventricular and mitral regurgitant volumes obtained by “including” method were significantly larger as compared with “excluding” method, see table. “Including” method identified severe MR in 68% while “excluding” method in 57% of cases. Overall agreement between the methods was present in 84% of cases, meaning a substantial rate of agreement (κ 0.67). Within respective methods, interobserver agreement was present in 77% of cases, interpreted as a moderate rate of agreement (κ 0.48–0.54)

Conclusion
“Including” trabeculae and papillary muscles into the LV cavity volume substantially increases rate of recognizing severe MR, due to larger LV volumes, particularly LV ESV, comparing with the “excluding” method. Moreover, inter-observer variability in similar extent as tracing method seems to impact differentiation between severe and non-severe MR.

Funding Acknowledgement
Type of funding source: None
Intravascular ultrasound assessment of the actual transcatheter heart valve dimensions among patients treated for a right ventricular outflow tract insufficiency after surgical reconstruction
Authors: Kalinczuk L , Skotarczak W , Rynkiewicz K , Mintz G.S , Zielinski K , Swierczewski M , Michalowska I , Biernacka K , Ryzyllo W , Demkow M 
Published: November 2020

Abstract

Introduction
Transcatheter heart valve (THV) deployment can be used to treat right ventricular outflow tract (RVOT) insufficiency, but it is unknown whether manufacturers' predicted THV dimensions correspond with actualy measured.

Purpose
To compare valve frame nominal dimensions predicted by the manufacturers' charts (Melody or Edwards SAPIEN [ES] 3) versus actual dimensions assessed using intravascular ultrasound (IVUS) with Visions PV.035 Digital Catheter (Philips) offering an imaging field of 60mm.

Methods
IVUS recordings were made post-THV deployment in 6 pts (median age 33 [20–44] yrs, 3 ♀, all with Tetralogy of Fallot) who had undergone prior corrective surgery (4 transannular patch, 1 bioprosthetic valve or 1 pulmonary homograft), but who presented with significant RVOT insufficiency. IVUS-visualized homograft cross-sections were perpendicular to its long axis. Offline volumetric measurements included the inner-THV dimension for a total of 16 evenly spaced cross-sections along the THV length. Assessed were THV inner-frame diameters (minimal and maximal), cross-sectional areas, and cross-sectional area of the visual orifice area identified at the coaptation site (Fig. 1). Each THV (1 Melody [Ø 22mm, 28mm nominal length] and 5 ES3 [1Ø 23mm, 18mm height; 4 Ø 29mm, 22.5mm height]) was implanted after pre-stenting using stents of 36, 39, or 48mm length, deployed on a 24mm (n=1) or 30mm (n=4) balloon-in-balloon catheter.

Results
Overall, 96 paired cross-sections were analyzed. Actual THV inner area was 95%±20% of that predicted. However, minimum THV inner diameter was smaller, but maximal inner diameter exceeded those predicted (Table 1). The ratios of measured-to-predicted minimal and maximal THV inner diameters were 97%±11% and 112%±13%, respectively, with a measured max/min inner THV frame diameter ratio of 1.16±0.13. However, the ratio of max/min lumen diameter measured at the coaptation site was of 1.11±0.11 signifying low eccentricity. Visual orifice area measured 364.3±87.6 mm2, and was 65%±8% of the measured inner THV area.

Conclusions
After balloon-expandable THV implantation to treat RVOT insufficiency, there are differences in dimensions between actually measured vs predicated by manufacturers' charts. IVUS allows online tomographic insight into the actual THV frame dimensions and the substantially smaller, but circular orifice area.
Figure 1. IVUS visualization

Funding Acknowledgement
Type of funding source: None
Prognostic value of right ventricular systolic function by speckle tracking echocardiography beyond conventional echocardiography in significant tricuspid regurgitation
Authors: Hinojar Baydes R , De Angelis V , Garcia-Martin A , Gonzalez-Gomez A , Sanroman M , Pascual M , Lorente A , Monteagudo J.M , Jimenez-Nacher J.J , Zamorano J.L , Fernandez-Golfin C 
Published: November 2020

Abstract

Background
Right ventricular (RV) systolic function is determinant in the evaluation of patients with significant tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is limited by the geometry and position of the RV. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function with the capability of detect subclinical RV dysfunction

Purpose
This study was aimed to evaluate the prognostic value of RV strain in consecutive patients with significant TR, in comparison with conventional parameters of RV systolic function.

Methods
Consecutive patients in stable clinical status with significant TR (severe, massive or torrential TR) evaluated in the Heart Valve Clinic were included. RV systolic function was measured with conventional echocardiographic parameters (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]), DTI S wave ('S) and with STE derived automatic peak global and free wall longitudinal strain (GLS, FW-LS respectively) using the EPIQ system. A combined endpoint of hospital admission due to heart failure or cardiovascular mortality was defined.

Results
A total of 100 patients were included (mean age was 76±10 years, 65% females, 84% in NYHA I/II, 86% functional TR). Mean values of RV function parameters are shown in the table. During a mean follow up of 24±10 months, 24% of the patients reached the combined endpoint. Patients with events showed impaired RV GLS and FW-LS (p&lt;0.01). Both parameters were predictive of the combined endpoint (table 1). Conventional parameters of RV systolic function were not associated with outcomes (p&gt;0.05 for all).

Conclusion
In patients with severe TR, RV strain values are superior to conventional parameters to detect RV dysfunction. Among different measurements of RV function, RV GLS and FW-LS were the only predictors of poor prognosis. These parameters should be included in the serial evaluation of these patients.

Funding Acknowledgement
Type of funding source: None