bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left ventricle myocardial deformation pattern in severe aortic valve stenosis without cardiac amyloidosis. AMY-TAVI study
Authors: Bastos Fernandez M , Lopez Otero D , Lopez Pais J , Pubul Nunez V , Neiro Rey C , Pena Gil C , Alvarez Barredo M , Martinez Monzonis M.A , Trillo Nouche R , Cacho Antonio C , Gonzalez Ferrero T , Antunez Muinos P.J , Torrelles Fortuny A , Perez Dominguez M , Gonzalez-Juanatey J.R 
Published: November 2020

Abstract

Background
The Longitudinal Strain (LS) pattern in cardiac amyloidosis (CA) typically spares the apex of the heart, and this is a sensitive and specific finding that can be used to distinguish AC from other causes of left ventricular (LV) hypertrophy.

Purpose
To assess the clinical profitability of the LV deformation echocardiographic criteria derived from LS described as suggestive of CA, in patients with severe symptomatic aortic stenosis (AS) without amyloidosis referred for TAVI.

Methods
Within AMY-TAVI study (NCT03984877). Prior to TAVI implantation, conventional echocardiographic parameters were analyzed, along with LV deformation parameters and strain phenotype using Speckle-Tracking Echocardiography. Strain derived Indices accepted for CA screening were calculated: RELAPS: relative apical LS (average apical LS/sum of the average basal and mid LS); SAB: septal apical to base ratio (apical septal LS/basal septal LS); EFSR: ejection fraction strain ratio (LVEF/GLS). After implant, technetium pyrophosphate99 scintigraphy and proteinogram were performed to diagnose or exclude CA, and those patients in which CA was excluded were selected.

Results
109 patients were consecutively included. The mean age was 81±6 yo, 58% were women. The mean aortic valve area (AVA) was 0.7±0.1 cm2 and the mean LVEF was 57.8±15%. Strain analysis could only be performed in 92 patients. Of these, 39 (42%) presented a LV strain pattern with relative apical sparing of LS respect to basal and middle segments (RELAPS&gt;1 pattern); 82 patients (89%) SAB was &gt;2.1; and 39 (42%) showed EFSR &gt;4.1. The RELAPS&gt;1 pattern was significantly associated with greater severity of AS based on AVA (0.7 cm2 in RELAPS &lt;1 vs 0,6 cm2 in RELAPS &gt;1, p=0.041), maximum velocity (4,4 vs 4,7 m/s, p=0.018), maximum aortic valve gradient (81 vs 91 mmHg, p=0.021) and medium gradient (49 vs 56 mmHg, p=0.020); higher degree of LV hypertrophic remodeling (Maximum wall thickness 14,3 vs 16,1 mm, p=0,003; Relative wall thickness 0,5 vs 0,6 mm, p=0,008); LV mass index: 168 vs 192 gr/m2, p=0,005; LV end-diastolic volume 112 vs 91 ml, p=0,005), and significantly lower myocardial contraction fraction (0,22 vs. 0,18, p=0,001).

Conclusions
In our series, patients with severe symtomatic AS without CA referred for TAVI frequently present a strain phenotype with relative apical preservation and a LVEF/GLS ratio similar to those described in CA. Our results suggest that the classic patterns of CA are common in patients with severe AS, in absence of said pathology, which limits its use for CA screening in these patients.
Polar map patterns according to RELAPS

Funding Acknowledgement
Type of funding source: None
Incremental benefits of echocardiographic indices over clinical parameters for screening cardiac amyloidosis in patients with left ventricular hypertrophy
Authors: Saito M , Nakao Y , Higaki R , Yokomoto Y , Ogimoto A , Suzuki M , Kawakami H , Hiasa G , Okayama H , Inoue K , Ikeda S , Yamaguchi O 
Published: November 2020

Abstract

Background
Cardiac amyloidosis (CA), characterized by amyloid protein deposition in the heart, is a treatable disease. Although left ventricular (LV) wall thickness is the most established imaging predictor for CA, several echocardiographic indices including deformation parameters also contribute to the screening of CA. However, it is unclear whether additive values of echocardiographic indices have greater benefit over the conventional clinical predictors for the screening of CA. Therefore, we sought to compare the incremental benefits of echocardiographic indices over the clinical parameters for the screening of CA and externally validate their incremental benefits.

Methods
We retrospectively studied 295 consecutive patients (median age, 67 years; male, 65%; mean LV wall thickness (MWT), 12 mm) with LV hypertrophy who underwent echocardiography as well as the detailed work-up for myocardium (Biopsy, technetium pyrophosphate scintigraphy (99mTc-PYP) or cardiac magnetic resonance imaging). CA was diagnosed through biopsy or 99mTc-PYP. The clinical model considers patients' age and the low-voltage in electrocardiography in reference to previous studies. Continuous echocardiographic variables were represented in binary through generally accepted external cutoff points. The incremental benefits of the echocardiography findings over the clinical model were assessed using with the help of both receiver-operated characteristic curve analysis and comparison of area under the curves. Furthermore, these incremental benefits were validated in the external validation sample (median age, 70 years; male, 69%; MWT, 12 mm).

Results
Among the enrolled patients, CA was observed in 18% of cases. Table presents the results of this study. Of the echocardiographic parameters, relative apical sparing pattern (RASP) was the greatest contributor for improvement of diagnostic accuracy of the clinical model. The next greatest contributor was LV wall thickness, followed by left atrial reservoir strain (LAS), E/e', left atrial volume index, ejection fraction strain ratio, and pericardial effusion, respectively. Similarly, RASP, LV wall thickness, global longitudinal strain, ejection fraction, LAS, and granular sparkling showed significant incremental benefit in the validation cohort. Only mean wall thickness, LV wall thickness, LAS, E/e' and RASP consistently improved the diagnostic accuracy of the clinical model.

Conclusion
During the screening process, adding LV wall thickness, LAS, and RASP to the clinical parameters may be useful for the accurate diagnosis of CA in patients with LV hypertrophy.
Figure 1

Funding Acknowledgement
Type of funding source: None
Non-invasive myocardial work: an echocardiographic measure of post-infarct scar on contrast-enhanced cardiac magnetic resonance imaging
Authors: El Mahdiui M , Van Der Bijl P , Abou R , De Lustosa R.P , Van Der Geest R , Ajmone Marsan N , Delgado V , Bax J.J 
Published: November 2020

Abstract

Background
Late gadolinium contrast enhanced cardiac magnetic resonance (LGE CMR) imaging accurately quantifies the extent of fibrosis and transmurality in chronically infarcted left ventricular (LV) segments, and identifies viability. Moreover, CMR characterizes the remote, non-infarcted zone, which is an emerging region of interest following ST-segment elevation myocardial infarction (STEMI). Non-invasive myocardial work is a novel LV function parameter - calculated from speckle-tracking strain echocardiography and sphygmomanometrically-determined blood pressure, which has shown excellent correlation with invasively measured myocardial work.

Purpose
To explore the relation of non-invasively estimated parameters of LV myocardial work to post-infarct scar on LGE CMR, and to compare myocardial work indices between the infarct core and remote zone in STEMI patients who were treated with primary percutaneous coronary intervention (PCI).

Methods
Patients with a STEMI who underwent primary PCI and LGE CMR, in addition to echocardiographic studies where non-invasive myocardial work analysis was feasible, were included. The LV was subdivided into non-infarcted, non-transmural and transmurally infarcted segments. The remote zone was defined as the non-infarcted myocardial segment diametrically opposed to the infarct core, without any evidence of LGE. Myocardial work indices were compared with linear mixed models, ANOVA and Wilcoxon signed rank tests.

Results
53 patients (89% male, age 58±9 years) and 689 segments were analysed. The mean scar burden comprised 14±7% of the total LV mass and 76 (11%) segments showed transmural LGE. The following non-invasive myocardial work indices: myocardial work index (MWI), constructive work (CW) and myocardial work efficiency (MWE) showed a significant inverse relationship with infarct transmurality (p&lt;0.05 for all comparisons) while a positive trend was observed for wasted work (WW) (p=0.086) (Figure 1). The core zone demonstrated lesser MWI (1237±568 vs. 1514±518 mmHg%; p=0.010), CW (1331±627 vs. 1827±537 mmHg%; p&lt;0.001) and MWE (92 (84–98) vs. 98 (95–99) %; p&lt;0.001) as well as greater WW when compared to the remote zone (107 (26–196) vs. 26 (10–90) mmHg%; p=0.001).

Conclusions
In STEMI patients who underwent primary PCI, MWI, CW and MWE were significantly related to the extent of transmural infarction, while WW demonstrated a trend. MWI, CW and MWE were significantly lower, and WW higher, in the core zone compared to the remote zone. Non-invasive myocardial work indices may provide an echocardiographic method for determining post-infarct viability, as well as characterization of the remote zone.
MW and scar transmurality on LGE CMR

Funding Acknowledgement
Type of funding source: None
Sex-specific difference in the association between arterial stiffness and subclinical left ventricular dysfunction
Authors: Yoshida Y , Nakanishi K , Daimon M , Ishiwata J , Sawada N , Hirokawa M , Kaneko H , Nakao T , Mizuno Y , Morita H , Di Tullio M , Homma S , Komuro I 
Published: November 2020

Abstract

Background
Increased arterial stiffness has been proposed as one of the key mechanisms of incident heart failure with preserved ejection fraction (HFpEF). However, the possible association between arterial stiffness and subclinical left ventricular (LV) dysfunction and possible sex-specific differences remain unclarified. LV strain is emerging as a highly sensitive tool to unmask early LV abnormalities.

Purpose
We investigated whether increased arterial stiffness is independently associated with subclinical LV dysfunction in a large community-based cohort without overt cardiovascular disease.

Methods
We examined 1,155 participants who underwent extensive cardiovascular examination. Speckle-tracking echocardiography was employed to assess LV global longitudinal strain (LVGLS) and circumferential strain (GCS), and arterial stiffness was assessed by cardio-ankle vascular index (CAVI).

Results
Mean age was 62±12 years, and 56% were male. CAVI as continuous variable was associated with abnormal LVGLS (&gt;−18.6%), independent of cardiovascular risk factors and pertinent laboratory and echocardiographic parameters (adjusted odds ratio [OR] 1.23, p=0.034), whereas there was no relationship with LVGCS. In sex-stratified analysis, more pronounced association between quartiles of CAVI and abnormal LVGLS was observed in women than in men (unadjusted OR = 6.43 in women and 2.46 in men for upper quartile vs. lower quartile, both p&lt;0.01; Figure). Multivariable analyses demonstrated that CAVI was significantly associated with abnormal LVGLS independent of cardiovascular risk factors in both sexes. However, after further adjustment for LV mass index and diastolic parameters, the independent association persisted in women (adjusted OR 1.49, p=0.041), but not in men (adjusted OR 1.15, p=0.209).

Conclusion
Increased arterial stiffness was independently associated with decreased LVGLS even in the absence of overt cardiovascular disease; a sex-specific pattern exists in the alteration of vascular-ventricular coupling, which might partially explain the greater susceptibility to HFpEF in women.

Funding Acknowledgement
Type of funding source: None
Left ventricular mechanical dispersion in flow-gradient patterns of severe aortic stenosis
Authors: Lavall D , Kuprat L.K , Kandels J , Stoebe S , Hagendorff A , Laufs U 
Published: November 2020

Abstract

Purpose
Patients with severe aortic stenosis are classified according to flow-gradient patterns. We investigated whether left ventricular (LV) mechanical dispersion, a marker of dyssynchrony and predictor of mortality, is associated with low-flow status in aortic stenosis.

Methods and results
400 consecutive patients with QRS duration &lt;120ms were included in the retrospective analysis. Patients with severe aortic stenosis (aortic valve area ≤1.0cm2) were classified as normal-flow (NF; stroke volume index &gt;35ml/m2) high-gradient (HG; mean transvalvular gradient ≥40mmHg) (n=79), NF low-gradient (LG) (n=62), low-flow (LF) LG ejection fraction (EF) ≥50% (n=57), and LF LG EF&lt;50% (n=23). Patients with moderate aortic stenosis (aortic valve area 1.5–1.0cm2; n=95) and patients with chronic systolic heart failure (n=84) without aortic stenosis served as comparison groups. Similar values of mechanical dispersion (calculated as standard deviation of time from Q/S onset on electrocardiogram to peak longitudinal strain in 17 left ventricular segments) was observed in patients with NF HG (49.4±14.7ms), NF LG (43.5±12.9ms), LF LG EF≥50% (47.2±16.3ms) and moderate aortic stenosis (44.2±15.7ms). Mechanical dispersion was increased in patients with LF LG EF&lt;50% (60.8±20.7ms) and in chronic heart failure (59.4±16.7ms) (p&lt;0.05 for both vs. NF HG‡, NF LG†, LF LG EF≥50%§ and moderate*; Figure). Mechanical dispersion correlated with LV end-systolic volume index (r=0.2530, p&lt;0.0001), LVEF (r=−0.2895, p&lt;0.0001) and global longitudinal strain (r=0.3108, p&lt;0.0001), but not with parameters of aortic stenosis.

Conclusion
Mechanical dispersion was similar among flow-gradient subgroups of severe aortic stenosis with preserved LVEF, but increased in patients with low-flow low-gradient and reduced LVEF. These findings indicate that mechanical dispersion is rather a marker of systolic myocardial dysfunction than of aortic stenosis.
Figure 1

Funding Acknowledgement
Type of funding source: None
Glucagon like peptide-1 receptor agonists and their combination with sodium-glucose cotransporter-2 inhibitors improve myocardial deformation and work index in type-2 diabetes after 12-month treatment
Authors: Ikonomidis I , Pavlidis G , Thymis J , Birba D , Kalogeris A , Kousathana F , Kountouri A , Balampanis K , Parissis J , Andreadou I , Katogiannis K , Frogoudaki A , Vrettou A.R , Iliodromitis E , Lambadiari V 
Published: November 2020

Abstract

Background/Introduction
Type-2 diabetes mellitus (T2DM) exacerbates mechanisms of atherosclerosis and heart failure.

Purpose
We investigated the effects of insulin, glucagon like peptide-1 receptor agonists (GLP-1RA), sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and their combination on LV myocardial function of T2DM patients.

Methods
A hundred-sixty T2DM patients (age: 58±10 years) were randomized to insulin (n=40), liraglutide (n=40), empagliflozin (n=40) or their combination (GLP-1RA+SGLT-2i) (n=40) as add-on to metformin. We measured at baseline, 4 and 12 months post-treatment: a) global LV longitudinal strain (GLS), systolic (LongSr) and diastolic (LongSrE) strain rate, global circumferential (GCS) and radial (GRS) strain, peak twisting (pTw), peak twisting velocity (pTwVel) and peak untwisting velocity (pUtwVel), b) global myocardial global work index (GWI), global constructive (GCW) and global wasted myocardial work (GWW) derived by pressure-myocardial strain loops using speckle tracking imaging.

Results
At 4 and 12 months post-treatment, all patients improved GLS, GCS, GRS and pUtwVel (p&lt;0.05). At 12 months, GLP-1RA or GLP-1RA+SGLT-2i provided a greater increase of GLS (11.5% and 13% vs. 6.8% and 2.3%), GCS (11.9% and 14.6% vs. 7.3% and 3.4%), GRS (3.8% and 4.3% vs. 2.2% and 1.6%), GWI (12.7% and 17.4% vs. 3.1% and 2%), GCW (12.3% and 15% vs. 2.2% and 7.8%) and a greater reduction of GWW (38.7% and 41.6% vs. 13.5% and 4.9%) compared with insulin or SGLT-2i, despite a similar HbA1c reduction (p&lt;0.05 for all comparisons) (Table). Patients under combined treatment with GLP-1RA+SGLT-2i achieved a 2-fold reduction of pTw and a 2-fold increase of pUtwVel than those under each one regimen or insulin (p&lt;0.05). The dual therapy showed the greatest effect on measured myocardial markers in patients with LVEF &lt;55% (p&lt;0.05).

Conclusions
Twelve-month treatment with GLP-1RA or combination of GLP-1RA and SGLT-2i showed a greater improvement of myocardial deformation and effective cardiac work than insulin or SGLT-2i treatment in T2DM. The combined therapy as second line was superior to either insulin, or GLP-1RA and SGLT-2i separately.

Funding Acknowledgement
Type of funding source: None
A deep learning approach to automate high-resolution blood vessel reconstruction on computerised tomography images with or without the use of contrast agents
Authors: Chandrashekar A.C , Handa A.H , Shivakumar N.S , Lapolla P.L , Grau V.G , Lee R.L 
Published: November 2020

Abstract

Background
Existing methods to reconstruct vascular structures from a computed tomography (CT) angiogram rely on injection of intravenous contrast to enhance the radio-density within the vessel lumen. Pathological changes present within the blood lumen, vessel wall or a combination of both prevent accurate 3D reconstruction. In the example of aortic aneurysmal (AAA) disease, a blood clot or thrombus adherent to the aortic wall within the expanding aneurysmal sac is present in 95% of cases. These deformations prevent the automatic extraction of vital clinically relevant information by current methods.

Objectives
In this study, we utilised deep learning segmentation methods to establish a high-throughput and automated segmentation pipeline for pathological blood vessels (ex. Aortic Aneurysm) in CT images acquired with or without the use of a contrast agent.

Methods
Twenty-six patients with paired non-contrast and contrast-enhanced CT images were randomly selected from an ethically-approved ongoing study (Ethics Ref 13/SC/0250), manually annotated and used for model training and evaluation (13/13). Data augmentation methods were implemented to diversify the training data set in a ratio of 10:1. We utilised a 3D U-Net with attention gating for both the aortic region-of-interest (ROI) detection and segmentation tasks. Trained architectures were evaluated using the DICE similarity score.

Results
Inter- and Intra- observer analysis supports the accuracy of the manual segmentations used for model training (intra-class correlation coefficient, “ICC” = 0.995 and 1.00, respective. P&lt;0.001 for both). The performance of our Attention-based U-Net (DICE score: 94.8±0.5%) in extracting both the inner lumen and the outer wall of the aortic aneurysm from CT angiograms (CTA) was compared against a generic 3-D U-Net (DICE score: 89.5±0.6%) and displayed superior results (p&lt;0.01). Fig 1A depicts the implementation of this network architecture within the aortic segmentation pipeline (automated ROI detection and aortic segmentation). This pipeline has allowed accurate and efficient extraction of the entire aortic volume from both contrast-enhanced CTA (DICE score: 95.3±0.6%) and non-contrast CT (DICE score: 93.2±0.7%) images. Fig 1B illustrates the model output alongside the labelled ground truth segmentation for the pathological aneurysmal region; only minor differences are visually discernible (coloured boxes).

Conclusion
We developed a novel automated pipeline for high resolution reconstruction of blood vessels using deep learning approaches. This pipeline enables automatic extraction of morphologic features of blood vessels and can be applied for research and potentially for clinical use.
Automated Segmentation of Blood Vessels

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): University of Oxford Medical Research Fund, John Fell Fund
Impact of baseline feature tracking multi-detector row computed tomography-derived left ventricular global longitudinal strain on left ventricular functional recovery in TAVI patients
Authors: Gegenava T , Bijl P , Vollema M , Kley F , Weger A , Hautemann D , Reiber J , Ajmone-Marsan N , Bax J , Delgado V 
Published: November 2020

Abstract

Background
Advances in left ventricular (LV) analysis with dynamic multi-detector row computed tomography (MDCT) permit measurement of LV global longitudinal strain (GLS) and have shown their impact on risk stratification of patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).

Purpose
To evaluate the influence of baseline feature tracking (FT) MDCT- derived LV GLS on LV functional recovery in severe AS patients undergoing TAVI.

Methods
A total of 194 patients with severe AS (50% male, 80±7 years) with dynamic MDCT data allowing LV GLS measurement with a novel FT algorithm and having complete echocardiography evaluation at baseline, at 3–6 months and at 1 year follow-up were evaluated. FT MDCT-derived LV GLS was measured at baseline and the study population was divided according to a cut-off value of MDCT LV GLS −14% (≤−14% [more preserved LV systolic function] vs. &gt;−14% [more impaired LV systolic function]).

Results
Transthoracic echocardiography (TTE)-derived Left ventricular ejection fraction (LVEF) increased over time in both groups: in patients with preserved and reduced MDCT LV GLS, and reached a higher value in patients with preserved MDCT LV GLS (52±7% at baseline, 55±7% at 3–6 months, 58±7% at 1 year follow-up vs. 43±10% at baseline, 49±10% at 3–6 months, 53±11% at 1 year follow-up; p=0.016) (Figure 1). TTE-derived LV GLS also showed greater improvement for patients with preserved MDCT LV GLS (−17±3% at baseline, −18±3% at 3–6 months, −20±3% at 1 year follow-up vs. −12±3% at baseline, −15±3% at 3–6 months, −16±3% at 1 year follow-up; p=0.027) (Figure 1).

Conclusions
In severe AS patients treated with TAVI, LV function improves significantly at 3–6 and at 12 months' follow-up and shows superior recovery in patients with more preserved baseline MDCT LV GLS, suggesting that MDCT-derived LV GLS has an important impact on LV functional recovery after TAVI.

Funding Acknowledgement
Type of funding source: None