bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reciprocal communication of perivascular epicardial adipose tissue and coronary atherogenesis
Authors: Wildauer M , Honold S , Beyer C , Senoner T , Stuehlinger M , Friedrich G , Feuchtner G , Plank F 
Published: November 2020

Abstract

Purpose
Perivascular epicardial adipose tissue (PEAT) has been linked to underlying coronary artery disease (CAD) and proposed to modulate adjacent atherosclerotic plaque formation. In vitro and ex vivo studies support bilateral influence of adipose tissue and vessel wall. Therefore, we quantified PEAT volume and composition and its dynamics in a low coronary risk patient cohort with a semi-automate software in serial CT exams.

Methods and materials
We retrospectively included 120 patients (27% females) from a tertiary care hospital who underwent serial cardiac CT angiographies with a low cardiovascular risk profile. All coronary CTs were evaluated in a standardized approach: epicardial adipose tissue (EAT) volume and attenuation was quantified in total, in the atrioventricular (RCA, LCX) or interventricular (LAD) sulcus and in a 5mm radius for each coronary artery (PEAT). Coronary plaques were quantified using a semi-automated software and compared to progression, stability of regression between the two scans. The measurements were compared on a per-patient and per-vessel basis between plaque-naïve and diseased vessels.

Results
Of 120 patients (32% female), 59.2%) had atherosclerotic plaque formation. After 36 months mean follow-up, 22 (18.3%) showed a CAD regression plaques, 39 (32.5%) had stable coronary arteries and 49 (40.8%) progressive CAD. Total EAT volume decreased by −15.6±37.2 mm3 in the regressive group, increased by 2.7±30.6mm3 in the stable group and by 24.3±37.1mm3 in the progressive CAD group (p=0.003).
Per-vessel analysis showed a significant decrease of perivascular EAT attenuation in patients with CAD regression (−3.8±7.6 HU) compared to CAD stable (1.2±9.1 HU) and CAD progressive patients (3.5±8.2 HU, p&lt;0.0001). Mean sulcus EAT attenuation did not show a significant change at follow-up (p=0.135)

Conclusion
Epicardial adipose tissue volume is mutually changing with the progression or regression of coronary artery disease. Perivascular but not epicardial attenuation levels correlated to adjacent plaque and support a direct bilateral influence.
Change per-vessel-basis (n=360)

Funding Acknowledgement
Type of funding source: None
Prognostic value of noninvasive combined anatomic/functional assessment by cardiac ct in patients with suspected coronary heart disease
Authors: Dewey M , Rochitte C , Ostovaneh M , Chen M , George R.T , Niinuma H , Kitagawa K , Laham R , Kofoed K , Nomura C , Sakuma H , Yoshioka K , Mehra V , Jinzaki M , Arbab-Zadeh A 
Published: November 2020

Abstract

Background
Noninvasive evaluation of patients with stable angina is preferable over invasive testing if it leads to similar patient outcome. The combination of coronary angiography and vasodilator challenge myocardial perfusion imaging by computed tomography allows fast, comprehensive assessment of patients with suspected coronary heart disease.

Purpose
To compare the long-term prognostic value of combined computed tomography angiography (CTA) and myocardial CT perfusion imaging (CTP) with invasive coronary angiography (ICA) and single photon emission tomography (SPECT) in patients with suspected hemodynamically significant coronary heart disease.

Methods
At 16 centres, 381 patients were followed for major adverse cardiac events (MACE) for the CORE320 study. All patients underwent coronary CTA, CTP, and SPECT before ICA. Prognostic performance according binary results (normal/abnormal) was assessed by 5-year major cardiovascular events (MACE) free survival and area under the receiver-operating-characteristic curve (AUC).

Results
Follow up beyond 2-years was available in 323 patients. MACE-free survival rate was greater among patients with normal combined CTA/CTP findings compared to ICA/SPECT: 85 vs. 80% (95% confidence interval [CI] for difference 0.1, 11.3) though event-free survival time was similar (4.54 vs. 4.37 years, 95% CI for difference: 0.03, 0.36). Abnormal results by combined CTA/CTP was associated with 3.83 years event-free survival vs. 3.66 years after abnormal combined ICA/SPECT (95% CI for difference: 0.05, 0.39, CI −1.0, 11.1) (Figure). Predicting MACE by AUC also was similar: 65 vs. 65 (difference 0.1; 95% CI: −4.6, 4.9). When MACE was restricted to death, myocardial infarction, or stroke, AUC for CTA/CTP was 66 vs. 61 by ICA/SPECT (difference 5.1; 95% CI: −7.1, 12.9).

Conclusions
Combined CTA/CTP yield similar 5-year prognostic performance as joined ICA/SPECT assessment in patients presenting with suspected coronary heart disease and thus may represent a fast, non-invasive alternative to the traditional diagnostic approach.
Figure 1. 5-year event-free survival

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): National Institutes of Health
Left ventricular remodeling after transcatheter mitral valve replacement with Tendyne
Authors: Fukui M , Sorajja P , Goessl M , Bae R , Sun B , Duncan A , Muller D , Cavalcante J 
Published: November 2020

Abstract

Background
Data on changes in left atrial (LA) and left ventricular (LV) volumes after transcatheter mitral valve replacement (TMVR) are limited.

Purpose
This study sought to describe the anatomical and functional changes in left-sided cardiac chambers by computed tomography angiography (CTA) from baseline to 1-month after TMVR with Tendyne prosthesis.

Methods
We analyzed patients who underwent TMVR with Tendyne prosthesis (Abbott Structural, Menlo Park, CA) between 2015 and 2018. Changes in LV end-diastolic volume (LVEDV), ejection fraction (LVEF), mass (LV mass), LA volume and global longitudinal strain (GLS) were assessed at baseline and at 1-month after TMVR with CTA. Specific Tendyne implant characteristics were identified and correlated with remodeling changes.

Results
A total of 36 patients (mean age 73±8 years, 78% men, 86% secondary MR) were studied. There were significant decreases in LVEDV (268±68 vs. 240±66ml, p&lt;0.001), LVEF (38±10 vs. 32±11%, p&lt;0.001), LV mass (126±37 vs. 117±32g, p&lt;0.001), LA volume (181±74 vs. 174±70 ml, p=0.027) and GLS (−12.6±5.1 vs. −9.5±4.0%, p&lt;0.001) from baseline to 1-month follow-up. Favorable LVEDV reverse-remodeling occurred in the majority (30 of 36 patients, or 83%). Closer proximity of the Tendyne apical pad to the true apex was predictive of favorable remodeling (pad distance: 25.0±7.7 vs. 33.5±8.8mm, p=0.02 for those with and without favorable remodeling).

Conclusions
TMVR with Tendyne results in favorable left-sided chamber remodeling in the majority of patients treated, as detected on CTA at 1-month after implantation. CTA identifies the favorable post-TMVR changes, which could be related to specific characteristics of the device implantation.

Funding Acknowledgement
Type of funding source: None
Comparison between echocardiography and cardiac magnetic resonance for differential diagnosis of left ventricular hypertrophy
Authors: Corsi E , Todiere G , Barison A , Grigoratos C , Aquaro G.D 
Published: November 2020

Abstract

Background
Left ventricular hypertrophy (LVH) may be due to different causes, ranging from, benign secondary forms (athlete's heart) to severe prognosis cardiomyopathies (i.e. cardiac amyloidosis). Early and accurate differential diagnosis is important to proper patient management. LVH may be detected by echocardiography signs of hypertrophy or other abnormalities often associated to hypertrophic phenotypes. Cardiac magnetic resonance (CMR) is often used to confirm the initial diagnostic suspicion. On the best of our knowledge, there are no study specifically designed to evaluate the final impact of CMR in changing or confirming the initial diagnostic echocardiographic suspicion.

Aim
To evaluate the clinical prognostic correlates of CMR in patients with echocardiographic or ECG suspicion of LVH (or cardiomyopathies with hypertrophic phenotype).

Methods and results
We enrolled 275 pts with echocardiographic evidence of LVH. Using current guidelines, the initial echocardiographic diagnostic suspicion was: hypertrophic cardiomyopathy (HCM) in 46.9% of pts; cardiac amyloidosis in 14.5%; hypertensive LVH in 17%; aortic stenosis in 1.5%; athlete's heart in 0.3%; undetermined LVH in 17%. CMR changed the diagnosis in 42% cases: the diagnosis of HCM increased from 44% to 72% of pts; hypertensive and undetermined LVH decreased significantly (respectively to 4% and 5%). Finally, the change in diagnostic suspicion was associated to reclassification of risk of patients: Kaplan-Meier curves demonstrated that HCM and cardiac amyloidosis had worst prognosis than undetermined or hypertensive LVH.

Conclusions
CMR changed the echocardiographic suspicion in almost half of patients with LVH. This study highlights the indication of CMR in patient with ECG or echocardiographic suspicion of LVH.
Kaplan-Meier curves

Funding Acknowledgement
Type of funding source: None
Diffusion tensor cardiovascular magnetic resonance detects altered myocardial microstructure in patients with acute st-elevation myocardial infarction
Authors: Rajakulasingam R , Nielles-Vallespin S , Ferreira P.F , Scott A.D , Khalique Z , Rogers P , Barnes G , Tindale A , Prendergast C , Cantor E , Wage R , Dalby M , Firmin D.N , Pennell D.J , De Silva R 
Published: November 2020

Abstract

Background
Diffusion Tensor Cardiovascular Magnetic Resonance (DT-CMR) can quantify metrics of tissue integrity (mean diffusivity [MD] and fractional anisotropy [FA]) and changes in laminar microstructures (sheetlets), which reorientate from more wall-parallel in diastole (DIA) towards wall-perpendicular in systole (SYS) as the myocardium thickens, quantified by E2 angle [E2A]. Microstructural changes after STEMI may provide new insights into adverse LV remodelling and risk stratification.

Methods
In vivo DT-CMR was performed 3–5 days after PPCI for first presentation STEMI (N=19, mean age 57±9, 79% male). DT-CMR was acquired in 2 short-axes (SYS & DIA) using a STEAM-EPI sequence. 12 segment analysis of MD, FA, E2A and E2A mobility (ΔE2A = E2ASYS − E2ADIA) was performed. Infarct (INF) segments were defined as &gt;25% LGE, adjacent (ADJ, located contiguous to INF) and remote (REM, all other segments). Wilcoxon signed rank tests were used with threshold P&lt;0.017 (Bonferroni corrected).

Results
See Table.
MD in both SYS and DIA was significantly higher in INF and ADJ regions compared to REM. FA in both SYS and DIA was lower in the INF and ADJ compared to REM. E2ADIA was higher in INF, indicating a more wall-perpendicular orientation of sheetlets, compared to ADJ and REM zones. E2ASYS in INF was significantly reduced, indicating a more wall-parallel orientation of sheetlets, compared to ADJ and REM regions, resulting in significantly reduced sheetlet mobility (ΔE2A).

Conclusions
Microstructural changes can be detected after acute STEMI by in vivo DT-CMR. Zonal changes in MD and FA may suggest loss of barriers to water diffusion and altered cardiomyocyte organisation, respectively. We provide the first report of reduced sheetlet mobility after acute STEMI in INF. Ongoing work is evaluating the mechanisms and prognostic importance of altered sheetlet mobility after STEMI.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation Clinical Research Training Fellowship
Cardiac magnetic resonance features of left dominant arrhythmogenic cardiomyopathy: differential diagnosis with myocarditis
Authors: Andreini D , Conte E , Casella M , Mushtaq S , Pontone G , Dello Russo A , Nicoli F , Catto V , Vettor G , Sommariva E , Rizzo S , Basso C , Tondo C , Pepi M 
Published: November 2020

Abstract

Objectives
To identify potential imaging features at cardiac magnetic resonance (CMR) specific for left-dominant arrhythmogenic cardiomyopathy (LDAC) diagnosis.

Materials and methods
Between January 2011 and May 2016, we considered 36 consecutive stable patients with a recent diagnosis of significant VA and ECG morphology consistent with a LV origin, detection of potential LV arrhythmic substrate at CMR, undergoing a clinically-indicated LV endomyocardial biopsy. Exclusion criteria were history of known cardiac disease, contraindications to CMR and impaired CMR image quality. After application of these criteria, in 9 patients endomyocardial biopsy showed tissue abnormalities consistent with the diagnosis of LDAC. From the same CMR-endomyocardial biopsy registry, a second group of 9 consecutive patients with a histological diagnosis of previous myocarditis were identified.

Results
Mid-wall LGE in the interventricular septum was detected in 5 myocarditis, without findings in LDAC group (p=0.03), whereas subepicardial LGE at the level of posterolateral wall of LV was detected in 8 cases of LDAC vs. 2 cases of myocarditis (p=0.02). Fat infiltration, and particularly subepicardial posterolateral fat infiltration, was found in all LDAC patients vs. one myocarditis only (p&lt;0.01). No differences in other CMR findings or in any clinical or echocardiographic parameters were found between patients with a biopsy consistent with LDAC vs. patients in whom biopsy suggested myocarditis.

Conclusions
In patients with significant VA and ECG morphology consistent with a LV origin, identification of morpho-functional involvement of the subepicardial layer of LV posterolateral wall at CMR (LGE, fat infiltration, wall dyskinesis) is consistent with a diagnosis of LDAC.

Funding Acknowledgement
Type of funding source: None
The prevalence and natural progress of myocardial fibrosis in Duchenne muscular dystrophy patients
Authors: Xu R , Xu H , Liu H , Guo Y 
Published: November 2020

Abstract

Purpose
The cardiac disease is now as the leading cause of morbidity and mortality in DMD patients. The early detection of cardiac involvement is challenging and the frequency and presence of the cardiac involvement in the first decade is uncertain. The aim of the current study was to characterize the frequency, pattern and extent of LGE in the first decade in DMD patients, and identify a set of prognosis factors that portend the presence and extent of LGE in those patients.

Methods
There are 93 DMD patients (mean age: 8.31±2.30 years, rang: 3–13 years) with a biopsy showing absent dystrophin and/or DNA analysis demonstrating a characteristic dystrophin mutation enrolled. All patients underwent a complete cine imaging and LGE imaging. The left ventricular function and tissue characteristic were analyzed and statistic.

Results
There were 42% patients presented LGE-positive. Six years old was the youngest age onset myocardial fibrosis, and after 7 years old, the frequency of LGE positive rising fast. Moreover, all LGE positive patients showed complex patterns with non-ischaemic pattern, including septum, papillary muscle and right ventricular involvement. The free wall, inferior, apical and septum were the most common position. The papillary and right ventricular were rarely common. And all patients presented right ventricular involvement associated with septum involvement. Moreover, compared with younger patients (&lt;7 years), the presence and extent of LGE in older patients (≥7 years) were significant higher. And the logistic analysis showed that the age is a strong predictor of presence of LGE (OR: 1.61, 95% CI: 1.26–2.05, P&lt;0.000).

Conclusion
The myocardial fibrosis could onset in DMD patients in the first decade with a rapid rising and presented with complex patterns. The early CMR examination is necessary for the assessment of cardiac involvement and should consider to complete in younger age in DMD patients.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The National Natural Science Foundation
Cardiac diastolic function of 8–9-year-old singletons following fresh or frozen embryo transfer compared to naturally conceived – a cardiac magnetic resonance study
Authors: Mizrak I , Asserhoej L.L , Jensen R.B , Lund M.A.V , Heldarskard G.F , Kjaer A.S.L , Greisen G , Vejlstrup N , Madsen P.L , Pinborg A 
Published: November 2020

Abstract

Background
Epigenetics may alter the cardiovascular system of children conceived after assisted reproductive technology (ART). Singletons born after frozen embryo transfer (FET) are more likely to be large for gestational age and fresh embryo transfer (ET) are at risk of being small for gestational age. Children conceived after ART may have endothelial dysfunction, and high body mass index and arterial blood pressure (ABP). Such changes may be associated with cardiac diastolic dysfunction.

Purpose
We investigate whether children conceived after fresh ET and FET are at risk of cardiac changes including left ventricular (LV) diastolic dysfunction.

Methods
150 9-year-old singletons have been recruited in a cardiac magnetic resonance imaging study (all scanned by April 2020). 50 children were born after natural conception (NC); 50 children after FET; and 50 children after fresh ET. Left atrium (LA) maximal volume, LA early emptying fraction (LAEEF), LV peak filling rates (PFR) and the peak ejection rate (PER)/PFR ratio are reported to assess the diastolic function.

Results
Preliminary data analyzed in a blinded manner from 59 children show no differences in ambulatory ABP, LV and right ventricular ejection fraction, end-diastolic and end-systolic volumes, stroke volumes and LV mass between the groups. With respect to LV diastolic function, no differences were seen in LA maximal volume and LAEEF; but the Fresh ET group tended to have lower PFR with a resultant PER/PFR ratio now increasing above unity compared to the other groups.

Conclusion
Preliminary data suggest a possible trend towards diastolic dysfunction in children born after fresh ET. If the lack of significant difference in heart function between NC and FET can be ascertained in the full cohort, this is reassuring.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Novo Nordisk Foundation
Cardiac magnetic resonance derived global longitudinal strain outperfoms established functional parameters in prognostication after ST-elevation myocardial infarction
Authors: Holzknecht M , Reindl M , Tiller C , Lechner I , Hornung T , Plappert D , Klug G , Reinstadler S.J , Bauer A , Mayr A , Metzler B 
Published: November 2020

Abstract

Background
Left ventricular ejection fraction (LVEF) is the parameter of choice for left ventricular (LV) function assessment and risk stratification of patients with ST-elevation myocardial infarction (STEMI); however, its prognostic value is limited. Other measures of LV function such as global longitudinal strain (GLS) and mitral annular plane systolic excursion (MAPSE) might provide additional prognostic information post-STEMI. However, comprehensive investigations comparing these parameters in terms of prediction of hard clinical events following STEMI are lacking so far.

Purpose
We aimed to investigate the comparative prognostic value of LVEF, MAPSE and GLS by cardiac magnetic resonance (CMR) imaging in the acute stage post-STEMI for the occurrence of major adverse cardiac events (MACE).

Methods
This observational study included 407 consecutive acute STEMI patients treated with primary percutaneous coronary intervention (PCI). Comprehensive CMR investigations were performed 3 [interquartile range (IQR): 2–4] days after PCI to determine LVEF, GLS and MAPSE as well as myocardial infarct characteristics. Primary endpoint was the occurrence of MACE defined as composite of death, re-infarction and congestive heart failure.

Results
During a follow-up of 21 [IQR: 12–50] months, 40 (10%) patients experienced MACE. LVEF (p=0.005), MAPSE (p=0.001) and GLS (p&lt;0.001) were significantly related to MACE. GLS showed the highest prognostic value with an area under the curve (AUC) of 0.71 (95% CI 0.63–0.79; p&lt;0.001) compared to MAPSE (AUC: 0.67, 95% CI 0.58–0.75; p=0.001) and LVEF (AUC: 0.64, 95% CI 0.54–0.73; p=0.005). After multivariable analysis, GLS emerged as sole independent predictor of MACE (HR: 1.22, 95% CI 1.11–1.35; p&lt;0.001). Of note, GLS remained associated with MACE (p&lt;0.001) even after adjustment for infarct size and microvascular obstruction.

Conclusion
CMR-derived GLS emerged as strong and independent predictor of MACE after acute STEMI with additive prognostic validity to LVEF and parameters of myocardial damage.

Funding Acknowledgement
Type of funding source: None
Risk stratification of patients with Brugada syndrome (BrS): the impact of myocardial strain analysis using cardiac magnetic resonance myocardial feature tracking (CMR-FT)
Authors: Hohneck A.L , Overhoff D , Rutsch M , Rudic B , Tueluemen E , Wolpert C , Akin I , Borggrefe M , Papavassiiu T 
Published: November 2020

Abstract

Objectives
This study evaluated the prognostic significance of cardiac magnetic resonance myocardial feature racking (CMR-FT) in patients with Brugada syndrome (BrS) to detect subclinical alterations and predict major adverse events (MAE).

Methods and results
CMR was performed in 106 patients (pts) with BrS. Biventricular global strain analysis was assessed using CMR-FT. Pts were followed for a mean of 11.1±3.5 years.
The study cohort was subdivided according to the presence of a spontaneous type 1 ECG (sECG), into sBrS (BrS with sECG, n=34 (32.1%)) and diBrS (BrS with drug-induced type 1 ECG, n=72 (67.9%)). Both left and right ventricular (RV) ejection fraction were reduced within the normal range in sBrS pts. CMR-FT revealed morphological differences between sBrS and diBrS pts regarding RV strain (circumferential (%) (sBrS 7.9±2.9 vs diBrS −9.5±3.1, p=0.02) and radial strain (%) (sBrS 12.0±4.3 vs diBrS 15.4±5.4, p&lt;0.01)). During follow up, MAE were noted in 12 pts (11.3%). The presence of a sECG was the strongest predictor for MAE (OR 0.70, 95% CI 0.53–0.90; p=0.008). RV global circumferential strain (GCS) was also associated with MAE (OR 0.16, 95% CI 0.03–0.82; p=0.03). A risk model which combined these two identified predictors showed a substantial risk increase for patients with both sECG and reduced RV-GCS.

Conclusion
Myocardial strain analysis detected early subclinical alterations, prior to apparent changes in myocardial function, in patients with BrS. Moreover, RV-GCS provided additional prognostic information on the occurrence of MAE during follow-up.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Deutsches Zentrum für Herz- und Kreislaufforschung (DZHK), German Centre for Cardiovascular Research