bluuebunny/crossref_metadata_2025_split huggingface dataset:
P4159Coronary flow capacity guidance optimizes the efficacy of percutaneous coronary intervention in patients with stable lesions: international registry of comprehensive physiologic evaluation
Authors: Hamaya R , Hoshino M , Kanaji Y , Kanno Y , Hada M , Yamaguchi M , Sumino Y , Sugiyama T , Lee J M , Koo B K , Escaned J , Kakuta T 
Published: October 2019

Abstract

Background
Fractional flow reserve (FFR) is the current standard for determining severity of epicardial stenosis and indication for percutaneous coronary intervention (PCI). However in practice, FFR is not enough robust to select lesions that will truly benefit from PCI. Coronary flow capacity (CFC) provides integrated information of coronary flow reserve (CFR) and coronary flow during hyperemia that is useful for identifying flow-limiting stenosis considering both epicardial and microvascular conditions.

Objective
We hypothesized that the effect of FFR-guided PCI would be enhanced by further consideration of CFC. This study aimed to investigate the prognostic effect of PCI according to CFC status of the stable lesions, using pressure-temperature sensor-tipped wire for FFR and CFC evaluation.

Methods
From a global, multicenter registry of comprehensive physiological assessment, a total of 1397 patients (1694 vessels) were enrolled. Three patients/vessels were excluded due to lost follow-up. Low CFC was defined for lesions with reduced CFR and the corresponding inverse of thermodilution-derived mean transit time under hyperemia, which represents hyperemic coronary flow. The effect of FFR-guided PCI on vessel-oriented composite outcomes (VOCO) was assessed by multivariate marginal COX proportional regression model with or without the interaction term between PCI and CFC, using the CFC definition with the CFR threshold of 2.0 (Figure: red + green area showing low CFC). Using the same model, variously defined CFC was tested to determine the optimal thresholds (Figure: red only area ∼ red + green + blue area).

Results
During the 5-year follow-up period, VOCO was identified for a total of 113 vessels. In the multivariate model, the HR of PCI was 0.963 (95% CI: 0.538–1.723). When the interaction was added to the model, the effect of PCI on VOCO incidence was significantly different according to CFC status (p=0.069 for interaction). The optimal criterion of CFC was made where Akaike Information Criterion of the model was minimized (CFR threshold of 2.9 for the CFC definition), where PCI had HR of 0.443 (95% CI: 0.196–0.999) and 1.521 (95% CI: 0.828–2.796) for lesions low and high CFC, respectively. CFR had no significant interaction with PCI (p=0.26).
CFC Map

Conclusion
The effect of PCI on VOCO was significantly different according to CFC status. PCI to lesions with low CFC was prognostically beneficial. Our results suggested the potential of CFC for optimizing PCI benefit in stable lesions after FFR assessment.
P4165Influence of restrictive right ventricular physiology in outcomes after transcatheter pulmonary valve implantation in adult patients
Authors: Gaspar Lopes Francisco A R , Malekzadeh-Milani S , Ladouceur M , Iserin L , Soulat G , Mousseaux E , Legendre A , Boudjemline Y , Karsenty C 
Published: October 2019

Abstract

Background
A restrictive right ventricular (RV) physiology (r-RVP) is present in almost half of the patients with repaired tetralogy of Fallot (ToF), but its effect on later patients' clinical status is controversial.

Purpose
Evaluate the outcomes after transcatheter pulmonary valve implantation (TPVI) in patients with restrictive versus non-restrictive RV.

Methods
Single-center retrospective study of patients who underwent TPVI for pulmonary regurgitation between 2008 and 2017. Electrocardiogram, transthoracic echocardiogram, cardiac magnetic resonance and cardio-pulmonary exercise test were performed previous to TPVI and repeated 12 months after. For statistical analysis restrictive physiology was defined as the presence of end-diastolic forward flow (EDFF) and RVEDVi <150ml/m2.

Results
Fifty-nine patients, 55 with tetralogy of Fallot, were included. R-RVP was present in 23 patients (39.0%). At the baseline, the majority of the patients were symptomatic, in NYHA functional class II–III (n=48, 81.4%) and with reduced cardiopulmonary performance (VO2max = 20.5mL/min/kg), both worse among patients with r-RVP (p=0.018 and p=0.018). During a mean follow-up of 446.4±226.1 days after TPVI one patient died. BNP levels were not significantly different from baseline. Despite self-reported functional capacity and exercise capacity improvement after TPVI (p<0.001), all parameters remained lower in r-RVP group. One year after TPVI, pulmonary and tricuspid regurgitation decrease significantly, as well as RVEDV, in both groups. However, RV systolic function remained unchanged in both groups. Regarding to the dysrhythmic profile, all patients with need for an implantable cardiac defibrillator and seven of the eight patients requiring radiofrequency ablation for sustained supraventricular arrhythmias during follow-up were in the group without r-RVP (p=0.038).
Kaplan-Meier survival curve

Conclusion
TPVI had a positive impact in clinical status in a cohort of patients with predominant PR regardless the presence of restrictive physiology. Moreover, besides higher VO2max and anaerobic threshold in the non-restrictive group, the magnitude of the improvement was not statistically different between the two groups. Nevertheless, in patients without r-RVP, a peculiar caution has to be focused regarding rhythmic issue during follow-up, despite the TPVI.
P4341Sex differences in the U-shaped relationship between physical activity and cardiovascular mortality in the general population
Authors: Takahashi T , Watanabe T , Watanabe M 
Published: October 2019

Abstract

Background
The beneficial effect of moderate physical activity on morbidity and mortality has been observed in the general population. However, sex differences in the impact of physical activity on cardiovascular mortality remain unclear. The aim of this study was to investigate the relationship between physical activity and cardiovascular mortality in the general population.

Methods
This longitudinal cohort study included 1,826 apparently healthy subjects who participated in a community-based health checkup.

Results
There were 97 deaths, including 31 cardiovascular deaths during 10-year follow-up. Subjects were divided into 4 groups based on the quartiles of physical activity (low, mild, moderate and high). There was a U-shaped relationship between physical activity and cardiovascular mortality in male subjects, but not in female subjects. Kaplan-Meier analysis demonstrated that high and low physical activity groups showed higher cardiovascular mortality compared with mild and moderate physical activity groups in male subjects. Cox proportional hazard analysis revealed that low and high physical activities were associated with cardiovascular mortality (hazard ratio 3.59 and 5.11, respectively) in male subjects. In contrast, physical activity was not associated with cardiovascular mortality in female subjects.

Conclusion
We identified a U-shaped relationship between the amount of physical activity and cardiovascular mortality in male subjects, but not in female subjects.
P4356Assessment of global and regional right ventricular systolic function in restrictive pulmonary disease by novel speckle tracking 3D echocardiography comparison with cardiac magnetic resonance imaging
Authors: Tanwar S , Sen N , Jain A , Mehta A , Kalra B , Bansal M 
Published: October 2019

Abstract

Background
Chronic restrictive pulmonary disease may alter right and left ventricular function by changing intrathoracic pressure. Pulmonary hyperinflation may increase right atrial pressure, leading to reduced venous return and subsequent reductions in RV pre-load. In CRPD patients, hyperinflation has been directly correlated with reduced atrial chamber size, global RV dysfunction, and reduced LV filling. Accurate assessment of global and regional right ventricular (RV) systolic function is challenging.

Purpose
The aims of this study were to confirm the reliability and feasibility of a three-dimensional (3D) speckle-tracking echocardiography (STE) system, using comparison with cardiac magnetic resonance imaging (CMR), and to assess the contribution of regional RV function to global function.

Methods
In a retrospective, cross-sectional study setting, RV volumetric data were studied in 200 patients who were referred for both CMR and 3D echocardiography within 1 month. Three-dimensional STE-derived area strain, longitudinal strain, and circumferential strain were assessed as global, inlet, outflow, apical, and septal segments.

Results
136 patients (68%) had adequate 3D echocardiographic data. RV measurements derived from 3D STE and CMR were closely related (RV end-diastolic volume, R2=0.89; RV end-systolic volume, R2=0.82; RV ejection fraction [RVEF], R2=0.68; P<0.003 for all). RVEF and RV end-diastolic volume from 3D STE were slightly but significantly smaller than CMR values (mean differences, −3% and −8 mL for RVEF and RV end-diastolic volume, respectively). Among conventional echocardiographic parameters for RV function (tricuspid annular plane systolic excursion, fractional area change, S' of the tricuspid annulus, RV free wall two-dimensional longitudinal strain), only fractional area change was significantly related to RVEF (r=0.30, P=0.005). Among segmental 3D strain variables, inlet area strain (r=−0.49, P<0.004) and outflow circumferential strain (r=−0.39, P<0.005) were independent factors associated with CMR-derived RVEF.

Conclusions
Severity of restrictive pulmonary disease influences RV systolic dysfunction, which is reflected in speckle tracking 3D echocardiographic parameters. Regional RV wall motion showed that heterogeneous segmental deformations affect global RV function differently; specifically, inlet area strain and outflow circumferential strain.RV volume and RVEF determined by STE were comparable with CMR measurements.
P4364A direct comparison between 2D and 4D deformation imaging in hypertrophic hearts. An agreement of disagreement
Authors: Pagourelias E , Mirea O , Duchenne J , Unlu S , Van Cleemput J , Papadopoulos C E , Bogaert J , Vassilikos V , Voigt J U 
Published: October 2019

Abstract

Background
Previous studies have directly compared 2-dimensional (2D) and 4-dimensional (4D) deformation imaging in normal and ischemic hearts suggesting a moderate agreement prone to technical considerations. However, the level of agreement between 2D and 4D-strain imaging has never been adequately addressed in hypertrophic hearts, nor has it been validated against a “ground truth”.

Purpose
We aimed at directly comparing 4D and 2D global and regional deformation parameters and depict which may best reflect underlying segmental fibrosis in hypertrophic cardiomyopathy (HCM), as defined by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR).

Methods
We included 40 HCM patients (54.1±14.3 years, 82.5% male, maximum wall thickness 19.3±4.8mm) who have consecutively undergone 2D-,4D-speckle tracking echocardiography and CMR. Global and segmental circumferential (CS) and longitudinal (LS) strain have been calculated from 2D acquisitions and 4D full volume data, where additionally radial (RS) and area (AS) strain have been extracted using an 18 segment left ventricle model. Accordingly, segmental fibrosis was defined by LGE in corresponding CMR slices.

Results
Deformation parameters (2D and 4D, global and regional) presented overall poor to moderate agreement (Figure A+B) with regional 4D_LS and 4D_CS values being constantly less negative compared to 2D derivatives (−7.29±6.94% and −8.53±8.8% accordingly). In regional analysis, 720 segments were evaluated of which 134 (19.7%) were enhanced and 95 of them thickened (68.8%) (thickness>12 mm), with segments presenting both characteristics showing the greatest impairment both in 2D and 4D strain values. Among segmental deformation indices, 2D_SLS showed the best area under the curve [(AUC)=0.78, 95% CI (0.75–0.81), p<0.0005] to detect segmental fibrosis, with 2D_SCS and all 4D deformation indices presenting significantly lower AUC (Figure C).

Conclusions
In HCM, 2D and 4D deformation parameters are not interchangeable, showing modest agreement. Thickness and tracking algorithm calculating assumptions seem to induce this variability. Nevertheless, among HCM patients 2D_SLS remains the best strain parameter for tissue characterization and fibrosis detection.

Acknowledgement/Funding
Supported with a scholarship by the Greek State Scholarship Foundation (IKY).
P4377Use of LV Deformation Imaging to predict long term Heart Failure Risk in high risk patients
Authors: Haji K , Marwick T , Neil C , Stewart S , Carrington M , Wright L , Chan Y , Simons K , Wong C 
Published: October 2019

Abstract

Background
The increasing prevalence of heart failure (HF), due to hypertension, ischaemic heart disease, diabetes, obesity, and ageing population demands identification of at-risk subgroup whom we could target on prevention strategies. In a same cohort of patients at risk of HF (70% with CAD), 13% developed new HF hospitalization or death over 4.3 years of follow-up, however, disease management program did not confer any benefit to outcome and LV ejection fraction (EF) was not predictive of progression to HF. Better risk stratification strategies are needed. In this study, we sought whether advanced echo measure on deformation, global longitudinal strain (GLS) would predict HF admission over a long term follow up and thereby define an at-risk group. Aim: To determine which of the LV morphology, function and deformation parameters, best predict new HF admission or HF death in pts at risk but without prior dx of HF.

Method
Echocardiograms (including measurement of LV, size, function, morphology and deformation) were obtained in 431 inpatients (mean age 65±11, 72% male) at risk of HF. LV global longitudinal strain (GLS) and strain rate (GLSR) were measured offline (EchoPac, GE). Long term (9 years) follow up data were obtained via data linkage.

Results
63 pts (15%) reached the end-point of HF admission or HF death. LV deformation showed a univariable association with outcome (Table). In multivariable analysis, including known significant predictors of outcome (age, sex, BMI, diabetes, hypertension), GLS less than 18 remained an independent predictor (Table), in addition to age and DM at baseline. EF and LV mass were not predictors of heart failure.
HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value Age 1.1 (1–1.1) <0.01 1.1 (1–1.1) 0.04 1 (1–1.1) 0.04 Sex 1.0 (0.6–1.7) 0.9 0.8 (0.4–1.8) 0.6 0.8 (0.4–1.8) 0.6 BMI 1.0 (1–1.1) 0.05 1 (0.9–1.1) 0.7 1 (0.9–1.1) 0.7 DM 2.6 (1.6–4.3) <0.01 2.7 (1.4–5.3) <0.01 2.7 (1.4–5.2) 0.04 LVMI 1.0 (1.0–1.0) <0.01 1 (0.9–1.0) 0.7 1 (0.99–1.0) 0.7 Impaired EF, % 1.0 (0.9–1.0) <0.01 1 (0.9–1.0) 0.16 0.97 (0.94–1.0) 0.04 Diastolic dysfunction 2.3 (1.4–3.7) <0.01 0.8 (0.3–1.7) 0.5 0.7 (0.3–1.7) 0.5 GLS 1.3 (1.4–1.2) <0.01 1.1 (1–1.2) 0.07 GLS <18 5.3 (2.8–10.2) <0.01 2.3 (1.1–5.1) 0.04

Conclusion
GLS <18 is independently associated with increasing new onset heart failure admission and HF mortality in patients at risk of HF.
P4379Pathophysiology of left atrial filling in mitral regurgitation. A new volumetric flow rate index describing disturbed left atrial filling behavior in mitral regurgitation by 3D TTE
Authors: Frumkin D , Stangl K , Muegge A , Buck T , Plicht B 
Published: October 2019

Abstract

Background
In chronic mitral regurgitation (MR) the left atrium (LA) is one of the first cardiac structures involved in remodeling by progressive volume overload. Real-time three-dimensional echocardiography is able to monitor volumetric changes of the left atrium during the heart cycle.

Purpose
We hypothesized that chronic volume overload due to MR leads to detectable changes in the LA filling behavior described by mean and maximum filling flow rates and their relation called volumetric flow rate index.

Methods
We prospectively analyzed data of 36 patients in different stages of chronic MR and 13 patients without MR. Transthoracic echocardiography was conducted using the Epiq 7G Ultrasound System. Standard 2D- and 3D apical 4-chamber views were recorded and stored for offline analysis. We generated volume-time-curves by 3D volume analysis to derive mean and maximum volumetric flow rates during LA reservoir, conduit and pump phase. Volumetric flow rate index was calculated as the quotient of mean flow rate/maximum flow rate.

Results
Average MR severity, calculated with the MR Scoring system introduced from Buck et al. and implicated in the ESC Guidelines, was 6.2 points (±2.5) according to Grade I-II. We included 13 patients without MR, 18 with mild MR, 12 patients with moderate MR, 6 patients with severe MR. Left ventricular ejection fraction was similar in the different groups (51,2±12,3%). Maximum and mean flow rate showed no significant correlation with MR severity. Correlation of MR severity with LA dilation (ml/m2 BSA) was r=0.41; p<0.001. Flow rate index showed strong significant correlation with MR severity in left atrial reservoir phase (r=−0.75; p<0.001). There was no statistically relevant difference of volumetric flow rate parameters in left atrial pump and conduit phase.
Line chart

Conclusions
We observed a significant correlation of the volumetric flow rate index to MR severity in the left atrial reservoir phase with stronger correlation than MR severity to left atrial dilation. The results of this work encourage further investigations to establish the presented volumetric flow rate index as a progression marker of MR and to evaluate its prognostic value.
P4383Machine learning approach for prdiction of postinfarction myocardial recovery using echocardiographic myocardial texture
Authors: Michalski B W , Skonieczka S , Strzelecki M , Simiera M , Szymczyk E , Wejner-Mik P , Lipiec P , Wierzbowska-Drabik K , Kasprzak J D 
Published: October 2019

Abstract

Background
Recovery of left ventricular (LV) function has significant prognostic significance after myocardial infarction (MI) but is challenging to predict. We applied machine learning algorithms (ML) to analyze echocardiographic myocardial texture for predicting long-term recovery of left ventricular myocardium

Methods
We used native and contrast-enhanced (Sonovue imaged with Contrast Perfusion Sequence, CPS) myocardial images acquired 7 days after reperfused ST-elevation MI from apical window recorded in 61 pts (19 females, age 59.7±11.9) with first ST-elevation MI treated with successful PCI. A custom software (MaZDa 4.6) was used for texture analysis. 299 image features were calculated for defined regions of interest in each image (9 features from histogram, 6 from gradient matrix, 20 from run length matrix, 220 from co-occurrence matrix, and 44 from wavelet transform). Up to 10 most reproducible parameters were selected based on low variation and, later, Fisher criterion with minimization of classification error along with average correlation coefficient. ML methods used to analyze textures included Multilayer perceptron neural network -MLP, support vector machines -SVM, Adaptive Boosting algorithm AdaBoost and library support vector machine. We defined recovery as: improvement of LV wall motion score index (WMSI), absence of remodeling defined as >8% increase in LV end-diastolic volume (LVEDV) and improvement >5% of LV ejection fraction % after 1 year.

Results
Effectiveness of tested methods was similar for predicting regional and local LV function evolution after one year. Results for native grayscale and red component of CPS myocardial perfusion images were comparable. Percent accuracy of prediction is shown in the table, with best result for WMSI.
Accuracy of 1-yr predictions of LV function change ΔWMSI ΔEF ΔLVEDV native grey contrast red contrast grey native grey contrast red contrast grey native grey contrast red contrast grey Adaptive Boosting 78% 79% 78% 64% 64% 59% 61% 60% 60% Neural network 77% 79% 78% 63% 63% 58% 62% 59% 60% Library support vector machine 77% 79% 78% 63% 65% 64% 61% 60% 58% Support vectro machine 77% 79% 78% 64% 65% 59% 61% 60% 58%

Conclusions
Echocardiographic myocardial texture can be analyzed using machine learning approaches to predict global or regional recovery of myocardial function. Accuracy for predicting regional WMSI improvement was superior to prognosing LVEDV or EF change. Performance of different tools did not differ between native and contrast enhanced images.
P4400Heart rate variability in supporters of the German national football team during FIFA world cup 2018
Authors: Brunner S , Hamm W 
Published: October 2019

Abstract

Objective
It is well known that emotional stress can trigger cardiovascular events. Although several studies have confirmed this relationship during big sport events, the underlying mechanisms are less well understood. Therefore, we aimed to analyse parameters of the cardiac autonomous nervous system during FIFA World Cup 2018.

Methods
We performed a high-resolution digital electrocardiography (ECG) in healthy supporters of the German national football team watching the final group stage match of FIFA World Cup 2018 between Germany and South Korea. As control, ECG recordings were performed watching a group stage match of another group without involvement of the German team (Japan against Poland). We analysed standard parameters of heart rate variability (HRV). Further, we analyzed the number of admissions to Chest Pain Units (CPUs) and Stroke Units (SUs) in Munich at the day of the German match (June 27th, 2018) and at predefined control periods.

Results
All measured HRV parameters (SDNN, RMSSD, LF and HF) were significantly lower during the match involving the German national football team compared to the control match (SDNN: 76.7 (67.4–83.9) versus 82.9 (72.5–96.5) ms, p<0.05; RMSSD: 32.0 (27.7–33.3) versus 41.3 (31.4–49.19 ms, p<0.05; LF: 1442 (1182–1637) versus 2000 (1563–2238) ms2, p<0.05; HF: 206 (158–259) versus 376 (242–417), p<0.05). Regarding the LF/HF ratio, there was no significant difference. The admission rate on CPUs and SUs was numerically higher at the day of the German match compared to the control days and compared to the predefined control period (40.8% higher).

Conclusion
Emotional stress during important football matches results in a dysbalance of the cardiac autonomous nerve system. These findings might provide a link to increased cardiovascular events during emotional stress.