bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adverse effects of exposure to ambient air pollution on coronary calcification
Authors: Huynh Q , Venkataraman P , Marwick T.H , Negishi K 
Published: November 2020

Abstract

Background
The association of air pollution with cardiovascular morbidity and mortality has been attributed to acute events (atherothrombosis). It is unclear whether air pollution may influence the subclinical stage of coronary artery disease (CAD). This study investigated the relationship between particulate matter &lt;2.5μm (PM2.5) and nitrogen dioxide (NO2) with coronary calcium score (CCS).

Methods
This study included 606 asymptomatic adults (49% men, aged 56±7 years) recruited from the community in two States of Australia (Victoria and Tasmania). Annual PM2.5 and NO2 concentrations were matched with residential address. CCS was measured using coronary CT scan. Medical history, physical measurements, biochemistry, and socioeconomic status were recorded for assessment of confounders.

Results
Average exposure to PM2.5 and NO2 were 6.7±1.5 (ppm) and 3.6±2.1 (μg/m3), respectively. Of the 606 participants, 17% had high CCS (≥100) and 4% had very high CCS (≥400). Exposure to higher annual PM2.5 was associated with greater odds of high CCS (OR=1.20 [95% CI: 1.02, 1.42]) and very high CCS (OR=1.47 [95% CI: 1.03, 2.11]). Similar adverse associations were also present for NO2 and high CCS (OR=1.13 [95% CI: 1.02, 1.25]) and very high CCS (OR=1.25 [95% CI: 1.06, 1.47]). These findings were independent of age, sex, body size, smoking, comorbidities and socio-economic status.

Conclusions
Ambient air pollution was associated with degree of coronary calcification, independent of standard risk factors. The link between air pollution and CAD is not limited to acute events but appears to include atherogenesis.

Funding Acknowledgement
Type of funding source: None
Quantified coronary plaque volume provides superior risk stratification up to 10 years
Authors: Deseive S , Straub R , Kupke M , Kitslaar P , Broersen A , Hadamitzky M , Massberg S , Hausleiter J 
Published: November 2020

Abstract

Background
Automated plaque quantification derived from coronary CT angiogragphy datasets provides exact and reliable assessment of coronary atherosclerosis burden.

Purpose
To investigate the potential for category based reclassification of patients based upon quantified coronary plaque volume in patients with 10 years of follow-up.

Methods
Coronary PV was quantified with dedicated software in 1577 patients with suspected coronary artery disease. Cardiac death and acute coronary syndrome were defined as endpoint. Patients were initially classified as low, intermediate or high risk based upon the Morise score. Quantified PV was used to reclassify patients as shown in Figure 1 Panel A. The applied cutoffs (PV=0, PV0–110.5 mm3 and PV&gt;110.5mm3) were established by previous work of our group. Categorical net reclassification improvement was used to compare the initial and updated patient stratification.

Results
Patients were followed for 10.4 years. The combined endpoint occurred in 59 patients, of whom 36 suffered from cardiac death, 18 had non-fatal myocardial infarction and 5 presented with unstable angina requiring recascularisation. The Morise score classified the majority of patients as intermediate risk patients (71%) and smaller proportions as low risk (21.9%) or high risk (7.1%). Quantified PV based reclassification resulted in reclassification of 800 (51%) patients. Of those, the majority was classified into a lower risk category (n=502). Calculation of the categorical NRI proved a significantly superior risk stratification when compared to the initial risk groups (0.48 with 95% CI 0.13 and 0.68, p&lt;0.001). The reclassification matrix is shown in Figure 1 Panel B. After reclassification, the estimated 10-year event rates for low, intermediate and high risk patients were 0.6% (95% CI 0 and 1.3%), 4.8% (95% CI 2.4 and 7.2%) and 11.3% (95% CI 6.6 and 13.9%) respectively.

Conclusion
Quantified coronary PV permits an effective and useful approach to reclassify patients with suspected coronary artery disease into superior risk categories.

Funding Acknowledgement
Type of funding source: None
Association between the progression of aortic valve calcification and coronary atherosclerotic plaque volume
Authors: Lee S.E , Budoff M.J , Conte E , Hadamitzky M , Leipsic J.A , Cademartiri F , Pontone G , Stone P.H , Bax J.J , Narula J , Lin F.Y , Berman D.S , Min J.K , Shaw L.J , Chang H.J 
Published: November 2020

Abstract

Background
It is unclear whether the annual progression of aortic valve calcification (AVC) is associated with the progression of coronary atherosclerosis.

Purpose
We explored the association between AVC and the total and compositional plaque volume (PV) progression.

Methods
We performed a prospective multinational registry of consecutive patients who underwent serial coronary computed tomography angiography (CTA) at ≥2-year intervals. AVC, and total and compositional PV at baseline and follow-up were quantitatively analyzed. Multivariate linear regression models were constructed.

Results
Overall, 594 patients (56% male, 61.5±9.7 years old) were included (mean coronary CTA interval, 3.9±1.5 years). At baseline, AVC was 30.9±117.3. Normalized total PV at baseline was 122.3±219.4mm3, encompassing 41.9±116.8mm3 of calcified PV and 80.4±131.5mm3 of non-calcified PV. After adjustment of age, sex, clinical risk factors, and drug use, AVC at baseline was independently associated with total and all compositional PVs (all p&lt;0.001). However, at follow-up, the annual progression of AVC was only associated with the annual progression of calcified PV (β=0.149, p=0.0089), but not with total and non-calcified PVs (all p&gt;0.05) (Table, Figure).

Conclusion
The overall burden of coronary atherosclerosis is associated with AVC at baseline. However, the progression of AVC is associated only with the progression of calcified PV but not with that of total and non-calcified PV.
Representative case

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The National Research Foundation (NRF) of Korea funded by the Ministry of Science and ICT (MSIT)
Evaluation of adverse plaque characteristics in coronary computed tomography angiography using combined near infrared spectroscopy
Authors: Shin S 
Published: November 2020

Abstract

Background/Introduction
Coronary computed tomography angiography (CCTA) has developed rapidly, enabling the evaluation of coronary stenosis as well as plaque characteristics. However, it is not clear whether the adverse plaque characteristics found in CCTA are really vulnerable plaques. Near-infrared spectroscopy (NIRS) is able to quantify cholesterol within coronary arteries by the lipid core burden index (LCBI).

Purpose
The purpose of this study was to determine whether positive remodeling (PR), low attenuated plaque (LAP) and spotty calcificaiton (SC) found in CCTA have high LCBI values in NIRS.

Methods
The study was single center, prospective, and cross-sectional. A total of 84 patients who underwent NIRS during percutaneous coronary intervention after CCTA imaging for coronary artery disease were studied. PR, LAP and SC were identified in the plaques visible on CCTA, and LCBI and maxLCBI (4mm) were measured by NIRS on the same plaque.

Results
In the presence of PR and LAP in the plaque, the maxLCBI (4mm) [PR: 468±161 vs. 319±214, p=0.032, LAP: 475±178 vs. 278±191, p=0.006] and LCBI [PR: 190±74 vs. 132±104, p=0.044, LAP: 182±96 vs. 124±93, p=0.038] values were significantly higher than those in the plaque without PR and LAP. However, with and without SC, there was no significant difference between the maxLCBI (4mm) [474±181 vs. 336±208] and LCBI [183±77 vs. 142±102, p=0.127] values.

Conclusion
Among the adverse plaque characteristics found in CCTA, PR and LAP were clearly correlated with maxLCBI (4mm) and LCBI measured by NIRS, but SC was less correlated.
APC vs. LCBI

Funding Acknowledgement
Type of funding source: None
Sex-specific risk for ischemia by invasive fractional flow reserve according to coronary atherosclerotic features: results from the CREDENCE trial
Authors: Van Den Hoogen I.J , Gianni U , Bax A.M , Van Rosendael A.R , Tantawy S.W , Berman D.S , Chang H.J , Genereux P , Knaapen P , Narula J , Pontone G , Lin F.Y , Min J.K , Shaw L.J , Bax J.J 
Published: November 2020

Abstract

Background
Evolving evidence suggests unique sex-specific mechanisms underlying coronary artery disease (CAD). However, it remains unknown if certain coronary atherosclerotic features confer a higher risk for ischemia in women versus men.

Purpose
To determine the association between coronary atherosclerotic features on coronary computed tomography angiography (CCTA) and ischemia by invasive fractional flow reserve (FFR) in women versus men.

Methods
Secondary analysis of the CREDENCE trial, including patients referred for nonemergent invasive coronary angiography (ICA). All patients underwent CCTA with semi-automatic quantification of coronary atherosclerosis, as well as ICA with FFR interrogation of all major epicardial arteries ≥2 mm. Generalized estimating equations were calculated to assess the association between coronary atherosclerotic features and invasive vessel-specific ischemia (FFR ≤0.80). Sex interactions were tested, adjusted for age.

Results
From 612 patients (mean age 64±10 years, 30% women) with 1,686 analyzed vessels, a total of 436 (26%) vessels were ischemic. Women were significantly older than men (p&lt;0.001), but with similar distribution of risk factors and medication usage (p≥0.09). In both women and men, all general and compositional features of coronary atherosclerosis were significantly associated with ischemia. However, tests for interaction (Figure 1) revealed higher relative odds for ischemia among women as compared to men for total percent atheroma volume ([PAV], p=0.006), the number of lesions with high-risk plaque (p=0.027), the number of lesions with &gt;30% stenosis (p=0.030), noncalcified PAV &lt;130 HU and &lt;350 HU (p≤0.003), and calcified PAV (p=0.007).

Conclusion
Our results support a prominent influence of coronary atherosclerotic features that uniquely impact ischemic risk among women more so than men. These data support the role of CCTA for providing valuable information to guide management of symptomatic women.
Figure 1. Ischemic risk in women vs. men

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health - National Heart, Lung, and Blood Institute
Availability and applicability of cardiac magnetic resonance imaging in diagnosis in cardiomyopathies: the Cardiomyopathy/Myocarditis registry of the EURObservational Research Programme of the ESC
Authors: Mizia-Stec K , Charron P , Blanes J.R.G , Elliott P , Kaski J.P , Maggioni A.P , Tavazzi L , Tendera M , Wybraniec M , Laroche C , Caforio A.L.P 
Published: November 2020

Abstract

Background
Cardiac magnetic resonance (CMR) constitutes a gold standard in the diagnosis of cardiomyopathies. Regardless of CMR advantages, the method is time-consuming, high-cost, with limited availability in some European regions.

Purpose
To assess the availability and applicability of CMR for establishing the diagnosis in different populations of patients with cardiomyopathies.

Methods
Overall, 3208 adult patients with cardiomyopathy (1119 / 34.9% females; median age at diagnosis: 49.0 years): 1260 with dilated (DCM), 1739 with hypertrophic (HCM), 66 with restrictive (RCM) and 143 with arrhythmogenic right ventricular cardiomyopathy (ARVC) enrolled in EURObservational Research Programme (EORP) – Cardiomyopathy/Myocarditis Long-Term Registry were analysed.

Results
CMR scan was performed as a baseline diagnostic method in 29.4% of patients; CMR was a single diagnostic method in 0.9% of patients and in 28.6% of patients CMR was used along with transthoracic echocardiography (TTE). In 67.6% of patients TTE was at the baseline the single diagnostic imaging method. Prevalence of CMR use in different cardiomyopathies was as follows: 20.6% in DCM, 33.8% in HCM, 36.4% in RCM and 51.1% in ARVC (p&lt;0.001). Range of CMR applicability in different European regions was diverse from 0% up to 63.2%.
The population with CMR use was younger, less symptomatic, with decreased prevalence of other cardiovascular risk factors and of associated cardiovascular diseases as compared to the population diagnosed without CMR scanning (p&lt;0.001).
Abnormal CMR results were present in 93.4% of patients with the highest percentage in RCM (95.8%) and HCM (94.9%) followed by DCM (91.5%) and the lowest abnormal CMR scan ratio in ARVC (87.7%) (p=0.030). The majority of CMR examinations comprised the assessment of late gadolinium enhancement (LGE, 93.3% at baseline). Presence of CMR LGE was observed in 69.3% of all patients: 59.1% in DCM, 73.8% in HCM, in 63.9% in ARVC and with the highest prevalence in RCM (83.3%) (p&lt;0.001).

Conclusion
The study reveals real-life data on the low availability and applicability of CMR in adult patients with cardiomyopathies. The analysis shows the advantages of CMR imaging but also identifies the gaps between recommendations and clinical practice. Improvement regarding access, training and reimbursement is necessary to offer CMR to cardiomyopathy patients in accordance with the ESC guidelines.

Funding Acknowledgement
Type of funding source: None
Late Gadolinium Enhancement at cardiac magnetic resonance predicts malignant ventricular arrhythmias in systemic sclerosis
Authors: Gargani L , Pugliese N.R , Meloni A , Bruni C , Todiere G , Guiducci S , Moggi-Pignone A , Lombardi M , Mavrogeni S , Matucci-Cerinic M , Pepe A 
Published: November 2020

Abstract

Background
Malignant arrhythmias due to cardiac involvement are a frequent cause of death in systemic sclerosis (SSc). Cardiac involvement, which is linked to both ischaemic and non-ischaemic fibrotic deposition, is often subclinical. Cardiovascular magnetic resonance (CMR) is the non-invasive gold standard for myocardial tissue characterization and can detect macroscopic myocardial fibrosis through late Gadolinium enhancement (LGE).

Aim
To evaluate the role of LGE to predict malignant arrhythmias requiring implantable cardioverter defibrillator (ICD) in SSc.

Methods
289 SSc patients underwent a thorough clinical evaluation and CMR exam using a 1.5 T scanner. Biventricular function parameter by SSFP cine images, oedema by STIR T2 images, and macroscopic fibrosis by LGE were assessed. Patients were followed-up and malignant ventricular arrhythmias requiring ICD implantation was considered as event.

Results
Out of 289 patients, 111 (38.4%) showed LGE and 83/111 (28.7% of the total population) showed a non-junctional distribution. During the follow-up (45±27 months), 10 patients needed ICD after malignant ventricular arrhythmias (7 patients with LGE, 3 patients without LGE). CMR predictors of cardiac events by univariate analysis were left and right ventricular ejection fractions, indexed right atrial area and non-junctional LGE. At multivariate analysis, macroscopic myocardial fibrosis detected by LGE was an independent predictor (hazard ratio 5.4; 95% C.I. 1.1–28.8, p&lt;0.05; see figure for Kaplan-Meier curves).

Conclusions
Presence of ventricular LGE at CMR may represent an independent predictor for further malignant ventricular arrhythmias requiring ICD implantation in SSc patients.
Kaplan-Meier curves

Funding Acknowledgement
Type of funding source: None
Identifying the value of RVEF for the prediction of major cardiovascular outcomes: a study of 7,131 patients undergoing cardiovascular magnetic resonance imaging
Authors: Purmah Y , Lei L , Dykstra S , Labib D , Mikami Y , Satriano A , Feutcher P , Fine N , Gaztanaga J , Howarth A , Heydari B , Merchant N , Bristow M , Lydell C , White J 
Published: November 2020

Abstract

Background
Right ventricular (RV) function remains poorly recognized for its value in predicting cardiovascular events at a population level. Cardiovascular Magnetic Resonance (CMR) imaging is the gold standard for RV assessment.

Purpose
To define the independent prognostic value of RVEF for the prediction of major adverse cardiovascular events (MACE) as primary outcome in patients with known or suspected cardiovascular disease.

Methods
Data was obtained from the Cardiovascular Imaging Registry of Calgary (CIROC). Patients underwent standardized CMR imaging protocols and analysis. Clinical events were identified from administrative data.

Results
7,131 patients were included. 870 primary outcome events occurred over 2.5 years follow-up. RVEF provided equivalent predictive utility versus LVEF (Table 1). There was an increase in events with worsening severity of RVEF (Figure 1), with a significant “threshold-effect” at an RVEF of 40%.

Conclusions
RVEF is a strong and independent predictor of MACE at a population level.
Figure 1

Funding Acknowledgement
Type of funding source: None
Relationship between cardiac magnetic resonance derived extracellular volume fraction and myocardial strain in patients with non-ischemic dilated cardiomyopathy
Authors: Azuma M , Kato S , Kodama S , Hayakawa K , Kagimoto M , Iguchi K , Fukuoka M , Fukui K , Iwasawa T , Utsunomiya D , Kimura K , Tamura K 
Published: November 2020

Abstract

Background
The feature tracking (FT) technique has been proposed as a robust method to evaluate the myocardial strain using conventional cine magnetic resonance imaging (MRI) of the left ventricle. Data is limited regarding the relationship between FT-derived myocardial strain and diffuse myocardial fibrosis evaluated by T1 mapping in patients with non-ischemic dilated cardiomyopathy (NIDCM).

Purpose
The aim of this study was to evaluate the correlation between extracellular volume (ECV) by T1 mapping and myocardial strain by FT in patients with NIDCM.

Methods
A total of sixty-four patients with NIDCM (62±12 years) and 15 controls (62±11 years) were studied. Using a 1.5T MR scanner, pre- and post- T1 mapping images of LV wall at mid-ventricular level was acquired to calculate ECV by modified Look-Locker inversion recovery (MOLLI) sequence. Radial strain (RS), circumferential strain (CS) and longitudinal strain (LS) was assessed by FT technique. ECV and myocardial strain were compared using a 6-segment model at mid-ventricular level.

Results
Compared to the controls, the NIDCM patients had a significantly higher ECV (0.30±0.02 vs. 0.24±0.01, p&lt;0.001) and impaired myocardial strain (RS, 24.2±3.0 vs. 52.2±6.2, p&lt;0.001; CS, −7.5±2.1 vs. −15.3±2.2, p&lt;0.001; LS −10.4±3.5 vs. −20.2±4.7, p&lt;0.001, respectively). Similar results were obtained when comparing all 6 myocardial segments (segment 7–12) (all p values &lt;0.001). In a segment-based analysis, a significant positive correlation was found between the ECV and CS (r=0.26 to 0.41; all p values &lt;0.05), a negative correlation was found between the ECV and RS (r=−0.31 to −0.41; all p values &lt;0.05). In a patient-based analysis, there were significant positive correlations between the ECV and CS (r=0.45, p&lt;0.001), ECV and LS from 2-chamber view (r=0.30, p=0.006), ECV and LS from 4-chamber view (r=0.37, p&lt;0.001). There was a significant negative correlation between the ECV and RS (r=−0.43, p&lt;0.001) (FIGURE)

Conclusions
In NIDCM patients, severity of myocardial fibrosis evaluated by T1 mapping is associated with impaired myocardial strain by FT technique.
Correlation between the ECV and strain

Funding Acknowledgement
Type of funding source: None
Comparison of cardiac MR feature tracking and myocardial MR tagging for assessment of regional ventricular function
Authors: Del Canto Serrano I , Tejero P , Lopez-Lereu M.P , Monmeneu J.V , Bodi V , Chorro F.J , Moratal D 
Published: November 2020

Abstract

Background
Quantification of regional myocardial function allows risk stratification in heart disease. CMR tagging (TAG) enables the evaluation of segmental cardiac deformation, but it has not reached clinical routine due to the long acquisition and post-processing times. Conversely, CMR feature-tracking (FT) is a post-processing method based on standard cine-MR imaging.

Purpose
To compare myocardial strain and torsion obtained with CMR-TAG and CMR-FT in healthy volunteers and myocardial infarction (MI).

Methods
42 subjects (18 healthy; 24 MI) underwent CMR (1.5T, cine/TAG sequences). Global and segmental (16-segment) circumferential strain (CS), and torsion were measured using FT (CVI42, Canada) and tagging (InTag, France). Inter-method agreement was assessed using 2-way-mixed intraclass correlation coefficient (ICC).

Results
The agreement for segmental and global CS measurements was good to excellent in both groups (Table). Torsion angle showed excellent (0.763) and good (0.697) agreement for healthy and MI.

Conclusion
CMR-FT strain and torsion measurements showed high agreement with CMR-tagging. Thus, CMR-FT provides a potential clinical alternative in the assessment of regional ventricular function.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Carlos III Health Institute, Spanish Ministry of Economy and Competiveness; Agencia Valenciana de la Innovaciόn, Generalitat Valenciana