bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of right ventricular late gadolinium enhancement scoring by cardiac magnetic resonance imaging in cardiac sarcoidosis
Authors: Koyanagawa K , Naya M , Manabe O , Furuya S , Tsuneta S , Ohira H , Tsujino I , Oyama-Manabe N , Anzai T 
Published: November 2020

Abstract

Background
The right ventricular (RV) function is a significant predictor of the prognosis and exercises tolerance in patients with left ventricular dysfunction. The previous study reported that RV late gadolinium enhancements (LGE) as assessed by cardiac magnetic resonance (CMR) imaging were present in 16% of pulmonary sarcoidosis. Although RV LGE is associated with a poor prognosis, a semi-quantitative assessment of RV LGE was not been established so far. Moreover, the frequency of RV dysfunction (RVD) in cardiac sarcoidosis (CS) and predictors of RVD are unclear.

Purpose
Our aim of this study is to establish RV LGE semi-quantitative scores and to clarify the rate and predictors of RVD in CS.

Methods
Forty-four consecutive patients with CS who underwent CMR imaging (median age, 63 [IQR 54–71] years old; 10 males) were studied. They were diagnosed as definitive based on the Heart Rhythm Society expert consensus statement. Two patients were excluded due to no long axial view. Thus, a total of 42 patients were included in this study. RV LGE was semi-quantitatively evaluated using the original score developed by ours. RV was classified into RV outflow tract (OT), basal, middle and apex. RVOT and apex are assigned 1 segment for each, and basal and middle are assigned 4 segments include anterior, septal, inferior and lateral (Figure1). In total, 10 segments were evaluated. RV LGE scores were analysed independently by the two operators. The RV ejection fraction was assessed in a long axial view without an RVOT (20 phases, 12 slices). We divided the cohort into the non-RVD group (RVEF ≥45%) and the RVD group (RVEF &lt;45%) and compared the RV scores between the two groups.

Results
The RVD was present in 31% of the entire cohort. The presence of RV LGE was significantly higher in the RVD group than the non-RVD group (83% vs. 43%, p=0.037). RV LGE score in the RVD group was significantly higher than that in the non-RVD group (2.83±1.95 vs. 0.83±1.21, p=0.001). The septal lesions in basal and middle levels accounted for 54% in all segments. RVEF showed a significant inverse correlation with RV LGE score (r=−0.57, p&lt;0.0001). In the ROC curve for RVD, the RV LGE score of more than 2 and equal could discriminate RVD from non-RVD with AUC of 0.813 (Sensitivity = 0.77, Specificity = 0.76, p=0.003).

Conclusion
RVD was observed in 31% of patients with definitive CS. The septal lesions were the most frequent in the RV LGE site, which suggests that the longitudinal abnormal motion of RV is a significant predictor of the RVD in patients with CS. RV LGE score is a valuable method to assess RVD.
RV LGE score

Funding Acknowledgement
Type of funding source: None
Evaluation of ATTR-cardiac amyloidosis employing Tc-99m pyrophosphate scintigraphy using planar, SPECT and gated SPECT imaging on dedicated cardiac CZT camera
Authors: Tshori S , Livschitz S , Volodarsky I , Fabrikant J , George J 
Published: November 2020

Abstract

Background/Introduction
Recent recognition that ATTR cardiac amyloidosis (ATTR-CA) is not uncommon and the emergence of novel therapeutic opportunities resulted in the publication of “Expert Consensus Recommendations for Multimodality Imaging in Cardiac Amyloidosis”. However, almost all data were derived from general purpose NaI cameras, while new cardiac dedicated CZT cameras are becoming more widespread.

Purpose
To evaluate Tc-99m pyrophosphate (PYP) scintigraphy on D-SPECT cardio dedicated CZT camera (Spectrum Dynamics) in suspected ATTR-CA patients.

Methods
Seventy three consecutive patients suspected for ATTR-CA underwent planar (5 min), SPECT and gated SPECT (10 min, 8 bins) scintigraphy 89±26 min after injection of Tc99m-PYP 740 MBq, followed by late scintigraphy after 92±36 min in 65 consecutive patients. Perguini visual score, planar H/CL and SPECT derived H/CL ratio were evaluated by two blinded independent experienced readers. Diagnosis was based on visual interpretation after blood pool and monoclonal gammopathy were excluded.

Results
Very good to excellent planar and SPECT image quality was observed in almost all patients. PYP scintigraphy was positive in 6/73 patients, with left ventricular wall uptake clearly evident in the planar images of most patients. There was perfect agreement between readers regarding positive/negative interpretation. There was also substantial inter-observer agreement regarding the Perguini scoring (Cohen's k with linear weighting 0.819, 95% CI 0.701–0.937). Inter-observer agreement for H/CL ratio was also good (Pearson's correlation coefficient r(71)=0.873). SPECT and gated SPECT images were helpful only in one positive patient, and did not have an added value in any of the negative studies. Slightly better images were observed during late scintigraphy, but there was no change in interpretation, and H/CL ratio was not significantly changed (median difference −0.01, IQR 0.09). Alas, Inter-observer agreement of H/CL ratio was lower (Pearson's correlation coefficient r(64)=0.633). We also evaluated H/CL ratio derived from SPECT based application of the camera manufacturer. Agreement between early planar and early SPECT based H/CL ratio was good for both readers (r(69)=0.778 and r(66)=0.747), but inter-observer agreement was lower (r(66)=0.697).

Conclusions
ATTR PYP scintigraphy using cardiac dedicated CZT camera yielded excellent images in almost all patients, and uptake in the left ventricular wall could be easily identified in positive patients. Inter-observer agreement was excellent for both visual scoring and planar H/CL ratio. Early planar images were high quality, and limited additional diagnostic value was observed for both SPECT and gated SPECT scintigraphy and from later acquisition.

Funding Acknowledgement
Type of funding source: None
Accuracy of 18F-FDG PET/CT in patients with the suspicion of cardiac implantable electronic device infections: good for pocket, not so good for endocarditis
Authors: Jeronimo Baza A , Olmos C , Vilacosta I , Ortega-Candil A , Rodriguez-Rey C , Perez-Castejon M.J , Fernandez-Perez C , Perez-Garcia C.N , Garcia-Arribas D , Ferrera C , Carreras J.L 
Published: November 2020

Abstract

Introduction
The usefulness of 18F-FDG PET/CT in the diagnosis of infective endocarditis (IE) associated with cardiac implantable electronic devices (CIED) is not well established.

Purpose
To assess the diagnostic yield of 18F-FDG PET/CT in patients with suspected CIED infections, placing special emphasis on differentiating between pocket infection (PI) and CIED-IE.

Methods
From 2013 to 2018, all patients (n=63) admitted to a tertiary care hospital with suspected CIED infection were prospectively recruited, undergoing a thorough diagnostic work-up that included blood cultures extraction, transthoracic (TTE) and transoesophageal echocardiography (TEE) and a PET/CT. When device explantation was required, material from the pocket, generator and leads were also cultured. The gold standard for the diagnosis of CIED-IE was a positive lead culture in the absence of PI when percutaneous extraction was performed or a positive culture from a surgically removed lead. In spite of negative lead cultures, the presence of typical TEE images of vegetations in a clinical context of positive blood cultures was also considered as CIED-IE.

Results
After the whole diagnostic process, 14 (22.2%) cases corresponded to isolated PI and 13 (20.6%) were categorized as CIED-IE. Considering radionuclide uptake in the intracardiac portion of the lead, values of sensitivity, specificity and global diagnostic accuracy of PET/CT for CIED-IE were 38.5%, 98.0% and 85.7%, respectively. Positive and negative likelihood ratio values, 19.2 and 0.6 respectively, suggest that a positive PET/CT is much more probable to correspond to a patient with CIED-IE, whereas it is not possible to exclude this diagnosis in case of a negative result. In the case of PI, fair sensitivity (72.2%) and good specificity values (95.6%) were obtained. Extracardiac lead SUVmax and SUVratio in PI were good, with an area under the ROC curve (AUC) of 0.870 and 0.879, respectively. However, semiquantitative analysis was not useful for the diagnosis of CIED-IE.

Conclusions
In patients with suspected CIED infection, the yield of 18F-FDG PET/CT differs depending on the site of infection, showing a very high specificity but poor sensitivity in CIED-IE; so negative studies must be interpreted with caution if the suspicion of CIED-IE is high.
ROC curves SUVmax and SUV ratio for PI

Funding Acknowledgement
Type of funding source: None
Splenic switch off as a novel marker for adenosine response in 13N-ammonia PET myocardial perfusion imaging – a pilot study
Authors: Bakula A , Patriki D , Von Felten E , Benetos G , Sustar A , Benz D.C , Wiedemann-Buser M , Treyer V , Pazhenkottil A.P , Graeni C , Gebhard C , Kaufmann P.A , Buechel R.R , Fuchs T.A 
Published: November 2020

Abstract

Background
Positron emission tomography myocardial perfusion imaging (PET MPI) is a robust and excellent tool for assessing ischemia. So far, however, no methodology has been established to distinguish truly reduced MFR due to microvascular dysfunction or three-vessel coronary disease (CAD) from seemingly impaired MFR due to inadequate adenosine response. Conversely, for cardiac stress magnetic resonance (CMR) the adenosine induced splenic switch-off (SSO) sign has been proposed as a potential marker for adequate adenosine response.

Purpose
We assessed the feasibility of detecting SSO in adenosine stress 13N-ammonia PET MPI using SSO in CMR as the standard of reference.

Methods
50 patients underwent simultaneous PET MPI and CMR on a hybrid PET/MR device with co-injection of 13N-ammonia and a gadolinium-based contrast agent during rest and adenosine-induced stress. In CMR, SSO was assessed qualitatively and quantitatively by calculating the ratio of the peak signal intensity of the spleen during stress over rest (SIR). Similarly, in PET MPI the splenic signal activity ratio (SAR) was calculated as the proportion of the maximal standard uptake value of the spleen in stress and rest. Additionally, MFR was quantified in PET MPI.

Results
Visual SSO in CMR was present in 37 (74%) patients, whereas 13 patients had no SSO. The median SIR in CMR was significantly lower in patients with visual SSO compared to patients without visual SSO (0.57 [IQR 0.49–0.62] vs. 0.89 [IQR 0.76–0.98]; p&lt;0.001). Similarly, median SAR in PET was significantly lower in patients with visual SSO in CMR compared to patients without visual SSO (0.4 [IQR 0.32–0.45] vs. 0.8 [IQR 0.47–0.98]; p&lt;0.001). SIR correlated significantly with SAR (r=0.4, p&lt;0.05). Mean MFR was significantly higher in patients with visual SSO compared to patients without visual SSO (3.38±0.86 vs. 2.53±0.84; p&lt;0.05).

Conclusion
Similarly to CMR, SSO can be detected in 13N-ammonia PET MPI. This might help distinguish adenosine non-responders from patients with truly impaired MFR due to microvascular dysfunction or multivessel CAD.
Figure 1. Splenic switch off (*) illustrated on transaxial 13N-ammonia PET MPI stress (A) compared to rest perfusion images (B) and similarly in stress (C) and rest (D) short axis CMR (**) in the same patient during adenosine induced stress and co-injection of 13N-ammonia and a gadolinium based contrast agent, acquired on a hybrid PET/MR device.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation (SNSF)
Qualitative and semiquantitative [18F]FDG-PET/CT analysis in patients with IE: a strategy to enhance specificity?
Authors: Boni R 
Published: November 2020

Abstract

Aim
The 2015 ESC Guideline for the diagnosis and management of infectious endocarditis (IE) included molecular imaging procedures such as radiolabeled leukocytes and [18F]FDG-PET/CT as major criteria to establish the diagnosis of IE. Whereas in case of radiolabeled leukocytes the criteria for defining positive and negative scan are well established, in case of [18F]FDG-PET/CT a consensus of the criteria that define a positive scan is still lacking.

Materials and methods
In this work we prospectively evaluated a series of 90 patients (M:F=60:30, mean age 67±16 years, median age 72 years, range 18–88) that performed [18F]FDG-PET/CT for suspected IE between January 2016 and January 2019 in our center to define which pattern of uptake and semiquantitative parameters (SUVmax, SUVmean, valve/liver, valve/lung and valve/mediastinum uptake ratio) present the highest diagnostic accuracy for IE. PET/CT results were correlated with transthoracic (TTE) or transesophageal (TEE) echocardiography, blood culture, the Duke criteria. The new ESC criteria were also evaluated.

Results
Globally PET/CT presented sensitivity=96% and specificity=75%, NPV= 97% and PPV=68%. A focal pattern of uptake was found 17/30 patients with confirmed IE (mean SUVmax=5.29±1.8, median SUVmax=5.5) whereas whereas a diffuse pattern of uptake was found in 11 patients with confirmed IE (mean SUVmax=8.1±3.5, median SUVmax=7.6). No significant differences between the valve/liver ratio uptake and the valve/mediastinum uptake ratio were found between positive and negative patients with either focal or diffuse pattern of uptake. Interesting, in presence of diffuse valve uptake both SUVmax and the valve/lung uptake ratio were significantly higher in patients with a final diagnosis of IE, including the group of patients under antimicrobial treatment (&gt;90%). PET/CT confirmed its ability to identify extracardiac sites of [18F]FDG uptake in presence of septic embolism (35%) and in patients with other diseases (vasculitis, vascular prosthesis infections, mediastinitis and cancer, particularly in patients with IE sustained by Streptococcus Gallolyticus).

Conclusions
Our results suggest pattern of [18F]FDG uptake more specific for valve infection is a focal uptake or a diffuse uptake with a SUVmax&gt;5 and a valve/lung ratio &gt;8.

Funding Acknowledgement
Type of funding source: None
Prognostic value of intracoronary imaging-derived measures for non-infarct related vessel revascularization throughout 7 years among patients with ST-elevation myocardial infarction
Authors: Ueki Y , Karagiannis A , Bar S , Yamaji K , Taniwaki M , Roffi M , Holmvang L , Maldonado R , Pedrazzini G , Kelbaek H , Radu M , Windecker S , Raber L 
Published: November 2020

Abstract

Background
Underlying plaque characteristics that lead to future revascularization during long-term follow-up remain poorly understood.

Purpose
We aimed to explore intracoronary imaging-derived measures as assessed by intravascular ultrasound (IVUS) and optical coherence tomography (OCT) associated with non-infarct related vessel revascularization (non-TVR) arising from imaged segments during long-term (up to 7 years) follow-up among patients with ST-elevated myocardial infarction (STEMI).

Methods
A total of 94 STEMI patients enrolled into the IBIS-4 (Integrated Biomarker Imaging Study-4) study undergoing serial (baseline and 13 months) IVUS and OCT in 2 non-infarct-related coronary arteries under high-intensity statin therapy were analyzed in the present study. Patients were divided into 2 groups according to the occurrence of non-TVR within previously imaged vessel segments (non-TVR: n=14, no non-TVR: n=80).

Results
Baseline characteristics including LDL level were comparable between groups. At baseline, lesions with future non-TVR were associated with greater percent atheroma volume by IVUS (55.6±5.4% vs. 49.6±6.1%, P&lt;0.001), minimum lumen area by OCT (3.4±1.7 mm2 vs. 6.0±3.3 mm2, P=0.004), and a higher prevalence of fibroatheroma (60.0% vs. 20.1%, P=0.007) by OCT compared with those without. Among patients with serial imaging, lesions with non-TVR had a trend towards a less reduction of percent atheroma volume (−0.2±3.8% vs. −2.4±4.2%, P=0.083).

Conclusion
Greater plaque burden, smaller lumen area, and higher prevalence of OCT-detected fibroatheroma at baseline were associated with non-infarct related vessel revascularization. Lesions with non-TVR tend to have less-pronounced regression of coronary atheroma despite intensive statin therapy and achieved LDL levels.
Non-TVR 7 years after index PCI

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation
Prediction of atrial fibrillation from normal ECG using artificial intelligence in patients with unexplained stroke
Authors: Baek Y.S , Lee S.C , Choi W.I , Kim D.H 
Published: November 2020

Abstract

Background
Stroke related to embolic and of undetermined source constitute 20 to 30% of ischemic strokes. Many of these strokes are related to atrial fibrillation (AF), which might be underdetected due to its paroxysmal and silent nature.

Purpose
The aim of our study was to predict AF during normal sinus rhythm in a standard 12-lead ECG to train an artificial intelligence to train deep neural network in patients with unexplained stroke (embolic stroke of undetermined source; ESUS).

Methods
We analyzed digital raw data of 12-lead ECGs using artificial intelligence (AI) recurrent neural network (RNN) to detect the electrocardiographic signature of atrial fibrillation present during normal sinus rhythm using standard 12-lead ECGs. We included 2,585 cases aged 18 years or older with multiple ECGs at our university hospital between 2005 and 2017 validated by crossover analysis of two electrophysiologists. We defined the first recorded AF ECG as the index ECG and the first day of the window of interest as 14 days before the date of the index ECG. We allocated ECGs to the training, internal validation, and testing datasets in a 7:1:2 ratio. We calculated recall, F1 score, and the area under the curve (AUC) of the receiver operatoring characteristic curve (ROC) for the internal validation dataset to select a probability threshold. We applied this developed AI program to 169 ESUS patients who has been diagnosed and had standard 12-lead ECGs in our hospital.

Results
We acquired 1,266 NSR ECSs from real normal subjects and 1,319 NSR ECGs form paroxysmal AF patients. RNN AI-enabled ECG identified atrial fibrillation with an AUC of 0.79, recall of 82%, specificity of 78%, F1 score of 75% and overall accuracy of 72.8% (Figure). ESUS patients were divided into three groups according to calculated probabilities of AF using AI guided RNN program: group 1 (35 patients with probability of 0–25% of paroxysmal AF), group 2 (86 patients with probability of 25–75% of paroxysmal AF) and group 3 (48 patients with probability of 75–100% of paroxysmal AF). In Kaplan-Meier estimates, Group 2 and 3 (more than 25% of PAF probabilities) tended to have higher AF incidence although it did not reach statistical significance (log-rank p 0.678) (Figure).

Conclusion
AI may discriminate subtle changes between real and paroxysmal NSR and can also be helpful in patients with ESUS to identify if AF is the underlying cause of the stroke. Further studies are needed in order to evaluate their possible use in future prognostic models.

Funding Acknowledgement
Type of funding source: None
Spectrum of Cardiac Arrhythmias in children with left ventricular non-compaction
Authors: Vasichkina E.S , Kovalchuk T.S , Pervunina T.M , Myravyev A , Fomicheva Y , Vershinina T.L , Kostareva A.A 
Published: November 2020

Abstract

Left ventricular non-compaction (LVNC) represents a genetically heterogeneous primary cardiomyopathy which occurs in both children and adults, can be isolated or combined with other congenital heart diseases and reveals substantial clinical polymorphism. Isolated LVNC is a rare phenomenon more commonly being a part other cardiovascular phenotypes such as hypertrophic cardiomyopathy, restrictive cardiomyopathy or congenital heart disorders. Clinical features on LVNC include main triade: heart failure, ventricular arrhythmias (VA) and thromboembolism.

Purpose
The aim of this study was to analyze the clinical characteristics of arrhythmias in children with LVNC.

Methods
We enrolled 15 patients diagnosed with LVNC. For all patients enrolled the clinical examination included ECG, echocardiography, Holter monitoring, family history and neurological examination. The echocardiographic diagnosis for LVNC was based on the criteria of Stollberger and Jenni. Several patients additionally received MRI. Target sequencing and WES were performed using a targeted panel of 108 cardiomyopathy-associated genes. All patients had a written parental consent form for including in this study.

Results
The mean age oat presentation was 7.46±4.4 year (from 0.5 to 14 year old).
4 patients had ventricular arrhythmias, which manifested as isolated premature ventricular contractions (PVCs) in two patients; ventricular tachycardia (VT) in two patients, 3 – supraventricular arrhythmias, 2 – WPW syndrome/phenomenon, 5 - atrioventricular block (1 and 2 degrees), atrial fibrillation – 1.
Antiarrhythmic therapy received 7 patients (3 with VA; 3 with SVA).
In total 21 variants of interest were identified in all 15 patients in 18 different genes. All four patients with variants in ion channel genes had documented supraventricular and ventricular arrhythmias. In 3 out of 5 patients with AV block variants in contractile sarcomeric and related genes were detected.
Four patients reached endpoints such as cardiovascular death (2 patients) and heart transplantation (2 patients).

Conclusions
Arrhythmic manifestations in children with left ventricular non-compaction can vary from conduction disease to SVT and ventricular arrhythmias and these arrhythmias have been associated with prognosis and outcome.

Funding Acknowledgement
Type of funding source: None
Mortality in patients with atrial fibrillation with or without heart failure following hospital discharge
Authors: Kartas A , Samaras A , Vasdeki D , Dividis G , Fotos G , Paschou E , Forozidou E , Tsoukra P , Kotsi E , Goulas I , Karagiannidis E , Karvounis H , Tzikas A , Giannakoulas G 
Published: November 2020

Abstract

Background
The association of heart failure (HF) with the prognosis of atrial fibrillation (AF) remains unclear.
OBJECTIVES
To assess all-cause mortality in patients following hospitalization with comorbid AF in relation to the presence of HF.

Methods
We performed a cross-sectional analysis of data from 977 patients discharged from the cardiology ward of a single tertiary center between 2015 and 2018 and followed for a median of 2 years. The association between HF and the primary endpoint of death from any cause was assessed using multivariable Cox regression.

Results
HF was documented in 505 (51.7%) of AF cases at discharge, including HFrEF (17.9%), HFmrEF (16.5%) and HFpEF (25.2%). A primary endpoint event occurred in 212 patients (42%) in the AF-HF group and in 86 patients (18.2%) in the AF-no HF group (adjusted hazard ratio [aHR] 2.27; 95% confidence interval [CI], 1.65 to 3.13; P&lt;0.001). HF was associated with a higher risk of the composite secondary endpoint of death from any cause, AF or HF-specific hospitalization (aHR 1.69; 95% CI 1.32 to 2.16 p&lt;0.001). The associations of HF with the primary and secondary endpoints were significant and similar for AF-HFrEF, AF-HFmrEF, AF-HFpEF.

Conclusions
HF was present in half of the patients discharged from the hospital with comorbid AF. The presence of HF on top of AF was independently associated with a significantly higher risk of all-cause mortality than did absence of HF, irrespective of HF subtype.

Funding Acknowledgement
Type of funding source: None