bluuebunny/crossref_metadata_2025_split huggingface dataset:
P5274Characterization of cardiac involvement in patients with MELAS syndrome in comparison to HCM patients by conventional LGE imaging and novel T1-mapping
Authors: Bietenbeck M , Florian A R , Meier C , Holtstiege V , Chatzantonis G , Yilmaz A 
Published: October 2019

Abstract

Background
MELAS syndrome (mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes) is a rare clinical subtype of mitochondrial myopathy. Cardiovascular magnetic resonance (CMR) images of MELAS-patients at an advanced state of the disease often show characteristic patterns: septal pronounced left ventricular (LV) hypertrophy and distinct focal myocardial scars in late-gadolinium-enhancement (LGE) images. This specific pattern is different from those seen in patients with hypertrophic cardiomyopathy (HCM) due to sarcomere protein mutations. Besides LGE imaging another method for the assessment of myocardial integrity, T1-mapping, has been established recently. This is the first study comparing native and enhanced T1-mapping (T1-na/en) as well as extracellular volume (ECV) values in HCM and MELAS.

Methods
12 patients with confirmed MELAS syndrome at different states of the disease, 13 HCM patients and 15 controls were included. All CMR studies were performed on a 1.5T MR scanner (Ingenia, Philips) using bSSFP cine sequences for the assessment of LV-function and MOLLI sequences for T1-na/en mapping. 15min after IV injection of 0.1mmol/kg BW Gadobutrol for LGE imaging, T1-en maps were acquired. For comparison of groups T1-na/en and ECV values in a basal short axis slice were used.

Results
Median and interquartile ranges of LV function, T1 and ECV are shown in the table. There was no difference in LV ejection fraction (LVEF) between the groups, but end-diastolic LV-mass was increased in HCM- and MELAS-patients vs. controls (p<0.001, p=0.028). In MELAS-patients, myocardial fibrosis was detected in focal spots clearly defined in both septum and free lateral wall. In HCM patients there was a rather diffuse LGE pattern in the hypertrophic septum and the RV insertion points. Here T1-na/en and ECV significantly differed from those measured in healthy controls (p<0.001, p<0.001, p=0.002). In the MELAS group T1-na values were significantly higher compared to controls (p=0.004) and significantly lower compared to HCM patients (p=0.003).
LV-function and mapping parameters of compared groups LV-EF, % LV-EDV, ml/m2 LV-mass, g/m2 T1-na, ms T1-en, ms ECV, % MELAS 57 (44–63) 86 (81–122) 80 (50–131) 969 (940–1033) 409 (381–465) 27 (24–35) HCM 60 (57–65) 50 (73–94) 94 (72–102) 1041 (1021–1074) 362 (346–430) 31 (28–36) Controls 61 (58–65) 72 (67–89) 53 (42–60) 937 (894–951) 464 (446–513) 26 (24–27)

Conclusion
Compared to healthy controls and HCM-patients, cardiac involvement in MELAS-patients is not only reliably visualized by conventional LGE imaging but also detected without the use of contrast agent by native T1-mapping. MELAS vs. HCM-patients show a different pattern of LGE and higher native T1 values, respectively.
P5275Cardiovascular magnetic resonance predictors of long term clinical outcome in myocarditis
Authors: Sanguineti F , Garot P , Hovasse T , Unterseeh T , Troussier X , Dinan-Magniez A , Garot J 
Published: October 2019

Abstract

Background
The natural history of acute myocarditis (AM) remains partially unknown and predictors of outcome are still debated. The study objectives were to determine the potential value of cardiovascular magnetic resonance (CMR) parameters for the long-term Major Adverse Cardiac Events (MACE) prediction in patients presenting with suspected AM. In our centre we published in 2015 a first analysis of the CMR myocarditis registry which included patients presenting with suspected AM in routine practice, clinically followed-up for 18 months (median follow up). This first analysis, in disagreement with the published data, did not find CMR predictors of MACE except for the LVEF.

Purpose
As in myocarditis MACE could have a gradual evolution, to confirm our initial results, the aim of this study is to reinvestigate in the same population, the potential value of CMR parameters with a longer follow-UP (median 8.34 years, interquartile range: 7.7 to 9.16 years).

Methods
In a single-centre longitudinal prospective study, 203 routine consecutive patients with clinical suspicion of AM and initial CMR-based diagnosis of AM (typical Late Gadolinium Enhancement, LGE) were clinically followed up. Various CMR parameters were evaluated as potential predictors of outcome. The primary endpoint was defined as the occurrence of at least one of the combined MACE: cardiac death or aborted sudden cardiac death, cardiac transplantation, sustained documented ventricular tachycardia, heart failure, recurrence of acute myocarditis, and the need for hospitalization for cardiac causes.

Results
The vast majority of patients (70,44%; N=143) presented with chest pain, mild to moderate troponin elevation and ST-segment or T wave abnormalities. Various CMR parameters were evaluated on initial CMR performed 3±2 days after acute clinical presentation (LV functional parameters, presence/extent of edema on T2, presence/extent of Early Gadolinium Enhancement (EGA) and extent of late gadolinium enhancement lesions). Out of the 203 patients, 35 (17.2%) experienced at least one major cardiovascular event during follow-up. Among all CMR parameters, initial alteration of LVEF was confirmed a MACE independent predictor by multivariate analysis (HR: 1.03 per 10% decrease, 95% CI: 1.01 to 1.06, p=0.04). Furthermore, at longer FU analysis, absence of EGA predicted adverse clinical outcome (HR: 2.7, 95% CI: 1.12 to 6.27, p=0.02) suggesting a potential protecting role of inflammatory response.

Conclusions
In routine clinical practice, in patients without severe hemodynamic compromise and a CMR-based diagnosis of AM, various CMR parameters such as the presence, extent and myocardial localisation of late gadolinium-enhanced LV myocardial lesions, were not predictive of events at long term follow up. CMR predictor of adverse clinical outcome were an initial alteration of LVEF and the absence of EGA.
P5284Fully automated quantification of biventricular volumes and function in cardiovascular magnetic resonance: applicability to clinical routine settings
Authors: Backhaus S J , Staab W , Steinmetz M , Ritter C O , Lotz J , Hasenfuss G , Kowallick J T , Schuster A 
Published: October 2019

Abstract

Background
Cardiovascular magnetic resonance (CMR) represents the clinical gold standard for the assessment of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards automated volumetric quantification. In this study, we sought to validate the accuracy of a novel approach providing fully automated quantification of biventricular volumes and function in a “real-world” clinical setting.

Methods
Three-hundred CMR examinations were randomly selected from the local data base. Fully automatic quantification of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic and systolic volumes (EDV/ESV), stroke volume (SV) and ejection fraction (EF) were performed overnight using commercially available software. Parameters were compared to manual assessments. Sub-group analyses were further performed according to image quality, scanner field strength, the presence of implanted aortic valves and repaired Tetralogy of Fallot (ToF).

Results
Biventricular automatic segmentation was feasible in all 300 cases. Overall agreement between fully automated and manually derived LV parameters was good (LV-EF: intra-class correlation coefficient [ICC] 0.95; bias −2.5% [SD 5.9%]), whilst RV agreement was lower (RV-EF: ICC 0.72; bias 5.8% [SD 9.6%]). Lowest agreement was observed in case of severely altered anatomy, e.g. marked RV dilation but normal LV dimensions in repaired ToF (LV parameters ICC 0.73–0.91; RV parameters ICC 0.41–0.94) and/or reduced image quality (LV parameters ICC 0.86–0.95; RV parameters ICC 0.56–0.91), which was more common on 3.0T than on 1.5T.

Conclusions
Fully automated assessment of biventricular morphology and function is robust and accurate in a clinical routine setting with good image quality and can be performed without any user interaction. However, in case of demanding anatomy (e.g. repaired ToF, severe LV hypertrophy) or reduced image quality, quality check and manual re-contouring is still required.

Acknowledgement/Funding
DZHK - German Centre for Cardiovascular Research
P5289Myocardial deformation after ST-elevation infarction measured by CMR feature tracking strain
Authors: Sjogren H , Pahlm U , Engblom H , Erlinge D , Heiberg E , Arheden H , Carlsson M , Ostenfeld E 
Published: October 2019

Abstract

Background
Left ventricular (LV) functional assessment is of imminent value after ST-elevation infarction (STEMI). LV longitudinal strain (LS) evaluates ventricular function on a myocardial level. Feature Tracking (FT) assesses strain from cine cardiac magnetic resonance (CMR) images. It is unknown how LV FT Regional LS (RLS) and Global LS (GLS) changes between the sub-acute and chronic phase after STEMI compared to controls and how GLS and RLS are related to culprit vessel (LAD, LCX or RCA) and infarction size (IS).

Aims
To assess 1) GLS with FT after 2–6 days (sub-acute) and 6 months (chronic phase) after STEMI compared with controls, 2) if GLS changes between sub-acute and chronic phase, and 3) the relationship between GLS and RLS to IS and infarct location.

Methods and results
Seventy-seven patients underwent CMR 2–6 days and 6 months after STEMI as well as 27 healthy controls. GLS was impaired at the sub-acute (−8.9±2.3%) and chronic phase (−14.3±2.9%) compared to controls (−18.4±2.4%; p<0.001 for both). GLS improved between the sub-acute and chronic phase (p<0.001). GLS correlated to IS (R=0.47 sub-acute; 0.49 chronic, p<0.001). LAD infarctions had lowest GLS and largest IS. RLS was more impaired in the culprit vessel territory compared to remote. RLS in the RCA region was lower for LAD than RCA infarctions. RLS was impaired in all 6 wall-regions in LAD infarctions, while LCX and RCA infarctions had preserved RLS in remote myocardium.
Global Longitudinal Strain (GLS)

Conclusion
GLS is impaired after STEMI and improves, but do not normalize, to the chronic phase. GLS is only moderately correlated to IS, indicating that other factors and co-morbidities are important to determine ventricular function. Even though RLS is most impaired in the affected region, remote regions can be substantially impaired in LAD-infarctions, why it would be difficult to pinpoint the culprit vessel based on RLS.
P5290Impact of extreme obesity on long-term outcomes following percutaneous coronary intervention
Authors: Biswas S , Dinh D , Noaman S , Duffy S J , Lefkovits J , Brennan A , Ajani A , Clark D J , Freeman M , Oqueli E , Hiew C , Reid C M , Stub D , Chan W 
Published: October 2019

Abstract

Background
Obesity is a growing health concern worldwide, particularly in developed countries where there has been an unprecedented rise in the proportion of overweight and obese individuals in the population. Previous studies have reported a protective effect of obesity compared to normal BMI in patients undergoing percutaneous coronary intervention (PCI). However, it is unclear whether this effect extends to the extremely obese over long-term follow-up.

Objective
To determine whether an obesity paradox persists in contemporary PCI practice over long-term follow-up, and in particular to further evaluate the association between extreme obesity and long-term clinical outcomes after PCI.

Method
We prospectively collected data on 25,645 patients undergoing PCI between 1 January 2005 and 30 June 2017 who were enrolled in the statewide multi-centre Melbourne Interventional Group Registry. This registry collects data on all patients undergoing PCI at 6 academic tertiary hospitals. Patients were stratified by World Health Organization-defined BMI categories. Long-term mortality data was obtained by linkage to the National Death Index (NDI), a database that contains records of all deaths occurring in Australia. The primary endpoint was NDI-linked mortality. Median length of follow-up was 4.4 years (IQR 2.0–7.6 years).

Results
Of the study cohort, 24.6% had normal BMI (18.5–24.9 kg/m2), 0.9% were underweight (BMI <18.5 kg/m2) and 3.3% were extremely obese (BMI ≥40 kg/m2). As BMI increased, mean age decreased while the prevalence of diabetes increased (p<0.001). The proportion of females at both extremes of BMI. Procedural characteristics were similar across the groups although there was more radial access and less femoral access used with increasing BMI (p<0.001). In terms of secondary prevention therapy, underweight patients were significantly less likely to receive a beta blocker, ACE inhibitor and statins, compared to the other BMI groups. In-hospital, 30-day and long-term mortality were all highest for underweight patients (37.7%) and lowest for the moderately obese patients (BMI 35–40 kg/m2) (12.2%). After adjustment for age, comorbidities and presentation with cardiogenic shock, a U-shaped association between the different BMI categories and adjusted hazard ratio for long-term mortality was observed (Figure 1).
Figure 1

Conclusion
An obesity paradox is still apparent in contemporary practice with elevated BMI up to 35 kg/m2 associated with reduced long-term mortality after PCI. However, this protective effect appears not to extend to patients with extreme obesity. Factors behind this phenomenon are likely multifactorial and require further mechanistic and epidemiological studies.
P5292Obesity paradox, hyperlipoproteinemia(a), autotaxin concentration and stenotic atherosclerosis of different vascular territories
Authors: Afanasieva O , Tmoyan N , Razova O , Afanasieva M , Ezhov M , Pokrovsky S 
Published: October 2019

Abstract

Background
Controversial data have recently emerged about the role of obesity in the development of cardiovascular diseases, otherwise known as “Obesity paradox”. Autotaxin (ATX) hydrolyzes lysophosphatidylcholine to lysophosphatidic acid, a lipid mediator involved in pathological processes, including obesity.

Purpose
To investigate the association between obesity and stenotic atherosclerosis of different vascular territories.

Methods
The study included 1225 patients with results of instrumental examination of coronary, carotid and lower limbs arteries. Stenotic atherosclerosis (≥50%) in any vascular bed was diagnosed in 889 patients.

Results
The patients were divided into two groups depending on body mass index (BMI) (table). The groups were comparable on age, lipids and frequency of CHD. The obesity negatively associated with lower extremity artery disease (LEAD) (odds ratio (OR) 0.51; 95% CI 0.36–0.72, p<0.01) adjusted for gender, age, smoking, type 2 diabetes, lipids and Lp(a). Multifocal atherosclerosis was also negatively associated with obesity (OR 0.44; 95% CI 0.28–0.71, p<0.01). ATX level was lower in patients with LEAD (median [25; 75%]: 492 [418; 573] ng/ml) vs. patients without LEAD (520 [424; 618] ng/ml, p<0.05). The similar results for ATX concentration were shown for patients with multifocal atherosclerosis vs. without stenotic atherosclerosis: 478 [414; 571] ng/ml vs. 551 [412; 678] ng/ml, p<0.05. The corresponding trend was observed in patients with and without coronary heart disease (CHD) (502 [421; 594] vs. 545 [425; 638] ng/ml, p=0.05). ATX level was associated with BMI (r=0.34, p<0.01) and negatively correlated with LEAD and multifocal atherosclerosis in obesity patients (r=−0.2, p<0.05 in both cases).
Characteristics of study groups Parameters Control, BMI <30 kg/m2, n=846 Obesity, BMI ≥30 kg/m2, n=379 Hypertension 585 (69%) 316 (83%)*** Type 2 diabetes 133 (16%) 115 (30%)*** Lipoprotein(a), mg/dl 23.9 [9.0; 54.7] 18.0 [6.6; 49.2]* Lipoprotein(a) ≥30 mg/dl 372 (44%) 137 (36%)* Autotaxin, ng/ml 513.5±137.3 528.4±140.1 Carotid atherosclerosis 293 (35%) 127 (33%) CHD 539 (64%) 206 (54%)** LEAD 224 (26%) 66 (17%)*** *p<0.05, **p<0.005, ***p<0.0005 compare with control group.

Conclusion
“Obesity paradox” was observed in the patients with LEAD, CHD and multifocal atherosclerosis and it could be associated with lysophosphatidic acid pathway.
P5302Significant correlation of visceral adiposity and adipocytokines with arterial inflammation in genetic dyslipidaemias
Authors: Koutagiar I , Toutouzas K , Antonopoulos A S , Skoumas I , Benetos G , Georgakopoulos A , Oikonomou E K , Kafouris P , Pianou N , Miliou A , Pitsavos C , Tousoulis D , Antoniades C , Anagnostopoulos C D 
Published: October 2019

Abstract

Background
The adipose tissue is now established as a major regulator of cardiovascular status, mediated by the secretion of several bioactive molecules, including adipocytokines. Individuals with genetic dyslipidaemias of either familial combined hyperlipidemia (FCH) or heterozygous familial hypercholesterolemia (heFH) subtype are characterized by accelerated atherosclerosis. Nonetheless, limited data exists on the relationship between adiposity and arterial inflammation, a marker of cardiovascular risk, in this setting.

Purpose
To investigate the relationship between adiposity indices and arterial inflammation evaluated by 18F fluorodeoxyglycose positron emission tomography (PET/CT) in patients with hereditary lipid metabolism disorders.

Methods
Consecutive patients with either FCH or heFH, free of statin therapy, and normolipidaemic individuals underwent PET/CT imaging. Arterial FDG uptake was estimated as the average value of target-to-background ratio (TBR) within aortic and carotid wall. Volumes of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were measured from CT images between the proximal (cephalic) end of the L1 and distal (caudal) end of the L3 vertebrae by selecting all voxels with attenuation between −190 and −30 Hounsfield Units (HU). Serum adiponectin and leptin levels were measured with ELISA by available commercial kits. For comparisons with arterial TBR, adiponectin and leptin concentrations above and below the 25th percentile, were stratified as high and low, respectively.

Results
In total, 60 individuals (20 FCH, 20 heFH and 20 controls) were included. A modest but significant correlation between SAT volume and arterial TBR (R=0.386, p=0.004) was detected. This relationship did not remain significant after controlling for VAT volume (p=0.303). A strong correlation between VAT volume and arterial TBR (R=0.621, p=0.001) was observed. This relationship remained significant after controlling for SAT volume (R=0.541, p<0.001). Arterial TBR values were higher in individuals with low plasma adiponectin levels (p=0.010). In addition, patients with higher leptin levels exhibited increased arterial FDG uptake compared to subjects with low serum leptin concentrations (p=0.05)

Conclusions
Abdominal adipose tissue imaging markers and serum adipocytokines correlate with arterial inflammation as assessed by PET/CT in patients with familial dyslipidaemias highlighting the role of abdominal adipose tissue for atherosclerosis progression in this population.
P5303Relationship of the dynamics of serum collagen and epicardial adipose tissue in patients with coronary heart disease and visceral obesity
Authors: Dyleva Y A , Gruzdeva O V , Uchasova E G , Borodkina D A , Belik E V , Kokov A N , Brel N K , Pecherina T B , Kashtalap V V , Karetnikova V N , Barbarash O L 
Published: October 2019

Abstract

Purpose
Study of the effect of epicardial adipose tissue and in serum collagen in patients with myocardial infarction depending on the presence of visceral obesity.

Methods
88 patients with CVD were assessed and divided into two groups based on the presence of visceral obesity (VO). Magnetic resonance imaging (MRI) was used to determine the area of the visceral (VAT) and subcutaneous adipose tissue (SAT) of the abdominal region, the thickness of epicardial adipose tissue, and the percentage of myocardial cardiac fibrosis a year after MI. VO was verified when the area of VAT >130 cm2. We investigated changes in serum collagen: collagen protein type I (COL-1), N-terminal propeptide of procollagen type III (PIIINP) and C-terminal propeptide of procollagen type I (PICP). All study was carried out in compliance with the Helsinki Declaration, and its protocol was approved by the Ethical Committee of Research Institute. Statistical analysis was performed using Statistica 10.0. All patients gave written informed consent to participate in the study.

Results
With VO, the thickness of the left ventricular epicardial tissue (EATLv) was 1.75 times greater, and that of the right ventricle (EATrv), 1.43 times more than in patients without VO. In the group of patients with VO, the presence of a direct correlation was established between the magnitude of the area of VAT and EATLv (r=0.26, p=0.02), EATrv (r=0.26, p=0.01). the results indicate that myocardial damage on the background of an acute MI is characterized by higher concentrations of COL-1 (29065 pg/ml), PICP (638 ng/ml) and PIIINP (31431 pg/ml), in the presence of VO during the hospital period of MI, and exceeded the figures of patients without VO 2.15, 1.07 and 1.19 times, respectively. One year after MI, the COL 1 level in both groups decreased compared with the acute MI period (1.68 times in patients without VO and 2.75 times in patients with VO), it still remained higher in patients with VO in 1,4 times higher. And the level of PICP was not significantly different on the first day of MI and a year after suffering MI in the studied groups. PIIINP decreased only in the group of patients without VO.
The data of the correlation analysis showed that EATLv was in direct connection with the level of serum collagen in patients with VO: EATLv - COL-1 (1 day (r=0.73; p=0.01), 1 year (r=−0, 84; p=0.00); EATLv - PICP (1 day (r=0.63; p=0.01), 1 year (r=0.57; p=0.03) and EATLv - PIIINP (1 day (r=0.61; p=0.03), 1 year (r=0.31; p=0.01).

Conclusions
Thus, the presence of VO in patients with MI is associated with higher concentrations of COL 1, PICP, PIIINP, both in the acute period of MI, and one year after a coronary catastrophe. The thickness of EAT is directly dependent on the degree of VO, and the concentration of COL-1, PICP and PIIINP on the value of EATLv.