bluuebunny/crossref_metadata_2025_split huggingface dataset:
Global Constructive Work predicts left ventricular reverse remodeling one year after MitraClip implantation in patients with functional mitral regurgitation
Authors: Papadopoulos K , Ikonomidis I , Chrissoheris M , Chalapas A , Kourkoveli P , Spargias K 
Published: November 2020

Abstract

Background
Percutaneous edge-to-edge mitral valve repair (PMVr) has recently been identified as an effective method for treating patients with functional mitral regurgitation. However, it is still unknown which patients will benefit by showing clinical improvement and left ventricular reverse remodeling.

Purpose
The purpose of this study is to analyze novel echocardiographic markers and identify markers of LV reverse remodeling after MitraClip implantation.

Methods
We retrospectively analyzed 58 high surgical risk (logistic EuroSCORE 23±15%) consecutive patients (aged 72±10yrs) with functional moderate-to-severe and severe mitral regurgitation (EROA 29±14mm2) and reduced LV contractility (EF 32±8%, GLS −8.6±3.7%). At baseline and 1-year after PMVr we assessed echocardiographic parameters such as MR severity, EF, Global Longitudinal Strain (GLS), Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW) and Global Work Efficiency (GWE).

Results
In patients with MitraClip implantation there was a significant reduction of MR (3.7±0.4 vs 1.7±0.8, p&lt;0.001) one year after the intervention. The EF and GLS did not improve after the implantation (32±8 vs 33±10%, p=0.178 & −8.6±3.7 vs −8.6±3.7%, p=0.922 respectively) but Global Work Index (GWI) and Global Constructive Work (GCW) demonstrated significant improvement (607±282 vs 650±260mmHg%, p=0.04 & 854±288 vs 949±325mmHg%, p&lt;0.001 respectively). The baseline EF, GLS, GWI, GCW and EROA were the factors that were significantly associated with more than 20% reduction of LVEDV one year after intervention (p&lt;0.02 for all). To be more specific, left ventricles with better performance and contractility combined with worse mitral regurgitation were the ones that responded better. Further, baseline GCW was the only factor that was significantly associated with reduction of the LVESV. A ROC curve analysis identified a cut-off value of 846mmHg% (AUC 0.759, 95% CI: 0.588–0.930; p=0.007) to be associated with 10% reduction of LVESV, with a sensitivity and specificity of 79% and 74% respectively.

Conclusions
Transcatheter edge-to-edge repair is an effective method for treating patients with FMR and improves LV performance one year after intervention. A preserved baseline GCW seems to be a good predictor of LV reverse remodeling after MitraClip implantation.

Funding Acknowledgement
Type of funding source: None
Vein of Marshall visualization in cardiac computed tomography
Authors: Mlynarski R , Mlynarska A , Golba K.S , Sosnowski M 
Published: November 2020

Abstract

The oblique vein of the left atrium (vein of Marshall) is a small vessel that descends obliquely on the back of the left atrium and ends in the coronary sinus near the area where great cardiac vein continues into the coronary sinus. Its cannulation can be useful, e.g. before selected electrophysiology procedures such as paroxysmal focal atrial fibrillation ablation. Because the vein of Marshall should also be avoided at the site of the implantation of the left ventricle lead, knowledge about its existence, position or diameters could be useful. There is a lack of complex data about the possibilities of visualizing the vein of Marshall in cardiac computed tomography.

Methods
354 patients were included into the research. Cardiac computed tomography (Aquilion 64, Toshiba: 64 slices, 0.5 mm; retrospective gating; contrast enhanced) was performed for all of the patients. A precise retrospective analysis of the CT data in all phases (every 10%) of the cardiac cycle during post processing was performed including searching for the target vein by using Vitrea workstations (Vital Images). Both multi planar reformatted reconstructions (MPR) and 3D volume renderings were used. The analyses were performed by two experienced researchers (more than 200 coronary venous system analyses previously performed).

Results
The vein of Marshall was found in 66 of the 354 patients (16.6%). An example of the visualization is presented in the figure below (MPR and 3D volume rendering). Its ostium to coronary sinus was found an average of 42.6±10.8 mm from the coronary sinus ostium to the right atrium. This value was statistically higher (p=0.0082) in the men (45.3±11.2) compared to the women (38.5±9.7). The vein of Marshall is a small vessel; its average diameter was 1.8±0.8 mm and length of the visible vessel that was measured was 8.7±7.5 mm. It was visualized statistically more frequently (p=0.0009) in the end-systolic phases (30–40–50% RR; 68.85% cases) compared to the end-diastolic phases (70–80% RR; 21.31% cases). Occasionally, it was optimally visualized in the other phases (9.83%).

Conclusion
It is possible to visualize the vein of Marshall using cardiac computed tomography. Because it exists in about 20% of population, during visualization, special attention needs to paid to obtaining quality images in CT especially in the end-systolic phases.
Vein of Marshall imaging (VR, MPR)

Funding Acknowledgement
Type of funding source: None
Compositional differences in atherosclerosis between the major epicardial arteries; a secondary analysis from the PARADIGM study
Authors: Bax A.M , Ma X , Van Den Hoogen I.J , Gianni U , Van Rosendael A.R , Tantawy S.W , Chun E.J , Kim Y.J , Lee B.K , Lee S.E , Min J.K , Chang H.J , Narula J , Lin F.Y , Shaw L.J 
Published: November 2020

Abstract

Background
Atherosclerotic plaques in the left circumflex artery (LCx) are associated with a lower risk of future events than plaques in the right coronary artery (RCA) and left anterior descending artery (LAD). High risk plaque subtypes including necrotic core and fibrofatty plaque can be evaluated on computed coronary tomography angiography (CCTA) by Hounsfield Unit (HU) density. To date, little is known regarding differences in high risk plaque composition between major epicardial vessels.

Purpose
The aim of this analysis was to compare plaque extent and composition between the three coronary arteries.

Methods
This is a secondary analysis of baseline scans from the PARADIGM study which enrolled consecutive patients with suspected coronary artery disease undergoing serial CCTA at a scan interval of ≥2 years. Plaque quantification by composition was performed in the three coronary arteries based on fixed HU thresholds: high risk subtypes consisting of necrotic core (&lt;30 HU) and fibrofatty plaque (31–130 HU), and other subtypes including fibrous (131–350 HU) and calcified plaque (≥351 HU). Comparisons between the coronary arteries were made using Generalized Estimating Equations (GEE) models, accounting for within-patient clustering of the coronary arteries and adjusting for ASCVD risk score and diabetes mellitus.

Results
From 1,271 patients (mean age 60.3±9.3 years; 57% men; median ASCVD score 9.3%), 3,813 vessels were analyzed. The prevalence of any plaque was lowest in the LCx, as was the prevalence of high risk plaque (Figure; P&lt;0.001 for both). The share of total plaque volume made up by high risk plaque subtypes was the lowest in the LCx (17.3% versus 22.5% [RCA] versus 24.4% [LAD]; P&lt;0.001). In contrast, calcified plaque made up the largest proportion in the LCx (44.5% versus 35.6% [RCA] versus 34.9% [LAD]; P&lt;0.001).

Conclusion
Prevalence of any plaque as well as high risk plaque subtypes was significantly higher in the LAD and RCA than in the LCx. Also, high risk plaque subtypes made up significantly the lowest proportion in the LCx, whereas calcified plaque made up the largest proportion in the LCx. These data support a different atherogenic milieu contributing to the variable risk patterns between the epicardial coronary arteries.
Figure 1. Prevalence of (high risk) plaque

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Leading Foreign Research Institute Recruitment Program through the National Research Foundation (NRF) of Korea funded by the Ministry of Science and ICT (MSIT) (Grant no. 2012027176).
320-multidetector cardiac computed tomography in the evaluation of conotruncal anomalies
Authors: Elnagar R , Ghieda U , Ibrahim A , Dawoud M 
Published: November 2020

Abstract

Background
Multi-detector computed tomography (MDCT) has become an effective tool in the assessment of congenital heart disease in infants and children.

Purpose
To evaluate the role of 320-row MDCT in the assessment of conotruncal anomalies and compare it with echocardiography (echo) considering the operative and/or catheter findings as the gold standard.

Methods
The studied group included 50 patients having conotruncal anomalies. All patients were evaluated with 320-row MDCT angiography. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of MDCT and echo were calculated. The patient effective dose was reported.

Results
The overall sensitivity, specificity, accuracy, PPV and NPV for MDCT angiography in assessment of various abnormalities in patients with conotruncal anomalies were 98.97%, 100%, 99.75%, 100% and 99.67% for MDCT angiography. Sensitivity, specificity, PPV and NPV of MDCT angiography were 97.87%, 100%, 100% and 99.04% and 99.49%, 100%, 100% &99.86% for the detection of intracardiac defects and extracardiac vascular anomalies respectively. The mean absorbed radiation dose was 63.63 mGy-Cm per scan and the mean effective dose was 1.56±0.47 mSv.

Conclusion
320-MDCT angiography offers an excellent diagnostic procedure in the preoperative evaluation of the complex anatomy of the conotruncal anomalies.

Funding Acknowledgement
Type of funding source: None
Reduced orbitofrontal grey matter volume in myocardial infarction with non-obstructive coronary arteries (MINOCA)
Authors: Williams M , Liang K , De Garate E , Mitrousi K , Harries I , De Francesco V , Langley S , Lawton C , Thai N.J , Bucciarelli-Ducci C 
Published: November 2020

Abstract

Background
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is seen in 6–10% of patients presenting acutely with suspected myocardial infarction. Cardiac magnetic resonance imaging (CMR) can identify an underlying cause in ∼80% of patients. These patients are more likely to have a history of mental health illness or an emotional or stressful precipitant.
Grey matter volume can be quantified in various anatomical regions of the brain and has been shown to be altered in common mental health conditions such as anxiety, stress and depression.
This is the first prospective study investigating the acute structural brain, cardiac and psychological changes using MRI in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) within 14 days of presentation compared to STEMI control patients.

Methods
Patients meeting the 2017 ESC definition of MINOCA were prospectively recruited with STEMI control patients from February to December 2019. All participants underwent brain and comprehensive cardiac MRI, bloods and baseline psychological evaluation. We used voxel-based morphometry (VBM) to quantify grey matter volume and changes were compared between groups.

Results
54 patients were included in this interim analysis (39 MINOCA, 15 STEMI controls). Demographics were largely similar but MINOCA patients were more likely to have a history of self-reported mental health disease (36% v 7%, p 0.03) and had significantly higher baseline anxiety (8.4 v 5.3, p 0.01) scores on the HADS questionnaire. We found that control patients have significantly greater grey matter volume in the orbitofrontal cortex (OFC) compared to MINOCA patients (pFWE-corr 0.002). The orbitofrontal cortex is involved in emotional processing and implicated in anxiety and depression. However, there was no association between grey matter volume in any brain region and anxiety, depression or perceived stress scale scores.

Conclusion
Patients with MINOCA are more likely to have a history of mental health disease and have higher anxiety scores at presentation than STEMI controls. They have less grey matter volume in the orbitofrontal cortex compared to STEMI controls.
Reduced Grey Matter Volume in the OFC

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Rosetrees Trust; James Tudor Foundation
Deep learning to diagnose cardiac amyloidosis from CMR findings
Authors: Aimo A , Martini N , Barison A , Della Latta D , Ripoli A , Chiappino S , Chiappino D , Passino C , Emdin M 
Published: November 2020

Abstract

Background
Cardiac magnetic resonance (CMR) is an important diagnostic technique for cardiac amyloidosis (CA). A deep learning (DL) approach to define the likelihood of CA based on automated interpretation of CMR images has never been attempted so far.

Methods
187 subjects underwent standard 1.5 T CMR examination (GE-Healthcare, Milwaukee, USA) as part of a diagnostic workup for either unexplained left ventricular hypertrophy or blood dyscrasia with suspected light-chain (AL) amyloidosis. Patients were randomly assigned to 3 subgroups, which were used for training (n=121, 65%), internal validation (n=28, 15%), and model testing (n=38, 20%). LGE images in different orientations (short-axis, 2- and 4-chambers) were selected as the most informative CMR features. A deep convolutional neural network was trained to classify CMR examinations as “amyloidosis” (probability ≥50%) or “no amyloidosis” (probability &lt;50%) based on these features. Different learning strategies (data augmentation, batch normalization in convolutional layers, dropout before dense layers) were adopted to prevent model overfitting. Binary cross entropy was used as loss function. For comparison, a machine learning (ML) model based on gradient boosting trees was built for the binary classification of patients (amyloidosis vs no amyloidosis) based on clinical and imaging features extracted from the CMR exam.

Results
CA was diagnosed in 101 subjects (54%; 45 AL, 56 transthyretin amyloidosis). A model including 2C, 4C and SA LGE images was created. In the test cohort, it allowed to diagnose CA with good diagnostic accuracy (84.2%), and an area under the curve (AUC) of 0.96 (Figure). The precision (positive predictive value), recall score (sensitivity), and F1 score (a measure of test accuracy) were 0.78, 0.94, and 0.86, respectively. An ML algorithm considering all available parameters (LV volumes and function, LGE presence and pattern, early darkening, pericardial and pleural effusion, etc.) displayed a similar diagnostic performance than the DL method (AUC 0.93 vs. 0.96; p=0.45).

Conclusions
The deep learning technique allowed to create an accurate diagnostic tool for CA based on LGE patterns, which could be easily converted into an online platform for automated image analysis.

Funding Acknowledgement
Type of funding source: None
The extent of pericardial involvement evaluated by cardiac MRI in patients with ST-Segment elevation myocardial infarction: predictors and outcomes
Authors: Massalha E , Di Segni E.L.I.O , Fardman A , Younis A , Brodov Y , Hersckovici R , Mazin I , Beigel R , Matetzky S , Goitein O 
Published: November 2020

Abstract

Background
The clinical diagnosis of peri-myocardial infarction pericarditis declined dramatically in the era of primary PCI and novel antiplatelet agents. However, recent data documents the presence of pericardial effusion in substantial proportion of acute MI patients, while recent randomized trial showed that anti-inflammatory drugs seem to improve cardiovascular outcomes, although the mechanism of the benefit remains uncertain.

Methods
We prospectively evaluated 187 consecutive patients, without known prior coronary disease, who underwent primary PCI for STEMI. All patients underwent cardiac MRI (CMR) on day 5±1 post admission. CMR was performed using a 1.5 T (n=101) and 3 T (n=86) scanners. Delayed enhancement (DE) and microvascular obstruction (MVO) were quantified as % of the left ventricular mass (LV). The presence of DE and MVO was recorded according to the AHA segments model. DE was also qualitatively assessed for the degree of transmurality in each segment. CMR pericarditis was defined as evidence of pericardial enhancement on DE images. The presence of pericardial effusion was also documented. Pericarditis extent was expressed as the number of pericardial segments with increased DE. Major adverse cardiac events were defined as the composite of death, recurrent myocardial infarction, stroke, urgent revascularization and hospitalization due to either heart failure or bleeding during the first year following STEMI.

Results
Pericardial effusion was found in 94 patients (50%) and enhancement of the pericardium on DE images in 120 patients (65%). In contrary, a clinical diagnosis of peri-myocardial infarction pericarditis was documented and anti-inflammatory therapy was initiated only in three patients (1%). A significant positive correlation was demonstrated between pericardial involvement and either quantitative or qualitative assessment of DE (p&lt;0.001, r=0.34) and MVO (p&lt;0.001, r=0.282). DE transmurality (per segment) was associated with both location of pericardial involvement and its extent (p&lt;0.001). A multivariate logistic regression analysis revealed that DE extent and MVO were independent predictors of pericardial involvement (OR 1.07; CI 95% 1.06–1.13, p=0.02 and OR 1.29; CI 95% 1.01–1.64, p=0.04 for DE and MVO respectively). Additional parameters that were associated with CMR diagnosis of pericarditis included higher maximal CRP levels and proximal coronary lesions. The 1-year incidence of major adverse events was similar in patients with or without CMR-defined pericarditis.

Conclusions
In contrast to the low rate of clinically diagnosed pericarditis, CMR documented pericardial involvement in more than 65% of STEMI patients. This finding is independently associated with the extent and degree and location of myocardial damage.

Funding Acknowledgement
Type of funding source: None
The use of Cardiac MRI in diagnosis of infective endocarditis: a comparative study with echocardiography
Authors: Elagha A , Meshaal M , Elaroussy W , Beniamin Y 
Published: November 2020

Abstract

Introduction
Echocardiography is a reliable imaging tool in diagnosing infective endocarditis (IE) according to “modified Dukes criteria”; however, it lacks tissue characterization of cardiac masses, transthoracic echocardiography (TTE) has low sensitivity in detection of vegetations, and moreover, transesophageal echo (TEE) is considered semi-invasive and intolerable in some situations. On the other hand, cardiac magnetic resonance (CMR) is a powerful true 3D imaging tool with wide field of view, and superior capability of tissue characterization of cardiac masses; however, modest information is available about utility of CMR in diagnosing IE.

Purpose
To assess the feasibility of CMR to identify vegetations and complications of IE, and compare obtained findings obtained with those obtained from echocardiography regarding: number and size of vegetations, detection of cardiac complications (e.g. aortic root abscess, periannular abscess, and shunts).

Materials and methods
Eighty consecutive patients with suspected IE were enrolled in the study. All patients underwent TTE; only those with left-sided lesions underwent TEE. When clinical situation allowed, CMR examination using 1.5 Tesla magnet were performed: SSFP sequence for mobile masses (SSFP), T1W (± fat suppression) and T2W, first-pass perfusion, and delayed hyperenhancement were used. Moreover, chest and abdominal survey was done.

Results
Sixty-one patients (45 males and 16 females) were able to undergo and complete CMR study. Affection of tricuspid valve was seen in 39.3%, mitral 31.1%, aortic 24.6%, and pulmonary 4.9% of cases. All vegetations visualized by echocardiography were also clearly detected by CMR. The sensitivity, specificity, accuracy and Kappa agreement of CMR with echocardiography in depicting &gt;0.5cm vegetations were all 100%. By tissue characterization, vegetations resemble features of thrombi (with variation in signal intensity according to age of vegetation). However, in some cases, masses have a unique pattern that is different from vegetations of IE, and subsequently other diagnoses were suggested (e.g. fibroelastoma, Libman-Saks endocarditis). In 22 patients, CMR provided more information than echocardiography, and in 6 patients, CMR changed completely the diagnosis.

Conclusion
Cardiac MRI is a powerful imaging tool in diagnosis of IE and its complications. In comparison with echocardiography, CMR can identify the presence, numbers, and size of vegetations accurately. Moreover, with its unique ability of tissue characterization, CMR helps distinguish vegetations from other masses; therefore changes the diagnosis of IE and subsequent management in some patients.

Funding Acknowledgement
Type of funding source: None
Increased remote extracellular volume measured by CMR T1 mapping allows early identification of left atrial dysfunction in hypertrophic cardiomyopathy
Authors: Tondi L , Pica S , Camporeale A , Figliozzi S , Bernardini A , Pluchinotta F , Secchi F , Lombardi M 
Published: November 2020

Abstract

Background
Myocardial fibrosis is a hallmark of hypertrophic cardiomyopathy (HCM). Cardiac magnetic resonance (CMR) detects replacement fibrosis (RF) through late gadolinium enhancement (LGE) and interstitial fibrosis (IF) in apparently unscarred myocardium by T1 mapping-derived increased extracellular volume (ECV). Differently from LGE, to date only few small studies have explored the clinical significance of IF in HCM and a correlation between IF and diastolic dysfunction (DD) has been proposed. However, DD detection is challenging in this population since the accuracy of standard echocardiographic parameters is controversial, especially in presence of left ventricular outflow tract obstruction (LVOTO). Left atrial (LA) dysfunction is associated with high left ventricular (LV) filling pressures and may represent an early marker of DD in HCM.

Purpose
To explore the correlation between IF and LA dysfunction in HCM patients with preserved systolic function.

Methods
93 consecutive HCM patients with preserved EF underwent a standard CMR scan. Semi-automatic threshold-based quantification of ventricular volumes, function and mass was performed. LA volumes (LAV) and function were evaluated by CMR feature-tracking (FT) analysis. The three atrial phasic functions were analyzed: (i) passive strain (εe), (ii) active strain (εa) and (iii) total strain (εs). LGE was quantified using the standard deviations (SDs) method (≥4 SDs). IF was assessed by T1 mapping-derived ECV quantification in remote myocardium (r-ECV). A matched group of 15 healthy subjects (HS) served as controls.

Results
Compared to HS, HCM patients showed increased LAV (LAV max: HS 39±9ml, HCM 59±20 ml; LAV min: HS 16±4 ml, HCM 34±17 ml; p&lt;0.001), reduced LA EF (HS 61±3%, HCM 45±12%, p&lt;0.001), impaired εs (HS 40±7%, HCM 29±11%, p&lt;0.001) and εe (HS 26±7%, HCM 15±7%, p&lt;0.001). No differences in εa were observed (HS 13±4%, HCM 14±7%, p 0.56). HCM patients were divided into 2 groups according to the presence of IF, defined as r-ECV values ≥29%. The two ECV groups did not differ in terms of LV EF, LA EF, LAV, LA area, E/E', LGE, LV mass, maximal wall thickness and LVOTO (all p&gt;0.05). HCM patients with increased r-ECV showed significantly impaired LA function in terms of all three strain parameters vs. normal r-ECV group (HCM r-ECV &lt;29%: εs 31±12%, εe15±7%, εa 15±5%; HCM r-ECV≥29%: εs 24±7%, εe 12±4%, εa 12±5%; all p&lt;0.05).

Conclusions
In HCM patients increased r-ECV correlates with LA dysfunction, hinting towards a possible role for IF in determining altered LV relaxation and DD.
LA strain in controls and HCM ECV groups

Funding Acknowledgement
Type of funding source: None