bluuebunny/crossref_metadata_2025_split huggingface dataset:
Feasibility, reproducibility, and clinical implications of the fully automated assessment for global longitudinal strain
Authors: Kawakami H , Wright L , Nolan M , Potter E.L , Yang H , Marwick T.H 
Published: November 2020

Abstract

Background
Despite of evidence on its usefulness, measurement of global longitudinal strain (GLS) has not been widely accepted as a clinical routine because it requires proficiency and is time-consuming. Automated assessment of GLS may be a solution to these barriers. This study sought to investigate the feasibility, reproducibility, and predictive value of automated strain analysis compared with semi-automated and manual assessment for global longitudinal strain.

Methods
In this validation study, different methods for the assessment of GLS were applied to echocardiograms of 561 asymptomatic people (age 71±5 years) with heart failure (HF) risk factors, recruited from the community. All patients were followed up for new-onset of HF and cardiovascular death. Measurement of GLS was repeated using the same apical images on three different measurement packages as follows: (1) fully automated GLS (AutoStrain), (2) semi-automated GLS (automated, corrected by a trained investigator), and (3) manual GLS (standard manual assessment by a trained investigator). We defined abnormal GLS for discrimination of LV systolic dysfunction using the cut-off of GLS =18% (absolute value).

Results
AutoStrain measurements were feasible in 99.5% of patients. Calculation time for automated (0.5±0.1 min/patient) and semi-automated assessment (2.7±0.6 min/patient) were significantly shorter than that for manual assessment (4.5±1.6 min/patient) (both p&lt;0.001), and the automated assessment showed excellent reproducibility. There was considerable discordance between automated and semi-automated/manual GLS (Figure 1), but normal systolic function was reliable identified. The prediction of cardiovascular events was reliable with automated, semi-automated and manual GLS (Figure 2).

Conclusion
A novel fully automated assessment for GLS is a feasible, rapid, reproducible and clinically applicable means of assessing LV function, and measurements in the normal range predict a favorable outcome.
Figure 1

Funding Acknowledgement
Type of funding source: None
Effects of catheter ablation on left atrial performance in different types of atrial fibrillation: a strain study
Authors: Katbeh A , De Potter T , Geelen P , Stefanidis E , Iliodromitis K , Barbato E , Van Camp G , Penicka M 
Published: November 2020

Abstract

Background
Atrial structural and functional changes may develop as a result of catheter ablation (CA) in patients with paroxysmal and persistent atrial fibrillation (AF). However, the relation between AF recurrence and atrial performance following CA is still under debate. Our aim is to describe the long-term effects of CA on LA remodeling and its correlates to the maintenance of sinus rhythm (SR).

Methods
We prospectively enrolled 178 consecutive patients (age: 63±9 years, 35% females) with paroxysmal AF undergoing first-CA (67%) or redo-CA (22%), and 20 individuals (11%) with long-standing persistent AF (PAF) undergoing first CA. All patients underwent comprehensive transthoracic echocardiography at baseline and at 12-month follow-up, including the assessment of reservoir and contractile strain (LAS) using two dimensional speckle tracking echocardiography in all three apical views. The study population was divided in two sub-groups according to AF recurrence during follow-up.

Results
During one-year follow-up, 144 (81%) patients maintained SR whereas 34 (19%) patients had AF recurrence [first-CA group 16 (13%), redo-CA group 8 (20%) and PAF group 10 (50%)]. Improvement of LAS was observed only in patients with paroxysmal and long-standing persistent AF who underwent the first CA and who remained in SR (Figure 1A, 1C). In contrast, recurrent AF was associated with absence of LAS improvement (Figure 1A, 1C). Different time course of LA performance was observed in the redo-CA group, i.e. LAS remained unchanged from baseline regardless of long-term maintenance of SR (Figure 1B). Moreover, at follow-up, no significant differences in LAS between redo-CA patients with SR versus AF were observed. Of note, in patients with long-standing persistent AF and SR, follow-up LAS increased to values observed in the redo-CA group.

Conclusion
LA performance following CA is strongly affected by complex interplay between extent of atrial electro-structural remodeling and CA procedure. Repeated wide CA might affects negatively LA compliance and contractility despite SR restoration.
Figure 1. Reservoir and contractile LAS at Baseline and 12-month follow-up in the First-CA (1A), the Redo-CA (1B) and the long-standing persistent AF (1C) groups in patients who maintained SR versus patients who had AF recurrence. *p value &lt;0.05 (baseline vs. follow-up).

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): International PhD programme in Cardiovascular Pathophysiology and Therapeutics (CardioPaTh).
Right ventricular strain for prediction of mortality in patients with preserved ejection fraction
Authors: Rothschild E , Baruch G.N , Kaplan A , Kapusta L , Topilsky Y 
Published: November 2020

Abstract

Introduction
Right Ventricular (RV) dysfunction is highly prevalent and has major prognostic implication in patients with Heart Failure (HF) with Preserved Ejection Fraction (HFpEF). Different functional indices have been proposed to evaluate RV function, most common are TEI-index, TAPSE and RVFAC%. Recent works suggested that 2-dimensional speckle tracking echocardiography (2DSTE) for RV global longitudinal strain (RVGLS) and free wall strain (RVFWS) are more sensitive in evaluating RV (dys)function than other functional and hemodynamic parameters in specific populations, such as HF with reduced EF.

Purpose
We aimed to assess if endocardial RVGLS, RVFWS, and RV Septal Wall Strain (RVSWS), might have a prognostic and additive value (on top of the conventional measurements) on the outcome of patients with preserved EF.

Methods
Retrospective analysis of RV parameters including Peak and End Systolic Strain of RVGLS, RVFWS and RVSWS, RV functional indices (RVFAC% and Machine like TAPSE), Systolic Pulmonary Artery Pressure, in 375 consecutive patients with Preserved Ejection Fraction (EF ≥50%; age 69.1±19; 51% female; Co-morbidity Charlson index 1 (3)). Multivariate Cox regression hazards model was used to determine the association between RV strain parameters to all-cause mortality.

Results
RVFWS, RVSWS and RVFAC% were strong predictors of mortality in univariate analysis (HR 1.07 [1.03–1.1]; p≤0.0001, HR 1.08 [1.05–1.12]; p≤0.0001, HR 0.97 [0.95–0.99]; p≤0.0002, respectively). Moreover, after adjustment for clinical (age, gender, Charlson index) and echocardiographic parameters (LA volume, E/e' average, systolic pulmonary pressure), all three parameters remained statistically significant predictors of all-cause mortality (p=0.004, p=0.024, p=0.026, respectively).
The best strain univariate predictor of mortality was RVGLS (HR 1.09 [1.05–1.13]; p≤0.0001), being superior to other RV functional indices and systolic pulmonary pressure. Also, after multivariate analysis it remained a statistically significant predictor of mortality (p=0.007).
All measurements had good intra-observer and inter-observer reproducibility (Single Measures ICC = 0.90 and ICC = 0.88, respectively).

Conclusions
2DSTE of RVGLS, RVFWS, RVSWS provides significant prognostic value to predict overall mortality in patients with Preserved Ejection Fraction with excellent reproducibility, incremental to routine clinical, hemodynamic and diastolic parameters.
Moreover, the strain results of the septal wall showed to be significant, thereover challenging the known hypothesis that the septal wall is mainly influenced by LV function.
Figure 1

Funding Acknowledgement
Type of funding source: None
Clinical characteristics and myocardial function assessed by traditional and novel echocardiographic methods in competitive triathletes with and without myocardial fibrosis
Authors: Knappe D , Muench J , Yildirim S , Witzel K , Tahir E , Lund G , Blankenberg S , Patten M 
Published: November 2020

Abstract

Background
The aim of the present study was to compare clinical characteristics and cardiac structure and function in competitive triathletes with and without myocardial fibrosis.

Methods
Cardiac fibrosis in 61 healthy male competitive triathletes (&gt;10 hrs of training per week, age 45±10 yrs) was quantified using LGE-sequences in CMR (1.5 tesla scanner).
Transthoracic echocardiography, physical examination, past medical history and routine lab diagnosis for exclusion of other conditions were performed.
Baseline characteristics like blood pressure at rest (BP), bodymass-index (BMI), and systolic and diastolic echocardiographic parameters (left atrial volume index (LAVI), e', E, A, right ventricular pressure gradient) as well as global longitudinal strain, were analysed by two independent observers blinded to the CMR measurements. Triathletes were sub-divided into LGE-positives (LGE+) vs. LGE-negatives (LGE-).

Results
All individuals appeared healthy with no drug history. Focal non-ischaemic LGE was detected in 19 triathletes. Compared to LGE-negative triathletes, LGE-positives showed significantly higher systolic BP (142 vs. 128 mmHg, p=0.004). Logistic regression showed, that per 10 mmHg enhanced blood pressure the chance for LGE rises by 89%. Triathletes with and without LGE demonstrated no difference in conventional echocardiographic measurements such as left ventricular ejection fraction and volumes and no difference in diastolic parameters. But the presence of MF did mediate global longitudinal strain (GLS).
Global longitudinal strain was significantly reduced in LGE positive athletes (LGE+: −19.8±3.4; LGE-: −21.7±2.4, p=0.04)

Conclusions
Reduced global longitudinal strain mediated as an early echocardiographic marker for subclinical changes in asymptomatic competitive triathletes with myocardial fibrosis compared to triathletes without LGE. Novel echocardiographic parameter such as longitudinal strain might serve as an easy tool to identify high endurance athletes at higher risk for cardiovascular events and that individuals with enhanced blood pressure should undergo cardiac consultation before starting endurance-training in competitive disciplines.

Funding Acknowledgement
Type of funding source: None
Performance of coronary calcium score and epicardial fat volume in early diagnostic of coronary artery disease
Authors: Agoston Coldea L , Zlibut A , Cionca C , Muresan I , Horvat D , Revnic R , Cojan-Minzat B.O , Gonciar D , Mocan T 
Published: November 2020

Abstract

Background
Coronary artery disease (CAD) remains a world leading cause of death, despite the development of traditional risk scores based on the quantification of cardiovascular risk factors. Coronary calcium score (CCS) determined by cardiac computed tomography (CCT) is a noninvasive tool with major implications in early diagnosis and in outcome prediction in CAD patients. Epicardial fat volume (EFV) is a recently described CCT-based diagnostic and prognostic tool of CAD and outcome.

Purpose
This study sought to investigate the performance of coronary calcium score and EFV in early diagnosing CAD.

Methods
We conducted a prospective, single-center, cross-sectional study on patients suspected of CAD. All patients were submitted to detailed clinical data, 12-lead electrocardiogram, estimating pretest probability, stress test, echocardiography, CCT imaging. In the study subjects was assessed CCS, EFV and the number of calcified plaques (NoP). The total CCS load was then ranked in the following scoring groups: 0 (no evidence of coronary calcium; reference group), 1–99 (minimal to mild), 100–399 (moderate), and 400–999 (extensive) and ≥1000 (very extensive). The subjects in the study were classified according to the NoP derived from their CCS scans (no plaques, 1–5, 6–10 and more than 10 calcified plaques). CAD was defined as coronary stenosis over 50% of the vessel.

Results
Among 540 patients (55.8±11.2 years of age; 52% women) met the enrollment criteria, 98 patients presented CAD. Spearman correlation analysis revealed strong correlations between EFV index and CCS (r=0.45; p&lt;0.0001) and between EFV index and NoP (r=0.44; p&lt;0.0001), after adjustment for age, sex, body mass index, hypertension, diabetes and low-density lipoprotein cholesterol. The area under the curve of the receiver-operator curve for CAD prediction by CCS &gt;70.3 UH (cut-off value) was significantly higher (AUC=0.927; p&lt;0.0001) by comparison with EFV index &gt;40.8 ml/m2 (AUC=0.816; p&lt;0.0001) and NoP &gt;4 (AUC=0.928; p&lt;0.0001). The association of all three parameter, CCS, EFV and NoP, increases the prediction power of CAD, providing an AUC of 0.969 with a 0.70 sensibility and 0.95 specificity.

Conclusion
The combined use of EPV, CCS and NoP has a very high predictive capacity for CAD, regardless of the classic cardiovascular risk factors. This increases the diagnostic capacity of CAD beyond every parameter used alone.

Funding Acknowledgement
Type of funding source: None
Prognostic value of non-ischemic ring-like left ventricular scar pattern in patients with apparently idiopathic ventricular arrhythmias: a CMR imaging study
Authors: Nucifora G , Muser D , Castro S , Casado Arroyo R , Benhayon D , Liuba I , Sadek M , Magnani S , Callans D , Frankel D , Selvanayagam J , Marchlinski F , Santangeli P 
Published: November 2020

Abstract

Background
The presence of left ventricular (LV) late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has been correlated to life-threatening arrhythmic events in patients with apparently idiopathic ventricular arrhythmias (VAs). Aim of the present study was to investigate the prognostic significance of a specific LV-LGE phenotype characterized by a subepicardial/midmyocardial “ring-like” pattern of fibrosis.

Methods
Out of a total of 518 consecutive patients with apparently idiopathic VAs who underwent CMR study, 79 (15%) had evidence of LV-LGE. Of these, 23 (4%) patients had LV LGE with ring-like pattern, defined as subepicardial or midmyocardial LGE involving at least 3 contiguous segments in the same slice (group A), while 56 (11%) patients had LV LGE with no ring-like pattern (group B). The remaining 439 patients had no LGE (group C). The end-point of the study was a composite SCD, resuscitated cardiac arrest and nonfatal episodes of ventricular fibrillation or documented sustained ventricular tachycardia.

Results
Group A patients were more frequently males compared to groups B and C (96% vs. 79% vs. 52%; p&lt;0.01) and had more frequently a family history of SCD and/or cardiomyopathy (30% vs. 11% vs. 5%; p&lt;0.01). All patients in Group A showed VAs with a predominant RBBB morphology vs. 38 (68%) patients in Group B and 65 (15%) in Group C (p&lt;0.01). During a follow-up of 63±39 months, the composite outcome occurred in 13 patients (57%) in Group A vs. 11 (20%) in Group B and 2 (1%) in Group C (p&lt;0.01).

Conclusion
In patients with apparently idiopathic VAs, a nonischemic LV-LGE with a ring-like pattern at CMR is associated with a high rate of malignant arrhythmic events during follow-up.

Funding Acknowledgement
Type of funding source: None
Prediction for cardiac prognosis in patients with congestive heart failure by machine learning on dual-isotope myocardial semiconductor SPECT
Authors: Shimizu M , Cho S , Hara K , Ohmori M , Tateishi R , Kaneda T , Yamakami Y , Shimada H , Manno T , Isshiki A , Kimura S , Fujii H , Suzuki M , Nishizaki M , Sasano T 
Published: November 2020

Abstract

Background
Dual-isotope (low doze 201TlCl and 123I-β-methyl-P-iodophenyl-pentadecanoic acid (BMIPP)) single photon emission computed tomography (SPECT) is utilized to estimate myocardial damage in patients with congestive heart failure (CHF). However, predictive model construction on the SPECT for cardiac death by machine learning was not studied.

Purpose
To elucidate predictive value of machine learning model on dual-isotope SPECT for CHF.

Methods
We enrolled consecutive 310 patients who admitted with CHF (77.1±3.1 years, 164 males). After initial treatment, they underwent electrocardiography gated SPECT and observed in median 507 days [IQR: 165, 1032]. Multivariate Cox regression analysis for cardiac death was performed, and predictive model was constructed by ROC curve analysis and machine learning (Random Forest and Deep Learning). The accuracies (= [True positive + True negative] / Total) of the prediction models were compared with ROC curve model.

Results
Thirty-six patients fell into cardiac death. Cox analysis showed Age, left ventricular ejection fraction (LVEF), summed rest score (SRS) of BMIPP, and mismatch score were significant predictors (Hazard ratio: 1.068, 0.970, 1.032, 1.092, P value: &lt;0.001, 0.014, 0.002, &lt;0.001, respectively). ROC curve analysis of them revealed the accuracy of the cut-off value was 0.479–0.773. Conversely, machine learning model demonstrated higher accuracy for cardiac death (Random Forest: 0.895, Deep Learning: 0.935). The top 4 feature importance of the random forest were LVEF (0.299), SRS BMIPP (0.263), Age (0.262), and mismatch score (0.160).

Conclusion
Machine learning model on SPECT was superior to conventional statistic model for predicting cardiac death in patients with CHF.

Funding Acknowledgement
Type of funding source: None
Subclinical leaflet thrombosis after transcatheter aortic valve implantation: association to reverse left ventricular remodeling
Authors: Kuneman J.H , Singh G.K , Hansson N.C , Poulsen S.H , Vollema E.M , Pedersen A.L.D , Norgaard B.L , Ajmone Marsan A , Delgado V , Bax J.J , Knuuti J 
Published: November 2020

Abstract

Background
Hypo-attenuated leaflet thickening (HALT) of transcatheter aortic valves can be observed on multidetector computed tomography (MDCT) and is considered as an early marker of leaflet thrombosis. Preliminary data has suggested that HALT will prevent or delay reverse left ventricular (LV) remodeling after transcatheter aortic valve implantation (TAVI).

Purpose
The purpose of the present study was to assess the association of HALT to reverse LV remodeling after TAVI.

Methods
In this multicenter study, patients who underwent MDCT after TAVI were evaluated. The presence of HALT was assessed with MDCT. Transthoracic echocardiograms were performed to assess LV dimensions and function before and 12 months after TAVI; transcatheter valve hemodynamics were assessed immediately after TAVI and at 12 months follow-up.

Results
A total of 169 patients (mean age 81±7 years, 53% male) who underwent MDCT performed 35 days [IQR 32–52] after TAVI were analyzed. HALT was observed in 42 (33%) patients. Before TAVI, LV mass (LVM) and LV mass index (LVMi) did not differ between patients with or without HALT: 227±80 vs. 234±62 g (p=0.568) and 121±37 vs. 126±32 g/m2 (p=0.35), respectively. Also LV ejection fraction (LVEF) was comparable between groups, 51±10 vs. 50±12%, p=0.64. LV end-diastolic volume (LVEDV) and LV end-systolic volume (LVESV) were lower in patients with HALT: 75 (67–115) vs. 99 (77–127) ml (p=0.030) and 39 (30–53) vs. 46 (33–65) ml (p=0.050), respectively. At 12 months follow-up, we found no differences in LVM or LVMi regression, decrease of LV volumes or transprosthetic gradients between groups (Figure 1).

Conclusion
Patients who presented with HALT had significantly lower LV volumes before TAVI. LV mass and volumes regressed significantly at 12 months after TAVI, however LV remodeling was not associated to the presence of HALT.

Funding Acknowledgement
Type of funding source: None
Negative impact of ultra-thin strut on neointimal coverage condition within one year after implantation as compared to thin sturt in biogradable-polymer sirorimus eluting stents
Authors: Shutta R , Nishino M , Kawamura A , Ukita K , Nakamura H , Yasumoto K , Tsuda M , Okamoto N , Tanaka A , Matsunaga Y , Yano M , Egami Y , Tanouchi J 
Published: November 2020

Abstract

Background
BIOSCIENCE randomized trial which compared biodegradable-polymer sirolimus-eluting stents with ultra-thin (60μm) strut (ultra-thin BP-SES) and durable-polymer everolimus-eluting stents with thin (81μm) strut (thin DP-EES) have reported that definite stent thrombosis within 1 year had more frequently occurred in ultra-thin BP-SES (0.9%) than in thin DP-EES group (0.4%) although it was not statistically significant. It suggests that neointimal coverage after stent implantation within 1 year might be different between ultra-thin BP-SES and thin DP-EES. Recently, two types of biogradable-polymer sirorimus eluting stents, thin (80μm) strut type (thin BP-SES) and ultra-thin (60μm) strut type (ultra-thin BP-SES), can be available in clinical settings.

Purpose
We compared neointimal coverage conditions between ultra-thin BP-SES and thin BP-SES by optical coherence tomography (OCT).

Methods
Consecutive Forty-six patients who underwent 21 ultra-thin BP-SESs or 25 thin BP-SESs implantation were enrolled. We compared incidences of acute coronary syndrome, type B2/C lesion, atherectomy device use, stent size, stent length, maximum inflation pressure, and 8-month follow-up OCT parameters including proportions of uncovered struts (%Uncovered), malapposed struts, (%Mallaposed) and mean neointimal hyperplasia thickness (mean NHT) between the two groups.

Results
%Uncovered and %malapposed were significantly higher and mean NHT was significantly lower in ultra-thin BP-SES than in thin BP-SES (Table). The other parameters were similar between the two groups.

Conclusion
Ultra-thin BP-SES showed worse neointimal coverage as compared to thin BP-SES within 1 year after stent implantation, which may increase stent thrombosis.

Funding Acknowledgement
Type of funding source: None