bluuebunny/crossref_metadata_2025_split huggingface dataset:
Real-time cardiac magnetic resonance tissue characterisation for fibrosis assessment in aortic stenosis
Authors: Backhaus S.J , Lange T , Beuthner B.E , Topci R , Wang X , Kowallick J.T , Lotz J , Seidler T , Toischer K , Zeisberg E.M , Puls M , Jacobshagen C , Uecker M , Hasenfus G , Schuster A 
Published: November 2020

Abstract

Background
Myocardial fibrosis is a major determinant of outcome in aortic stenosis (AS). Novel fast real-time (RT) cardiac magnetic resonance (CMR) mapping techniques allow comprehensive quantification of fibrosis but have not yet been adequately validated against standard techniques and histology.

Methods
Patients with severe AS underwent CMR before (n=110) and left ventricular (LV) endomyocardial biopsy (n=46) at transcatheter aortic valve replacement (TAVR). Midventricular short axis native, post-contrast T1 and extracellular volume fraction (ECV) maps were generated using commercially available 5(3)3 MOLLI and RT single-shot inversion recovery fast low-angle shot (FLASH) with radial undersampling. ECV and LV mass were used to calculate LV matrix volumes. Variability and agreements were assessed between RT, MOLLI and histology using intraclass correlation coefficients, coefficients of variation and Bland Altman analyses.

Results
RT and MOLLI derived ECV were similar for myocardium (26.2 vs. 26.5, p=0.073) and inter-ventricular septum (26.2 vs. 26.5, p=0.216). MOLLI native T1 time was in median 20 ms longer compared to RT (p&lt;0.001). Agreement between RT and MOLLI was best for ECV (ICC &gt;0.91), excellent for post-contrast T1 times (ICC &gt;0.81) and good for native T1 times (ICC &gt;0.62). Diffuse collagen volume fraction by biopsies was in median 7.8%. ECV (RT r=0.345, p=0.039; MOLLI r=0.40, p=0.010) and LV matrix volumes (RT r=0.45, p=0.005; MOLLI r=0.43, p=0.007) were the only parameters associated with histology.

Conclusions
RT mapping offers precise T1 and ECV assessments with similar agreement with histology as compared to conventional MOLLI techniques. Single-shot real time techniques may be advantageous in sicker patients prone to dyspnoea or arrhythmia.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): German Research Foundation
Quantitative 4D Flow CMR analysis of intracardiac blood flow energetics in ischemic cardiomyopathy patients
Authors: Riva A , Camporeale A , Sturla F , Pica S , Tondi L , Giese D , Castelvecchio S , Menicanti L , Redaelli A , Votta E , Lombardi M 
Published: November 2020

Abstract

Background
Ischemic cardiomyopathy (ICM) is often associated with negative LV remodelling after myocardial infarction, sometimes resulting in impaired LV function and dilation (iDCM). 4D Flow CMR has been recently exploited to assess intracardiac hemodynamic changes in presence of LV remodelling.

Purpose
To quantify 4D Flow intracardiac kinetic energy (KE) and viscous energy loss (EL) and investigate their relation with LV dysfunction and remodelling.

Methods
Patients with prior anterior myocardial infarction underwent a CMR study with 4D Flow sequences acquisition; they were divided into ICM (n=10) and iDCM (n=10, EDV&gt;208 ml and EF&lt;40%). 10 controls were used for comparison. LV was semi-automatically segmented using short axis CMR stacks and co-registered with 4D Flow. Global KE and EL were computed over the cardiac cycle. NT-proBNP measurements were correlated with average and peak values, during systole and diastole.

Results
Both LV volume and EF significantly differ (P&lt;0.0001) between iDCM (EDV=294±56 ml, EF=24±8%), ICM (EDV=181±32 ml, EF=34±6%) and controls (EDV=124±29 ml, EF=72±5%). If compared to controls, both ICM and iDCM showed significantly lower KE (P≤0.0008); though lower than controls, EL was higher in iDCM than ICM. Within the iDCM subgroup, diastolic mean KE and peak EL reported good inverse correlation with NT-proBNP (r=−0.75 and r=−0.69, respectively). EL indexed (ELI) to average KE during systole was higher in the entire ischemic group as compared to controls (ELI(ischemic) = 0.17 vs. ELI(controls) = 0.10, P=0.0054).

Conclusions
4D Flow analyses effectively mapped post-ischemic LV energetic changes, highlighting the disproportionate intraventricular EL relative to produced KE; preliminary good correlation between LV energetic changes and NT-proBNP will deserve further investigation in order to contribute to early detection of heart failure.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Italian Ministry of Health
Prognostic value of vasodilator stress perfusion CMR in patients with previous coronary artery bypass graft (CABG)
Authors: Pezel T , Kinnel M , Sanguineti F , Garot P , Hovasse T , Landon V , Unterseeh T , Champagne S , Louvard Y , Morice M.C , Garot J 
Published: November 2020

Abstract

Background
The accuracy and prognostic value of stress perfusion cardiac magnetic resonance (CMR) are well established in patients with suspected or proven coronary artery disease (CAD). Because myocardial contrast kinetics may be altered in patients with previous coronary artery bypass graft (CABG), most studies have excluded those patients in whom prognostic data are missing.

Purpose
To assess the safety and prognostic value of vasodilator stress perfusion CMR in patients with previous CABG.

Material
Between 2008 and 2018, we prospectively included consecutive patients with CABG referred for vasodilator stress perfusion CMR with dipyridamole. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined by cardiovascular death, nonfatal myocardial infarction or late coronary revascularization (&gt;90 days after CMR). The safety of the stress perfusion CMR was assessed by clinical monitoring for 1 hour after the end of the CMR. Univariable and multivariable Cox regressions were performed to determine the prognostic association of inducible ischemia and late gadolinium enhancement (LGE) on CMR.

Results
Of 866 CABG patients (70±9 years, 89% men), 852 (98%) completed the CMR protocol and 771 (89%) completed the follow-up (median 4.2±2.7 years). Reasons for failure to complete CMR included renal failure (n=4), intolerance to stress agent (n=4), claustrophobia (n=2), poor gating (n=2) and declining participation (n=2).
Stress CMR was well tolerated without occurrence of death or severe adverse event. In this cohort, 531 (61%) patients had a myocardial infarction defined by the presence of LGE with ischemic patterns in CMR. Patients without inducible ischemia or LGE experienced a substantially lower annual event rate of MACE (12.8%) than those with ischemia and without LGE (27.6%), or those with both ischemia and LGE (28.2%; p&lt;0.001 for all). Using Kaplan-Meier analyses, the presence of myocardial ischemia was correlated with the occurrence of MACE and cardiac mortality (both p&lt;0.0001) (Figure). In multivariable stepwise Cox regression, the absence of inducible ischemia was an independent predictor of a lower incidence of MACE (HR 2.17, 95% CI 1.56–3.13; p&lt;0.001) and cardiovascular mortality (HR 2.38; 95% CI 1.39 0.25–4.03; p=0.001).

Conclusions
Stress CMR is feasible, safe and has a good discriminative prognostic value to predict the occurrence of MACE and cardiovascular mortality in patients with CABG.
Kaplan-Meier: MACE (A) – CV Mortality (B)

Funding Acknowledgement
Type of funding source: None
The relationship between arrhythmogenicity and novel parametric cardiac magnetic resonance indices in systemic sclerosis patients
Authors: Mavrogeni S , Gargani L , Pepe A , Monti L , Markousis-Mavrogenis G , Koutsogeorgopoulou L , Karabela G , Katsifis G , Bruni C , Dimitroulas T , Mukherjee M , Lima J , Kitas G.D , Sfikakis P.P , Matucci-Cerinic M 
Published: November 2020

Abstract

Introduction
Cardiac involvement in systemic sclerosis (SSc) accounts for 26–36% of deaths. This most frequently manifests as ventricular rhythm disturbances (VRDs), eventually culminating in sudden cardiac death. However, no specific guidelines exist for implantation of cardioverter defibrillators (ICD) in SSc patients. Parametric cardiovascular magnetic resonance (CMR) indices of myocardial oedema and fibrosis like native T1/T2 mapping have been shown to be associated with prognosis in SSc patients with acute cardiac events and normal echocardiograms. However, their relationship with arrhythmogenicity per se has not been previously investigated in SSc.

Objectives
To investigate the relationship between parametric CMR indices and arrhythmogenicity in SSc patients.

Methods
84 consecutive SSc patients (80% diffuse-cutaneous SSc) from eight European centers presenting with cardiac symptoms were examined using a 1.5 T CMR system. 24h Holter recordings were obtained within a month of the CMR scan. The presence of VRDs was defined as any type of premature ventricular contraction (PVC) in couples, triplets, bigeminism, trigeminism, quadrigeminism and non-sustained ventricular tachycardia, as well as having &gt;30 PVCs per hour. Logistic regression analysis was used to evaluate the relationship between VRD occurrence and native T1/T2 mapping as well as myocardial extracellular volume fraction (ECV).

Results
Mean age in the cohort was 55 (13) years and 78 (93%) patients were female. Of these, 67 (80%) experienced at least one type of VRDs. Each 10 ms increase of native T1-mapping was associated with a higher occurrence of VRDs [odds ratio (95% confidence interval): 1.21 (1.08–1.36), p=0.001]. Similarly, a 1% increase in ECV conferred an increased probability of experiencing VRDs [1.25 (1.01–1.53), p=0.037]. Lastly, a 1ms unit increase in T2-mapping also led to increased probability of having experienced VRDs [1.09 (1.01–1.19), p=0.035].

Conclusion
Parametric CMR indices are associated with arrhythmogenicity in SSc patients with cardiac symptoms and should be investigated further in larger studies for their clinical utility in selecting high-risk SSc patients for ICD implantation.

Funding Acknowledgement
Type of funding source: None
Isolated apical perfusion defect in SPECT-CT scans, is there any prognostic value?
Authors: Lopes J , Monteiro M , Campos D , Saleiro C , Costa S , Sousa J , Puga L , Gomes A , Silva J , Ferreira M , Goncalves L 
Published: November 2020

Abstract

Background
Myocardial perfusion imaging (MPI) plays a significant role in diagnostic and therapeutic decision making in coronary artery disease (CAD). An isolated apical defect in the 17th segment in SPECT/CT scans is a common finding, sometimes attributed to the apical thinning phenomenon. However, the clinical significance of apical thinning or other isolated apical defects is unknown.

Purpose
The purpose of this study is to assess the prognostic impact of an isolated apical perfusion defect (17th segment) in patients (P) with suspicion of significant CAD.

Methods
A cohort of 612 consecutive P that underwent a MPI test with a SPECT/CT scanner, between January 2017 and December 2017, in a single nuclear medicine centre, was included in this retrospective study.
The inclusion criteria for this study were either a normal perfusion exam (group 1 – G1) or only an isolated apical defect in the 17th segment, either reversible suggesting ischemia (group 2 – G2) or fixed suggesting necrosis (group 3 – G3). Images with and without attenuation correction were analysed. Mean follow-up was 29±4 months.
The chi square test was used for categorical variables, and analysis of variance for continuous variables. Binary logistic regression was used to control for confounding.

Results
A total of 612 P were included (57% male sex, mean age of 69±10) and divided in G1 (n=494, 80.7%), G2 (n=62, 10%) and G3 (n=56, 9.2%). P in G3 had higher body mass index (31±7, p=0.028) and higher prevalence of dyslipidemia (84%, p=0.001), while P in G1 had lower ejection fraction at rest (54±15, p=0.001). There was no association between the presence of isolated apical defect and all- cause mortality (G1 = 7.3% vs G2 = 6.5% vs G3 = 5.4%, p=0.851). There was a statistically significant difference between groups in the referral for coronary angiography in the bivariate analysis (G1 = 7.9% vs G2 = 35.5% vs G3 = 10.7%, p=0.001), but this association did not remain when accounted for potential confounders (angina, ejection fraction, previous CAD and diabetes) – OR=3.94, 95% CI: [0.968–16.093], p=0.056.
In those P that underwent coronary angiography, there was no statistically significant difference between the 3 groups in revascularization of significant CAD (G1 = 38.5% vs G2 = 36.4% vs G3 = 50%, p=0.830). During the follow-up time, 11 P of group 1 suffered an acute coronary syndrome (ACS), but there were no events in group 2 or 3.

Conclusion
Isolated apical myocardial defect on a SPECT/CT exam has no association with all-cause mortality in this patients. There is no significant difference in referral for coronary angiography or need for coronary revascularization between P with normal exams and P with isolated apical defects.

Funding Acknowledgement
Type of funding source: None
Prediction of myocardial viability in chronic phase in patients with acute myocardial infarction by simultaneous dual-isotope imaging with 99mTc-sestamibi/123I-BMIPP SPECT using CZT camera system
Authors: Fujita Y , Hida S , Igarashi Y , Hatano T , Morishima T , Yamashita J , Murata N , Ito R , Chikamori T 
Published: November 2020

Abstract

Objectives
The objective of this study was to determine the optimal cut-off value of % uptake of simultaneous dual-isotope (99mTc-sestamibi/123I-BMIPP) SPECT in patients with acute myocardial infarction (AMI) for prediction of myocardial viability in chronic phase.

Methods
We evaluated 30 consecutive patients with AMI who had undergone both dual-SPECT in acute phase and stress myocardial SPECT using 99mTc-tracers in chronic phase by Discovery NM530c. Regional % uptake with a 17-segment model was obtained using QPS software. The presence of myocardial viability was defined when regional % uptake ≥50% in 99mTc SPECT at rest in chronic phase was observed. Receiver operating characteristic (ROC) curves were analyzed to determine the optimal cutoff values of regional % uptake in both left anterior descending artery (LAD) territory and non-LAD coronary territory in acute phase to predict the myocardial viability in chronic phase.

Results
The cutoff values for prediction of viable myocardium were %uptake ≥47% for 99mTc-sestamibi, %uptake ≥31% for 123I-BMIPP in acute phase in LAD territory and %uptake ≥52% for 99mTc-sestamibi, %uptake ≥48% for 123I-BMIPP in non-LAD territory. The respective sensitivities, specificities and the area under the ROC curve (AUC) values in the prediction of myocardial viability were 92%, 92% and 0.94 with 99mTc-sestamibi, 90%, 85%, 0.92 with 123I-BMIPP in LAD territory, and 81%, 93% and 0.92 with 99mTc-sestamibi, 81%, 90%, 0.92 with 123I-BMIPP in non-LAD territory. There were no significant differences in AUC values between 99mTc-sestamibi and 123I-BMIPP in both LAD territory and non-LAD coronary territory.

Conclusions
In the simultaneous 99mTc-sestamibi/123I-BMIPP dual-isotope imaging in patients with AMI, these results suggest that not only 99mTc-sestamibi SPECT, but also 123I-BMIPP SPECT may be possible to predict the presence of myocardial viability in chronic phase. But it should be noted that the optimal cutoff values of regional % uptake in acute phase to predict the myocardial viability may differ for LAD territory and non-LAD coronary territory.

Funding Acknowledgement
Type of funding source: None
Impact of early post-stress LV Dis-sinchrony assessed by TC99m GSPECT myocardial perfusion: ischemic patients vs. normal subjects
Authors: Cortes C.M , Aramayo G E.N , Barboza P , Embon M 
Published: November 2020

Abstract

Purpose
We aimed to determine the value of early post-stress Tc99msestamibi gated SPECT imaging for detecting changes in the two phase analysis synchrony parameters: Histogram bandwidth (HB) and Standard deviation (SD) in ischemic patients compared to normal subjects.

Methods
We prospectively included normal subjects and consecutive patients who had a positive stress test (angina or ST deviation during stress test). Both groups followed the same GSPECT protocol: an early stress image (acquired at maximum 10 minutes after the tracer injection), a delayed stress image (after 45 min of tracer injection) and the rest image. Phase analysis indices HB and SD were compared from early stress/ rest images and delayed stress/rest images in both groups. We compared the change of SD and HB indices (stress minus rest) for early and delayed images. The ischemic group was divided into mild ischemia (SDS≤3), moderate ischemia (SDS&gt;3 and&lt;8), and severe ischemia (SDS≥8)

Results
Twenty nine normal subjects and 57 ischemic patients were included. Thirty per cent of the ischemic group had mild ischemia, 32% moderate ischemia and 37% severe ischemia. SD and HB values decreased in early and delayed-stress images compared to those of rest images in normal subjects (all p&lt;0,05). In the ischemic group early-stress SD increased compared to rest SD (p&lt;0,05) while delayed- stress SD did not change. Early-stress HB did not change in comparison to rest HB while delayed-stress HB decrease compared to rest HB.The figure shows the comparison of SD and HB between early-stress, delayed-stress and rest images in normal subjects and ischemic patients. The Table shows the comparison of the change of SD and HB indices (stress minus rest) for early and delay images.

Conclusion
LVMS indices obtained by phase analysis of Tc99sestamibi GSPECT imaging, HB and SD decrease significantly when derived from early and delayed stress images compared to rest images in normal subjects. A progressive significant increase in SD and HB values in delayed and early stress images was observed in this population what could be an expression of post-ischemic LV dis-synchrony. Larger amounts of ischemia are related to progressive higher changes in SD and HB from early and delayed stress images versus rest images.

Funding Acknowledgement
Type of funding source: None
Prediction of the improvement of left ventricular wall motion after acute myocardial infarction by simultaneous dual-isotope imaging with 99mTc-sestamibi/123I-BMIPP using cadmium-zinc-telluride SPECT
Authors: Hida S , Fujita Y , Igarashi Y , Hatano T , Morishima T , Yamashita J , Murata N , Ito R , Chikamori T 
Published: November 2020

Abstract

Background/Introduction
Although both the presence of 99mTc-sestamibi/123I-BMIPP mismatch and the reverse redistribution of 99mTc-sestamibi in patients with acute myocardial infarction (AMI) are known to significant markers for predicting the improvement of left ventricular (LV) wall motion in the infarcted territory in chronic phase, few studies evaluated them by simultaneous dual-isotope (99mTc-sestamibi/123I-BMIPP) imaging using cadmium-zinc-telluride (CZT) SPECT system.

Purpose
The purpose of this study was to evaluate whether the presence of 99mTc-sestamibi/123I-BMIPP mismatch or the reverse redistribution of 99mTc-sestamibi make better prediction of the improvement of LV wall motion in the infarcted territory.

Methods
We evaluated 30 consecutive patients with AMI who had undergone both dual-isotope (99mTc-sestamibi/123I-BMIPP) SPECT in acute phase and stress myocardial SPECT using 99mTc-tracers in chronic phase by Discovery NM530c. Both 99mTc-sestamibi/123I-BMIPP mismatch and reverse redistribution of 99mTc-sestamibi were determined using traditional definition. The improvement of LV wall motion in the infarcted territory from acute phase to chronic phase was assessed using QGS.

Results
Of 30 patients, the improvement of LV wall motion in the infarcted territory from acute phase to chronic phase was found in 20 patients. Both the presence of 99mTc-sestamibi/123I-BMIPP mismatch and reverse redistribution of 99mTc-sestamibi were significantly linked to predict the improvement of LV wall motion (p=0.0001, p=0.011, respectively). The respective sensitivities, specificities and accuracies in the prediction of the improvement of LV wall motion in the infarcted territory were 90%, 90% and 90% with 99mTc-sestamibi/123I-BMIPP mismatch, and 60%, 90%, 70% with reverse redistribution of 99mTc-sestamibi.

Conclusions
In the simultaneous 99mTc-sestamibi/123I-BMIPP dual-isotope imaging using CZT SPECT system, both the presence of 99mTc-sestamibi/123I-BMIPP mismatch and the reverse redistribution of 99mTc-sestamibi in acute phase are useful for predicting the improvement of LV wall motion in chronic phase, but the presence of 99mTc-sestamibi/123I-BMIPP mismatch is superior to the reverse redistribution of 99mTc-sestamibi for it.

Funding Acknowledgement
Type of funding source: None
Pharmacological stress test for myocardial ischemia when Adenosine is contraindicated: prospective documentation of side effects in over 700 patients with COPD or bronchial asthma
Authors: Keller M , Silber S 
Published: November 2020

Abstract

Background
In the face of an increasingly elder population, physical exercise tests become less feasible with an increasing need for pharmacological stress tests, preferably with imaging techniques. For myocardial stress tests provoking myocardial ischemia, vasodilator stress is most frequently used. Whereas Dipyridamole should be obsolete, the predominant drug applied within this context is Adenosine for myocardial scintigraphy, magnetic resonance imaging and FFR. Adenosine, however, is contraindicated in patients with COPD or bronchial asthma, predominantly due to a possible exacerbation of bronchospasm or other pulmonary side effects. In contrast, Regadenoson, was especially developed as a highly selective A2A receptor agonist to circumvent these problems.

Methods
Regadenoson was applied with the standard injection dose of 400 μg in 780 consecutive patients with a history of COPD or bronchial asthma for SPECT myocardial perfusion scintigraphy. 12% of the patients had a preexisting first degree AV-block. Blood pressure, heart rate and possible side effects were prospectively monitored and documented for 10 minutes after the injection.

Results
The mean age was 70.8±8.9 years, 52% of the patients were female, 48% were male. 69% had a history of COPD and 31% of bronchial asthma. The maximum increase in heart rate was significant from 66.1±8.1 to 98.3±17.4 bpm. The maximum decrease in systolic blood pressure was significant from 124.3±12.9 to 117.3±24.7 mmHg. Most frequent side effects were a feeling if increased breathing (73%), headache (22%), feeling of warmth (22%), pressure in the stomach (17%) and pressure in the chest (16%). Complications: only 1 patient (without preexisting first degree AV-block) developed a systolic drop in blood pressure from 107 to 60 mmHg with transient severe dyspnoea. No induction of bronchospasm or other pulmonary side effects were observed.

Conclusion
In patients with COPD or bronchial asthma undergoing a pharmacological stress test, Adenosine is contraindicated due to its – potentially severe – pulmonary side effects, Regadenoson is the vasodilator of choice in these patients. In our series, no severe complication was observed – even not in patients with a preexisting first degree AV-block.

Funding Acknowledgement
Type of funding source: None