bluuebunny/crossref_metadata_2025_split huggingface dataset:
P1458Telemonitoring of patients with chronic heart failure (CHF): evaluation of mortality, costs and utilization
Authors: Franz W M , Rabbe S , Schreyoegg J , Blankart R , Hager L , Lehner M 
Published: October 2019

Abstract

Background
The telemonitoring program aims at optimizing the treatment for high risk CHF patients (NYHA II-IV) of a German sickness fund. All participants were equipped with remote monitoring devices such as body-scale, blood pressure monitor or 12-channel ECG system. With these devices information are collected in electronic medical records and analysed by a medical professional, who contacts the patient according to a predefined algorithm aiming for early interventions in order to prevent emergency hospitalization. The 24/7 intervention program is supported by coaching modules related to co-morbidities. All patient related data were provided by the sickness fund.

Methodology
For the evaluation the patient collective of a German sickness fund was screened for eligibility. Inclusion criteria are at least one inpatient stay due to heart failure or related conditions within the past 24 months before the start of the program as well as at least one outpatient diagnosis of heart failure or heart failure related diseases. Exclusion criteria are defined to eliminate patients with diagnoses such as cancer treatments, dialysis or mental illnesses.
After the first selection of all relevant patients for the study population patients are assigned to either intervention or control group. To ensure pre-treatment balance on important characteristics between treatment- and control group different methods such as propensity score matching and propensity weighting are used. For these methods patient characteristics e.g., on costs, medications and comorbidities are used for the period of 24 months before the start of the intervention. Intervention groups were enrolled in 11 waves. The observation period was 24 months (Q3/2015-Q2/2017). In a first analysis total health care costs consisting of inpatient and outpatient care, pharmaceutical as well as medical aids were analysed. Following this outpatient contacts, length of hospital stays and the number of prescribed drugs related to heart failure will be analysed. Further, mortality will be used as an outcome parameter.

Results
Preliminary results for the Gamma regression after propensity score matching on 714 patients in each group suggest a significant negative effect of the intervention of 0,1431 (p=0,005) for the total cost in the study, leading to an average decrease in cost of −2.187€ per patient. There were 998 hospitalizations accounted for in the intervention group vs. 1197 hospitalizations in the control group.
These effects appear to be driven by a decrease in inpatient costs, while costs in other areas such as outpatient care or drugs increased slightly.

Conclusion/Outlook
The preliminary results using propensity score matching suggest a sizable cost reduction for patients in the telemedical treatment group. Results on utilization and outcomes are still pending.

Acknowledgement/Funding
Funding by IKK Suedwest and SHL Telemedicine
P1462Return to physical activity among women following newly diagnosed dilated cardiomyopathy or myocardial infarction
Authors: Burch A E , Kutyifa V , Erath J W , Assmus B , Bondermann D , Russo A M 
Published: October 2019

Abstract

Background
Resuming activity following a new diagnosis of dilated cardiomyopathy (DCM) or myocardial infarction (MI) is important for improvements in morbidity and mortality. Activity is also associated with an improved ejection fraction (EF) and lower risk of reinfarction. Patient management could benefit from having normative values and expected gains in activity early following diagnosis of DCM or MI.

Purpose
Assess the change in activity among women for the first 30 days after hospital discharge following a new DCM diagnosis or MI.

Methods
Female adult patients prescribed a wearable cardioverter defibrillator (WCD) for a diagnosis of DCM (n=3550) or MI (n=1422) with low EF were included. Step count was measured by WCD accelerometer. Change in activity over time was analyzed, including weekly percentage gains.

Results
Women with DCM were significantly younger (64, SD = 13) than women post-MI (67, SD = 12). Median daily step count across the entire 30-day period was 4093 (IQR: 2123–6609). Women with DCM demonstrated a higher step count compared to women post-MI, 4405 (IQR: 2348–6986) and 3352 (IQR: 1644–5709), respectively, even after correcting for the difference in age between the groups. The greatest increases in activity for all occurred from week 1 to week 2. Women with DCM or post-MI had a 15.4% and 19.1% increase, respectively. Incremental increases in activity continued throughout the month.

Conclusion
Physical activity among women with newly diagnosed DCM or MI and a low EF increased within the first 30 days. The most significant increase occurred from week 1 to week 2. This data can be used as a benchmark to develop and assess prescriptive activity programs for women.
P1465Artificial intelligence in echocardiography - Steps to automatic cardiac measurements in routine practice
Authors: Karuzas A , Sablauskas K , Skrodenis L , Verikas D , Rumbinaite E , Zaliaduonyte-Peksiene D , Ziuteliene K , Vaskelyte J J , Jurkevicius R , Plisiene J 
Published: October 2019

Abstract

Introduction
The growth of artificial intelligence (AI) use in echocardiography over the past years has been exponential, proposing new paths to overcome inter-operator variability and experience of the operator. Even though the applications of AI are still in their infancy within the field of echocardiography, the potential of AI implies future directions and is eager to assist for accuracy and efficiency of manual tracings. Deep learning, a subset of machine learning algorithms, is gaining popularity in echocardiography as a state of the art in visual data analysis.

Purpose
To evaluate deep learning for two initial tasks in automated cardiac measurements: view recognition and end-systolic (ES) and end-diastolic (ED) frame detection.

Methods
A total of 230 patients' (with various indications for study) 2D echocardiography data was used to train and validate neural networks. Raw pixel data was extracted from EPIQ 7G, Vivid E95 and Vivid 7 imaging platforms. Images were labeled according to their view: parasternal long axis (PLA), basal short axis, short axis at mitral level, apical two, three and four chambers (A4C). Additionally, ES and ED frames were labeled for A4C and PLA views. Images were de-identified by applying black pixel masks to non-anatomical data and removing metadata. Convolutional Neural Network (CNN) architecture was used for the classification of 6 different views. A total of 34752 and 3972 (5792 and 662 per view) frames were used to train and validate the network, respectively. Long-term Recurrent Convolutional Network (LRCN) combining temporal and spatial cognition was used for ES and ED frame detection. A total of 195 and 35 sequences with a length of 92 frames were used to train the LRCN.

Results
CNN for view classification had an AUC of 0.95 (sensitivity 95%, specificity 97%). Accuracy was lower for visually similar views, namely apical three-chamber and apical two-chamber. Training for ES and ED detection was achieved when training LRCN for regression instead of classification of each frame. LRCN for cardiac cycle evaluation had an average Framed Difference (aFD) of 2.31 (SD±2.15) for ED and 1.97 (SD±2.04) frames for ES detection which corresponds to error rate of about 0.04 s.

Conclusion
Determining echocardiographic view and evaluating cardiac cycle are the first steps in automating cardiac measurements. We have demonstrated the potential of two deep learning algorithms in accomplishing these tasks. Initial results are promising for the development of neural networks for cardiac segmentation and measuring of anatomical structures.
P1471Multimodality imaging of left ventricular function and volumes in patients with acute and chronic myocardial injury - Novel insights
Authors: Drabik L , Kwiecien E , Mazurek A , Urbanczyk M , Szot W , Kostkiewicz M , Banys R P , Brzyszczyk-Marzec M , Skubera M , Iwaszczuk P , Plazak W , Prokop-Staszecka A , Majka M , Podolec P , Musialek P 
Published: October 2019

Abstract

Introduction
The three main techniques to evaluate myocardial function and volumes: two-dimensional echocardiography (TTE), gated single photon emission computed tomography (SPECT) and cardiac magnetic resonance imaging (cMRI), have important differences in accessibility and practicality.

Purpose
We aimed to evaluate: TTE, SPECT and cMRI in the measurement of left ventricular ejection fraction (LVEF), left ventricular end-diastolic (LVEDV) and left ventricular end-systolic volumes (LVESV) in patients with acute and chronic myocardial ischemic injury.

Methods
Consecutive patients with first large acute myocardial infarction (AMI) [LVEF ≤45% and/or cMRI infarct size ≥10% of left ventricle, 2–5 days after pPCI, n=10] and patients with chronic ischemic heart failure (CIHF) [LVEF ≤45% by SPECT, NYHA class II or III, n=10] were enrolled. Multimodality imaging using the study techniques was performed within 36 hours.

Results
LVEF measured with TTE, SPECT and cMRI did not differ between both groups (AMI: 41±2.5%, 37.9±2.7%, 41±2.7%; p=0.07, CHF: 29.6±3.2%, 29.7±3.0%, 32.9±4.9%; p=0.42). LVEDV and LVESV evaluated by SPECT were +33.6%, +38.2% higher in the AMI group and +40.7%, 40.4% higher in the CIHF group compared with TTE (p<0.001). When measured with cMRI they were +52.1%, +50.5%, +31.5%, +25.5% higher (AMI, CIHF group, respectively), compared with TTE (p<0.001).
There was a strong positive correlation between LVEF derived from TTE and SPECT (r=0.81, AMI; r=0.92, CIHF), TTE and cMRI (r=0.89, AMI; r=0.75, CIHF), SPECT and cMRI (r=0.88, AMI; r=0.76, CIHF; all p<0.01). As well as for LVEDV (r=0.79, 0.88; 0.90, 0.85; 0.76, 0.87; all p<0.05) and LVESV measurements (r=0.90, 0.91; 0.94, 0.89; 0.85, 0.85, all p<0.05).
Figure 1

Conclusions
There is a strong correlations between TTE, SPECT, and cMRI in the assessment of left ventricular function in patients with AMI or CIHF. However, TTE appears to significantly underestimate left ventricular volumes in relation to SPECT and cMRI.
P1482Preclinical diastolic dysfunction assessed by left atrial strain and association with incident heart failure
Authors: Potter E , Ramkumar S , Yang H , Kawakami H , Negishi K , Marwick T H 
Published: October 2019

Abstract

Background
Left atrial strain in the reservoir phase (LASr) measures passive LA stretch and is a sensitive marker of left ventricular diastolic dysfunction (DD). However, reduced LASr has not been prospectively validated against clinical heart failure (HF) endpoints and its place in diastology evaluation is unclear.

Aim
We sought whether DD grades defined by previously validated ranges of LASr predicted incident HF and whether reclassifying indeterminate diastolic function based on reduced LASr could facilitate assessment of HF risk.

Methods
Community dwelling elderly subjects were recruited and underwent baseline clinical and echocardiographic assessment. Where imaging was suitable, speckle-tracking echocardiography assessed LASr and subjects were assigned DD grades based on published ranges: normal >35%, grade 1 24–35%, grade 2 19–24%, grade 3 <19%. Current ASE/EACVI recommendations were used to identify those with indeterminate function; LASr-defined DD (LASr-DD) was defined as LASr ≤23%. Follow-up was ≤2 years and incident HF adjudicated by Framingham criteria.

Results
Of 610 subjects (age 71±5 yrs., 46% male) LASr analysis was feasible in 590 (97%); average LASr was 39% (IQR 34–43%). Incident HF was associated with LASr-DD grade, occurring in 8 (36%) with grade ≥2, 14 (10%) with grade 1 and 39 (9%) with normal function (p<0.001). Adjusted odds ratio for incident HF for LASr-DD grade ≥2 was 3.12 (95% CI 1.06–9.1, p=0.038) Diastolic function was indeterminate in 147 (24%) subjects; of 144 (98%) with LAS analysis, 6 (75%) of those with LASr-DD vs. 15 (11%) with normal LASr experienced incident HF (p<0.001).
Univariable Multivariable* OR (95% CI) p-value OR (95% CI) p-value LASr-DD grade:   1 1.13 (0.59–2.15) 0.7 0.84 (0.42–1.69) 0.63   ≥2 5.7 (2.26–14.5) <0.001 3.12 (1.06–9.1) 0.038 *Adjusted for age, hypertension, diabetes, BMI, global longitudinal strain, E/e', LA volume index, LV mass index (all p<0.1 on univariable analysis).
Incorporating LA strain in practice

Conclusion
DD defined by LASr is predictive of HF for grades ≥2 independent of other diastolic measures. Indeterminate diastolic function with LASr ≤23% is associated with incident HF. LASr may complement current diastolic function assessment recommendations.

Acknowledgement/Funding
Baker Heart and Diabetes Institute
P1486Semi-automated volume-strain loops: a new tool in TTE to assess diastolic dysfunction
Authors: Hubert A , Le Rolle V , Galli E , Hernandez A , Donal E 
Published: October 2019

Abstract

Aim
This work aims to evaluate a novel semi-automatic tool for the assessment of volume-strain loops by transthoracic echocardiography (TTE). The proposed method was evaluated on a typical model of left ventricular (LV) diastolic dysfunction: the cardiac amyloidosis.

Method
18 patients with proved cardiac amyloidosis were compared to 19 controls, from a local database. All TTE were performed using Vivid E9 or E95 ultrasound system. The complete method includes several steps: 1) extraction of LV strain full traces from apical 4 and 2 cavities views, 2) estimation of LV volume from these two traces by spline interpolations, 3) resampling of LV strain curves, determined for the same cardiac beat, (in apical 4-, 2- and 3- cavities views) as a function of pre-defined percentage increments of LV-volume and 4) calculation of the LV volume-strain loop area. (Figure 1, panel B)

Results
(Table 1): LVEF was similar between both groups whereas global longitudinal strain was significantly lower in amyloidosis group (−14.4 vs −20.5%; p<0.001). Amyloidosis group had a worse diastolic function with a greater left atrial volume index (51 vs 22ml/m2), a faster tricuspid regurgitation (2.7 vs 2.0 m/s), a greater E/e' ratio (17.3 vs 5.9) with a p<0.001 for all these indices. Simultaneously, the global area of volume-strain loop was significantly lower in amyloidosis group (36.5 vs 120.0%.mL). This area was better correlated with mean e' with r=0.734 (p<0.001) than all other indices (Figure 1, panel A).
Table 1 Amyloidosis (N=18) Controls (N=19) p Global strain-volume loop area (%.mL) 36.5±21.3 120.0±54.2 <0.001 Global longitudinal strain (%) −14.4±3.8 −20.5±1.8 <0.001 Left ventricular ejection fraction (%) 62±7 65±5 0.08 Left atrial volume index (ml/m2) 51±22 22±5 <0.001 E/A 1.72±0.97 2.07±0.45 0.17 Mean e' 5.5±1.3 14.4±2.8 <0.001 Mean E/e' 17.3±5.4 5.9±1.4 <0.001 Tricuspid regurgitation velocity (m/s) 2.7±3.8 2.0±0.3 <0.001
Figure 1

Conclusion
LV volume-strain loop area appears a very promising new tool to assess semi-automatically diastolic function. Future applications will concern the integration of LV volume-strain loop area as novel feature in machine-learning approach.
P1488Single wave mitral inflow pattern caused by left ventricular diastolic dyssynchrony in patients with heart failure
Authors: Takemoto K T , Hirata K , Akasaka T A 
Published: October 2019

Abstract

Background
Mitral E and A waves could fuse to form a single wave in tachycardia. Patients with heart failure (HF) occasionally show single wave mitral inflow despite of non-tachycardiac condition.

Purpose
To investigate mechanisms of single wave mitral inflow in HF patients with sinus rhythm and normal heart rate.

Methods
A total of 60 HF patients, including 20 single wave (SW), 20 impaired relaxation (IR) and 20 pseudonormalized (PN) mitral inflow patterns were retrospectively enrolled. All the patients were in sinus rhythm under 85 bpm. Patients with bundle branch blocks and first-degree heart block were excluded. We compared basic echo measurements, magnitude of left ventricular (LV) diastolic dyssynchrony, isovolumic relaxation time (IRT) and BNP levels among 3 groups. Diastolic dyssynchrony was determined as standard deviation of interval between aortic valve closure and peak early diastolic wave of longitudinal strain across 16 LV myocardial segments using 2D speckle tracking echocardiography.

Results
There was no significant difference in heart rate among 3 groups. Patients with SW showed significantly large magnitude of diastolic dyssynchrony (4.1±1.1) compared to those with IR (2.7±0.7) and PN (2.9±0.9ms), respectively. Likewise, IRT of SW (7.1±2.7) was longer than IR (3.2±0.8) and PN (2.4±0.9ms). BNP level in patients with IR (153±111) was significantly lower than those with SW (558±432) and PN (523±263pg/ml).
Representative cases

Conclusion
HF patients with SW could be caused by LV diastolic dyssynchrony and their BNP levels are comparable to those with PN.
P1494Usefulness of longitudinal strain adjusted to regional thickness in hypertrophic cardiomyopathy
Authors: Mansencal N , Utado S , Hauguelf-Moreau M , Mallet S , Charron P , Szymanski C , Dubourg O 
Published: October 2019

Abstract

Background
In hypertrophic cardiomyopathy (HCM), longitudinal strain analysis allows to early detect left ventricular (LV) contraction abnormalities despite preserved LV ejection fraction. In current software, the width of the region of interest (ROI) is the same over the entire myocardial wall, and might analyze partially LV hypertrophic segments.

Purpose
The aim of this study is to evaluate a novel software for strain analysis with an adjustable ROI according to each segment thickness.

Methods
We included 110 patients: 55 patients with HCM (HCM group) and 55 healthy subjects (age- and sex-matched control group). All patients underwent echocardiography using a Vivid 9 GE system and measurements were performed using EchoPAC software. Global longitudinal strain (GLS) and regional strain for each of the 17 segments was calculated with standard software (for 2 groups) and with software adjusted to the myocardial wall thickness (for HCM group).

Results
GLS was significantly decreased in the HCM group as compared to the control group (−15.1±4.8% versus −20.5±4.3%, p<0.0001). In HCM group, GLS (standard method versus adjusted to thickness) were not significantly different (p=0.34). Interestingly, regional strain adjusted to thickness was significantly lower than standard strain in hypertrophic segments, especially in basal inferoseptal segment (p=0.0002), median inferoseptal segment (p<0.001) and median anteroseptal segment (p=0.02). Strain adjusted to thickness was still significantly lower in the most hypertrophic segments (≥20 mm) (−3.7±3%, versus −5.9±4.4%, p=0.049 in the basal inferoseptal segment and −5.7±3.5% versus −8.3±4.5%, p=0.0007 in the median inferoseptal segment). Analysis of strain adjusted to thickness had a better feasibility (97.5% versus 99%, p=0.01).

Conclusion
Analysis of longitudinal strain adjusted to regional thickness is feasible in HCM and allows a better evaluation of myocardial deformation, especially in the most LV hypertrophic segments.
P1497Reversible exercise-induced left ventricular dysfunction in symptomatic patients with previous Takotsubo syndrome - Insights from exercise echocardiography
Authors: Yakupoglu H Y , Saeed S , Manivarmane R , Senior R , Lyon A R , Khattar R S 
Published: October 2019

Abstract

Introduction
Takotsubo syndrome (TTS) is an acute heart failure syndrome usually associated with rapid and spontaneous recovery of left ventricular (LV) function. However, approximately 10% of patients have persistent symptoms and seek further medical advice.

Purpose
To determine the cardiovascular haemodynamic and LV contractile response to exercise in these TTS survivors with ongoing symptoms.

Methods
This was a case-control study of 20 symptomatic patients with previous TTS referred for treadmill exercise echocardiography (EE), and 20 age-, sex- and ethnicity-matched control subjects with normal treadmill EE. Among the TTS group, EE was performed at a median of 8 months (mean 17±21 months) following the index event. Demographic characteristics, resting and EE data were collected. LV ejection fraction (EF) was measured at rest and peak stress. Global longitudinal and circumferential strain (GLS, GCS) were measured at rest.

Results
All 20 TTS patients were Caucasian postmenopausal females (mean age 63.5±6.6 years). There were no significant differences in body mass index (BMI), resting heart rate (HR) and the prevalence of cardiovascular risk factors compared to controls. Resting systolic and diastolic blood pressure (SBP, DBP) were higher in TTS patients (144±17 mmHg versus 128±18 mmHg, and 81±10 mmHg versus 74±9 mmHg, respectively). A comparative analysis of the resting and stress echo data is given in Table 1. The stress echo data showed similar exercise time and peak HR, but higher peak SBP in TTS patients. TTS patients had blunted contractile response to exercise with lower peak LVEF, ΔLVEF (exercise minus resting EF) and peak wall motion score index (WMSI) compared to controls. Among the 20 TTS patients, 12 had exercise-induced wall motion abnormalities: 6 involved the apical segments and 6 developed global dysfunction. In these 12 patients, the mean ΔLVEF was reduced (4%). In the other 8 patients, the ΔLVEF was 16% and pooled the TTS cohort had blunted contractile response with exercise compared to controls (ΔLVEF 8% vs. 19% in the control group, p=0.001).
Table 1

Conclusions
Our study shows that symptomatic patients with previous TTS have a blunted contractile response to exercise manifest as reversible apical or global LV dysfunction. These findings might indicate the need for treatment. Further systematic investigation of the therapeutic and prognostic implications of this reversible exercise-induced myocardial dysfunction is needed.