bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-resolution analysis with multiphase computed tomography of the left atrio-ventricular junction in mitral annular disjunction
Authors: Jouan J , Masari I , Bliah V , Soulat G , Craiem D , Mousseaux E 
Published: November 2020

Abstract

Background
Mitral annular disjunction (MAD) has been associated with myxomatous mitral valve disease (MMVD) but functional analyses of the mitral annulus (MA) and the entire left atrio-ventricular junction (LAVJ) are lacking from high-resolution imaging to understand MAD physiopathology.

Purpose
Using multiphase cardiac computed tomography imaging (4D-MCCTI), we aimed at characterizing the morphological changes of MA and LAVJ throughout the cardiac cycle.

Methods
Volume imaging data sets through time were obtained from 4D-MCCTI of 2 groups of 10 patients as defined by echocardiographic diagnosis of MMVD and/or MAD: MMVD+MAD+, MMVD+MAD− and 20 case-controls without mitral regurgitation (MMVD−). Data were implemented in a custom software for 3D semi-automated delineation of 18 points around MA perimeter. Coordinates of these points in each of the 10 time-phases within an RR interval were used for MA reconstruction and calculation of areas, perimeters, 360°-diameters and parameters of planar/vertical deformation. Subsequently, left ventricle (LV) and left atrium (LA) inner contours were delineated.

Results
Groups were similar for age, body surface area and LV ejection fraction. Compared to the 2 other groups, MA expansion in MMVD+MAD+ started early after end-diastole, following LA expansion, and reached a maximum at end-systole (ES): 3D-area ES: 13.9±4.0cm2/m2, 3D-perimeterE S: 10.4±1.6cm/m2 versus respectively 8.8±3.0cm2/m2, 7.9±1.4cm/m2 in MMVD+MAD− (p&lt;0.001) and 6.1±1.3cm2/m2, 7.0±1.1cm/m2 in MVVD− (p&lt;0.001). However throughout the cardiac cycle, MA perimeter reduction was not altered in MMVD+MAD+: −14.0±6.3%, compared to MMVD+MAD−: −10.1±5.6% and MMVD−: −8.7±2.3% (p=0.09). MA shape modification was different in MMVD+MAD+ group, MA becoming more elliptical during systole, whereas MA reached a minimal eccentricity index (EcI) at ES in both MMVD+MAD− and MMVD− groups: EcIES = 0.63±0.09 versus 0.52±0.15 and 0.49±0.13 (p=0.04), respectively (Figure). Surprisingly, vertical deformation of MA increased during early systole in MMVD+MAD+ group when MA became more planar in the MMVD+MAD− and MMVD− groups.

Conclusions
MA function was globally preserved in MAD but was desynchronized with respect to LV contraction.
Eccentricity index of mitral annulus

Funding Acknowledgement
Type of funding source: None
The utility of coronary artery calcium in non-gated high resolution CT thorax scans in predicting cardiac events as compared to the Framingham risk score: a retrospective study
Authors: Saluja S , Contractor H , Daniells M , Sobolewska J , Khan K , Mitchell L , Saluja S , Jiang X , Anderson S.G 
Published: November 2020

Abstract

Background
There is existing evidence to suggest a correlation between coronary artery calcification (CAC) measured using ECG-triggered chest computed tomography and cardiovascular disease. Further evidence has emerged to suggest a correlation between CAC measured using non-gated CT scans and cardiovascular disease. Herein, we sought to ascertain the utility of incidental findings of CAC on non-triggered high resolution CT (HRCT) thorax used for patients undergoing lung cancer screening or follow-up for interstitial lung disease and Framingham risk score (FRS) in predicting cardiovascular events.

Methods
The Computerised Radiology Information Service (CRIS) database was manually searched to determine all HRCT scans performed in a single trust from 05/2015 to 05/2016. The reports issued by Radiologists and images of selected studies were reviewed. For patients with CAC, we calculated the calcium score for patients using the Agatston method. Clinical events were determined from the electronic medical record without knowledge of patients' CAC findings. For these patients, the Framingham Risk Score (FRS) was also calculated. The primary end point of the study was composite of all-cause mortality and cardiac events (non-fatal myocardial infarction, coronary revascularization, new atrial fibrillation or heart failure episode requiring hospitalization).

Results
We selected 300 scans from a total of approximately 2000 scans performed over this time. Data at follow up was available for 100% of the patients, with a median duration of follow up of 1.6 years. Moderate to severe CAC was found in 35% of people. Multivariable analysis showed good concordance between CAC and FRS in predicting composite clinical end point. The Odds Ratio for cardiac events in patients with moderate to severe CAC was 5.3 (p&lt;0.01) and for composite clinical end point was 3.4 (p&lt;0.01). This is similar to the OR predicted by the FRS: 4.8; p&lt;0.01 and 3.1; p&lt;0.01 respectively. Only 6.2% of patients with moderate to severe CAC were currently statin treated.

Conclusion
In this retrospective study of patients with respiratory disease attending for HRCT scanning, co-incidentally detected CAC predicts cardiac events, with good concordance with the FRS. The incidental finding of CAC on non-gated CT scanning should be reported with Agatston score calculation allowing consideration of intervention to mitigate cardiovascular risk and optimize. Further multi-centre prospective studies of this strategy, with a larger patient cohort should be conducted to clarify the utility of CAC as a prediction tool to modify cardiac risk.

Funding Acknowledgement
Type of funding source: None
The painful chest pain history: improving risk stratification with coronary calcium score
Authors: Teo H.K , Lim L.M , Aurangzeb A , Koh S.Y , Huang Z.J , Ho J.S , Tan S.Y , Huang W.T 
Published: November 2020

Abstract

One of the commonest presentations to the Cardiology outpatient clinic is chest pain. Conventional risk scores for predicting coronary artery disease (CAD) depend greatly on chest pain histories which can be subjective and disadvantage individuals who present with less typical symptoms. The coronary calcium score (CACS) has a quick turnabout time and is an objective marker of atherosclerosis which can provide actionable information on presence of coronary artery disease.
This study aims to explore a) if CACS can be a surrogate for chest pain history to better manage patients with atypical presentations, and b) determine the feasibility of utilising CACS in a new risk model as a form of triage for chest pain in the outpatient specialist setting.
Two cohorts of patients who underwent CT Coronary angiogram (CTCA) were used: Asymptomatic patients with no obstructive coronary artery disease (CAD) and patients with symptomatic chest pain. The readouts of the CTCA include presence or absence of obstructive CAD (epicardial artery stenosis ≥50% on CTCA) and the CACS. In the asymptomatic cohort, we derived the formula for the median predicted CACS using latent class analysis and quantile regression with age and gender.
The symptomatic cohort was divided into derivation and validation groups. Multivariate logistic regression was used to select significant risk factors for CAD and develop the prediction model. The presence of a ≥10-point difference between the patient's actual CACS and predicted median CACS was established as a predictive parameter. Performance of the model was assessed and compared with the CAD I consortium score using area under the curve (AUC), net classification index and integrated discriminative index in the validation group.
In the asymptomatic cohort of 1911 persons, gender and age were significant factors used to calculate median predicted CACS. In the derivation cohort of 2345 patients, a CACS of 10-point difference between patient's CACS and predicted medium calcium score had a negative predictive value of 96.8%. Performance AUC (Figure 1) of the various models were: new model with chest pain history 0.887 (95% CI 0.858–0.916); without chest pain history 0.884 (95% CI 0.854–0.913); CAD I Consortium score 0.746 (95% CI 0.707–0.784). Both models performed significantly better than calcium score alone, p-value = 0.011.
Coronary calcium score is an objective measure of coronary atherosclerosis and appears to be a reliable surrogate for chest pain history. A new risk marker of positive 10-points difference between patient's calcium score and predicted median calcium score can potentially better risk stratify patients presenting with chest pain in the outpatient setting.

Funding Acknowledgement
Type of funding source: None
Downstream testing after an halted coronary CT angiography due to high coronary artery calcium score
Authors: Gama F , Rocha B , Freitas P , Ferreira A , Abecasis J , Guerreiro S , Saraiva C , Santos A.C , Andrade M.J , Ventosa A , Almeida M , Pintao S , Mendes M 
Published: November 2020

Abstract

Background and aim
In many centers, coronary artery calcium score (CACS) is performed immediately before coronary CT angiography (CCTA) in order to exclude heavy calcification that could hamper test performance. When high CACS values are found, CCTA is usually aborted and other tests suggested. However, there are no recommendations on which test to pursue, and little data on their diagnostic yield in this setting. The aim of this study was to assess the type and results of downstream testing among patients whose CCTA study was halted due to high CACS.

Methods
Single-centre retrospective study of consecutive patients undergoing CCTA for suspected obstructive coronary artery disease (CAD). A CACS threshold of &gt;400 was generally used to cancel CCTA. Downstream testing and its results were assessed using electronic medical records. A group of consecutive patients with CACS &lt;400 who underwent CCTA was used for comparison.

Results
Of the 795 patients who performed CCTA for suspected CAD, 86 (10.8%), had their test halted due to high CACS (57 men, mean age 71±11 years). In this subgroup, the median pre-test probability for CAD was 27% (interquartile range 25) and the median CACS was 983 (interquartile range 930). Compared to patients who underwent CCTA, those who saw their tests cancelled were older, more frequently male, and had higher prevalence of cardiovascular risk factors and higher pre-test probability for CAD.
Patient's downstream testing is illustrated in Figure. From the 86 patients enrolled, 12 are currently waiting for downstream tests and were excluded from further analysis. Overall, 35 patients ended up performing invasive coronary angiography (ICA, 47.3%) of whom 19 (54.3%) had significant CAD. Among those who underwent non-invasive testing (N=19, 25.7%), 10 (52.6%) had significant ischemia and 4 (21%) underwent additional testing with ICA. In 24 patients (32.4%), no downstream testing was pursued. Finally, 17 (22.3%) patients underwent coronary revascularization, either percutaneous (N=10, 13.5%) or surgical (N=7, 10.8%).

Conclusion
Invasive coronary angiography is the most frequently used downstream test when CCTA is halted due to high CACS values, and shows significant CAD in roughly half of the cases. Considering the high prevalence of significant CAD, direct referral for ICA (with the possibility of invasive functional testing) seems a reasonable approach.

Funding Acknowledgement
Type of funding source: None
Association of coronary high-intensity plaque on T1-weighted magnetic resonance imaging and circulating malondialdehyde-modified low-density lipoprotein levels with cardiac events
Authors: Hiraya D , Sato A , Hoshi T , Watabe H , Ieda M 
Published: November 2020

Abstract

Background
Although elevated oxidized low-density lipoprotein could play critical roles in vulnerable plaque, there are no studies that compared coronary high-intensity plaque (HIP) on non-contrast T1-weighted magnetic resonance imaging (T1WI_MRI) and circulating malondialdehyde-modified low-density lipoprotein (MDA-LDL) levels for the prediction of cardiac events.

Methods and results
A total of 139 patients with coronary artery stenosis (&gt;70%) were examined with non-contrast T1WI using a 1.5-T MRI (HIP: n=63, non-HIP: n=76). Scheduled percutaneous coronary intervention (PCI) for culprit lesions was performed within 48 h after MRI. HIP was defined as a signal intensity of coronary plaque to cardiac muscle ratio (PMR) of ≥1.4. At admission, circulating levels of MDA-LDL and other lipid-related markers were measured. We evaluated the subsequent cardiac events, which were defined as major adverse cardiac events (MACE; cardiac death, myocardial infarction, and/or ischemia-driven PCI) during follow-up periods (5.6±1.3 years). Circulating MDA-LDL levels were significantly higher in patients with HIP than in those without HIP (p&lt;0.0001). MDA-LDL levels were significantly correlated with PMR (r=0.490, p&lt;0.0001). In multivariable logistic regression analysis, MDA-LDL levels were independently associated with the presence of HIP (OR 1.05; 95% CI, 1.02–1.08, p&lt;0.0001). The incidence of MACE was significantly higher in patients with HIP (27%) than in those without HIP (5%; p=0.011 by the log-rank test). In the multivariable Cox proportional hazard analysis, the MDA-LDL levels (HR 1.03; 95% CI:1.01–1.05, p=0.007) and PMR (HR 2.39; 95% CI:1.19–4.65, p=0.016) were significantly associated with MACE. For MACE prediction, the C-statistic values for MDA-LDL, PMR, and PMR+MDA-LDL were 0.724, 0.791, and 0.800, respectively. Compared with MDA-LDL alone, the addition of PMR to MDA-LDL increased the net reclassification improvement by 0.78 (p=0.012).

Conclusions
MDA-LDL levels might be associated with the presence of HIP in patients with coronary artery disease. Furthermore, adding PMR to MDA-LDL levels markedly improved MACE prediction.

Funding Acknowledgement
Type of funding source: None
Left ventricular septal convexity in differentiating hypertrophic cardiomyopathy from hypertensive heart disease – cardiac MRI study
Authors: Tarkiainen M , Sipola P , Jalanko M , Helio T , Jaaskelainen P , Magga J , Peuhkurinen K , Husso M , Kivela K , Laine M , Lauerma K , Kuusisto J 
Published: November 2020

Abstract

Background
Subjects with hypertrophic cardiomyopathy (HCM) and hypertensive heart disease (HHD) have left ventricular hypertrophy (LVH). It is a common clinical problem to distinguish HCM from HHD. Septal convexity (SC) into the left ventricle is increased in subjects with hypertrophic cardiomyopathy (HCM)-causing mutations with and without LVH.

Purpose
Our objective was to study if SC by cardiac magnetic resonance (CMR) differentiates between HCM and HHD.

Methods
We measured SC in 29 subjects with hypertension and LVH (left ventricular maximal wall thickness (LVMWT) ≥13 mm), in 49 subjects with HCM (LVMWT ≥13 mm) caused by the D175N mutation in the alpha-tropomyosin (TPM1) or the Q1061X mutation in the myosin binding protein C (MYBPC3) genes, and in 20 healthy controls with no LVH. SC into the LV was measured in end-diastolic 4-chamber images as the maximal distance between LV septal endocardial border and a line connecting septal mid-wall points at the level of tricuspid valve insertion and at the level of apical right ventricular insertion on the LV.

Results
Subjects with HCM had significantly increased septal convexity compared to subjects with HHD both in non-indexed and in BSA-indexed measurements (10.7±4.0 mm vs 4.9±2.7 mm, P&lt;0.001 and 5.5±2.1 mm/m2 vs 2.4±1.3 mm/m2, P&lt;0.001). To differentiate between HCM and HHD, septal convexity cutoff value of 7.85 mm performed best with sensitivity of 77% and specificity of 90%. BSA-indexed SC cutoff value of 3.68 mm differentiated between HCM and HHD with sensitivity of 81% and specificity of 86%.

Conclusions
CMR derived septal convexity is easily measured and is useful in discriminating between HCM caused by sarcomere mutations versus HHD.
Measurement of septal convexity

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Finnish Foundation of Cardiovascular Research, the special governmental subsidy for health sciences research of the University Hospital of Kuopio
In-depth phenotyping of cardiac diseases by MRI in HIV-positive people reveals diverse and independent forms of myocardial involvement
Authors: Arendt C , De Leuw P , Haberl A , Stephan C , Vasquez M , Arcari L , Zhou H , Zainal H , Albrecht M , Vogl T , Zeiher A , Nagel E , Puntmann V 
Published: November 2020

Abstract

Background
It is increasingly recognised that non-ischaemic and ischaemic myocardial involvement represent important drivers of cardiac diseases in people living with HIV (PLWH). Non-invasive measurements with cardiac magnetic resonance (CMR) directly inform on the type of myocardial damage.

Purpose
To screen for the prevalence and type of cardiovascular disease (CVD) in PLWH using stress CMR in a cohort with highly active antiretroviral therapy (HAART).

Methods
This prospective cross-sectional study enrolled consecutive PLWH undergoing standardised evaluation for CVD using imaging. All participants underwent a standardised CMR protocol in a 3 Tesla scanner for function and volumes (cine), stress perfusion (regadenosone), scar (late gadolinium enhancement (LGE)), diffuse fibrosis (native T1-mapping) and oedema (native T2-mapping). Blood samples were additionally collected prior to CMR.

Results
141 participants were identified (n=32 in category C/AIDS). 16 patients had previously documented (n=23) myocardial diseases: myocarditis, n=1 non-obstructive coronary artery disease (CAD), n=8 myocardial infarction, n=3 congestive heart failure, n=3, and arrhythmia, n=8. Mean value for hs-cTnT, CRP and NT-proBNP was 9±18ng/l, 0.3±0.6mg/l and 104±229ng/l. 14 subjects had impaired LV-EF (&lt;50%) and 35 presented borderline LV-EF (50–55%). Myocardial LGE was present in 28 patients: non-ischemic pattern, n=16, ischemic pattern, n=11, and both patterns, n=1. Two patients had relevant inducible ischaemia, whereas a pattern of microvascular disease (MVD) was found in 26 patients. 72 subjects had diffuse fibrosis and 25 had active inflammation. Elevated native T1/T2 was significantly associated with low (&lt;350/μl), current, and initial CD4-count (χ2=5.317, p=0.021; χ2=3.841, p=0.050), just as with category C/AIDS (χ2=4.949, p=0.026). Native T2 showed a significant correlation with initial CD4-count (r=−0.252, p=0.008) and current NT-proBNP (r=0.190, p=0.030), but not with other laboratory values.

Conclusions
CMR in PLWH reveal high prevalence of cardiac involvement, which is predominantly non-ischaemic inflammatory in origin. MVD is a major presentation compared to relevant ischaemia due to epicardial CAD. Individual cardiovascular risk assessment in PLWH using CMR may bear a potential for personalised treatment.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The German Centre for Cardiovascular Research (DZHK)
Right ventricular functional changes detected by CMR during ajmaline challenge in patients with Brugada syndrome
Authors: Tondi L , Mecarocci V , Sturla F , Pica S , Giannelli L , Ciconte G , Camporeale A , Santinelli V , Lombardi M , Pappone C 
Published: November 2020

Abstract

Background
3D echocardiography has recently revealed alterations of right ventricular (RV) function in Brugada syndrome (BrS) during ajmaline challenge (AC). Cardiac magnetic resonance (CMR) is the gold standard for functional and anatomical RV assessment. CMR feature-tracking (FT) analysis is able to detect subtle functional changes in the underlying myocardial substrate.

Purpose
To investigate RV functional changes during AC in BrS patients using CMR-FT analysis.

Methods
24 consecutive BrS and 28 matched controls underwent CMR. CMR protocol included paraxial and parasagittal cine bSSFP sequences, acquired before and 2÷5 minutes after ajmaline infusion (1 mg/kg in 5 minutes), to obtain a comprehensive evaluation of the RV free wall. All patients were closely monitored with ECG. Semi-automatic threshold-based quantification of ventricular volumes, function and mass was performed in QMass. CMR-FT analysis of RV function was performed in QStrain. Values of longitudinal strain (LS) and transverse displacement (TD) of the RV wall before and after AC were compared in BrS patients and in the control group.

Results
AC induced Type 1 ECG pattern in all BrS patients and no ECG changes in controls. In BrS patients TD of the RV free wall was significantly reduced (P≤0.003) at peak ajmaline effect; controls reported sub-millimetric TD changes. LS of the RV wall was significantly impaired in BrS patients (P&lt;0.0001) on both b SSFP sequences; LS remained comparable (P=0.62) in controls on the parasagittal sequence; minor but not negligible (P=0.01) LS changes were noticed on the paraxial stack. (Table 1)

Conclusions
In patients with BrS CMR-FT analysis during AC unveils dysfunctional RV wall mechanics in areas generally associated with abnormal electrical activity.
TD and LS in a Brs patient post AC

Funding Acknowledgement
Type of funding source: None
Reproducibility of left atrial assessment in cardiac magnetic resonance imaging
Authors: Alfuhied A , Marrow B , Gulsin G , Steadman C , McCann G.P , Singh A 
Published: November 2020

Abstract

Background
Left atrial (LA) volume and strain are recognised as predictors of adverse outcomes in cardiovascular disease. We aimed to determine the test-retest reproducibility of LA assessment derived from cardiac MRI in subjects with and without cardiovascular disease.

Methods
38 participants had two MRI scans a week apart: aortic stenosis (n=16); type 2 diabetes (n=16) and healthy volunteers (n=6). Images were analysed by a single trained observer using Medis v3.1, medical imaging system, Leiden, Netherlands. LA strain and strain rate were assessed with Feature Tracking (QStrain v2.0), corresponding to LA reservoir, conduit, and contractile function. LA ejection fraction (LAEF) was calculated using biplane area-length method (QMass v8.1). Both were assessed on 4- and 2-chamber long-axis standard steady-state free precession cine images, and average values calculated.

Results
As shown in the table, the test-retest reproducibility for strain and strain rate was moderate for reservoir phase (CoV 25–28%, ICC ∼0.70) and poor for conduit and contraction phases (CoV&gt;40%). The test-retest repeatability for LA volumes and LAEF was good (CoV 16–29%, ICC≥0.70).

Conclusion
LA strain assessment using feature tracking is a poorly reproducible technique on CMR. However, good test-retest reproducibility for LA volumes and EF.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.