bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predicting pacemaker implantation after TAVR with procedural CT
Authors: Gama F , Teles R.C , Oliveira A , Brizido C , Goncalves P , Brito J , Ferreira A , Abecasis J , Almeida M , Mendes M 
Published: November 2020

Abstract

Background and aim
The need for permanent pacemaker implantation (PPMI) is a burdensome complication of transcatheter aortic valve replacement (TAVR). Calcium distribution in the aortic-valvular complex (AVC) and, more recently, membranous septum (MS) length seem to be surrogate markers for conduction abnormalities after specific last generation balloon and self-expandable expandable valves. We sough to evaluate whether such pre-procedural association remains across the entire device spectrum.

Methods
Single-centre prospective study of 239 consecutive patients (140 women, median age of 84) with severe symptomatic aortic stenosis patients who underwent ECG-gated contrast-enhanced multi-detector computed tomography (MSCT) before TAVR since Jun/2017. Exclusion criteria were those with previous PPMI, previous bioprothesis, congenital bicuspid valve, and poor imaging quality. The J-score with an 850-Hounsfield unit threshold was used to detect areas of calcium in the region of interest. AVC was characterized by leaflet sector and region, using 3mensio Valves software 7.0 TM. An independent team retrospectively measured MS length blindly by determining the thinnest part of the interventricular septum in the coronal view in the better-defined systolic phase (usually at 40% of the R-R interval, Figure). Device selection (75.8% self-expandable devices, 20.1% balloon expandable, 3.1% other) and positioning were performed according to the operator criteria. Final implant depth was assessed based on the pre-release angiogram or final aortography.

Results
Mortality at 30-days was 1.3% and PPMI occurred in 43 patients (18%). Median MS length was 9.59mm (IQR: 3.11mm). After multivariable logistic regression analysis, MS length emerged as the single significant protective predictor for PPMI (OR: 0.14; 95% 95% CI: 0.05–0.42; p&lt;0.001), independently of the device used (p&lt;0.001). MS length showed strong discriminatory ability for PPMI (c-statistic 0.93; 95% CI 0.88–0.99). Sensitivity/specificity decision plots yielded an MS length of 6.9 mm as the optimal cut-off point for predicting the need for PPMI with a positive and negative predictive value of 91% and 93%, respectively (Figure). There wasn't any calcium accumulation within a specific region of AVC that independently predicted the outcome.

Conclusion
In our experience, a short membranous septum was strongly and independently associated with new permanent pacemaker implantation, regardless of the device type.
Our findings suggest that this simple measure should be routinely made to help device selection and implantation technique.

Funding Acknowledgement
Type of funding source: None
Extracting hypertrophic cardiomyopathy features from cardiac magnetic resonance reports by natural language processing
Authors: Dewaswala-Bhopalwala N , Chen D , Bhopalwala H , Hossein Pour S , Moon S , Bos D , Scott C , Geske J , Noseworthy P , Ommen S.R , Erickson B.J , Araoz P.A , Nishimura R.A , Ackerman M.J , Arruda-Olson A.M 
Published: November 2020

Abstract

Objective
Determine if information regarding hypertrophic cardiomyopathy (HCM) can be accurately retrieved from cardiac magnetic resonance (CMR) reports using natural language processing (NLP).

Background
CMR imaging is used for diagnosis and risk stratification of HCM. Manual annotation of information from CMR is time-consuming. NLP is an artificial intelligence method for automating extraction of information from narrative text.

Methods
We identified 200 HCM patients who had CMR reports from 1998 to 2018. These patients were randomly allocated into training (100 patients with 185 CMR reports) and testing sets (100 patients with 206 reports). An NLP system with 2 tiers was developed; the first extracted information regarding HCM diagnosis while second extracted categorical or numeric concepts for HCM classification. NLP performance was compared with gold-standard manual annotation.

Results
NLP algorithms achieved very high performance across all concepts with mean positive predictive value (PPV) = 0.96. An outlier was the performance for abstracting the presence of an apical pouch from CMR reports, which had noticeably lower PPV= 0.78 which be attributed to the low number of cases with this finding.

Conclusions
The algorithms developed can be translated to clinical decision support systems to increase efficiency and contribute to improved quality of care.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Study supported by the National Heart, Lung and Blood Institute of National Institutes of Health (K01HL124045), the Mayo Clinic Center for Clinical and Translational Science (CCaTS), and the Mayo Clinic K2R award. Content is solely the responsibility of authors and does not necessarily represent official views of the National Institutes of Health.
UK national and regional trends in cardiovascular magnetic resonance usage – the British Society of CMR survey results
Authors: Keenan N , Captur G , McCann G , Berry C , Myerson S , Fairbairn T , Hudsmith L , O'Regan D , Westwood M , Greenwood J 
Published: November 2020

Abstract

Background
CMR is an imaging modality recommended for multiple indications. Access to CMR is a key issue for its clinical use. We surveyed all CMR units in the UK.

Methods
An online survey of CMR units in the UK, with responses analysed by region and compared with population data.

Results
Response rate was 100% (Table). The UK performed a total of 102,886 scans in 2017, and 117,967 in 2018 representing a 1-year 14.7% increase and a 10-year increase of 573% compared to 2008 data (20,597).By head of population in 2018 there were 1,776 CMR scans per million people, with significant variation nationally and regionally, e.g. 4,256 per million in London vs. 396 per million in Wales (Figure). Mean number of scans per unit was 1,404, (range 98–10,000) with wide variation in referral to diagnostic times (mean 45.7 days, range 5–180) (Figure).
Clinical indications for CMR were: heart failure 21%, cardiomyopathy 27%, function and viability 22%, stress 24%, vascular disease 5%, valvular 5%, myocarditis/pericardial 10%, paediatric /congenital 10%, others e.g. transplant/masses 4%, with overlap. There were 358 consultants reporting CMR in 2018 (234 (65%) cardiologists and 124 (35%) radiologists). 81% of units had a CMR service for patients with pacemakers and defibrillators.

Conclusion
The survey shows the state of CMR in the UK. The 10-year growth has been remarkable, but there are wide disparities in terms of use, access and wait times with potential implications for clinical care. Action is needed to make access equitable across the UK.
Figure 1

Funding Acknowledgement
Type of funding source: None
Safety and hemodynamic response of regadenoson stress cardiovascular magnetic resonance imaging in heart transplant recipients
Authors: Muniz Saenz Diez J , Luque Gonzalez M , Martinez Leon A , Ibero Valencia J , Iglesias Colino E , Riesgo Garcia A , Shangutov Kulichok O , De La Torre Carazo F , Rodriguez Junquera M , Irazusta Olloquiegui X , Soriano Aguadero I , Caballeros M , Salterain Gonzalez N , Rabago Juan Aracil G , Bastarrika G 
Published: November 2020

Abstract

Background
The non-invasive detection of coronary allograft vasculopathy remains a challenge, and there is no consensus about which technique should be used. The hypersensitivity to vasodilator drugs (such as adenosine) of heart transplant recipients may have limited the use of stress cardiovascular magnetic resonance imaging (stress-CMR) in this group of patients. Regadenoson is a more specific agonist of adenosine receptors. There is still little data on its safety profile and the hemodynamic response it causes in these patients.

Purpose
We aimed to observe safety and hemodynamic response to regadenoson in heart transplant recipients.

Methods
We studied 505 consecutive patients (22 transplanted and 483 non-transplanted) who underwent stress-CMR between 06/06/2017 and 10/10/2019. We compared the hemodynamic response (blood pressure and heart rate) and the adverse effects and symptoms caused by regadenoson in both groups. Student t test and χ2 were used to compare the continuous and the qualitative variables between both groups, respectively.

Results
In transplant patients there were no events requiring finalization of the test (e.g. atrioventricular block, symptomatic arterial hypotension or poor tolerance to the symptomatic response to regadenoson). There were no differences in the incidence of symptoms after drug administration in transplanted versus non-transplanted patients (50% vs. 50.4%, p=0.97), and all of those symptoms were transient and well tolerated. Transplant recipients presented an attenuated hemodynamic response compared to non-transplanted patients (Table 1).

Conclusions
Stress-CMR with regadenoson is a safe and well tolerated technique in heart transplant recipients. In this group of patients, the hemodynamic response is blunted compared to non-transplanted patients. This lower response has been previously described in obese and diabetic patients, and it does not appear to affect the performance of the test. Further studies should confirm these findings.

Funding Acknowledgement
Type of funding source: None
Feasibility and prognostic value of vasodilator stress perfusion CMR in patients with atrial fibrillation
Authors: Pezel T , Sanguineti F , Kinnel M , Bonnet G , Landon V , Hovasse T , Garot P , Unterseeh T , Champagne S , Louvard Y , Morice M.C , Garot J 
Published: November 2020

Abstract

Background
Several studies have demonstrated the consistently high diagnostic and prognostic value of stress perfusion imaging with cardiovascular magnetic resonance (CMR). The feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with atrial fibrillation (AF) is unknown, because most studies have excluded arrhythmic patients from analysis.

Purpose
The aim of our study was to assess the technical feasibility and the prognostic value of vasodilator stress perfusion CMR in patients with AF.

Material
Between 2008 and 2018, we prospectively included consecutive patients with AF referred for vasodilator stress perfusion CMR with dipyridamole. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or non-fatal myocardial infarction (MI). The secondary outcome was all-cause mortality. The diagnosis of AF was confirmed on 12-lead ECG before and after CMR, and patients with sinus rhythm during CMR were excluded. In the CMR protocol, to limit AF-related artifacts on cine images, an arrhythmia rejection algorithm, or real-time sequences were used. Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR.

Results
Of 639 patients with AF and suspected or stable chronic CAD (72±9 years, 77% men), 602 (94%) completed the CMR protocol, and among those 538 (89%) completed the follow-up (median follow-up 5.1 (3.3–7.1) years). Reasons for failure to complete CMR included AF-related ECG-gating problems (n=17), intolerance to stress agent (n=7), renal failure (n=6), declining participation (n=4) and claustrophobia (n=3).
Stress CMR was well tolerated without occurrence of death or severe disabling adverse event. Patients without inducible ischemia or LGE experienced a substantially lower annual event rate of MACE (1.2%) than those with ischemia and without LGE (8.9%), or those with both ischemia and LGE (9.8%; p&lt;0.001 for all). Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE (hazard ratio HR 7.56; 95% confidence interval CI: 4.86–11.80; p&lt;0.001) (Figure).
In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the presence of inducible ischemia was an independent predictor of a higher incidence of MACE (HR 5.88; 95% CI: 3.70–10.07; p&lt;0.001) and all-cause mortality (HR 2.51; 95% CI: 1.47–4.17; p&lt;0.001).

Conclusion
Stress CMR is technically feasible and has a good discriminative prognostic value to predict the occurrence of MACE and all-cause mortality in patients with AF.
Kaplan-Meier curves for MACE

Funding Acknowledgement
Type of funding source: None
Prevalence of microvascular dysfunction and association with clinical outcomes in heart failure with preserved ejection fraction
Authors: Arnold J , Kanagala P , Budgeon C.A , Jerosch-Herold M.J , Singh A.S , Khan J.N , Gulsin G.S , Squire I.B , Ng L.L , McCann G.P 
Published: November 2020

Abstract

Introduction
Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of symptomatic heart failure. A recently proposed paradigm for the pathophysiology of HFpEF postulates a central inflammatory aetiology with coronary microvascular function at its core. However, the pathophysiological and clinical significance of microvascular dysfunction in HFpEF remains uncertain.

Purpose
Utilising cardiovascular magnetic resonance (CMR), we sought to (1) quantify coronary microvascular function, (2) evaluate the impact of microvascular dysfunction and fibrosis on long-term clinical outcomes and (3) examine the relationship between myocardial perfusion and fibrosis.

Methods
In a prospective, observational study, 147 subjects (104 HFpEF without a prior history or CMR evidence of coronary artery disease, and 43 asymptomatic controls) underwent multiparametric CMR, comprising left ventricular volumetric assessment, absolute quantitation of myocardial blood flow [MBF] during adenosine stress (140mcg/kg/min) and at rest, and evaluation of diffuse myocardial fibrosis (extracellular volume [ECV]). The primary endpoint was the composite of death or hospitalisation with heart failure.

Results
104 HFpEF patients (mean age 73±9 years, mean ejection fraction 56%) and 43 controls (mean age 73±5 years, mean ejection fraction 58%) were studied. There was no significant difference in resting MBF (1.10±0.42ml/min/g in HFpEF subjects vs 1.00±0.38 ml/min/g in controls, p=0.23), though hyperaemic MBF was lower in HFpEF subjects (1.66±0.68 ml/min/g vs 1.97±0.59 ml/min/g, p=0.01). Myocardial perfusion reserve [MPR] was also lower in HFpEF subjects (1.73±0.75 vs 2.22±0.76; p&lt;0.01). Microvascular dysfunction (defined as MPR&lt;2.0) was present in 70% of HFpEF patients (versus 33% of controls, p&lt;0.01). During median follow-up of 3.4 years, there were 46 composite events. MPR was predictive of clinical outcome (one unit increase – hazard ratio [HR] 0.57; 95% CI 0.35–0.92; p=0.02), as was ECV (one standard deviation [SD] increase – HR 1.65; 95% CI 1.14–2.39; p=0.01). However, there was no significant linear correlation between MPR and diffuse fibrosis (r&lt;0.01, p=0.99).

Conclusion
Microvascular dysfunction is highly prevalent in HFpEF and is associated with adverse clinical outcomes. The lack of correlation between abnormal myocardial perfusion and fibrosis challenges the assertion of a direct causal link between these entities.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): NIHR, BHF
Prevalence, correlates and prognostic relevance of mid-wall late gadolinium enhancement in patients with ischaemic cardiomyopathy
Authors: Nucifora G , Tsoumani Z , De Angelis G , Caiffa T , Bradley J , Sinagra G , Miller C , Schmitt M 
Published: November 2020

Abstract

Background
LGE imaging is an established CMR imaging technique for the assessment of myocardial replacement fibrosis. The presence of mid-wall LGE has been described in ∼30% of patients with non-ischemic dilated cardiomyopathy and is known to be associated with poor outcome. Conversely, little is known regarding the clinical significance of mid-wall LGE in patients with ischemic cardiomyopathy (ICM). Aim of the present study was to investigate the prevalence, correlates and prognostic role of mid-wall late gadolinium enhancement (LGE) in a consecutive cohort of patients with ICM.

Methods
A total of 319 consecutive outpatients with ICM (mean age 64±11 years, 87% males) were included. All patients had CMR with LGE imaging and were followed for a median of 13 months. The outcome end-point was a composite of cardiovascular death, aborted sudden cardiac death, appropriate implantable cardioverter-defibrillator therapy, heart failure hospitalisations, implantation of left ventricular (LV) assist device or occurrence of heart transplant.

Results
Mean LV ejection was 37±9%, mean ischemic-type LGE expressed as % of LV mass was 16±9%, while mid-wall LGE was observed in 32 (10%) patients. LVEDV index (OR 1.02, 95% CI 1.01–1.03, p=0.001) and LV sphericity index (OR 1.04, 95% CI 1.01–1.07, p=0.024) were the only variables significantly and independently related to the presence of mid-wall LGE. The outcome end-point was documented in 37 (12%) patients. Ischemic-type LGE expressed as % of LV mass (HR 1.04, 95% CI 1.01–1.08; p=0.015) and the presence of mid-wall LGE (HR 4.5, 95% CI 2.2–9.2; p&lt;0.001) were the only independent predictors of the composite outcome. Mid-wall LGE had significant incremental predictive value compared to the extent of ischemic-type LGE (Δχ2=16.5, p&lt;0.001). The Kaplan-Meier survival curves showing survival from the composite end-point according to the presence/absence of mid-wall LGE in patients with ischemic-type LGE expressed as % of LV mass &lt; the median value 14.6% and. ≥14.6% are shown in the Figure.

Conclusions
Mid-wall LGE is observed in a substantial minority of patients with ICM. In this population, the presence of mid-wall LGE is associated with adverse LV remodeling and worse prognosis.
Figure 1

Funding Acknowledgement
Type of funding source: None
Elevated native T1 values is in myocardial regions supplied by stenotic coronary arteries
Authors: Brodov Y , Matetzky S.M , Konen E.K , Di Segni M.D.S , Younes A.Y , Massalha E.M , Berkovitch A.B , Chernomordik F.C , Goitein O.G 
Published: November 2020

Abstract

Background
T1 mapping is a novel tool allowing robust quantification of myocardial damage.

Purpose
To quantify and compare the native T1 values in myocardial segments supplied by an infarct related artery (IRA) and stenotic and non-stenotic artery (non IRA).

Methods
Consecutive patients with first STEMI underwent primary PCI for IRA and some non IRA's a followed by cardiac MRI scan within 5±2 days. Obstructive coronary disease was defined as ≥50% stenosis. MRI studies (3T) included steady state free precession, late gadolinium enhancement and MOLLI T1 mapping. T1 mapping values were presented using a 16th segment AHA model. T1 segmental values were compared between the IRA and non IRA (stenotic and non-stenotic).

Results
The study cohort included 61 patients (mean age 59 y, male 90%). A total of 891 segments were analyzed (excluded segments (artifacts) N=85). Mean native T1 values for LAD IRA (stented), LAD non-IRA (≥50% stenosis) (not stented), LAD non IRA (≥50% stenosis) (stented) and LAD non IRA (&lt;50% stenosis) were 1455±72; 1321±44; 1322±22 and 1283±32, respectively, overall P&lt;0.001. For LCX IRA (stented), LCX non-IRA (≥50% stenosis) (not stented), LCX-non IRA (≥50% stenosis) (stented) and LCX non IRA (&lt;50% stenosis) were 1362±75; 1277±50; 1277±72 and 1289±77, respectively, overall P&lt;0.001. For RCA IRA (stented), RCA non-IRA (≥50% stenosis) (not stented), RCA-non IRA (≥50% stenosis) (stented) and RCA non IRA (&lt;50% stenosis) were 1438±92; 1334±43; 1374±101 and 1311±34, respectively, overall P&lt;0.001. Native T1 values in non-IRA LAD ≥50% stenosis vs LAD &lt;50% stenosis were 1321±40 and 1283±32, respectively P=0.02, whereas non-IRA RCA ≥50% stenosis vs RCA &lt;50% stenosis were 1345±61 and 1312±34 respectively, P=0.05.

Conclusion
As expected, the highest native T1 values were documented in the stented IRA's. However, native T1 values were also elevated in non IRA's (both stented and non-stented) with obstructive coronary disease (≥50% stenosis) in comparison with non-obstructive disease (&lt;50% stenosis, documenting the presence of myocardial damage in remote segments. This finding sheds new light on the issue of complete revascularization in STEMI patients.

Funding Acknowledgement
Type of funding source: None
Infectious endocarditis: improving diagnostic performance in native and prosthetic valve infectious with 18F-FDG PET/CT
Authors: De Almeida J.P.L , Marinho V , Silva R , Goncalves F , Costa G , Goncalves L , Ferreira M.J 
Published: November 2020

Abstract

Background
The diagnosis of infective endocarditis (IE) remains a clinical challenge. Diagnostic accuracy of the modified Duke criteria is suboptimal for native valve endocarditis (NVE) and even worse in the presence of prosthetic material-related infection (PVE). We aim to evaluate the diagnostic performance of 18F-FDG PET in patients with suspected IE referred to perform PET/CT.

Methods
Consecutive patients with suspected IE, referred to perform PET/CT between May 2016 and June 2019 were included. Diagnostic performance of modified Duke criteria (mDC) and PET/ CT for IE for NVE and PVE was determined.

Results
In total, 82 patients (mean age of 61±19 years, 62% of male gender) were enrolled. There were 67 18F-FDG PET/CT concordant results with final diagnosis, corresponding to a 96% of agreement, k=0.91 (p=0.04). A SUVmax cutoff value of ≥3.1 identified positive cases with 88.9% sensitivity and 70.0% specificity. In patients with NVE, the addition of PET/CT to the mDC resulted in a reduction of the number of possible IE cases (from 58% to 4.3%). In patients with PVE/intracardiac devices, PET/CT allowed reclassification of 67.4% of possible cases to 4.2%. An alternative diagnosis was provided in 55.6% of the negative IE cases.

Conclusions
18F-FDG PET/CT proved to be a useful diagnostic tool in patients with both suspected NVE and PVE with good sensitivity and specificity, resulting in a significant decrease of the number of possible endocarditis. Furthermore, it allowed the identification of the cause of clinical scenario in more than 50% of patients in which the diagnosis was excluded.
18F-FDG PET SUV max ROC for IE diagnosis

Funding Acknowledgement
Type of funding source: None